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Recovery Planning
Topic Collection
August 28, 2019

Topic Collection: Recovery Planning

Planning for recovery is just as essential as planning for response. Ideally, recovery plans would be developed before a disaster and are implemented while response is still ongoing to support healthcare facilities and providers in returning to normal operations, or establishing a new normal state. This will allow them to safely continue to provide care to the community and maintain financial viability following a disaster. The resources in this collection highlight planning guidance/guidelines, tools, lessons learned, and promising practices to assist healthcare emergency planners with recovery. The Continuity of Operations (COOP)/ Business Continuity Planning Topic Collection contains related resources that can minimize the impact and thus, speed recovery. Additional recovery-related resources may be found in hazard-specific and/or care location/setting topic collections. 

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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ASPR TRACIE. (2019). Federal Recovery Programs for Healthcare Organizations.
As disasters continue to have direct effects on healthcare facilities, organizational financial and administrative preparedness capabilities are gaining more attention. This tip sheet provides an overview of eligibility factors, program/grant requirements, and pre- and post-disaster federal financial opportunities (e.g., direct reimbursement and disaster-related loans) for healthcare facilities.
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ASPR TRACIE. (2022). Tips for Retaining and Caring for Staff after a Disaster. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This tip sheet provides general promising practices—categorized by immediate and short-term needs—for facility executives to consider when trying to retain and care for staff after a disaster or during a public health emergency such as the COVID-19 pandemic.
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Cage, J. (2013). Joplin Pays it Forward: Community Leaders Share Our Recovery Lessons.
This document compiles stories of those that were part of the response and recovery efforts after the Joplin tornado in 2011. The firsthand accounts include lessons learned from the operation of surge medical clinic and volunteer coordination points; coordination of thousands of volunteers; and health care service relocation and other recovery efforts. NOTE: Lessons learned from healthcare facilities are addressed in pages 55-73.
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Federal Emergency Management Agency. (2019). National Disaster Recovery Framework, 4th Edition.
The National Disaster Recovery Framework (NDRF) establishes a common platform and forum for how the whole community builds, sustains, and coordinates delivery of recovery capabilities. It defines core recovery principles; roles and responsibilities for coordinators and stakeholders; communication and collaboration among stakeholders; recovery planning guidance; and ways that communities can rebuild stronger, smarter, and safer.
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Greater New York Hospital Association. (2017). Recovery Checklist for Hospitals After A Disaster.
Hospital staff can utilize this facility recovery checklist to check for potential issues in the facility after a disaster.
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Harvard School of Public Health, Emergency Preparedness and Response Exercise Program. (2014). Essential Functions and Considerations for Hospital Recovery Version 2.
Based on an extensive literature review (including federal guidelines), review of hospital plans, interviews with staff from hospitals affected by critical incidents, and information from a 2013 workshop on recovery-based lessons learned, the authors developed this document to help hospitals prepare to manage recovery from all types of events.
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Institute of Medicine. (2015). Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. (Book available for purchase; PDF is free for guests to download.)
This book is the result of a consensus study that included several public and closed meetings on disaster recovery. It emphasizes the need to understand that the disaster recovery process offers communities the unique opportunity to not only "return to normal," but to improve upon the status quo. Doing so can improve a community's resilience, health, preparedness for future events, and sustainability. Recommended: Review “Summary of Findings” sections to more easily navigate this extensive resource.
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Runkle, J., Brock-Martin, A., Karmaus, W., and Svendsen, E. (2012). Secondary Surge Capacity: A Framework for Understanding Long-Term Access to Primary Care for Medically Vulnerable Populations in Disaster Recovery. American Journal of Public Health. 102(12):e24-32.
The authors advocate for the expansion of surge capacity plans to meet the chronic health care needs of vulnerable populations that increase following the acute phase of disaster response. They use a health services model to identify factors that perpetuate health disparities following disasters. To address these disparities, the authors recommend a baseline assessment of needs, with the expectation that such health care needs will expand post-disaster.
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St. Louis Hospital Preparedness Committee. (2015). St. Louis Area Regional Hospital Re-Entry Plan.
This plan describes how the healthcare organizations in the St. Louis Area region will coordinate regionally to conduct re-entry operations following evacuation or operational interruption as a result of a disaster and includes the role of the medical operations center in coordinating this effort. It also includes information on managing identification, credentialing, and granting access management for healthcare facility personnel after an incident.
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Toner, E., McGinty, M., Schoch–Spana, M., et al. (2017). A Community Checklist for Health Sector Resilience Informed by Hurricane Sandy. Health Security. 15(1): 53-69.
