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Ambulatory Care and Federally Qualified Health Centers (FQHC)
Topic Collection
September 20, 2019

Topic Collection: Ambulatory Care and Federally Qualified Health Centers (FQHC)

During disasters or public health emergencies clinics, community health centers, mental/behavioral healthcare providers, federally-qualified health centers, private physician offices, ambulatory procedure centers, and other outpatient facilities play a critical part in the response by addressing the needs of patients with both acute and chronic conditions. Failures, damage, or compromise to ambulatory care operations can dramatically increase the stress on the emergency medical services and hospital systems and also result in exacerbations of chronic medical conditions that add additional healthcare burdens.

The resources in this Topic Collection can help emergency planners in these types of facilities plan for and respond to a variety of incidents. (Note: access the Homecare and Hospice Topic Collection for resources specific to those providers and patients.)

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. (2018). Medical Surge and the Role of Health Clinics.
Because of their extensive geographic coverage, strong community ties, and potential to reach medically underserved areas, health clinics play a key stakeholder role in emergency and disaster preparedness and response. ASPR TRACIE conducted this exploratory study to learn more about the scope and level of implementation of emergency management activities among health clinics, including activities that some clinics may have initiated in response to the CMS Final Rule. (Access the report summary: https://files.asprtracie.hhs.gov/documents/aspr-tracie-medical-surge-and-the-role-of-health-clinics-summary.pdf.)
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ASPR TRACIE. (2018). Medical Surge and the Role of Urgent Care Centers.
This report summarizes findings from interviews ASPR TRACIE conducted with urgent care physicians and center administrators in 44 states to collect their feedback on the role their facilities could play in the nation’s healthcare preparedness and response activities. (Access the summary here: https://files.asprtracie.hhs.gov/documents/aspr-tracie-medical-surge-and-the-role-of-urgent-care-centers-summary.pdf.)
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ASPR TRACIE. (2021). Rural Health Clinic / Federally Qualified Health Center Requirements: CMS Emergency Preparedness Final Rule (Updated).
This document combines excerpts from the Final Rule and the recently released Interpretive Guidelines from CMS to provide a consolidated overview document of requirements for Rural Health Clinics and Federal Qualified Health Centers.
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Koh, H.K., Shei, A.C., Bataringaya, J., et al. (2006). Building Community-Based Surge Capacity Through A Public Health And Academic Collaboration: The Role Of Community Health Centers. Public Health Reports. 121(2):211-6.
The authors describe a collaboration among community health centers (CHCs), government agencies, and academia in the Boston area to develop community-based surge capacity. They describe the project in detail, and discuss lessons learned about how CHCs can help provide a "flexible, linked network of 'reserve' health care capacity to supplement, support, and extend the efforts of acute care hospitals in their communities."
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Medisys Health Networks. (2006). Ambulatory Care Network Integration into Hospital Surge Event Response. Center for Infectious Disease Research and Policy.
This report describes a process for integrating ambulatory care centers into hospital surge capacity response plans. This included identifying ambulatory care center assets to inform the development of a set of roles they may fill to support hospital emergency response. Portions of the document could be replicated and adapted to help hospitals integrate ambulatory care centers into their surge planning.
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Porth, L. (2012). Lessons Learned from the Missouri Disasters of 2011- A Focus on Joplin. Missouri Hospital Association.
This report outlines the findings from numerous healthcare organizations following the Missouri disaster events of 2011.
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The Joint Commission. (2013). Trial by Fire: Lessons Learned from the Chevron Fire’s Unprecedented Patient Surge.
Staff from two hospitals in California share their experiences related to a sustained (mainly) outpatient medical surge of 15,000 patients over a two-week period associated with a petrochemical explosion. The authors emphasize the non-traditional nature of the surge response (outpatient versus inpatient) and highlight strategies to: enhance staffing from community partners; obtain and receive needed equipment for patient treatment; and address security concerns, and medical records challenges.
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U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2016). Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers.
This rule establishes consistent emergency preparedness requirements for health care providers participating in Medicare and Medicaid, increases patient safety during emergencies, and establishes a more coordinated response to natural and man-made disasters.
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Community Integration

