Emergency Operations Plan: How Health Leaders Prepare for Disasters

Hospital tent with overflow beds.Hurricanes, floods, wildfires, disease outbreaks and mass casualty events are just a few crises that hospitals address in an emergency operations plan. Hospitals play a crucial role in maintaining efficient and quality care during such events.

Health care leaders have learned important lessons from major weather events, terrorist attacks and other disasters, and they continue to learn from challenges related to the COVID-19 pandemic. However, strong hospital leaders recognize that improvement is ongoing and complacency can cost lives.

The Importance of an Emergency Operations Plan

A hospital’s goal during a catastrophe is to continue providing quality care and achieving positive patient outcomes. An emergency operations plan must be put in place to maintain continuity of care and manage any disaster.

All stakeholders and representatives from every department should participate in developing the plan to ensure a coordinated response. Additionally, well-trained staff should understand their roles in maintaining high-quality service. Hospitals that aren’t prepared for potential disasters are likely to experience disruptions to service and care.

COVID-19: Risks of a Flawed Emergency Operations Plan

Most recently, at the onset of the COVID-19 pandemic, hospital leaders discovered weaknesses in their emergency operations plans. Hospitals typically plan for disasters they’re most likely to face based on their location. For example, hospitals in Kansas may plan for tornados, but not hurricanes.

The limits of planning based on the status quo have come to light during the global COVID-19 pandemic. Previous infectious diseases in modern times, such as Ebola, had never turned into a massive outbreak. As COVID-19 spread, hospital leaders soon discovered that they lacked sufficient personal protective equipment (PPE) for staff due to supply chain issues. They also faced a ventilator shortage.
Some hospitals managed the patient surge by developing community partnerships, so they could set up COVID units in other locations. It took time to work through these issues. More robust emergency operations plans could’ve saved time while administrators worked on solutions.

Key Elements of an Emergency Operations Plan

In 2016, the Centers for Medicare & Medicaid Services (CMS) issued the Emergency Preparedness Requirements for Participating Medicare and Medicaid Providers and Suppliers Final Rule, which established standard requirements for disaster preparedness that most hospitals use as a framework today. The rule, plus guidelines from The Joint Commission, an independent nonprofit that accredits hospitals, makes a good starting point for health care leaders.

One of the first steps in a hospital’s emergency operations plan should be to activate the hospital command center and notify all staff. Other critical tasks include managing communications, resources and assets, safety and security, staff responsibilities, utilities, and continued clinical operations. Best practices for these tasks include the following:


The hospital command center should have multiple communications methods, including a dedicated phone line and radios compatible with those of local agencies and emergency services. All essential personnel and hospital units should have walkie-talkies.

They should also maintain a backup system for the primary communications system. In the event that all systems fail, hospitals should have staff already designated as runners.

Resources and Assets

The hospital should maintain a list of all supplies on hand for emergencies, and key staff should know where to find them. Staff should have access to durable medical equipment, either through storage or through agreements made beforehand with suppliers. The facility should have enough food and water on hand for at least three to four days, even at surge capacity.

Safety and Security

The facility should have a safety plan that identifies potential safety hazards and ways to control and mitigate those hazards. It should have a detailed fire safety plan. In addition, the hospital should have a security team in place and have a plan for surge staffing. Security personnel should be able to monitor, control and lock all entrances and exits, if needed. The staff should have enough PPE to protect against hazards, including chemical, biological and radiological agents.

Staff Responsibilities

Hospital staff members need to understand their responsibilities during emergencies. Designated staff members may be part of a previously established incident command group or emergency command and need to know their responsibilities as members of these groups. Hospitals should also have a system in place to notify staff or volunteers who may be deployed during an incident.


The facility should have enough generator capacity to power essential services for three to four days. The emergency operations plan should also clarify which services are essential. The facility should store generators in a safe, dry location. Hospitals should have enough fuel to power the generators for at least three full days of essential services. Hospitals also need enough medical gases, such as oxygen, for three to four days without resupply.

Continued Clinical Operations

During any disaster, a hospital needs to stay up and running. A plan should identify which services are essential and which staff and resources will take on responsibility for those services.

Hospital administrators should have plans in place to support operations for up to 30 days. This may involve community or vendor partnerships and memorandums of understanding that define expectations. Many hospitals now have mutual aid agreements with other local health providers in the event that they need to transfer patients.

Tips to Improve an Emergency Operations Plan

Hospitals stand ready, now more than ever, to manage disasters. As many hospital leaders know, however, it’s usually what you haven’t prepared for that causes the most problems. Tips to strengthen an existing plan include the following:

Be Redundant

A strong emergency operations plan is redundant, meaning it plans for every possible situation, and then some. For example, having a generator on hand isn’t enough. Does the hospital maintain a backup generator? What’s the plan for an alternate fuel source? Essentially, a hospital needs to have a backup plan for its backup plan.

Make It Easy to Navigate

If a hospital’s emergency operations plan comprises a huge three-ring binder, the hospital could be in trouble when disaster strikes. A well-formatted, concise plan, whether an electronic or a hard copy, can help staff act faster.

A strong plan may use a format that’s easy to navigate quickly, such as a checklist of all necessary steps with a space for staff members to initial as they complete them. It may also have separate documents for staff members to list their responsibilities. Regardless of format, all staff members should know exactly where to find the plan.

Evaluate Regularly

Hospital administrators should routinely evaluate the emergency operations plan and update it if needed. For example, staff members designated for certain roles may no longer work at the hospital, so alternate staff members should be assigned. Plans are often only evaluated annually, but they should be reviewed more frequently.

Practice, Practice, Practice

The plan only works if the key players know it well and understand what they’re supposed to do during a crisis. Hospitals should run regular, frequent drills to prepare for various possible catastrophic events. This not only helps staff prepare but also shows hospital leaders weaknesses in the plan that they need to address.

Preparing for Future Disasters

A thorough but easy-to-follow emergency operations plan can mean the difference between a hospital managing a crisis while continuing to deliver patient care and having to evacuate patients due to lack of preparation. Health care leaders have learned from past catastrophes, but hospitals can and should continue to build on those lessons.

Discover a Career in Preparing for Health Care Emergencies

Are you prepared? Health care managers interested in learning more about developing an effective emergency operations plan or other health care administrative strategies may be well served by exploring USC’s executive MHA  program.



American College of Healthcare Executives, Healthcare Executives’ Role in Emergency Management

California Hospital Association, Emergency Operations Plan (EOP)

Centers for Disease Control and Prevention, Preparedness & Planning

Centers for Medicare & Medicaid Services, Emergency Preparedness Rule

HealthLeaders, “Guide Your Hospital Successfully Through the COVID-19 Crisis: 4 Strategies”

HealthLeaders, “How to Improve Emergency Preparedness for Pandemics”

The Joint Commission, Emergency Management

U.S. Department of Health and Human Services, Hospital Preparedness Program