The authors incorporated lessons learned from Hurricane Sandy into this checklist of actions for healthcare, public health, nongovernmental organizations, and private entities to strengthen the resilience of their community’s health sector. There is a general checklist of actions for all stakeholders, as well as guidance provided by type of healthcare facility.
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U. S. Government Accountability Office. (2015). Hurricane Sandy: An Investment Strategy Could Help the Federal Government Enhance National Resilience for Future Disasters.
The U.S. Government Accountability Office was asked to review federal efforts to strengthen disaster resilience during Hurricane Sandy recovery. This report addresses (1) how federal recovery funds were used to enhance resilience; (2) the extent to which states and localities were able to maximize federal funding to enhance resilience; and (3) actions that could enhance resilience for future disasters.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2015). Healthcare COOP and Recovery Planning:  Concepts, Principles, Templates and Resources.
This guide includes an overview of healthcare continuity of operations planning, customizable templates, and other related resources. It includes links to information on continuity planning, online courses, and other COOP resources.
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U.S. Department of Homeland Security, Office of Cyber and Infrastructure Analysis. (2014). Sector Resilience Report: Hospitals.
This report features information on the "Hospitals Segment" within the Healthcare and Public Health Sector and Direct Patient Healthcare Subsector. The authors share results from assessments and recommendations for improving system and facility resilience.
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Zane, R., Biddinger, P., Gerteis, J., and Hassol, A. (2010). Hospital Assessment and Recovery Guide. U.S. Department of Health and Human Services.
This guide is designed to help hospital staff conduct an initial assessment of a hospital after a closure or evacuation due to an emergency event. The guide is divided into 11 sections, each with its own team and assessment assignment: Administration, Facilities, Security and Fire Safety, Information Technology and Communications, Biomedical Engineering, Medical, Ancillary Services, Materials Management, Building and Grounds Maintenance/ Environmental Services, and Support Services.
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    2/5/2016 12:11:26 PM

Education and Training

Chandra, A. and Acosta, J. (2013). Building Resilient Communities: An Online Training. RAND Corporation.
This online, self-guided training takes participants through modules on community resiliency and resources, as well as other topics to enhance their resilience following a disaster. Health centers and hospitals are among the target audiences.
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Federal Emergency Management Agency, Emergency Management Institute. (2018). IS-2900: National Disaster Recovery Framework (NDRF) Overview.
This two-hour course provides individuals supporting disaster recovery efforts with a foundation in National Disaster Recovery Framework (NDRF) key concepts, core principles and roles and responsibilities of NDRF leadership (including those of individuals and households to governmental entities at the local, State, tribal, and Federal levels, and between public, private and nonprofit sectors).
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Mangieri, W., Pereira, E., Chavez, A. et al. (2014). Healthcare System Recovery: Financial Sustainability After a Disaster. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This 90-minute webinar focuses on ways to mitigate post-disaster recovery costs healthcare systems may face.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2019). Health and Social Services Recovery Introduction.
This course defines the U.S. Department of Health and Human Services' (HHS) Recovery Support Function and its mission scope. Instructors highlight related mission requirements, methods, and examples of the applicability of HHS day-to-day programs in support of disaster recovery.
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Event-Specific Lessons Learned

Abramson, D. and Culp, D. (2013). At the Crossroads of Long-Term Recovery: Joplin, Missouri Six Months after the May 22, 2011 Tornado. National Center for Disaster Preparedness, Columbia University.
Researchers interviewed key officials, community leaders, and individuals affected by the tornadoes that struck Joplin in 2011. This report highlights the town's "positive recovery trajectory," due to four critical actions and accomplishments involving: quick debris removal, the rebuilding and reopening of schools, hospital staff being retained while a sponsor committed to building a new facility, and the establishment of the Citizens Advisory Recovery Team.
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Abramson, D., Culp, C., Sury, J., and Johnson, L. (2011). Planning for Long-Term Recovery Before Disaster Strikes: Case Studies of 4 US Cities: A Final Project Report. National Center for Disaster Preparedness, Columbia University.
The authors conducted case studies with four cities using four disaster scenarios (earthquake, tsunami, flood, and hurricane) to examine their long-term recovery plans. They conclude that four main variables influence the level of recovery planning: context, governance, framework, and resources.
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American College of Emergency Physicians (ACEP). (2015). Lessons Learned from Hurricane Sandy and Recommendations for Improved Healthcare and Public Health Response and Recovery for Future Catastrophic Events.
This report summarizes the findings from a research project conducted to evaluate how the healthcare system was negatively affected in preparation for, during, and after Hurricane Sandy. Lessons learned from the hospital, EMS, and ancillary services (i.e., pharmacies, methadone clinics, dialysis/kidney centers, and medical supply companies) sectors are noted to assist healthcare professionals, medical facilities, and public health better prepare for future disasters.
