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Coalition Models and Functions
Topic Collection
September 9, 2022

Topic Collection: Coalition Models and Functions

Over the last decade, there has been an emphasis on healthcare coalitions (HCCs)—groups of local healthcare and responder organizations that collaborate to prepare for and respond to emergencies. Healthcare coalitions reflect the unique needs and characteristics of local jurisdictions. The resources in this collection can help new and existing healthcare coalition members learn more about the history of coalitions, the functions and structures of effective coalitions, and how other coalitions have learned and grown from actual disasters. The COVID-19 pandemic tested the capacity and capabilities of the entire U.S. healthcare system. It also presented an opportunity to examine successes and opportunities in HCC responses to the pandemic. New HCCs were formed because of COVID-19, while others changed their models and functionality to better serve their communities. ASPR TRACIE analyzed how HCCs responded to COVID-19 to better understand the technical assistance (TA) needs of HCCs to prepare for future all hazards emergencies.

Note: ASPR TRACIE has two other Topic Collections focused on HCCs: Coalition Administrative Issues and Coalition Response Operations (including Mutual Aid). There are also numerous resources within this collection related to pediatric issues and HCCs. For pediatric-specific resources, visit the ASPR TRACIE Pediatric Topic Collection.

The ASPR TRACIE team also welcomes plans or resources that may represent 'best practices' to share with others which will be reviewed and may be selected for a Topic Collection. To share your plan or resource, contact the ASPR TRACIE Assistance Center.

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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Must Reads

ASPR TRACIE. (2021). Healthcare Coalition Engagement in COVID-19 Assessment (Infographic).
This infographic highlights findings from a multi-phased effort that included an online survey open to all healthcare coalitions about various aspects of their response to the pandemic and eight focus groups with a subset of survey respondents.
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Barbera, J.A. and Macintyre, A.G. (2007). Medical Surge Capacity and Capability: A Management System for Integrating Medical and Health Resources during Large-Scale Emergencies, Second Edition. U.S. Department of Health and Human Services.
This handbook describes the changes to the federal public health and medical response structure since the development of the original MSCC handbook in 2004. The MSCC Management System describes a framework of coordination of public and private entities across six tiers of response, of which tier two is the management of healthcare coalitions (see Chapter 3). This document is considered to be a foundational document for coalition development that describes the response system.
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Barbera, J.A. and Macintyre, A.G. (2009). Medical Surge Capacity and Capability: The Healthcare Coalition in Emergency Response and Recovery. U.S. Department of Health and Human Services.
The authors wrote this guide as a companion piece to the Medical Surge Capacity and Capability handbook, providing tips for developing, implementing, and maintaining effective healthcare coalitions.
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  • Alan Dixon We need a hospital & clinic directory app for first responders with expertise stat analytics per hospital clinic with search tool find by expertise & availability ~Alan Tyler Dixon https://asprtracie.hhs.gov/technical-resources/25/coalition-response-operations-including-mutual-aid/21 Sent from my iPhone
    11/24/2017 3:31:56 PM
Centers for Disease Control and Prevention (2015). Community Planning Framework for Healthcare Preparedness.
This document includes information to help planners enhance and/or develop a community's medical surge plans. It is organized into chapters, such as: Building Planning Teams and Coalitions; Models of Healthcare Delivery; Alternate Care Systems; Essential Healthcare Services; and Crisis Standards of Care. The chapter on coalitions defines roles and responsibilities for planning teams and coalitions, and the steps necessary to determine a community's healthcare needs.
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Hanfling, D. (2013). Role of Regional Healthcare Coalitions in Managing and Coordinating Disaster Response. Institute of Medicine.
This white paper was prepared for the January 2013 workshop on Nationwide Response to an Improvised Nuclear Device Attack. It focuses on the role of coalitions in catastrophic disaster event response, and how coalitions that organize to form regional networks can improve communication of resource needs and provide situational awareness. The experiences of building coalitions in the National Capital Region are also discussed.
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Kim, D.H. (2016). Emergency Preparedness and the Development of Health Care Coalitions: A Dynamic Process. Journal of Nursing Clinics.
The author provides an overview of the history of hospital preparedness (including the healthcare preparedness program) and the role of healthcare coalitions (HCCs) in emergency preparedness. The author also explains how HCCs contribute to healthcare and community resilience and can help hospitals meet Centers for Medicare and Medicaid Services regulatory requirements.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (n.d.). From Hospitals to Healthcare Coalitions: Transforming Health Preparedness and Response in Our Communities. (Accessed 9/30/2022.) U.S. Department of Health and Human Services.
This 2007-2009 report provides an overview of the Hospital Preparedness Program (HPP), the move toward healthcare coalitions, shares profiles of grant awardees, and includes a chapter on the “future” of HPP.
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Coalition Model Examples and Development Issues

Cross Hansel, T., Osofsky, H.J., Langhinrichsen-Rohling, J., et al. (2015). Gulf Coast Resilience Coalition: An Evolved Collaborative Built on Shared Disaster Experiences, Response, and Future Preparedness. (Abstract only.) Disaster Medicine and Public Health Preparedness. 9(6).