Ablah, E., Konda, K.S., Konda, K., et al. (2010). Emergency Preparedness Training and Response among Community Health Centers and Local Health Departments: Results from a Multistate Survey. (Abstract only.) Journal of Community Health. 35(3): 285-293.
A national survey of local health departments and community health centers noted that general collaboration between them was occurring, however participation in "functional drills or exercises" was still needed. Opportunities exist for disaster planning, communication, and activities such as mass dispensing exercises which would support access to care for medically underserved and vulnerable populations.
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* ASPR TRACIE. (2018). Medical Surge and the Role of Health Clinics.
Because of their extensive geographic coverage, strong community ties, and potential to reach medically underserved areas, health clinics play a key stakeholder role in emergency and disaster preparedness and response. ASPR TRACIE conducted this exploratory study to learn more about the scope and level of implementation of emergency management activities among health clinics, including activities that some clinics may have initiated in response to the CMS Final Rule. (Access the report summary: https://files.asprtracie.hhs.gov/documents/aspr-tracie-medical-surge-and-the-role-of-health-clinics-summary.pdf.)
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ASPR TRACIE. (2018). Medical Surge and the Role of Urgent Care Centers.
This report summarizes findings from interviews ASPR TRACIE conducted with urgent care physicians and center administrators in 44 states to collect their feedback on the role their facilities could play in the nation’s healthcare preparedness and response activities. (Access the summary here: https://files.asprtracie.hhs.gov/documents/aspr-tracie-medical-surge-and-the-role-of-urgent-care-centers-summary.pdf.)
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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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Community Healthcare Association of New York State, Primary Care Emergency Preparedness Network. (2016). Community Integration Guide. New York City Department of Health and Mental Hygiene.
This document provides information on how primary care centers can build partnerships with community and healthcare sector partners to build resilient communities post-disasters.
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Harris, M.D. and Yeskey, K. (2011). Bioterrorism and the Vital Role of Family Physicians. American Family Physicians. 84(1):18-20.
In this editorial, the authors share ways that primary care providers can prepare themselves and their practices to respond to bioterrorism. The authors contend that these efforts should include getting to know local public health staff, coordination among local practices, urgent care centers, and hospital emergency departments to support surge capacity in the community; and getting involved in community, state, and national initiatives such as the Medical Reserve Corps or Disaster Medical Assistance Teams.
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Koh, H.K., Shei, A.C., Bataringaya, J., et al. (2006). Building Community-Based Surge Capacity Through A Public Health And Academic Collaboration: The Role Of Community Health Centers. Public Health Reports. 121(2):211-6.
The authors describe a collaboration among community health centers (CHCs), government agencies, and academia in the Boston area to develop community-based surge capacity. They describe the project in detail, and discuss lessons learned about how CHCs can help provide a "flexible, linked network of 'reserve' health care capacity to supplement, support, and extend the efforts of acute care hospitals in their communities."
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Peters, R., Hipper, J. and Chernak, E. (2018). Primary Care Medical Practices: Are Community Health Care Providers Ready for Disasters? Disaster Medicine and Public Health Preparedness, 1-5.
The authors discuss results from a study they conducted in 2014 “to determine the capacity of community primary care practices to meet the needs of patients during public health emergencies and to identify the barriers and resources necessary to participate in a coordinated response with public safety agencies.” They note that primary care preparedness efforts should focus on continuity of operations planning; improved coordination with government and community partners; and preparedness for patients with special health care needs to support community resilience.
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* The Joint Commission. (2013). Trial by Fire: Lessons Learned from the Chevron Fire’s Unprecedented Patient Surge.
Staff from two hospitals in California share their experiences related to a sustained (mainly) outpatient medical surge of 15,000 patients over a two-week period associated with a petrochemical explosion. The authors emphasize the non-traditional nature of the surge response (outpatient versus inpatient) and highlight strategies to: enhance staffing from community partners; obtain and receive needed equipment for patient treatment; and address security concerns, and medical records challenges.
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Van Otterloo, J., Seib, K., Ault, K.A., and Omer, S.B. (2016). Women’s Health Providers as Vaccine Providers in Public Health Emergencies. (Abstract only.) Journal of Reproductive Medicine. 59(7-8): 401-408.
A survey conducted of 152 women’s health practices in Washington and California noted that less than 20% participated in emergency preparedness activities. The majority of practices did ask about vaccination histories of their patients, however delivery of vaccines could be improved if barriers were addressed such as having a vaccine supply, billing issues and public interest was increased. It would provide surge capacity for a potential high-risk group.
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Education and Training

Grode, G., Wright, T., Lipovtsev, A., and Gonnella, K. (2018). Public Health Preparedness for Health Centers: Navigating the Preparedness Landscape. National Healthcare for the Homeless Council.
This presentation discusses: results from a training and technical assistance survey of health centers from 2016; how the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness (EP) Rule applies to health centers; and some information sources health centers may access to support preparedness and response planning for their facilities.
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National Nurse-Led Care Consortium. (n.d.). Emergency Preparedness. (Accessed 2/1/2019.)
This webpage includes links to fact sheets and a webinar series covering the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness (EP) Rule; the health center role in emergency response; and health center staff readiness to respond to outbreaks of infectious disease.
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Pirner, J., Lewis, K., Chambers, J., et al. (2012). Role of the Federally Qualified Health Centers in Community Disaster Response Planning-HCPHP Webinar Series: Session 15.. Saint Louis University, School of Public Health, Heartland Centers, Center for Public Health and Preparedness.
This hour-long archived webinar provides an overview of the components of emergency preparedness planning, the role of the federally qualified health center (FQHC) in emergency response, and examples of how FQHCs have utilized their response systems in past emergencies. In addition, the program includes a description of the Incident Command System (ICS), specific roles of staff members assigned to the ICS, and integration of the FQHC ICS into community emergency response plans.
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Primary Care Emergency Preparedness Network. (n.d.). Community Health Center Coastal Storm Exercise Plan. (Accessed 1/7/2020.) New York City Department of Health and Mental Hygiene.
This HSEEP-compliant full-scale/functional exercise planning tool can help planners develop a hurricane-specific operations-based exercise for community health centers. It may be referenced by other healthcare facilities for developing similar exercises.
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Guidance: Behavioral Health Facilities