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Arrieta, M.I., Foreman, R.D., Crook, E.D., and Icenogle, M.L. (2008). Insuring Continuity of Care for Chronic Disease Patients After a Disaster: Key Preparedness Elements. American Journal of Medical Sciences. 336(2):128-33.
The authors interviewed 30 key informants (KI), including health and social service providers that provide healthcare to the under- and uninsured along the Mississippi and Alabama Gulf Coast. Pre-disaster issues of importance were patient education and preparedness; evacuation guidance and support; planning for special medical needs shelters; and health care provider preparedness. Post-disaster issues were communication; volunteer coordination/credentialing; and donation management, particularly for medications.
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Arrieta, M.I., Foreman, R.D., Crook, E.D., and Icenogle, M.L. (2009). Providing Continuity of Care for Chronic Diseases in the Aftermath of Katrina: From Field Experience to Policy Recommendations. Disaster Medicine and Public Health Preparedness. 3(3):174-82.
The authors interviewed 30 key informants, including health and social service providers that provide healthcare to the under- and uninsured along the Mississippi and Alabama Gulf Coast. Respondents indicated that mental health, diabetes mellitus, hypertension, respiratory illness, end-stage renal disease, cardiovascular disease, and cancer were medical management priorities after a disaster. The most frequently mentioned barrier to providing care was maintaining continuity of medications. Inaccessible medical records, poor patient knowledge, and financial constraints also impacted care. Implemented or suggested solutions included better pre-disaster patient education; support for electronic medical records at community health centers; and better management of donated medications/medical supplies.
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ASPR TRACIE. (2022). Healthcare System Recovery Timeline: A White Paper for Texas.
Following a number of related technical assistance requests and in anticipation of future information needs from healthcare systems impacted by current and future disasters, ASPR TRACIE developed this white paper to answer the question: “How long does it take the healthcare system to recover from a major hurricane?”
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Boston Public Health Commission. (2013). 2013 Boston Marathon Emergency Support Function 8 (ESF-8) Public Health and Medical Planning, Response, and Recovery Operations (April 15-April 26): Final After Action Report.
This after action report provides an overview of the Boston Marathon bombing and the collaborative planning between public health and healthcare that occurred before and in the weeks just after the incident. The report focuses on 10 specific public health and healthcare capabilities and lists related observations, strengths, areas for improvement, and recommendations. There is “a particular emphasis on the recovery efforts and public health's role as it relates to mass care and human service efforts.”
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Budds, D. (2016). Designing A Disaster-Proof Hospital. Fast Company
The author, an architect, describes how the Southeast Louisiana Veterans Healthcare System was rebuilt by applying the lessons learned from that disaster as well as unique needs of veterans. Key features of the new hospital are meant to ensure that it can continue operations for up to 5 days post-disaster impact, including placement of the Emergency Room on the second floor; placing the generator fill line above the 500-year flood line; placing the generator underground; and placing the power grid on the fourth floor of the hospital.
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Cage, J. (2013). Joplin Pays it Forward: Community Leaders Share Our Recovery Lessons.
This document compiles stories of those that were part of the response and recovery efforts after the Joplin tornado in 2011. The firsthand accounts include lessons learned from the operation of surge medical clinic and volunteer coordination points; coordination of thousands of volunteers; and health care service relocation and other recovery efforts. NOTE: Lessons learned from healthcare facilities are addressed in pages 55-73.
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Henry J. Kaiser Family Foundation. (2018). Health Care in Puerto Rico and the U.S. Virgin Islands: A Six-Month Check-Up After the Storms.
This document provides an overview of the status of the recovery in Puerto Rico and the U.S. Virgin islands six months after Hurricanes Irma and Maria, with a focus on the health care systems and health needs of residents. It builds on earlier work that examined how residents in Puerto Rico were faring two months after the hurricanes, and key issues for recovery in Puerto Rico and the U.S. Virgin Islands identified during a Fall 2017 roundtable with key stakeholders.
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Lee, D., Smith, S., McStay, C., et al. (2014). Rebuilding Emergency Care After Hurricane Sandy. (Abstract only.) Disaster Medicine and Public Health Preparedness. 9:1-4.
The authors describe their experience managing a freestanding emergency department at the Bellevue Hospital Center in New York City following Hurricane Sandy. They provide a model that could possibly be replicated to augment and temporarily replace emergency care capacity following future natural disasters.
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Morse, S. (2015). When Disaster Strikes: CFOs Help Hospitals Recover After Joplin Tornado, Hurricane Sandy.