This article describes the development of the Gulf Coast Resilience Coalition, which supports communities in disaster resilience, preparedness, response, and recovery while also focusing on improving access to behavioral health services after a disaster.
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Devereaux, A., Yang, H., Seda, G., et al. (2020). Optimizing Scarce Resource Allocation During COVID-19: Rapid Creation of a Regional Health-Care Coalition and Triage Teams in San Diego County, California. Disaster Medicine and Public Health Preparedness 16(1).
The authors describe a virtual gathering of 100 subject matter experts who arrived at a consensus for allocating resources during the COVID-19 pandemic. They found that the rapid formation of healthcare coalitions, continuous process improvement, and communication were key when managing the COVID-19 surge.
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Hanfling, D. (2013). Role of Regional Healthcare Coalitions in Managing and Coordinating Disaster Response. Institute of Medicine.
This white paper was prepared for the January 2013 workshop on Nationwide Response to an Improvised Nuclear Device Attack. It focuses on the role of coalitions in catastrophic disaster event response, and how coalitions that organize to form regional networks can improve communication of resource needs and provide situational awareness. The experiences of building coalitions in the National Capital Region are also discussed.
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Harris, C., Waltz, T., O’Neal, J., et al. (2015). Conceptualization of a Health Care Coalition Framework in Georgia Based on the Existing Regional Coordinating Hospital Infrastructure. (Abstract only.) Disaster Medicine and Public Health Preparedness. 10(1).
In 2001, the State of Georgia created a Regional Coordinating Hospital (RCH) infrastructure tasked with coordinating regional disaster responses. It was determined that hospitals alone could not be responsible for community preparedness, and in 2012 Georgia began to create healthcare coalitions (HCC) comprised of healthcare organizations, nursing homes, community health centers, volunteer groups, law enforcement, and other community organizations to improve community resilience. The authors highlight the preparedness gaps and improvements in state disaster response attributed to HCCs.
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Healthcare Coalition Council of King County. (n.d.). King County Healthcare Coalition. (Accessed 10/31/2022.) Center for Infectious Disease Research and Policy.
This presentation reviews how the coalition in King County, Washington defines coalition responsibilities; benefits to members; expectations of members; coalition governance; priorities; and planning issues. This was the original model used in the early formation of the King County Healthcare Coalition when it was based at Public Health- Seattle & King County. It is now known as the Northwest Healthcare Response Network and is a private 501c3 entity involving multiple counties.
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* McCulley, K. and Sinclair, S. (2012). Advancements in HPP Regional Healthcare Coalitions: Utah’s Experience.
This presentation provides an overview of Utah’s regional coalitions. It includes membership, organizational requirements, roles/ responsibilities, key components and functions, shared assets, and core deliverables.
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* McElwee, J.A. (2012). Taking A Regional Healthcare Coalition Approach To Mitigating Surge Capacity Needs Of Mass Casualty Or Pandemic Events. Naval Postgraduate School Thesis.
This report provides a detailed analysis of healthcare coalition development, comparing and contrasting a number of different coalition models. It uses a case study methodology to provide qualitative analysis of three different healthcare coalitions, focused on governance, level of participation, and funding.
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National Association of County and City Health Officials and the Association of State and Territorial Health Officials. (2010). Healthcare Coalition Matrix.
This is a useful matrix that compares and contrasts a number of different healthcare coalition models. Please note that some links in the matrix are broken.
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Priest, C. and Stryckman, B. (2015). Identifying Indirect Benefits of Federal Health Care Emergency Preparedness Grant Funding to Coalitions: A Content Analysis. (Abstract only.) Disaster Medicine and Public Health Preparedness. 9(6):704-11.
The authors reviewed data from telephone interviews conducted with regional stakeholders from several healthcare coalitions to assess their opinions on the benefits of federal preparedness funding. Overall, participants noted dual-use technology and programs and the positive effect of relationships on day-to-day operations as primary indirect benefits; the authors emphasized the need for additional research on return on investment from federal grant funding.
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Rambhia, K., Waldhorn, R., Selck, F., et al. (2012). A Survey of Hospitals to Determine the Prevalence and Characteristics of Healthcare Coalitions for Emergency Preparedness and Response. (Abstract only.) Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 10(3): 304-313.
The authors surveyed acute care hospitals across the U.S. and found that the coalition approach to disaster planning is almost universal. They provide recommendations for further development of healthcare coalitions and strategies for improving local and national preparedness.
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  • Andrea Esp You have to pay for the article.
    9/1/2016 11:49:53 AM
Region 9 Healthcare Coalition. (2018). Region 9 Healthcare Coalition Preparedness Plan.
This disaster preparedness plan was created by a healthcare coalition in Washington state and discusses bolstering community resilience by using available resources to provide efficient and appropriate patient care. The document covers coalition mission, scope, a hazard vulnerability assessment, communication, and exercise coordination, among other focus areas.