U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Response. (2012). Planning for Psychiatric Patient Movement During Emergencies and Disasters.
This tip sheet highlights basic considerations that can help public health and medical planners prepare for the movement of patients of psychiatric facilities in the event of a disaster.
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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2016). Publications and Resources on Disaster Preparedness, Response, and Recovery.
The resources found on this webpage are geared towards disaster behavioral health professionals who work with survivors and responders.
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Guidance: Health Centers

* ASPR TRACIE. (2018). Medical Surge and the Role of Health Clinics.
Because of their extensive geographic coverage, strong community ties, and potential to reach medically underserved areas, health clinics play a key stakeholder role in emergency and disaster preparedness and response. ASPR TRACIE conducted this exploratory study to learn more about the scope and level of implementation of emergency management activities among health clinics, including activities that some clinics may have initiated in response to the CMS Final Rule. (Access the report summary: https://files.asprtracie.hhs.gov/documents/aspr-tracie-medical-surge-and-the-role-of-health-clinics-summary.pdf.)
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ASPR TRACIE. (2021). Rural Health Clinic / Federally Qualified Health Center Requirements: CMS Emergency Preparedness Final Rule (Updated).
This document combines excerpts from the Final Rule and the recently released Interpretive Guidelines from CMS to provide a consolidated overview document of requirements for Rural Health Clinics and Federal Qualified Health Centers.
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Association of State and Territorial Health Officials. (2007). Developing Partnerships with Community Health Centers for Emergency Preparedness Planning.
This guidance document outlines collaborative disaster planning practices between state health agencies and community health centers to enhance operations plans, training, and exercise development.
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Association of State and Territorial Health Officials. (2008). Collaborating with Community Health Centers for Preparedness.
This report outlines the work of the Task Force on Health Agency-Community Health Center Coordination in Preparedness, the roles and responsibilities of each task force partner in emergency responses, and provides recommendations for and examples of effective collaboration among the partners. There is a section on roles and responsibilities, and one on partnerships that defines the essential elements of successful collaboration.
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Community Healthcare Association of New York State, Primary Care Emergency Preparedness Network. (2017). Business Continuity Planning Workshop Participant Materials.
This resource includes business continuity planning tools and templates for use by health centers and other providers. (Note: Contact CHCANYS at emteam@chcanys.org for the most current Word versions of this template.)
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Katz, R., Goldstein, M., and Hayashi, A.S. (2016). Ensuring the Use of Federal Assets in Public Health Emergencies: The Role of the Federal Tort Claims Act in Enabling the Responsiveness of Federally Funded Community Health Centers. Public Health Reports. 123(1): 89–92.
The authors examine the role of the Federal Tort Claims Act (FTCA), which provides legal liability coverage for federal government employees, in aiding the emergency deployment of first-responder health-care workers employed by federally qualified health centers. An overview of the FTCA, as well as a discussion of a federal ruling's public health policy and practice implications for communities nationwide, are included.
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National Association of Community Health Centers. (n.d.). Developing and Implementing an Emergency Management Plan for Your Health Center. (Accessed 10/16/2019.)
This webpage bulletin describes why health centers need to develop emergency operations plans, and also provides guidance on the planning process and plan content and links to related resources.
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U.S. Department of Health and Human Services, Health Resources & Services Administration. (2007). Health Center Emergency Management Program Expectations (Program Information Notice (PIN) 2007-15).
While slightly dated, this document provides an overview of the role of health centers in emergency preparedness. It explains the purpose of an emergency management plan and key components, and emphasizes the importance of collaboration, communication, information sharing, and financial and operational stability.
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U.S. Department of Health and Human Services, Health Resources & Services Administration. (2020). Requesting a Change in Scope to Add Temporary Service Sites in Response to Emergency Events.
This Program Assistance Letter provides an update to the process for requesting a change in scope to the federal scope of project to add temporary locations in response to emergency events.
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Guidance: Other Facilities and Providers