In this article, leaders from hospitals affected by natural disasters (including the Joplin tornado in 2011, Hurricane Sandy in 2012, and the Massachusetts snow storms of winter 2014-2015) discuss their experiences with insurance claims, and financial and other considerations related to recovery.
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Office of the Inspector General. (2014). Hospital Emergency Preparedness and Response During Superstorm Sandy. U.S. Department of Health and Human Services.
The authors surveyed 174 Medicare-certified hospitals located in declared disaster areas in Connecticut, New Jersey, and New York during Superstorm Sandy and conducted 10 site visits and collected other types of data. They found that a small percent of hospitals (7%) evacuated during the storm (the rest sheltered in place). The report describes several cases of flooded hospitals and recommends continued community disaster collaboration.
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Porth, L. (2012). Preparedness and Partnerships: Lessons Learned from the Missouri Disasters of 2011. Missouri Hospital Association.
This report describes response and recovery operations by several hospitals during the 2011 natural disasters in Missouri, with many implications for COOP planning. It summarizes lessons learned, with a focus on the Joplin tornado.
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Sanborn, B. (2018). Hurricane Florence: Lessons From Hospitals That Survived Recent Natural Disasters. Healthcare Finance.
This article discusses some key areas hospitals should focus on to support response and recovery from disasters, including security; mental/behavioral health for staff; telehealth capabilities; plans to mitigate revenue and cash flow interruptions; and ways to leverage resources when part of a larger network.
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Shin, P., Sharac, J., Gunsalas, R., et al. (2017). Puerto Rico's Community Health Centers: Struggling to Recover in the Wake of Hurricane Maria. George Washington University, Milken Institute School of Public Health.
This Issue Brief discusses how Puerto Rico's health centers helped to address urgent and emerging health care needs in an environment of limited communications availability, and access to electricity and clean water. The challenges discussed can help healthcare facilities with developing their recovery plans.
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U. S. Government Accountability Office. (2015). Hurricane Sandy: An Investment Strategy Could Help the Federal Government Enhance National Resilience for Future Disasters.
The U.S. Government Accountability Office was asked to review federal efforts to strengthen disaster resilience during Hurricane Sandy recovery. This report addresses (1) how federal recovery funds were used to enhance resilience; (2) the extent to which states and localities were able to maximize federal funding to enhance resilience; and (3) actions that could enhance resilience for future disasters.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Office of Emergency Management, Division of Recovery. (2018). The Health and Social Services Disaster Recovery-Six Years in Retrospective.
The authors provide an overview of the Division of Recovery, the National Disaster Recovery Framework, and the role of recovery in healthcare preparedness and response capabilities. The document includes lessons learned from several natural disasters around the Nation and links to helpful resources are included in an appendix.
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Williams, R., Williams, G., and Burton, D. (2012). The Use of Social Media for Disaster Recovery. University of Missouri Extension.
The authors share lessons they learned from creating and maintaining the "Joplin Tornado Info" and "Branson Tornado Info" Facebook pages. The guidance in this document can help emergency managers set up their own social media platforms and draft messages before an incident occurs.
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General Information

Abramson, D., Stehling-Ariza, T., Park, Y., et al. (2010). Measuring Individual Disaster Recovery: A Socioecological Framework. National Center for Disaster Preparedness, Columbia University.
The authors developed a framework for measuring disaster recovery based on five measures: housing stability, economic stability, physical health, mental health, and social role adaptation.
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American Academy of Family Physicians. (n.d.). Disaster Response and Recovery. (Accessed 6/21/2019.)
This resource discusses disaster response and recovery considerations for office-based providers, including those related to structural safety, insurance, HIPAA data breaches, and financial recovery assistance.
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ASPR TRACIE. (2017). Recovery Resources.
This ASPR TRACIE TA response provides an extensive literature review of published and grey literature, and open source media accounts of past disaster recovery reports; as well as responses to several questions related to healthcare system’s ability to “recover” and return to baseline (or the “new normal”) following a disaster. Related Topic Collections: Recovery Planning and Continuity of Operations (COOP)/ Failure Plan.
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ASPR TRACIE. (2018). Financial Assistance for Rural Hospitals.
This ASPR TRACIE TA response provides information from FEMA Regional and ASPR Recovery Division representatives related to how rural hospitals can submit requests for assistance with FEMA paperwork. In addition, it includes several links to resources on how healthcare facilities can apply for grant and funding assistance.
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ASPR TRACIE. (2022). Tips for Retaining and Caring for Staff after a Disaster. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This tip sheet provides general promising practices—categorized by immediate and short-term needs—for facility executives to consider when trying to retain and care for staff after a disaster or during a public health emergency such as the COVID-19 pandemic.