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Rogers, T. and Maloni, M. (2018). Health and Medical Coordinating Coalitions: An Introduction to the Western Massachusetts HMCC.
This document provides an overview of the Western Massachusetts Health and Medical Coordinating Coalition, including activities, benefits, and leadership roles.
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Slemp, C. (2013). Putting the Coalition in Context. West Virginia Public Health and Medical Preparedness Conference.
This PowerPoint presentation encourages the development of a strong coalition by understanding the purpose and philosophy of coalition building.
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Terndrup, T., Leaming, J., Adams, R., and Adoff, S. (2012). Hospital-Based Coalition to Improve Regional Surge Capacity. The Western Journal of Emergency Medicine. 13(5):445-52.
The authors examined the effect of a newly developed regional healthcare coalition (in south Central Pennsylvania) on six surge capacity-related objectives. In a two-year period, the healthcare coalition improved areas under all objectives. The authors also found that designating and training a coordinator for the state healthcare volunteer database contributed to a significant increase in volunteer registrations from the participating hospitals.
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* Toner, E., Ravi, S., Adalja, A., et al. (2015). Doing Good by Playing Well with Others: Exploring Local Collaboration for Emergency Preparedness and Response. (Abstract only.) Health Security. 13(4): 281-289.
The authors researched the extent and quality of existing collaborations and identified factors that impede or facilitate the integration of the preparedness community. They discuss ways to strengthen collaboration, and use six key findings to inform the development of tools to help coalitions better assess and improve their own preparedness community integration.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (n.d.). From Hospitals to Healthcare Coalitions: Transforming Health Preparedness and Response in Our Communities. (Accessed 9/30/2022.) U.S. Department of Health and Human Services.
This 2007-2009 report provides an overview of the Hospital Preparedness Program (HPP), the move toward healthcare coalitions, shares profiles of grant awardees, and includes a chapter on the “future” of HPP.
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* Walsh, L., Craddock, H., Gulley, K., et al. (2015). Building Health Care System Capacity to Respond to Disasters: Successes and Challenges of Disaster Preparedness Health Care Coalitions. (Abstract only.) Prehospital and Disaster Medicine. 30(2): 112-122.
The authors interviewed nine healthcare coalition leaders to identify benefits and challenges related to healthcare coalitions and their ability to augment healthcare system preparedness for disasters. The article discusses promising practices for: stakeholder engagement; communicating value and purpose; simplifying processes; formalizing connections; and incentivizing participation.
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Development and Management Guidance

Acosta, J., Howards, S., Chandra, A., et al. (2015). Contributions of Health Care Coalitions to Preparedness and Resilience: Perspectives From Hospital Preparedness Program and Health Care Preparedness Coalitions. Disaster Medicine and Public Health Preparedness. 9(6): 690-697.
The authors conducted a literature review and interviews with leaders from 22 coalitions and hospital preparedness programs. They determined five dimensions of success: strong member participation, diversity of members, positive changes in members' capacity to respond to or recover from disaster, sharing of resources among members, and being perceived as a trendsetter. They also listed barriers and suggest that coalitions develop a common typology that could be used to specify coalition capabilities and functions.
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ASPR TRACIE. (2015). Strategic Development for Building Operational Healthcare Coalitions.
In this webinar, speakers share information on operationalizing healthcare coalitions and summarize requests for technical assistance received by ASPR TRACIE on healthcare coalition models and roles in response and recovery.
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Barbera, J.A. and Macintyre, A.G. (2007). Medical Surge Capacity and Capability: A Management System for Integrating Medical and Health Resources during Large-Scale Emergencies, Second Edition. U.S. Department of Health and Human Services.
This handbook describes the changes to the federal public health and medical response structure since the development of the original MSCC handbook in 2004. The MSCC Management System describes a framework of coordination of public and private entities across six tiers of response, of which tier two is the management of healthcare coalitions (see Chapter 3). This document is considered to be a foundational document for coalition development that describes the response system.
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Barbera, J.A. and Macintyre, A.G. (2009). Medical Surge Capacity and Capability: The Healthcare Coalition in Emergency Response and Recovery. U.S. Department of Health and Human Services.
The authors wrote this guide as a companion piece to the Medical Surge Capacity and Capability handbook, providing tips for developing, implementing, and maintaining effective healthcare coalitions.
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  • Alan Dixon We need a hospital & clinic directory app for first responders with expertise stat analytics per hospital clinic with search tool find by expertise & availability ~Alan Tyler Dixon https://asprtracie.hhs.gov/technical-resources/25/coalition-response-operations-including-mutual-aid/21 Sent from my iPhone
    11/24/2017 3:31:56 PM
* Barnett, D. Knieser L., and Errett N.A., et al. (2020). Reexamining Health-Care Coalitions in Light of COVID-19. Disaster Medicine and Public Health Preparedness.