* AmeriCares. (2015). Disaster Preparedness Planning Guide for Free and Charitable Clinics.
The guide provides clinic administrators with instructions on steps they can take in advance to ensure their clinics respond effectively and recover despite power outages, facility damage, and other obstacles. Note: The first link on the website is the actual planning guide; however links are also provided to a guide checklist, and the guide playbook template.
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ASPR TRACIE. (2021). Ambulatory Surgical Center Requirements: CMS Emergency Preparedness Final Rule (Updated).
This document combines excerpts from the Final Rule and the recently released Interpretive Guidelines from CMS to provide a consolidated overview document of requirements Ambulatory Surgical Centers.
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ASPR TRACIE. (2021). Community Mental Health Center Requirements: CMS Emergency Preparedness Final Rule (Updated).
This document combines excerpts from the Final Rule and the recently released Interpretive Guidelines from CMS to provide a consolidated overview document of requirements for Community Mental Health Centers.
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ASPR TRACIE. (2021). Programs of All-Inclusive Care for the Elderly Requirements: CMS Emergency Preparedness Final Rule (Updated).
This document combines excerpts from the Final Rule and the recently released Interpretive Guidelines from CMS to provide a consolidated overview document of requirements for Programs of All-Inclusive Care for the Elderly.
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Chernak, E., Hipper, T., Kriun, H. et al. (2013). Integrating Community Pediatricians into Public Health Preparedness and Response Activities in Pennsylvania. Pennsylvania Department of Health.
This document provides a plan for building a sustainable network of pediatric medical providers in ambulatory settings who can deliver healthcare to children throughout all phases of the emergency management cycle in partnership with public health and other stakeholders. It is co-published with the Pennsylvania Chapter, American Academy of Pediatrics, and the Center for Public Health Readiness and Communication, Drexel University School of Public Health.
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Emergency Medical Services Agency- Los Angeles County. (2013). Ambulatory Surgical Center Guide to Disaster Preparedness and Response.
This plan outlines specific strategies to assist various types of healthcare providers plan for and provide a coordinated disaster response. While specific to Los Angeles County, some portions of the document are more widely applicable.
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Freedy, J., and Simpson, W. (2007). Disaster-Related Physical and Mental Health: A Role for the Family Physician. American Family Physician. 75(6): 841-846.
The authors encourage family physicians to educate themselves about disaster-related physical and mental health threats, and list common health outcomes under both domains. They emphasize the need for primary care providers to be able to anticipate increased resource use and screen for mental health impacts in their affected patients for a long time after the initial event.
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Joint Commission. (2017). Standards Revisions for Emergency Management Final Rule in Ambulatory Health Care.
This resource provides revised standards for compliance with the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness (EP) Rule, specific to ambulatory health care. (Note: the information contained in this document has been incorporated into the Rule.)
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Keyes, B. and Crouch, J. (2018). Emergency Management for Ambulatory Surgical Centers Chapter 15 2018 Edition.
These webinar slides discuss requirements for emergency management, as identified in the 2018 edition of the Ambulatory Surgical Center Chapter 15 of the HFAP manual.
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Rebmann, T., Hilley, S., McCaulley, M., et al. (2013). Infection Prevention for Ambulatory Care Centers During Disasters. Association for Professionals in Infection Control and Epidemiology.
This document was designed to be used by ambulatory care center emergency management planners and includes infection prevention recommendations/guidance on topics such as: triage area, visitor management, quarantine, hand hygiene, personal protective equipment, waste management, and environmental decontamination.
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Texas Health and Human Services. (n.d.). Minimum TAC Requirements for Written. (Accessed 2/1/2019.)
This document includes Texas-specific minimum requirements for written disaster plans for the following facilities: nursing homes; adult day care facilities; homecare agencies; and hospice providers. It also includes emergency plan components and can be tailored by other states.
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U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2016). Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers.
This rule establishes consistent emergency preparedness requirements for health care providers participating in Medicare and Medicaid, increases patient safety during emergencies, and establishes a more coordinated response to natural and man-made disasters.
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Wu, H., Fairley, J., Steinberg, J., and Kozarsky, P. (2014). The Potential Ebola-Infected Patient in the Ambulatory Care Setting: Preparing for the Worst Without Compromising Care. Annals of Internal Medicine. 162(1):66-67.
The authors discuss implications of people with undiagnosed Ebola reporting to healthcare facilities. They worked with key stakeholders to develop a list of considerations for patient management, which is displayed in Table 1.
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Guidance: Programs of All-Inclusive Care for the Elderly (PACE)

Centers for Medicare & Medicaid Services. (2013). Emergency Preparedness Regulations for Programs of All-Inclusive Care for the Elderly (PACE) (460.84).
The proposed rule explains Programs of All-Inclusive Care for the Elderly (PACE) and PACE-specific emergency preparedness information.
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Texas Department of Aging and Disability Services. (2012). Emergency Preparedness.
This document includes Texas-specific minimum requirements for written disaster plans for the following facilities: nursing homes, adult day care facilities, homecare agencies, and hospice providers. It also includes emergency plan components and can be tailored by other states.
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Lessons Learned

