Ambulatory Care and Federally Qualified Health Centers (FQHC)
Topic Collection
August 7, 2024
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.
Must Reads
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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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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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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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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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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This report outlines the findings from numerous healthcare organizations following the Missouri disaster events of 2011.
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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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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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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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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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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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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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This chapter of the Health Center Program Compliance Manual outlines the requirements for community health care providers specific to creating and maintaining partnerships with other health facilities in their catchment areas. Doing so can help reduce non-urgent use of hospital emergency departments and improve patient care. The chapter also provides information on how health centers can demonstrate compliance with these requirements (e.g., document select efforts, obtain documentation that illustrates coordination).
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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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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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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
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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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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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
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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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
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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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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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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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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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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This research, though based on slightly older data, illustrates to what extent community health care organizations are collaborating with other types of health care providers. The authors found that while sharing information between behavioral health care providers and medical providers was common, joint case conferences were less so, partly due to health centers not using electronic health records and/or having fewer behavioral health workers. The authors advocate for financial incentives and technical assistance to boost support of integrated care.
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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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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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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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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
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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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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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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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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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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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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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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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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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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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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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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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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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)
The proposed rule explains Programs of All-Inclusive Care for the Elderly (PACE) and PACE-specific emergency preparedness information.
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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
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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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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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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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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This organization presents several case studies in how Federally Qualified Health Centers (FQHCs) have worked with refugees, immigrants, and migrants in the past to promote care for these populations. Examples include community-based organizations matching cultural navigators with patients in Colorado and FQHC partnerships in Washington state, New York, and California.
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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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This report outlines the findings from numerous healthcare organizations following the Missouri disaster events of 2011.
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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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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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Lessons Learned: Behavioral Health Facilities
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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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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Plans, Tools, and Templates
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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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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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
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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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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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
This toolkit can help local health departments and community health centers collaborate to better reach and provide preventive care and medical treatment to underserved populations. It includes three “tools:” a worksheet to assess potential partnerships, an action plan for activities that enhance partnerships, and a tool that can help partners identify strategies to address challenges identified during these processes.
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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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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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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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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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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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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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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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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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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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This template can be used by Federally Qualified Health Centers when developing their emergency operations plans.
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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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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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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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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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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
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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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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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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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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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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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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The resources on this webpage can be used by staff responsible for emergency planning in private physicians’ offices.
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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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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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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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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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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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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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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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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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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
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
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