This article uses a strengths, weaknesses, opportunities, and threats analysis to understand healthcare coalition (HCC) models’ performance during COVID-19. The authors include concrete recommendations for stronger coalitions including better evaluation of HCCs, reexamining existing HCC administration, and supporting future healthcare preparedness efforts.
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Carrier, E., Yee, T., Cross, D., and Samuel, D. (2012). Emergency Preparedness and Community Coalitions: Opportunities and Challenges. (Abstract only.) Research Brief. (24):1-9.
This article discusses ways to broaden emergency preparedness coalition membership of critical partners, such as nursing homes and primary care providers, by providing incentives for more stakeholders to join existing coalitions or building preparedness into activities providers are already participating in. The authors advocate for developing outcomes-based measures of success as opposed to using membership and plan development status.
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Centers for Disease Control and Prevention (2015). Community Planning Framework for Healthcare Preparedness.
This document includes information to help planners enhance and/or develop a community's medical surge plans. It is organized into chapters, such as: Building Planning Teams and Coalitions; Models of Healthcare Delivery; Alternate Care Systems; Essential Healthcare Services; and Crisis Standards of Care. The chapter on coalitions defines roles and responsibilities for planning teams and coalitions, and the steps necessary to determine a community's healthcare needs.
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Cormier, S., Wargo, M., and Winslow, W. (2015). Transforming Health Care Coalitions From Hospitals to Whole of Community: Lessons Learned From Two Large Health Care Organizations. (Abstract only.) Disaster Medicine and Public Health Preparedness. 11(6).
This article focuses on how a large healthcare system spanning 23 states and a Pennsylvania public safety agency utilized healthcare coalitions to improve resilience, health, and safety of their communities.
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Courtney, B., Toner, E., Waldhorn, R., et al. (2009). Healthcare Coalitions: The New Foundation for National Healthcare Preparedness and Response for Catastrophic Health Emergencies. (Abstract only.) Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 7(2):153-6.
The authors provide an overview of the Hospital Preparedness Program and the Center for Biosecurity of the University of Pittsburgh's research for the Assistant Secretary for Preparedness and Response. The authors define healthcare coalitions, highlight their structure and functions, and illustrate how they overcame challenges.
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Downey, L., Ireson, C., Slavova, S., and McKee, G. (2008). Defining Elements of Success: A Critical Pathway of Coalition Development. (Abstract only.) Health Promotion Practice. 9(2):130-9.
The authors present a model that describes milestones in coalition formation. They conclude that a clear definition of the coalition structure; coalition enhancement; funding; community support; leadership; education and outreach to the community; membership; partnerships; data and evaluation; and publicity are critical to coalition formation.
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Hupert, N., Biala, K., Holland, T., et al. (2015). Optimizing Health Care Coalitions: Conceptual Frameworks and a Research Agenda. Disaster Medicine and Public Health Preparedness. 9(6): 717-723.
The authors provide an overview of the Hospital Preparedness Program and healthcare coalitions in general. This is followed by a description of two frameworks they created to give coalition leaders improved insight into “how different enterprises achieve similar ends relevant to emergency response.” The authors also provide a research agenda related to coalition contribution to the healthcare system.
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Koch, A., Bohn, J., Corvin, J., and Seaberg, J. (2022). Maturing Into High-Functioning Health-Care Coalitions: A Qualitative Nationwide Study of Emergency Preparedness and Response Leadership. (Abstract only.) Disaster Medicine and Public Health Preparedness. 10(1-9).
The authors conducted a qualitative study and identified three factors related to "high-functioning" healthcare coalitions: (1) having an established and growing partnership, (2) being value-driven culture, and (3) being response ready.
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* McElwee, J.A. (2012). Taking A Regional Healthcare Coalition Approach To Mitigating Surge Capacity Needs Of Mass Casualty Or Pandemic Events. Naval Postgraduate School Thesis.
This report provides a detailed analysis of healthcare coalition development, comparing and contrasting a number of different coalition models. It uses a case study methodology to provide qualitative analysis of three different healthcare coalitions, focused on governance, level of participation, and funding.
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Myers, L., Myers, L., and Grant, L. (2012). The Creation of Regional Partnerships for Regional Emergency Planning. Journal of Business Continuity and Emergency Planning. 4(4):338-51.
The authors describe a model process for developing or enhancing an all-hazards regional emergency planning network among public agencies, non-governmental organizations, faith-based organizations and the private sector to create regional collaboration and allow for scarce resource allocation during a disaster.
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National Healthcare Coalition Resource Center. (2017). Region 9 Healthcare Coalition Strategic Planning Workshop: Final Report.
This report provides information on levels of collaboration, desired core services, stakeholders and partners, funding sources, governance models, and more. It also discusses recent trainings, exercises, and how the coalition handled their 2017 response to influenza.
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* Porth, L. and Gatz, J. (2013). Healthcare Coalitions: An Emergency Preparedness Framework for Non-Urban Regions. Missouri Hospital Association.