Ali, M. and Williams, M. (2019). Correction to No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015-2016. Journal of Community Health. 44(2): 387–394.
Three rounds of mystery patient drills simulating either influenza-like illness measles were conducted at 41 community health centers in New York City from April 2015 through December 2016. Through qualitative analysis, several strengths (e.g., established protocols, effective communication) and challenges (e.g., hand hygiene, explaining isolation rationale) were identified. The authors note that these types of drills can serve as helpful emergency preparedness tools for community health centers and provide examples of key evaluation components.
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Fowkes, V., Blossom, J., Sandrock, C., et al. (2010). Exercises in Emergency Preparedness for Health Professionals in Community Clinics. Journal of Community Health. 35(5):512-518.
The authors discuss the progress made by 90 community practice sites across California following their completion of multidisciplinary tabletop exercises. The discussion reviews planning and scheduling challenges, and strategies that helped overcome them.
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Journal of Urgent Care Medicine. (2019). Disaster Strikes-What’s The Plan for Your Urgent Care Center?
This article summarizes lessons learned from leaders of urgent care organizations located throughout the U.S. that have experienced natural disasters or other emergencies. Recovery considerations related to staffing, staff support, and medical and non-medical supplies, are discussed.
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Maduro, R. (2017). Community Health Network in Houston Leverages Open Source Tech to Help Victims of Hurricane Harvey. Open Health News..
This blog post discusses how a Federally Qualified Health Center (FQHC) in Texas leveraged open source technology for their electronic medical records system to reach patients who would otherwise have been inaccessible following Hurricane Harvey.
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McDade, C. (2014). Sunrise Community Health: Flood 2013.
The speaker shared the clinics' planning and response steps carried out during flooding in 2013 that affected areas in Colorado. Lessons learned included the need for a stronger relationship with healthcare coalitions, having a back-up provider on call, and the need for more training (e.g., on the incident command system).
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Millin, M.G., Jenkins, J.L., and Kirsch, T. (2006). A Comparative Analysis of Two External Health Care Disaster Responses Following Hurricane Katrina. (Abstract only.) Prehospital Emergency Care. 10(4): 451-456.
The authors analyzed data from two disaster temporary healthcare clinic sites (one in Louisiana, staffed by out-of-state volunteers and the other in Mississippi, with a federal Disaster Medical Assistance Team) to better understand the needs and medical conditions of the 500 patients seen over two days of operation. The majority of visits were for chronic diseases, primary health care, vaccinations, and to obtain medications that patients did not have with them. The authors noted the need for improvements in primary care disaster planning, including for pediatric patients, for social services, and for pharmaceuticals to treat acute and chronic conditions.
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Paek, H., Niess, M., Padilla, B., and Olson, D. (2018). A Community Health Center Blueprint for Responding to the Needs of the Displaced after a Natural Disaster: The Hurricane Maria Experience. (First page only.) Journal of Health Care for the Poor and Underserved. 29(2): doi:10.1353/hpu.2018.0040.
The authors discuss the experience of a health center in Connecticut caring for a large influx of patients from Puerto Rico after Hurricane Maria, including how staffing plans and patient flow were implemented.
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Porth, L. (2012). Lessons Learned from the Missouri Disasters of 2011- A Focus on Joplin. Missouri Hospital Association.
This report outlines the findings from numerous healthcare organizations following the Missouri disaster events of 2011.
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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).
The authors explain how the use of electronic medical records (EMR) helped the healthcare community maintain operations after the Joplin tornado and emphasize the importance of incorporating EMR and information technology into emergency operations plans.
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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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* The Joint Commission. (2013). Trial by Fire: Lessons Learned from the Chevron Fire’s Unprecedented Patient Surge.
Staff from two hospitals in California share their experiences related to a sustained (mainly) outpatient medical surge of 15,000 patients over a two-week period associated with a petrochemical explosion. The authors emphasize the non-traditional nature of the surge response (outpatient versus inpatient) and highlight strategies to: enhance staffing from community partners; obtain and receive needed equipment for patient treatment; and address security concerns, and medical records challenges.
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Lessons Learned: Behavioral Health Facilities

Ford, E. (2013). Evacuation of Psychiatric Inpatients from Bellevue Hospital Post Hurricane Sandy. (Note: only available via iTunes.) Psychiatric Times.
In this podcast Dr. Elizabeth Ford discusses her experience during the evacuation of psychiatric patients from Bellevue Hospital in Manhattan in the immediate aftermath of Hurricane Sandy. Sixty-one incarcerated psychiatric patients had to be evacuated from the 19th floor due to flooding and loss of electricity.
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Haggerty, E. (2013). When Bellevue Had to Evacuate Its Criminally Insane. Bedford+Bowery.
This article describes Bellevue Hospital’s experience during the evacuation of psychiatric patients after Hurricane Sandy. Sixty-one incarcerated psychiatric patients had to be evacuated from the 19th floor and transported to other facilities. During this evacuation patients were cooperative, which helped with the success of the evacuation.
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Massachusetts League of Community Health Centers. (2012). Health Needs Continue Two Years After Haiti Quake.
Health centers in Massachusetts ("home to the third largest Haitian population in the country") were asked to provide support (including behavioral health care) to the community after the 2010 earthquake.
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Plans, Tools, and Templates