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Hardy, D. and Miller, L. (2012). Urban Area Recovery Planning with CBR Hazards: Lessons Learned from Seattle and Denver. Federal Emergency Management Agency.
The document can help emergency planners establish an approach and process for creating a multijurisdictional recovery framework for urban areas. The authors focus on chemical, biological, and radiological events.
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Institute of Medicine. (2012). Post-Incident Recovery Considerations of the Health Care Service Delivery Infrastructure - Workshop Summary.
This document is a summary of a workshop session during the 2012 Public Health Preparedness Summit that focused on sustaining health care delivery past the response phase of a disaster and the full recovery of local health care delivery systems. The session focused on identifying services to support the affected health care service delivery infrastructure and ways to facilitate long-term recovery. It also includes lessons learned from prior disasters to inform pre-incident planning for recovery and mass casualty care.
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Institute of Medicine. (2015). Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. (Book available for purchase; PDF is free for guests to download.)
This book is the result of a consensus study that included several public and closed meetings on disaster recovery. It emphasizes the need to understand that the disaster recovery process offers communities the unique opportunity to not only "return to normal," but to improve upon the status quo. Doing so can improve a community's resilience, health, preparedness for future events, and sustainability. Recommended: Review “Summary of Findings” sections to more easily navigate this extensive resource.
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Office of the Assistant Secretary for Preparedness and Response. (2016). 2017-2022 Health Care Preparedness and Response Capabilities. U.S. Department of Health and Human Services.
This 70-page document describes the four capabilities that healthcare coalitions and individual healthcare facilities need to prepare for, respond to, and recover from emergencies. The capabilities are: foundation for healthcare and medical readiness; healthcare and medical response coordination; continuity of healthcare service delivery; and medical surge. For example, Capability 1, Objective 4 covers training and preparing the healthcare and medical workforce (Objective 4, Activities 3-5 also contain specific information about exercises within the HPP program) and Capability 3, Objective 7 is focused on coordinating healthcare delivery system recovery.
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. (n.d.). Health and Social Services Recovery Support Function. (Accessed 3/12/2024.)
The National Disaster Recovery Framework (NDRF) established the Health and Social Services (H&SS) Recovery Support Function (RSF) to assist locally-led recovery efforts to restore or improve disaster-impacted public health, healthcare, and social services capabilities and networks.
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U.S. Department of Homeland Security, Office of Cyber and Infrastructure Analysis. (2014). Sector Resilience Report: Hospitals.
This report features information on the "Hospitals Segment" within the Healthcare and Public Health Sector and Direct Patient Healthcare Subsector. The authors share results from assessments and recommendations for improving system and facility resilience.
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Guidance/Guidelines

ASIS International. (2009). Organizational Resilience: Security, Preparedness and Continuity Management Systems - Requirements with Guidance for Use Standard. (ASIS SPC.1-2009, American National Standard).
This standard provides criteria to establish, check, maintain, and improve a management system to enhance prevention, preparedness (readiness), mitigation, response, continuity, and recovery from an emergency, crisis, or disaster. This is also one of three standards adopted by the U.S. Department of Homeland Security’s Private Sector Preparedness (PS-Prep) Program.
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ASPR TRACIE. (2019). Federal Recovery Programs for Healthcare Organizations.
As disasters continue to have direct effects on healthcare facilities, organizational financial and administrative preparedness capabilities are gaining more attention. This tip sheet provides an overview of eligibility factors, program/grant requirements, and pre- and post-disaster federal financial opportunities (e.g., direct reimbursement and disaster-related loans) for healthcare facilities.
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Centers for Medicare and Medicaid Services. (2017). Temporary Hospitals Established in Response to Catastrophic Damage from Hurricanes.
This document addresses the CMS requirements regarding the temporary hospitals that have been established in the U.S. Virgin Islands and Puerto Rico due to hospital closures impacted by Hurricanes Irma and Maria. It also provides information on payment and billing issues.
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Federal Emergency Management Agency. (2015). Effective Coordination of Recovery Resources for State, Tribal, Territorial, and Local Incidents.
Emergency planners can use this guide to learn more about the tasks and challenges that state, tribal, territorial and/or local governments most encounter when managing a recovery process. It includes sections on leading the recovery process, assessment and evaluation, resources identification, and “building resilience into recovery.”
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Federal Emergency Management Agency. (2017). Pre-Disaster Recovery Planning Guide for Local Governments.
This planning guide is intended for local governments to help them develop pre-disaster recovery plans. It includes several forms, checklists, and a step-by-step process for local planners to use as they plan for recovery efforts.