This guidance is targeted to non-urban communities in Missouri developing regional healthcare coalitions. It provides guidance on coalition membership, structure, governance, and roles/ responsibilities during a response (including coordination with city, county, regional, and state partners).
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Raynor, J. (2011). What Makes an Effective Coalition?
The author discusses two aspects of coalitions: how/when to form them and the differences between types of coalitions.
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* Toner, E., Ravi, S., Adalja, A., et al. (2015). Doing Good by Playing Well with Others: Exploring Local Collaboration for Emergency Preparedness and Response. (Abstract only.) Health Security. 13(4): 281-289.
The authors researched the extent and quality of existing collaborations and identified factors that impede or facilitate the integration of the preparedness community. They discuss ways to strengthen collaboration, and use six key findings to inform the development of tools to help coalitions better assess and improve their own preparedness community integration.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2014). Disaster Behavioral Health Coalition Guidance.
This document provides guidance for establishing a disaster behavioral health coalition for disaster response and recovery to facilitate communication across provider groups, coordinate behavioral health care efforts, and help identify existing and emergent needs. Checklists of guidelines for successful coalitions, ways to recruit members, and Disaster Behavioral Health Coalition activities are included.
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Various Authors. (2013). Healthcare Coalition Development. Florida Department of Health, Governor's Hurricane Conference.
This presentation reviews federal expectations of coalitions; basic coalition frameworks; structures and roles of coalitions in Florida; and lessons learned from coalitions planning, exercising, and responding together. It also includes a series of questions for planners to consider with regard to administration; partnership building; defining core planning teams; defining members; and challenges and barriers for consideration.
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* Walsh, L., Craddock, H., Gulley, K., et al. (2015). Building Health Care System Capacity to Respond to Disasters: Successes and Challenges of Disaster Preparedness Health Care Coalitions. (Abstract only.) Prehospital and Disaster Medicine. 30(2): 112-122.
The authors interviewed nine healthcare coalition leaders to identify benefits and challenges related to healthcare coalitions and their ability to augment healthcare system preparedness for disasters. The article discusses promising practices for: stakeholder engagement; communicating value and purpose; simplifying processes; formalizing connections; and incentivizing participation.
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Education and Training

Center for Leadership in Public Health Practice, University of South Florida Center for Leadership in Public Health Practice. (2013). Collaborative Partnerships and Your Community-Based Disaster Coalition - Identifying, Engaging, Motivating, and Sustaining.
This free online training course includes three modules focused on organizing a community disaster preparedness coalition or strengthening existing coalitions. The modules include: Identifying Collaborative Partnerships; Engaging, Motivating, and Sustaining; and Sustaining Coalitions. The training also includes a course overview and final steps.
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Foster, R., Kagey, B.T., and Hogan, J. (2015). FEMA Promising Practice: Whole Community Inclusion Emergency Preparedness Planning at the State Level. Americans with Disabilities Act National Network.
This 90-minute webinar discusses strategies for inclusion and integration of individuals with access and functional needs in coalition planning efforts. Examples from Utah and Georgia are included.
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Hansen, C., Dodgen, D., Kaul, R., et al. (2014). Integrating Behavioral Health to Strengthen Healthcare Preparedness Capabilities and Coalitions. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This 90-minute webinar reviews how behavioral health may be integrated into coalition planning to enhance all eight healthcare preparedness capabilities. Federal and other planning resources are discussed, as is ongoing work to integrate behavioral health considerations into planning in Maine, Los Angeles, Washington, D.C., and Kentucky.
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* Hansen, C., Dodgen, D., Levine, C., et al. (2014). Pediatric Preparedness for Healthcare Coalitions: Part II. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This 90-minute webinar reviews resources, strategies, and partnerships used by medical planners and healthcare coalitions to strengthen pediatric components of their jurisdiction's healthcare preparedness capabilities. Included are lessons learned from the response to Superstorm Sandy and the Alaska Shield/Hale Borealis exercise.
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* Hick, J., McCulley, K., and Scott, L. (2014). Health and Medical Coordinating Coalitions Webinar Transcript. (Accessed 9/8/2022.)
This webinar highlights three coalitions (represented by each of the speakers) and the rationale behind their design. The Utah model specifically includes rural/frontier coalitions.
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Kansas Healthcare Coalition Steering Committee. (2013). Goal, Purpose, and Charge of Regional Coalitions.
This presentation provides an overview of healthcare coalitions in the “Who, What, Where, When, Why, and How” format.
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Kenningham, K., Koelemay, K., and King, M. (2014). Pediatric Disaster Triage Education and Skills Assessment: A Coalition Approach. (Abstract only.) Journal of Emergency Management. 12(2):141-51.
This article describes the successful coalition-wide training for medical providers to enhance their preparedness and response skills by the King County Healthcare Coalition (now known as the Northwest Healthcare Response Network). This article provides an example of creating value for members and consistency of training across a region.
