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Hazard Vulnerability/Risk Assessment
Topic Collection
July 10, 2024

Topic Collection: Hazard Vulnerability/Risk Assessment

Hazard vulnerability analysis (HVA) and risk assessment are systematic approaches to identifying hazards or risks that are most likely to have an impact on a healthcare facility and the surrounding community. Conducting a risk assessment / HVA is also a requirement in the CMS Emergency Preparedness Rule.  The Joint Commission Emergency Management and NFPA (Healthcare 99-101, Chapter 12, Emergency Management) also require an HVA. Multiple tools and resources are available to help healthcare organizations and public health departments prioritize their planning efforts based on these identified hazards.  

Ideally, an HVA should be conducted with input from experts from outside the institution/agency to ensure the incorporation of additional context for the risk assessment. For example, jurisdictional emergency management, NOAA, and state agencies may have quantitative and qualitative probability and impact data based on risk assessments and actual events that can contribute to the facility/coalition HVA. This data may prompt additional discussions and provide valuable input and resources for consideration in addition to contributing to the HVA. 

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

Campbell, P., Trockman, S.J., and Walker, A.R. (2011). Strengthening Hazard Vulnerability Analysis: Results of Recent Research in Maine. Public Health Reports. 126(2):290-293.
The authors discuss results from interviews with staff members at eight hospitals in Maine to document HVA processes and develop recommendations for improvement. Researchers conducting the interviews were from the Harvard School of Public Health and the Southern Maine Regional Resource Center for Public Health Emergency Preparedness.
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Drexel University School of Public Health, Center for Public Health Readiness and Communication. (2013). Pennsylvania Public Health Risk Assessment Tool (PHRAT). Pennsylvania Department of Health.
This tool guides public health planners through an analysis of the health-related impacts of various hazards that can occur in their jurisdictions, and helps them prioritize planning efforts for those emergencies.
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Federal Emergency Management Agency. (2018). Comprehensive Preparedness Guide (CPG) 201: Threat and Hazard Identification and Risk Assessment (THIRA) and Stakeholder Preparedness Review (SPR) Guide. (Third Edition.)
This guide provides communities with a three-step process for conducting a Threat and Hazard Identification and Risk Assessment (THIRA). While it incorporates healthcare, this guide is community-based. It builds upon previous versions of the CPG and describes a standard process for identifying community-specific threats and hazards; setting capability targets for each core capability identified in the National Preparedness Goal; and estimating resources needed to meet the capability targets. This edition also includes the three-step process for a Stakeholder Preparedness Review (SPR) (formerly State Preparedness Report), as this process is interconnected with the THIRA process. Healthcare should be aware of the THIRA process and assure that their input is considered and that accurate numerics are used.
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Kaiser Permanente (2017). Kaiser Permanente Hazard Vulnerability Analysis (HVA) Tool.
This tool provides a systematic approach to analyzing hazards that may affect demand for hospital services, or a facility’s ability to provide those services, helping to prioritize planning, mitigation, response, and recovery activities. This revised version of the commonly used tool incorporates data on actual activations experienced by the user, to more fully inform risk analysis.
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Los Angeles County Department of Public Health, Emergency Preparedness and Response Program (2013). Health Hazard Assessment and Prioritization (hHAP).
This tool was developed by the Los Angeles Department of Public Health—in collaboration with the Orange County Health Care Agency, the Long Beach Department of Health and Human Services, and the Pasadena Department of Public Health—and provides a 6-step hazard vulnerability assessment process. It offers a health-focused mechanism to engage the community, identify organizational priorities, and improve an agency’s or community’s capability to successfully prepare for, respond to, and recover from potential emergency threats. Both the hHAP Instrument and Manual are provided as downloads.
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U.S. Department of Homeland Security. (2016). Healthcare and Public Health Sector-Specific Plan.
This plan, updated in 2016, is designed to guide the Health and Public Health (HPH) Sector’s internal, collaborative, and cross-sector efforts "to enhance the security and resilience of HPH critical infrastructure to all-hazards across its physical, cyber, and human dimensions." Updates include refreshed goals and objectives and more emphasis on select priorities (e.g., information sharing and emergency response).
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Education and Training