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Federal Emergency Management Agency. (2019). National Disaster Recovery Framework, 4th Edition.
The National Disaster Recovery Framework (NDRF) establishes a common platform and forum for how the whole community builds, sustains, and coordinates delivery of recovery capabilities. It defines core recovery principles; roles and responsibilities for coordinators and stakeholders; communication and collaboration among stakeholders; recovery planning guidance; and ways that communities can rebuild stronger, smarter, and safer.
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Harvard School of Public Health, Emergency Preparedness and Response Exercise Program. (2014). Essential Functions and Considerations for Hospital Recovery Version 2.
Based on an extensive literature review (including federal guidelines), review of hospital plans, interviews with staff from hospitals affected by critical incidents, and information from a 2013 workshop on recovery-based lessons learned, the authors developed this document to help hospitals prepare to manage recovery from all types of events.
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Louisiana Governor’s Office of Homeland Security and Emergency Preparedness. (2013). Procurement Guide: Getting and Keeping Your FEMA Grant Dollars.
This guide was created to assist eligible applicants in identifying and applying the required federal regulations (44 CRF 13.36) when using FEMA funds for the procurement of disaster and non-disaster materials, supplies, public works projects and services.
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New Zealand Red Cross. (2015). Leading in Disaster Recovery: A Companion Through the Chaos.
This resource was developed for leaders and includes information presented under nine primary messages from “leaders in disaster recovery around the globe.” The authors supplement each message with quotes, questions to consider, and tools to assist with implementation.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2015). Healthcare COOP and Recovery Planning:  Concepts, Principles, Templates and Resources.
This guide includes an overview of healthcare continuity of operations planning, customizable templates, and other related resources. It includes links to information on continuity planning, online courses, and other COOP resources.
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Yale New Haven Health System, Center for Emergency Preparedness and Disaster Response. (2012). A Quick Guide: FEMA Reimbursement for Acute Care Hospitals.
This guide provides information on the Federal Emergency Management Agency’s (FEMA) hospital reimbursement policies and the related application process.
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* Zane, R., Biddinger, P., Gerteis, J., and Hassol, A. (2010). Hospital Assessment and Recovery Guide. U.S. Department of Health and Human Services.
This guide is designed to help hospital staff conduct an initial assessment of a hospital after a closure or evacuation due to an emergency event. The guide is divided into 11 sections, each with its own team and assessment assignment: Administration, Facilities, Security and Fire Safety, Information Technology and Communications, Biomedical Engineering, Medical, Ancillary Services, Materials Management, Building and Grounds Maintenance/ Environmental Services, and Support Services.
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Information Technology (IT) and Utility Issues

Bartock, M., Cichonski, J., Souppaya, M., et al. (2016). Guide for Cybersecurity Event Recovery (NIST SP 800-84). National Institute of Standards and Technology, U.S. Department of Commerce.
The authors provide guidance for cyber attack recovery planning and emphasize the importance of learning from past events and developing, testing, and improving recovery planning. This document includes an example scenario that demonstrates guidance and informative metrics that may be helpful for improving information systems resilience.
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Centers for Disease Control and Prevention. (2017). Healthcare Water System Repair.
This webpage discusses infection control recommendations for use during a boil water alert, as well as recovery actions to take after the boil water alert is lifted. There is also a section specific to sterile processing, which provides the requirements by the CDC and the Association for the Advancement of Medical Instrumentation (AAMI).
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Shelton, S., Hamm, J., Olatosi, B., and Ory Johnson, R. (2018). Recovery of Surgical Equipment Sterile Processing During a Floodwater Boil Advisory. (Abstract only.) Disaster Medicine and Public Health Preparedness.
The authors of this article discuss the challenges faced in recovering their sterile processing for surgical equipment after floodwater contaminated their public water supply. They provide considerations for recovery plans, such as including a potable water source and a method to connect it to a required location.
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Shin, P. and Jacobs, F. (2012). An HIT Solution for Clinical Care and Disaster Planning: How One Health Center in Joplin, MO Survived a Tornado and Avoided a Health Information Disaster. Online Journal of Public Health Informatics. 4(1).
This article describes the planning one health center undertook to secure its data so that it could be accessed after a disaster, and discusses why healthcare information technology must be a priority focus for planning. The authors advocate for increased federal funding and clear guidelines from federal planning partners in support of physical security, data back-up, and redundancy planning, as well as staff training to support these technology needs.
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Non-Hospital Setting

American Academy of Family Physicians. (n.d.). Actions to Take After a Disaster. (Accessed 6/21/2019.)