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* Mason, W., Randolph, J., Boltz, R., et al. (2014). Rural Coalition Development and Immediate Bed Availability. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This 90-minute webinar reviews the unique challenges of building and operating healthcare coalitions in rural settings. Speakers discuss policy and partnership lessons learned from a disaster in Arkansas; bed surge and mass fatality support and coordination best practices from a Greyhound bus disaster in Pennsylvania; Community Assessment Tool (CAT) implementation in Nebraska; and rural healthcare coalition development strategies used in Missouri.
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* McCulley, K., Apodaca, R., Russell, M., et al. (2014). Healthcare Coalitions: Governance and Sustainability. National Association of County and City Health Officials.
This 2-hour webinar includes information on how healthcare coalitions are setting up their operational governance models. Speakers provide detailed information on the formation of their coalitions, (including key decision points and foundational documents), and highlight sustainability practices being implemented. A summary matrix of information presented is available for ease of reference. (Note: scroll to the bottom of the page to access the recording.)
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The MESH Coalition. (2013). FEMA Reauthorization: Ensuring the Nation is Prepared. Testimony of Bobby A. Courtney, MESH Coalition Chief Programming Officer.
This Congressional testimony reviews the example of the MESH Coalition, and its contribution to preparedness in the State of Indiana. It reviews its many functions, and describes the model under which the coalition was established. MESH has a broader mission than just preparedness that may be an option for some coalitions.
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Plans, Tools, and Templates

ASPR TRACIE. (2017). Healthcare Coalition Preparedness Plan. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This template provides general headers and descriptions for a sample health care coalition (HCC) Preparedness Plan Template. The resources used to develop this template include sample HCC plans and the Health Care Preparedness and Response Capabilities.
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Fairfax County, Virginia. (n.d.). ESF-8 Public Health and Medical Services Plan. (Accessed 9/8/2022.)
This plan describes roles and responsibilities for ESF-8 partners in Fairfax County that may be useful to coalitions in developing coordination structures and plans for their communities. Fairfax County is an urban county with a population of over 1 million. Page 7 specifically outlines the roles and responsibilities of the Northern Virginia Hospital Alliance.
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Hodge, J., Anderson, E., Kirsch, T., and Kelen, G. (2011). Facilitating Hospital Emergency Preparedness: Introduction of a Model Memorandum of Understanding. (Abstract only.) Disaster Medicine and Public Health Preparedness. 5(1):54-6.
Prolonged national emergencies (e.g., pandemics) stress the healthcare system and require significant and sustained coordination of staff, stuff, and space among healthcare within and across regions. Planners can use the information in this article to develop a Memorandum of Understanding to allocate scarce resources among providers across regions in the event of such an emergency.
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Illinois Department of Public Health. (2018). Illinois Department of Public Health Emergency Support Function (ESF) 8 Plan.
This plan describes concept of operations, roles and responsibilities, and command structures for ESF-8 members in Illinois that may be useful to coalitions in developing coordination structures and plans for their communities when integrated into ESF-8. This plan can be used as a guidance or template for regional healthcare coalitions. Illinois has seven Public Health and Medical Service Response Regions with a state-wide population of approximately 12.8 million.
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Kansas Department of Health and Environment. (2013). Healthcare Coalition Charter Template.
This coalition charter template may be used by other coalitions as a model for developing their own charters. This modifiable template includes categories such as mission, membership, conducting business, leadership roles, and additional provisions. Guidance for coalitions as they complete the template is also provided in italics throughout the document.
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National Association of County and City Health Officials. (2017). Fact Sheet: The Role of Healthcare Coalitions in Emergency Response.
This resource aims to strengthen healthcare coalitions by identifying coalition response roles and providing strategies for building response capacity. Brief coalition response case studies based on the Boston Marathon Bombings and the Chimney Wildfire are included.
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Public Health and Law Enforcement Emergency Preparedness Workgroup. (2008). Framework for Improving Cross-Sector Coordination for Emergency Preparedness and Response: Action Steps for Public Health, Law Enforcement, the Judiciary, and Corrections. Centers for Disease Control and Prevention.
This document highlights opportunities for cross-sectoral and cross-jurisdictional collaboration on public health and law enforcement.
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Public Health-Seattle and King County, Washington. (2015). ESF 8 Basic Plan-Health, Medical and Mortuary Services.
This plan describes concept of operations, roles and responsibilities, and command structures for ESF-8 members in King County, Washington that may be useful to coalitions in developing coordination structures and plans for their communities. This plan includes concept of operations and roles and responsibilities that involve the Northwest Healthcare Response Network (healthcare coalition).
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University of Iowa, College of Public Health, Upper Midwest Preparedness and Emergency Response Learning Center. (2013). Capability-Based Training and Education Resources for Coalitions.
This toolkit consists of a catalog of online trainings, resources, and drills and exercises organized by each of the 15 Public Health Emergency Preparedness Capabilities. There are six sections: Community Preparedness; Community Recovery; Emergency Operations Coordination; Emergency Public Information and Warning; Fatality Management; and Information Sharing.