Federal Emergency Management Agency. (2013). IS-318: Mitigation Planning for Local and Tribal Communities.
This free course can help local or Tribal government officials, first responders, and other stakeholders: learn more about the Stafford Act; identify and bring together experts and stakeholders (e.g., hospital and other healthcare facility planners) to assist with the process; and use local or tribal mitigation planning guidance to develop a hazard mitigation plan.
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Iowa Department of Public Health and University of Iowa, College of Public Health, Upper Midwest Preparedness and Emergency Response Learning Center (UMPERLC). (2012). Community Partnering: A Risk Assessment and Emergency Operations Planning Scenario.
This hour-long community-based planning course includes discussion of how to apply risk assessment to the development of emergency operations plans; considerations for conducting risk assessments; and how to determine resources and information necessary to analyze threats, hazards, operational priorities, and courses of action. The intended audience is local public health administrators and local county emergency managers.
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* Saruwatari, M. (n.d.). Conducting a Hazard and Vulnerability Analysis. (Accessed 9/5/2024.) Kaiser Permanente.
This slide set from a presentation describes how to conduct a Hazard Vulnerability Analysis (HVA) in the healthcare setting; highlights specific tools that can be used to mitigate risks once hazards have been identified and prioritized; shares the use of HVA in annual emergency management planning activities and demonstrates a new way to prioritize risks using actual incident information.
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Shapland, M. (n.d.). Healthcare Risk Mitigation Plan: Overview, Components & Sample. (Accessed 9/5/2024.) Study.com.
This brief lesson provides an overview of risk mitigation planning (including examples) for healthcare facilities.
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Texas A&M Engineering. (2019). Critical Asset Risk Management.
This free two-day course is offered in several locations across the U.S. and helps participants understand risks to their facilities and mitigation strategies. Students will be able to practice conducting vulnerability assessments on-site (at local facilities) and identify potential mitigating strategies.
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Texas A&M Engineering. (2019). Disaster Preparedness for Hospitals and Healthcare Organizations Within the Community Infrastructure.
This two-day course is offered in several locations across the U.S. and can help a variety of healthcare industry staff (e.g., planners, directors, regulatory personnel) understand the natural, technological, and human-caused hazards that may make their facilities vulnerable. Participants will learn about response and recovery issues specific to medical facilities, including which resources may be necessary for response and recovery.
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Environmental Hazards

Borden, K.A., and Cutter, S.L. (2008). Spatial Patterns of Natural Hazards Mortality in the United States. International Journal of Health Geographics. 17(7):64.
The authors examine the spatial patterns of natural hazard mortality at the county-level for the U.S. from 1970–2004 using a combination of geographical and epidemiological methods. This information can help to better inform local emergency practitioners who plan for and respond to disasters in their communities.
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Borden, K.A., Schmidtlein, M.C., Emrich, C.T., et al. (2007). Vulnerability of U.S. Cities to Environmental Hazards. (Abstract only.) Journal of Homeland Security and Emergency Management. Volume 4, Issue 2, ISSN (Online) 1547-7355.
The authors of this paper explore the variability in vulnerability to natural hazards among 132 urban areas using three indices of vulnerability: social; built environment; and hazard impact. They also examine the relative levels of vulnerability compared to federal Urban Areas Security Initiative (UASI) funding.
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Houghton, A., and English, P. (2014). An Approach to Developing Local Climate Change Environmental Public Health Indicators, Vulnerability Assessments, and Projections of Future Impacts. Journal of Environmental and Public Health. Article ID 132057.
The authors provide a three-tiered approach to develop local climate change environmental public health indicators. These indicators can assist local health departments with incorporating climate-related trends into the larger health department planning process and can be used to perform vulnerability assessments.
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Lane, K., Charles-Guzman, K., Wheeler K., et al. (2013). Health Effects of Coastal Storms and Flooding in Urban Areas: A Review and Vulnerability Assessment. Journal of Environmental and Public Health. Article ID 913064.
The authors provide a review of the health impacts of U.S. coastal storms, with a focus on outcomes relevant to New York City (NYC) and urban coastal areas, and incorporate lessons learned from Superstorm Sandy. Based on the literature reviewed, indicators of health vulnerability were selected and mapped within NYC neighborhoods.
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National Oceanic and Atmospheric Administration (NOAA). (2011). Coastal County Snapshots.
Users can select their county to get more information on exposure and resilience to coastal hazards that can be used to inform their hazard vulnerability analysis (HVA) and associated response and recovery plans. The snapshots incorporate data from the Federal Emergency Management Agency (FEMA) floodplain maps, U.S. Geological Survey critical facilities database, and NOAA land cover and demographics databases.
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Guidance