This checklist was created to assist practices that are severely damaged or destroyed with damage assessment and recovery.
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American Academy of Pediatrics. (2018). Post-Disaster Considerations for Pediatricians in Practice.
This resource reviews considerations for pediatricians in practice following a disaster. Topics include: first 48 hours after disaster; medical services (i.e., what you can and cannot provide post-disaster); communications; staff; space; insurance; vaccine loss; medical billing; personal care; and long-term recovery.
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ASPR TRACIE. (2021). Post-Disaster Lessons Learned: Dialysis Patient Management.
ASPR TRACIE presents findings from resources and references related to post-disaster dialysis operations in response to numerous requests for technical assistance. A previously completed technical assistance response on the post-Sandy improvements to dialysis patient management is included for additional reference.
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Centers for Medicare and Medicaid Services. (n.d.). Emergency Preparedness for Dialysis Facilities. (Accessed 3/21/2017.)
This is a guidance document for chronic dialysis centers to use in the development of their emergency plans. Pre-event planning, response, and recovery are discussed.
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Florida Healthcare Association. (2016). Post-Storm Recovery Planning Considerations.
This document provides post-storm recovery guidance and checklists for nursing homes/ long term care facilities.
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Kennedy, J. and Kennedy, T. (2017). Hospice Lessons Learned: Surviving the 2017 Hurricanes and Wildfires. National Hospice and Palliative Care Organization Newsline.
This article includes lessons learned for caring for patients and staff during hurricanes and wildfires. Lessons pertaining to preparedness, response, and recovery are discussed.
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Kopp, J., Ball, L., Cohen, A. et al. (2007). Kidney Patient Care in Disasters: Emergency Planning for Patients and Dialysis Facilities. Clinical Journal of the American Society of Nephrology. 2(4):825-38.
The authors provide recommendations for an emergency plan for dialysis patients that includes considerations for continuity of care during emergencies, and recovery in the post-disaster setting. Preparedness tasks to ensure patient safety are presented along a timeline.
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Plans, Tools, and Templates

ASPR TRACIE. (2018). Healthcare Coalition Recovery Plan Template.
ASPR TRACIE developed this template to help healthcare coalitions (HCCs) develop/ organize their recovery plan. A sample plan outline is provided in Appendix A; recovery plan development support resources from ASPR are included in Appendix B; and Appendix C includes a full list of resources referenced in this template.
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California Emergency Medical Services Authority. (2014). HICS Job Action Sheets.
Emergency planners can review the “Demobilization and System Recovery” information at the end of each Job Action Sheet to better understand recovery roles for each position.
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California Emergency Medical Services Authority. (2014). Incident Response Guides.
Each guide includes a section on “Demobilization and System Recovery;” emergency planners can incorporate this information into their facility plans.
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California Hospital Association. (2020). Hospital Repopulation after Evacuation: Guidelines and Checklist.
The California Hospital Association worked with subject matter experts to identify best practices and regulatory agency requirements that have to be taken into account when repopulating after full or partial evacuation of general acute care hospital inpatient buildings. The guide includes a checklist that can be completed electronically or printed and filled out by hand.
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Centers for Disease Control and Prevention. (2005). Checklist for Infection Control Concerns when Reopening Healthcare Facilities Closed Due to Extensive Water and Wind Damage.
This checklist provides guidance for completing building and life safety inspections prior to restoration work, and guidance for infection control review of facilities to be done before the hospital can reopen. Attachment A includes a site specific checklist for selected areas of the facility (e.g., laboratory, pharmacy).
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Centers for Disease Control and Prevention. (2013). Remediation and Infection Control Considerations for Reopening Healthcare Facilities Closed Due to Extensive Water and Wind Damage.
This page provides information to assist healthcare facilities with the tasks involved during clean-up and reopening of healthcare facilities after a natural disaster. It includes checklists for mold remediation and structural recovery, water and electrical utilities, ventilation system, structural building materials, medical equipment, certification for occupancy, and post-reoccupation surveillance.
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Greater New York Hospital Association. (2017). Recovery Checklist for Hospitals After A Disaster.
Hospital staff can utilize this facility recovery checklist to check for potential issues in the facility after a disaster.
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Mercy Hospital Joplin. (2018). Temporary Hospital Buildout and Design: Floorplans.
These floorplans can help healthcare facility planners and builders erect temporary, hard-sided facilities to replace buildings damaged by disasters.
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New Jersey Hospital Association. (2017). Weathering the Storm: A Hurricane Planning, Response, and Recovery Toolkit.
This toolkit was developed to help state hospitals prepare for, respond to, and recover from hurricanes. The plan focuses on sheltering in place and recovery. Included are a series of assessment checklists, including three specifically focused on recovery (demobilization; patient transfer and discharge; and financial resources).