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University of Kansas. The Community Toolbox. (n.d.). Chapter 5. Section 5. Coalition Building I: Starting a Coalition. (Accessed 10/31/2022.)
This toolkit—while not specific to healthcare—provides several resources on how to start a coalition. It includes a checklist, examples of how coalitions got started, various tools, and a PowerPoint presentation summarizing the major points of this Section of the toolkit.
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Utah Department of Health. (2013). Regional Coalition Tracking Reporting Tool. (Note: This resource is available in the ASPR TRACIE Information Exchange or contact ASPR TRACIE to receive a copy.)
This spreadsheet was developed to track work plan progress, measures, memberships, and progress towards meeting the Healthcare Preparedness Capabilities of regional coalitions in Utah. The tool (Excel spreadsheet) is customizable for other jurisdictions. Please log into the ASPR TRACIE Information Exchange to download a copy of the tool or contact ASPR TRACIE if you are interested in receiving the resource.
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Western MA Health and Medical Coordinating Coalition. (2016). Western MA Health and Medical Coordinating Coalition (HMCC) Duty Officer Quick Reference Guide.
This fact sheet outlines the roles of the healthcare coalition (HCC) duty officer. It can be replicated and customized by other HCCs.
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Rural/Frontier

Fisher, S., Biesiadecki, L., and Schemm, K. (2014). Responding to Medical Surge in Rural Communities: Practices for Immediate Bed Availability. The National Association of County and City Health Officials.
The focus of this report is on immediate bed availability in rural healthcare settings. The authors conducted a literature review and synthesized data collected during interviews with representatives in four areas: Mississippi, Southwest Utah, Virginia, and Southeast Texas.
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* Hick, J., McCulley, K., and Scott, L. (2014). Health and Medical Coordinating Coalitions Webinar Transcript. (Accessed 9/8/2022.)
This webinar highlights three coalitions (represented by each of the speakers) and the rationale behind their design. The Utah model specifically includes rural/frontier coalitions.
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Ken-Opurum, J., Darbishire, L., and Miller, D.K., et al. (2020). Assessing Rural Health Coalitions Using the Public Health Logic Model: A Systematic Review. (Abstract only.) American Journal of Preventive Medicine.
This systematic review discusses the role of healthcare coalitions in rural settings where residents may experience poorer health outcomes due to lack of access to healthcare and other social determinants. The authors highlight important considerations for rural healthcare coalitions, including conducting pilot studies, increased community engagement, creating subcommittees, and conducting regional needs assessments.
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* Mason, W., Randolph, J., Boltz, R., et al. (2014). Rural Coalition Development and Immediate Bed Availability. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This 90-minute webinar reviews the unique challenges of building and operating healthcare coalitions in rural settings. Speakers discuss policy and partnership lessons learned from a disaster in Arkansas; bed surge and mass fatality support and coordination best practices from a Greyhound bus disaster in Pennsylvania; Community Assessment Tool (CAT) implementation in Nebraska; and rural healthcare coalition development strategies used in Missouri.
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* McCulley, K. and Sinclair, S. (2012). Advancements in HPP Regional Healthcare Coalitions: Utah’s Experience.
This presentation provides an overview of Utah’s regional coalitions. It includes membership, organizational requirements, roles/ responsibilities, key components and functions, shared assets, and core deliverables.
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* McCulley, K., Apodaca, R., Russell, M., et al. (2014). Healthcare Coalitions: Governance and Sustainability. National Association of County and City Health Officials.
This 2-hour webinar includes information on how healthcare coalitions are setting up their operational governance models. Speakers provide detailed information on the formation of their coalitions, (including key decision points and foundational documents), and highlight sustainability practices being implemented. A summary matrix of information presented is available for ease of reference. (Note: scroll to the bottom of the page to access the recording.)
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National Association of County and City Health Officials. (2018). Fact Sheet: Rural and Frontier Healthcare Coalitions: A Preparedness and Response Snapshot.
This fact sheet provides information for rural healthcare coalitions, including coalition characteristics, preparedness and response roles, jurisdictional benefits, and barriers for rural healthcare coalitions. It also contains several stories from the field.
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* Porth, L. and Gatz, J. (2013). Healthcare Coalitions: An Emergency Preparedness Framework for Non-Urban Regions. Missouri Hospital Association.
This guidance is targeted to non-urban communities in Missouri developing regional healthcare coalitions. It provides guidance on coalition membership, structure, governance, and roles/ responsibilities during a response (including coordination with city, county, regional, and state partners).
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Specific Hazard Considerations and Event Lessons Learned

ASPR TRACIE. (2021). Healthcare Coalition Engagement in COVID-19 Assessment (Infographic).
This infographic highlights findings from a multi-phased effort that included an online survey open to all healthcare coalitions about various aspects of their response to the pandemic and eight focus groups with a subset of survey respondents.
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* Barnett, D. Knieser L., and Errett N.A., et al. (2020). Reexamining Health-Care Coalitions in Light of COVID-19. Disaster Medicine and Public Health Preparedness.