Federal Emergency Management Agency. (2013). Mitigation Ideas: A Resource for Reducing Risk to Natural Hazards.
This guide provides strategies for risk mitigation under four primary action categories: (1) Local Planning and Regulations, (2) Structure and Infrastructure Projects, (3) Natural Systems Protection, and (4) Education and Awareness Programs. It includes strategies for healthcare facilities, buildings in general, and links to related resources.
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* Federal Emergency Management Agency. (2018). Comprehensive Preparedness Guide (CPG) 201: Threat and Hazard Identification and Risk Assessment (THIRA) and Stakeholder Preparedness Review (SPR) Guide. (Third Edition.)
This guide provides communities with a three-step process for conducting a Threat and Hazard Identification and Risk Assessment (THIRA). While it incorporates healthcare, this guide is community-based. It builds upon previous versions of the CPG and describes a standard process for identifying community-specific threats and hazards; setting capability targets for each core capability identified in the National Preparedness Goal; and estimating resources needed to meet the capability targets. This edition also includes the three-step process for a Stakeholder Preparedness Review (SPR) (formerly State Preparedness Report), as this process is interconnected with the THIRA process. Healthcare should be aware of the THIRA process and assure that their input is considered and that accurate numerics are used.
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Lundberg, R. and Willis, H. (2015). Assessing Homeland Security Risks: A Comparative Risk Assessment of 10 Hazards. Homeland Security Affairs Journal, 11(10).
The authors used open source data and a standardized set of attributes to examine ten homeland security risks (e.g., natural disasters and terrorist incidents). The annualized risk to the U.S. is supported by various tables and graphics throughout the article.
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Rozell, D.J. (2015). A Cautionary Note on Qualitative Risk Ranking of Homeland Security Threats. Homeland Security Affairs Journal, 11(3) Homeland Security Affairs Journal, 11(3).
The authors discuss the pros and cons of using qualitative versus quantitative data to assess homeland security threats. They suggest combining quantitative risk models with “managerial review and judgment.”
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* Saruwatari, M. (n.d.). Conducting a Hazard and Vulnerability Analysis. (Accessed 9/5/2024.) Kaiser Permanente.
This slide set from a presentation describes how to conduct a Hazard Vulnerability Analysis (HVA) in the healthcare setting; highlights specific tools that can be used to mitigate risks once hazards have been identified and prioritized; shares the use of HVA in annual emergency management planning activities and demonstrates a new way to prioritize risks using actual incident information.
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Lessons Learned

Campbell, P., Trockman, S.J., and Walker, A.R. (2011). Strengthening Hazard Vulnerability Analysis: Results of Recent Research in Maine. Public Health Reports. 126(2):290-293.
The authors discuss results from interviews with staff members at eight hospitals in Maine to document HVA processes and develop recommendations for improvement. Researchers conducting the interviews were from the Harvard School of Public Health and the Southern Maine Regional Resource Center for Public Health Emergency Preparedness.
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Plans, Tools, and Templates