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South Carolina Department of Health and Environmental Control. (2016). Post-Disaster Hospital Reopening Procedures.
This document provides a step-by-step guide for hospitals to follow prior to reopening. It includes five primary steps with action items under each.
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St. Louis Hospital Preparedness Committee. (2015). St. Louis Area Regional Hospital Re-Entry Plan.
This plan describes how the healthcare organizations in the St. Louis Area region will coordinate regionally to conduct re-entry operations following evacuation or operational interruption as a result of a disaster and includes the role of the medical operations center in coordinating this effort. It also includes information on managing identification, credentialing, and granting access management for healthcare facility personnel after an incident.
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Toner, E., McGinty, M., Schoch–Spana, M., et al. (2017). A Community Checklist for Health Sector Resilience Informed by Hurricane Sandy. Health Security. 15(1): 53-69.
The authors incorporated lessons learned from Hurricane Sandy into this checklist of actions for healthcare, public health, nongovernmental organizations, and private entities to strengthen the resilience of their community’s health sector. There is a general checklist of actions for all stakeholders, as well as guidance provided by type of healthcare facility.
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Tucker, E. (n.d.). Hospital Disaster Preparedness Budget Model. (Accessed 2/8/2023.) Centers for Disease Control and Prevention.
This tool can help healthcare executives prepare their facility finances for a large-scale public health emergency. This model estimates the resources needed by healthcare department (e.g., administration, emergency room, facilities, information and technology) during a disaster. Users can also calculate the amount of cash reserves an executive may need for maintaining operations while awaiting reimbursement from insurance companies or government agencies.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2015). Healthcare COOP and Recovery Planning:  Concepts, Principles, Templates and Resources.
This guide includes an overview of healthcare continuity of operations planning, customizable templates, and other related resources. It includes links to information on continuity planning, online courses, and other COOP resources.
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* Zane, R., Biddinger, P., Gerteis, J., and Hassol, A. (2010). Hospital Assessment and Recovery Guide. U.S. Department of Health and Human Services.
This guide is designed to help hospital staff conduct an initial assessment of a hospital after a closure or evacuation due to an emergency event. The guide is divided into 11 sections, each with its own team and assessment assignment: Administration, Facilities, Security and Fire Safety, Information Technology and Communications, Biomedical Engineering, Medical, Ancillary Services, Materials Management, Building and Grounds Maintenance/ Environmental Services, and Support Services.
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Agencies and Organizations

California Hospital Association. Recovery.
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U.S. Department of Homeland Security. Resilience.
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This ASPR TRACIE Topic Collection was comprehensively refreshed and reviewed in August 2019 by the following subject matter experts (listed in alphabetical order): Eric Alberts, EM, CHS-V, FPEM, FPEM-HC, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Manager, Emergency Preparedness, Orlando Health, Inc. (Hospital System); Joshua Barnes, Recovery Division, HHS/ASPR; Peter Brewster, U.S. Department of Veterans Affairs, Program Manager, Education and Training; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Onora Lien, Executive Director, Northwest Healthcare Response Network; Mary Massey, BSN, MA, PHN, VP, Emergency Management, California Hospital Association; and Mary Russell, EdD, MSN, Healthcare Emergency Response Coalition, Palm Beach County Florida. 

It was comprehensively reviewed in August and September 2015 by the following subject matter experts (listed in alphabetical order): Eric Alberts, BS, FPEM, CHS-V, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Manager, Emergency Preparedness, Orlando Health, Inc. (Hospital System); Paul D. Biddinger, MD, Center for Disaster Medicine, Massachusetts General Hospital, and Harvard TH Chan School of Public Health EPREP Program; Peter Brewster, U.S. Department of Veterans Affairs, Director, Education and Training; Benjamin Dauksewicz, MA, CEM, Mount Sinai St. Luke’s–Roosevelt; Natalie N. Grant, MPH, Program Analyst, HHS ASPR, Office of Emergency Management (OEM), Recovery, and Hurricane Sandy Health & Social Services Recovery Support Function Field Coordinator; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Bill Mangieri, CBCP, CHEP, Field Project Officer Region VI, National Healthcare Preparedness Program, Office of Emergency Management, Assistant Secretary for Preparedness& Response, U.S. Department of Health & Human Services; Esmeralda Pereira, MS, Division Director, Recovery, U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response; Mary Russell, EdD, MSN, Emergency Services, Boca Raton Regional Hospital; and Matthew L. Smith, Chief, Continuity of Operations Branch, HHS/ASPR/OEM Division of Resilience.

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