This article uses a strengths, weaknesses, opportunities, and threats analysis to understand healthcare coalition (HCC) models’ performance during COVID-19. The authors include concrete recommendations for stronger coalitions including better evaluation of HCCs, reexamining existing HCC administration, and supporting future healthcare preparedness efforts.
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* Hansen, C., Dodgen, D., Levine, C., et al. (2014). Pediatric Preparedness for Healthcare Coalitions: Part II. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This 90-minute webinar reviews resources, strategies, and partnerships used by medical planners and healthcare coalitions to strengthen pediatric components of their jurisdiction's healthcare preparedness capabilities. Included are lessons learned from the response to Superstorm Sandy and the Alaska Shield/Hale Borealis exercise.
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Institute of Medicine. (2013). Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary, Chapter 9: Roles of Regional Healthcare Coalitions in Planning and Response. National Academies Press.
This report summarizes the presentations from a 2013 workshop held by the Institute of Medicine and the National Association of County and City Health Officials focused on response requirements faced by public health and healthcare systems in response to an improvised nuclear device (IND) detonation. Chapter 9 specifically discusses the roles and work of healthcare coalitions to advance regional planning for IND incidents. The specific challenges of patient forward movement unique to a nuclear event are discussed.
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Lee, A., Upton, L., Denham, M., and Williamson, J. (2021). COVID-19 Data Driven Planning: The SouthEast Texas Approach. (Abstract only.) Journal of Emergency Management. 20(7):39-56.
The authors reviewed South East Texas Regional Advisory Councils' (SETRAC) collection, processing, and analysis of COVID-19 data "in the largest national medical setting in the United States." This case study highlights best practices in risk and crisis communications, emphasizes the need for cross-sector collaboration and standardization of data collection, and examines process that effect information sharing between the healthcare and homeland security sectors.
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* Mason, W., Randolph, J., Boltz, R., et al. (2014). Rural Coalition Development and Immediate Bed Availability. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This 90-minute webinar reviews the unique challenges of building and operating healthcare coalitions in rural settings. Speakers discuss policy and partnership lessons learned from a disaster in Arkansas; bed surge and mass fatality support and coordination best practices from a Greyhound bus disaster in Pennsylvania; Community Assessment Tool (CAT) implementation in Nebraska; and rural healthcare coalition development strategies used in Missouri.
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Upton, L., Kirsch, T., Harvey, M., et al. (2017). Health Care Coalitions as Response Organizations: Houston After Hurricane Harvey. Disaster Medicine and Public Health Preparedness. 11(6).
This article discusses the role of a healthcare coalition (HCC) in response to the 2017 landfall and flooding of Hurricane Harvey in Texas. The authors cover HCC operational and strategic planning, information sharing, and resource coordination during the disaster response.
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Upton, L., Lee, A., and Denham, M.A. (2021). Building Resilient Coalitions: Health and Medical Response Through COVID-19. Disaster Management & Human Health Risk, VII.
This study discusses the role of a healthcare coalition (the SouthEast Regional Advisory Council, or SETRAC) in building capacity for healthcare organizations near Houston. The authors examined after action reports from Hurricane Laura and winter storm Uri (which both took place during the COVID-19 pandemic) to examine SETRAC’s established, developing, and unmet capabilities and strategies for identified meeting challenges.
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Agencies and Organizations

U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Hospital Preparedness Program.
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This ASPR TRACIE Topic Collection was refreshed in September 2022. It was comprehensively reviewed in October 2015 by the following subject matter experts (alphabetical order):

Eric Alberts, BS, FPEM, CHS-V, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Manager, Emergency Preparedness, Orlando Health, Inc. (Hospital System); Amanda Bogard, M.A., Barren River District Health Department; Hillary A. Craddock, MPH, University of Maryland; Craig DeAtley, PA-C, Grant Director, Director Institute for Public Health Emergency Readiness, Washington Hospital Center; Kelly Gulley, Project Coordinator, National Center for Disaster Medicine and Public Health (NCDMPH), Uniformed Services University of the Health Sciences (USUHS); Dan Hanfling, MD (Panel Chair, Editor) Contributing Scholar, UPMC Center for Health Security, Member, InterAgency Board, Attending Physician, BestPractices, Inc. (a division of EmCare), and Clinical Professor of Emergency Medicine, George Washington University; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Mark Jarrett, MD, MBA, MS, Sr. Vice President and Chief Quality Officer, Associate Chief Medical Officer, North Shore-LIJ Health System and Professor of Medicine, Hofstra – North Shore LIJ School of Medicine; Onora Lien, MA, Executive Director, Northwest Healthcare Response Network; Kevin McCulley, Public Health and Medical Preparedness Manager, Bureau of EMS and Preparedness, Utah Department of Health; Mary Russell, EdD, MSN, Emergency Services, Boca Raton Regional Hospital; Sue Snider, MA, Executive Director, Northern Virginia Hospital Alliance; and Eric Toner, MD, UPMC Center for Health Security.
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