Administration for Strategic Preparedness and Response. (2023). RISC Toolkit 2.0. U.S. Department of Health and Human Services.
The Risk Identification and Site Criticality (RISC) Toolkit is an objective, data-driven all-hazards risk assessment that can be used by public and private organizations within the Healthcare and Public Health Sector to inform emergency preparedness planning, risk management activities, and resource investments. The RISC Toolkit provides owners/operators in the HPH Sector with nationally recognized standards-based evaluation criteria in an easy-to-follow, guided format. It can be utilized by a wide variety of HPH stakeholders including but not limited to hospitals, long-term care facilities, community health centers, health care coalitions, and public health agencies.
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  • Tony Barker Great tool that has very effective resource links. Makes the HVA process evidence based and provides an excellent format for use. Thank you to the development team!
    12/12/2018 12:56:37 PM
American Health Care Association/ National Center for Assisted Living. (2013). Hazard Vulnerability Assessments for Healthcare Facilities.
This three-page outline can help planners who work in assisted living and more traditional healthcare settings conduct hazard vulnerability assessments. It includes a link to related references at the end.
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ASPR TRACIE. (2024). ASPR TRACIE Evaluation of Hazard Vulnerability Assessment Tools. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This comparison chart shows the similarities and differences among the primary hazard vulnerability assessment (HVA) tools used by public health and health care organizations, and the Federal Emergency Management Agency’s Threat and Hazard Identification Risk Assessment (THIRA). Each description includes a summary of its primary use/purpose, as well as information on who developed the tool and how, the format of the tool, the calculations approach, and the benefits and limitations of the tool.
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California Association of Health Facilities. (n.d.). Hazard Vulnerability Assessments. (Accessed 9/5/2024.)
This page includes links to several general and state-specific hazard vulnerability assessment tools.
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Centers for Disease Control and Prevention. (2011). Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza.
This planning tool can help community planners--in context with community partners--assess disaster readiness from a healthcare system perspective. The tool can assist with identifying core agency partners’ capabilities and resources and instances where the same vendors are being used for resource supplies by the partners, and can help planners address gaps in their community’s capabilities or potential shortages in resources.
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Children's Hospital Colorado. (2013). Community Hazard Vulnerability Assessment.
This Community Hazard Vulnerability Assessment (CHVA) is based upon the work of many partners including Children’s Hospital Colorado and a Wisconsin workgroup consisting of state and local emergency management and public health departments, tribal health and hospital emergency planners. The CHVA incorporates the four phases of emergency management and takes an all-hazards approach to address national and local planning scenarios.
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DC Emergency Healthcare Coalition. (2015). DC Emergency Healthcare Coalition Enhanced Hazard Vulnerability Analysis (HVA).
This comprehensive Word document includes the rationale, process, and findings of the DC Emergency Healthcare Coalition’s Enhanced Hazard Vulnerability Analysis (HVA) conducted in July 2015. It may be used as a reference for other coalitions in the conduct of their respective HVAs.
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DC Emergency Healthcare Coalition. (2017). APPENDIX F: Step 5 of Enhanced HVA for DC Emergency Healthcare Coalition.
This Excel file lists vulnerabilities (e.g., life safety, continuity of operations) by hazard (e.g., terrorist attack, external flood, mass casualty incident) as they relate to the District of Columbia Emergency Healthcare Coalition.
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Drexel University School of Public Health, Center for Public Health Readiness and Communication. (2013). Pennsylvania Public Health Risk Assessment Tool (PHRAT). Pennsylvania Department of Health.
This tool guides public health planners through an analysis of the health-related impacts of various hazards that can occur in their jurisdictions, and helps them prioritize planning efforts for those emergencies.
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Emergency Medical Services for Children Innovation and Improvement Center. (2024). Pediatric Hazard Vulnerability Analysis Template.
This downloadable Excel template can help regions determine hazards’ impacts on a region and how prepared regions and/or hospitals are for the pediatric consequences of each hazard. The tool categorizes hazard impact along three dimensions, each with specific pediatric considerations, allowing users to produce an overall vulnerability and risk score for each hazard. This tool is not meant to be a thorough checklist of preparation, but instead spur the inclusion of general pediatric considerations into risk analysis, disaster planning, and emergency response. It is not intended to replace a hospital HVA with facility-specific processes.