National Nurse-Led Care Consortium. (2019). Health Center Emergency Management Plan Template. (Free registration is necessary to download the Word version of this template.)
Health center staff can use this template to create and customize their own emergency operations plans, compliant with the Centers for Medicare & Medicaid Services Emergency Preparedness Rule. After completion of the free registration, the web page provides access to two comprehensive templates: (1) Health Center Emergency Management Plan and (2) NNCC Communications Plan.
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National Nurse-Led Consortium. (2019). Health Center Communications Plan Template. (Free registration necessary to download Word version of template.)
Health center staff can use this template to create and customize their own emergency communications plans, compliant with the Centers for Medicare & Medicaid Services Emergency Preparedness Rule.
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Northwest Health Services Coalition. (2019). Exercise/Drill Materials.
This web page includes links to a variety of templates (e.g., after action reports, drills/tabletop examples, scenarios, and evaluation guides) healthcare facilities can tailor to suit their needs.
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Plans, Tools, and Templates: Behavioral Health Facilities

Mississippi State Department of Health. (2018). Community Mental Health Center Emergency Operations Plan Template.
This template may be used to develop an Emergency Operations Plan for a Community Mental Health Center. In addition to the all hazards base plan, the template includes incident-specific annexes.
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Substance Abuse and Mental Health Services Administration. (2013). Disaster Planning Handbook for Behavioral Health Treatment Programs: Technical Assistance Publication (TAP) Series 34. U.S. Department of Health and Human Services.
The information in this handbook can help behavioral health treatment program staff plan (or enhance existing plans) for all types of disasters. The guide includes informative chapters and templates that can be customized or used as is by program staff.
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* Wisconsin Department of Health Services. (2018). CMS Emergency Preparedness Rule Toolkits.
This webpage includes links to toolkits and other resources designed to help certain types of healthcare facilities better understand the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Rule. There is both a PDF (toolkit) and Word version (workbook) for each facility type, and the relevant CMS rules for each facility type are included. Each toolkit includes sample templates and planning worksheets that can help facilities develop compliant plans, policies, and procedures.
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Plans, Tools, and Templates: Health Centers

California EMS Authority and California Primary Care Association. (2004). Community Clinic and Health Center Emergency Operations Plan. California Clinic Emergency Preparedness Project.
Healthcare emergency planners can use this slightly dated but comprehensive and detailed template to develop or maintain an existing emergency management program. The template includes the language, procedures, policies, and forms needed to create a clinic plan.
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  • Audrey Mazurek Thank you Rachel for letting us know about this broken link. It has now been fixed. Looking forward to your rating and comments about this and our other resources.
    10/2/2015 12:49:05 PM
  • Rachel Heckscher Link is broken
    9/1/2015 2:31:38 PM
* 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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Centers for Medicare & Medicaid Services. (2015). Effective Health Care Provider Emergency Planning.
This toolkit provides a variety of information and numerous links to resources that can assist healthcare centers in the emergency planning process. Guidance on the Centers for Medicare & Medicaid Survey and Certification Process is also provided (note: new regulations released in 2016).
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Community Health Care Association of New York State. (2016). Mystery Patient Drill Toolkit.
This toolkit is intended for use by community health centers, and tests how long it takes for a potential patient with a highly infectious disease to be identified and for staff to begin exposure mitigation procedures; how long it takes for a patient to be transferred to an isolation room; and the capability of the facility to make notifications internally and to the health department.
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Community Healthcare Association of New York State, Primary Care Emergency Preparedness Network. (n.d.). Development Planning and Compliance Checklist for FQHCs. (Accessed 11/12/2018.) New York City Department of Health and Mental Hygiene.
This checklist may be used as a guide to determine whether your health center's emergency management program contains all the required elements within the Centers for Medicare & Medicaid (CMS) Emergency Preparedness (EP) final rule.
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Community Healthcare Association of New York State, Primary Care Emergency Preparedness Network. (2015). Infectious Disease Outbreak Plan.
The purpose of this plan template is to outline the essential steps primary care facilities should take for infected patients and provide continuity of services to non-infected patients. It is intended to provide a broad view of infectious disease outbreak planning with the understanding that disease-specific information and guidance will provide more detail during the actual response.
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Community Healthcare Association of New York State, Primary Care Emergency Preparedness Network. (2018). Primary Care Emergency Preparedness Network Coastal Storm Plan. New York City Department of Health and Mental Hygiene.
This plan template outlines the steps primary care facilities should take to minimize disruption in providing care to patients during major coastal storms.
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Health Outreach Partners and Migrant Health Promotion. (2015). Including Outreach Workers and Community Health Workers in Health Center Emergency Preparedness and Management.
This tip sheet focuses on how outreach workers can support basic emergency management expectations for health centers, including emergency management planning, linkages and collaborations, and communication and information sharing.
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Mississippi State Department of Health. (2017). Rural Health Clinic/Federal Qualified Health Center Emergency Operations Plan Template.
This template may be used to develop an Emergency Operations Plan for a Rural Health Clinic/Federally Qualified Health Center. In addition to the all hazards base plan, the template includes incident-specific annexes.
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National Healthcare for the Homeless Council. (n.d.). Community Health Center Emergency Planning Guidelines. (Accessed 11/5/2018.)
Emergency management staff can use this template (available in Microsoft Word) to develop community health center plans.
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Ohio Association of Community Health Centers. (2012). Emergency Operations Plan: Federally Qualified Health Center Template.
This template can be used by Federally Qualified Health Centers when developing their emergency operations plans.
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Primary Care Development Corporation. (2017). Emergency Management and Community Resilience: A Capacity-Building Toolkit for Health Centers.
This toolkit was created to help increase emergency management capacity among health center staff. It can also be used to help guide staff in their planning and emergency management endeavors.
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Santa Barbara County Public Health Department. (2018). 2018 Extended Power Outage Exercise.
This webpage includes links to Santa Barbara County’s exercise materials, including objectives and exercise forms, for the annual statewide full-scale exercise held in California. The scenario for the 2018 exercise was an extended power outage with evacuations.
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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. Department of Health and Human Services, Health Resources & Services Administration. (2016). Form 10: Emergency Preparedness Report.
This form, which is also part of the Health Resources & Services Administration’s Health Center Program Site Visit Guide, can be used by health centers when preparing their annual emergency preparedness and management reports. The form can also serve as a short checklist of emergency preparedness activities a health center should undertake.
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* Wisconsin Department of Health Services. (2018). CMS Emergency Preparedness Rule Toolkits.
This webpage includes links to toolkits and other resources designed to help certain types of healthcare facilities better understand the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Rule. There is both a PDF (toolkit) and Word version (workbook) for each facility type, and the relevant CMS rules for each facility type are included. Each toolkit includes sample templates and planning worksheets that can help facilities develop compliant plans, policies, and procedures.
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Plans, Tools, and Templates: Other Facilities