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* Federal Emergency Management Agency. (2018). Comprehensive Preparedness Guide (CPG) 201: Threat and Hazard Identification and Risk Assessment (THIRA) and Stakeholder Preparedness Review (SPR) Guide. (Third Edition.)
This guide provides communities with a three-step process for conducting a Threat and Hazard Identification and Risk Assessment (THIRA). While it incorporates healthcare, this guide is community-based. It builds upon previous versions of the CPG and describes a standard process for identifying community-specific threats and hazards; setting capability targets for each core capability identified in the National Preparedness Goal; and estimating resources needed to meet the capability targets. This edition also includes the three-step process for a Stakeholder Preparedness Review (SPR) (formerly State Preparedness Report), as this process is interconnected with the THIRA process. Healthcare should be aware of the THIRA process and assure that their input is considered and that accurate numerics are used.
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Federal Emergency Management Agency. (2019). Hazard Mitigation Planning.
This web page includes links to several hazard mitigation planning resources directed towards state, tribal, and local officials.
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Federal Emergency Management Agency. (2021). National Risk and Capability Assessment.
This resource provides access to a suite of tools that support emergency preparedness at the community and national level. The Threat and Hazard Identification and Risk Assessment (THIRA) tool evaluates a stakeholders level of risk and helps them better understand how to manage and mitigate those risks; the Stakeholder Preparedness Review (SPR) tool assists jurisdictions with identifying capability gaps related the the THIRA; and the comprehensive preparedness guide provides additional information on mitigation planning and use of the suite of tools.
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Federal Emergency Management Agency. (2021). Resilience Analysis and Planning Tool (RAPT).
This tool provides the ability for state and local emergency medical planners to access and visualize population data within the U.S. Data layers include the ability to identify at-risk populations, infrastructure capacity data, and hazard zones including those related to nuclear power plants.
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Florida Department of Health. (2018). Florida Public Health Risk Assessment Tool.
This county-specific tool helps planners assess risk in their community by comparing their capabilities and resources against the fifteen Centers for Disease Control and Prevention Preparedness Capabilities, producing gap analyses, estimating the impacts of hazards to public health, healthcare, and mental health, and measuring the positive effect of mitigation factors such as community resilience.
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Iowa Department of Public Health and University of Iowa, College of Public Health, Upper Midwest Preparedness and Emergency Response Learning Center (UMPERLC). (2012). General Healthcare Risk Assessment Tool. (Free registration required.)
This healthcare-specific risk assessment tool is based on existing hazard and vulnerability assessment (HVA) tools, such as the Kaiser Permanente HVA tool, and the UCLA Center for Public Health and Disaster Hazard Risk Assessment Instrument. Access the public health risk assessment tool here: https://prepareiowa.training-source.org/training/courses/General%20LPHA%20Community%20Risk%20Assessment/detail.
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Kaiser Permanente (2017). Kaiser Permanente Hazard Vulnerability Analysis (HVA) Tool.
This tool provides a systematic approach to analyzing hazards that may affect demand for hospital services, or a facility’s ability to provide those services, helping to prioritize planning, mitigation, response, and recovery activities. This revised version of the commonly used tool incorporates data on actual activations experienced by the user, to more fully inform risk analysis.
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Los Angeles County Department of Public Health, Emergency Preparedness and Response Program (2013). Health Hazard Assessment and Prioritization (hHAP).
This tool was developed by the Los Angeles Department of Public Health—in collaboration with the Orange County Health Care Agency, the Long Beach Department of Health and Human Services, and the Pasadena Department of Public Health—and provides a 6-step hazard vulnerability assessment process. It offers a health-focused mechanism to engage the community, identify organizational priorities, and improve an agency’s or community’s capability to successfully prepare for, respond to, and recover from potential emergency threats. Both the hHAP Instrument and Manual are provided as downloads.
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Louisiana Department of Health. (2000). Hazard Vulnerability Analysis Tool.
This tool can help emergency planners calculate probability, risk, and preparedness levels for a variety of risks and hazards.