* AmeriCares. (2015). Disaster Preparedness Planning Guide for Free and Charitable Clinics.
The guide provides clinic administrators with instructions on steps they can take in advance to ensure their clinics respond effectively and recover despite power outages, facility damage, and other obstacles. Note: The first link on the website is the actual planning guide; however links are also provided to a guide checklist, and the guide playbook template.
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ASPR TRACIE. (2018). Medical Surge and the Role of Urgent Care Centers (Questions and Answers for Urgent Care Centers and Stakeholders).
This tip sheet provides considerations that may assist urgent care centers, health care coalitions, and other partners to engage with and support each other's emergency preparedness activities. It is a supplement to the ASPR TRACIE Medical Surge and the Role of Urgent Care Centers Report, where a key finding was that urgent care centers are willing to participate in emergency preparedness and response efforts but have not been engaged in such efforts and lack knowledge of how to get involved.
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Centers for Disease Control and Prevention. (n.d.). Abbreviated Pandemic Influenza Plan Template for Primary Care Provider Offices: Guidance from Stakeholders. (Accessed 10/3/2019.) U.S. Department of Health and Human Services.
The planning tool, based on discussion during an August 2009 CDC-sponsored stakeholder meeting, identifies considerations in a wide range of subject areas that primary care office staff should keep in mind when developing their office pandemic plans.
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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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Centers for Disease Control and Prevention. (2012). Medical Office Preparedness Planner: A Tool for Primary Care Provider Offices. U.S. Department of Health and Human Services.
This document was created to help primary care providers develop pandemic influenza response plans. It includes a monthly planning calendar, as well as a detailed plan template for practices to fill in.
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Centers for Disease Control and Prevention. (2018). Planning Resources by Setting: Pediatric Offices and Hospitals.
The resources on this webpage can help physician and pediatric offices plan for patient surge and other issues related to an influenza pandemic.
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Centers for Disease Control and Prevention. (2018). Planning Resources by Setting: Physicians’ Offices.
The resources on this webpage can be used by staff responsible for emergency planning in private physicians’ offices.
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Drexel University Dornsife School of Public Health. (n.d.). Primary Care Medical Practices and Public Health Emergency Preparedness. (Accessed 11/5/2018.)
This web page links to emergency preparedness resources for primary care practices, such as an "Emergency Preparedness Checklist for Practices" and an "Emergency Plan Guidance and Template for Practices."
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Kentucky Medical Association. (n.d.). Model Disaster Plan for a Physician Practice. (Accessed 11/5/2018.)
This model disaster plan can be tailored by physicians and their staff in the event of a critical incident that affects the practice's operations.
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McNeal, M., Daniels, E., Akintobi, T.H., et al. (n.d.). Emergency Preparedness Toolkit for Primary Care Providers. (Accessed 7/11/2019.) Morehouse School of Medicine.
This planning guide is meant for medical practices and can help emergency planners enhance practice readiness, planning, and response for emergencies and disasters, which will assist communities in the aftermath of an event. The toolkit includes fact sheets, templates, trainings, and other resources and links to references.
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Medisys Health Networks. (2006). Ambulatory Care Network Integration into Hospital Surge Event Response. Center for Infectious Disease Research and Policy.
This report describes a process for integrating ambulatory care centers into hospital surge capacity response plans. This included identifying ambulatory care center assets to inform the development of a set of roles they may fill to support hospital emergency response. Portions of the document could be replicated and adapted to help hospitals integrate ambulatory care centers into their surge planning.
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Minnesota Department of Health. (2016). Infection Prevention and Control for Outpatient (Ambulatory) Care Clinics.
This toolkit can help clinic staff plan for and respond to an influenza pandemic. It includes templates, checklists, and fact sheets that can be tailored by the user.
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Mississippi State Department of Health. (2017). Ambulatory Surgical Center Emergency Operations Plan Template.
This template may be used to develop an Emergency Operations Plan for an Ambulatory Surgical Center. In addition to the all hazards base plan, the template includes incident-specific annexes.
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Moses, S. (2013). Family Practice Office Emergency Supplies. Family Practice Notebook
This resource includes emergency supply checklists for family practice offices/ primary care clinics. It identifies airway and cardiovascular-specific equipment, along with assessment tools (e.g., blood pressure cuffs), universal precaution supplies (e.g., gloves and face masks), medications, and other items.
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Rothkopf, L. and Wirshup, M.B. (2013). A Practical Guide to Emergency Preparedness for Office-Based Family Physicians. Family Practice Management. 20(2):13-18.
The authors of this article discuss an emergency preparedness program that was developed for their practice; however, this program can be adapted for use in other physician offices. It also includes an emergency supplies checklist for family medicine offices.
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* Wisconsin Department of Health Services. (2018). CMS Emergency Preparedness Rule Toolkits.
This webpage includes links to toolkits and other resources designed to help certain types of healthcare facilities better understand the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Rule. There is both a PDF (toolkit) and Word version (workbook) for each facility type, and the relevant CMS rules for each facility type are included. Each toolkit includes sample templates and planning worksheets that can help facilities develop compliant plans, policies, and procedures.
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Plans, Tools, and Templates: Rural Facilities

* Wisconsin Department of Health Services. (2018). CMS Emergency Preparedness Rule Toolkits.
This webpage includes links to toolkits and other resources designed to help certain types of healthcare facilities better understand the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Rule. There is both a PDF (toolkit) and Word version (workbook) for each facility type, and the relevant CMS rules for each facility type are included. Each toolkit includes sample templates and planning worksheets that can help facilities develop compliant plans, policies, and procedures.
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Agencies and Organizations

Centers for Medicare & Medicaid Services. Emergency Preparedness Rule.
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Health Resources and Services Administration. Health Center Volunteer Health Professionals (VHP).
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National Association of Community Health Centers. Emergency Management/Continuity of Operations.
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This ASPR TRACIE Topic Collection was refreshed and comprehensively reviewed in January 2019 by the following subject matter experts (listed alphabetically):

John Hick, MD, HHS ASPR and Hennepin County Medical Center; Alexander Lipovtsev, LCSW, Director, Emergency Management, Community Health Care Association of New York State; Jason Patnosh, AVP, Partnership and Resource Development, National Association of Community Health Centers; DJ Phalen, MA, BSPH, CHPP, EMT, CHSO, TLO, Director of Emergency Management, Security, and Facilities at Health Center Partners of Southern California and Healthcare and Public Health National Sector Chief at InfraGard National Members Alliance (INMA); and Mary Russell, EdD, MSN, Healthcare Emergency Response Coalition, Palm Beach County, Florida.

It was comprehensively reviewed in September 2016 by the following subject matter experts (listed alphabetically): Dahna Batts, MD, Centers for Disease Control and Prevention; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Sherline Lee, MPH, Centers for Disease Control and Prevention; Christopher Riccardi, CHSP, CHEP, Emergency Preparedness Program Manager, Providence Health and Services; Mary Russell, EdD, MSN, Emergency Services, Boca Raton Regional Hospital; Helga Scharf-Bell, DNP, CRNP, MSN, RN, Special Events and IRCT Support, HHS/ ASPR/ OEM; Staff from the Health Resources and Services Administration; and Tina T. Wright, Massachusetts League of Community Health Centers.

 

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