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National Centers for Environmental Information. (2024). Storm Events Database. National Oceanic and Atmospheric Administration.
This database contains information on storm data in the U.S. since January 1950. Patterns in storms can be used to evaluate risks for health care facilities and assist with scenarios for emergency planning.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2015). Hospital Resource Vulnerability Assessment (RVA) Implementation Guide.
This guidance document facilitates the use of the "Hospital Resource Vulnerability Assessment (RVA)." This guide should be reviewed prior to using the RVA. It includes strategies for completing the tool and lists benefits and recommendations for implementation. A list of frequently asked questions that may be helpful in introducing the tool to supervisors and administration/ committee members is also part of the guide.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2015). Hospital Resource Vulnerability Assessment (RVA).
Note: Before using this tool, access the "Resource Vulnerability Assessment (RVA) Implementation Guide." The Hospital Resource Vulnerability Assessment (RVA) is a voluntary tool designed to complement a Hazard Vulnerability Analysis and assist hospitals with identifying and prioritizing preparedness gaps, and creating a yearly analysis and prioritization cycle. The RVA examines the specific resources of the hospital including the plans, space, staff, and supply considerations. Persons using assistive technology may not be able to fully access information in this file. For assistance accessing this document, please contact an ASPR TRACIE Technical Assistance Specialist at 1-844-5-TRACIE (587-2243) or askasprtracie@hhs.gov, Monday through Friday, 9am – 5pm Eastern Time (excluding federal holidays).
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2019). ASPR Healthcare and Public Health Risk Identification and Site Criticality (RISC) Toolkit Webinar.
The RISC Toolkit (visit https://www.phe.gov/Preparedness/planning/RISC/Pages/default.aspx) was developed with the input of a team of healthcare partners and risk management subject matter experts and designed to help healthcare facility owners and operators identify infrastructure risks in an easy-to-follow format using objective, national-level data. In this webinar, speakers provided a brief overview of the RISC Tool and share how they have implemented the toolkit.
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U.S. Department of Health and Human Services’ Sustainable and Climate Resilient Health Care Facilities Initiative (SCRHCFI) (2016). Climate Resilient Health Care Facilities Toolkit.
This online toolkit can help healthcare facility planners learn more about implementing best practices in climate resilience. It is based on a framework composed of the following five elements: Climate Risks and Community Vulnerability Assessment; Land Use, Building Design, and Regulatory Context; Infrastructure Protection and Resilience Planning; Essential Clinical Care Service Delivery Planning; and Environmental Protection and Ecosystem Adaptations.
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U.S. Department of Homeland Security. (2016). Healthcare and Public Health Sector-Specific Plan.
This plan, updated in 2016, is designed to guide the Health and Public Health (HPH) Sector’s internal, collaborative, and cross-sector efforts "to enhance the security and resilience of HPH critical infrastructure to all-hazards across its physical, cyber, and human dimensions." Updates include refreshed goals and objectives and more emphasis on select priorities (e.g., information sharing and emergency response).
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Valley Health System. (2023). Valley Health System Hazard Vulnerability Assessment Tool. (Contact ASPR TRACIE for access to this document.)
This HVA template can be used by other healthcare facilities or systems to assess their level of preparedness for various scenarios including human-caused, natural, and technical hazards.
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Agencies and Organizations

Federal Emergency Management Agency. Hazard Identification and Risk Assessment.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response 5.4 Hazards Vulnerability Analysis.
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This ASPR TRACIE Topic Collection was refreshed and comprehensively updated in April 2019 by the following subject matter experts (listed in alphabetical order): Eric R. Alberts, CEM, FPEM, FPEM-HC, CHPP, CHEP, SEM, Corporate Manager, Emergency Preparedness, Orlando Health, Inc. (Hospital System); Scott Aronson, MS, Principal, RPA / Practice Leader – Healthcare RPA, a Jensen Hughes Company; Marc Barbiere, MPH, CEM, Program Manager, Health Emergency Preparedness and Response Administration (HEPRA), District of Columbia Department of Health (DC Health); John Hick, MD, HHS ASPR and Hennepin County (MN) Medical Center; Jeff Rubin, PhD, CEM, Tualatin Valley Fire & Rescue; and Mary Russell, EdD, MSN, Healthcare Emergency Response Coalition, Palm Beach County, FL.

 

It was was comprehensively reviewed in April 2015 by John Hick, MD, HHS ASPR and Hennepin County Medical Center. Additional assistance was provided by Alicia Livinski, Biomedical Librarian, HHS National Institutes of Health.

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