Topic Collection Cover Page

Rural Disaster Health
Topic Collection
January 28, 2026

Topic Collection: Rural Disaster Health

Rural areas are served by a variety of healthcare facilities and practitioners who face specific challenges associated with workforce and other resource shortages, shrinking rural healthcare services, socioeconomic factors that add to resident health risks, and public health issues that often compete with the ability to plan for and respond to natural and human-caused events. Tribal communities (some of which are located in rural areas) have the autonomy to respond to and manage incidents that occur on their lands. These resources include information for and lessons learned by healthcare practitioners who serve rural and tribal communities.  Furthermore, in 2022, in response to rural hospital closures and provide rural communities continued access to healthcare, the Centers for Medicare & Medicaid Services published a final rule establishing initial policies for Rural Emergency Hospitals (REHs) as a new Medicare provider type.  

Planners may also wish to access several other related ASPR TRACIE Topic Collections for more information. The Populations with Access and Functional Needs Topic Collection helps ensure that planning before an incident occurs is inclusive of the whole community. Ambulatory Care and Federally Qualified Health Centers highlights the roles that clinics, community health centers, mental/behavioral healthcare providers, federally-qualified health centers, private physician offices, and other outpatient facilities play in disaster response by addressing the needs of patients with both acute and chronic conditions. The Alternate Care Sites Collection highlights recent case studies, lessons learned, tools, and promising practices for developing and activating these sites. And the Virtual Medical Care Topic Collection sheds light on the recent increase in the use of virtual medical care/platforms (e.g., call centers and web- or telephone-based triage and treatment systems) to coordinate care and provide remote access to specialty care and assessment (e.g., trauma, stroke, and psychiatric) which can be leveraged during disasters to broaden access to specialty consultation (e.g., for burn injuries or pediatric patients). Access all comprehensively developed Topic Collections for general emergency operations planning and information specific to facility type and hazard.

This Collection was refreshed in January 2026. 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


This document: outlines current request processes for federally recognized tribes and Urban Indian Organizations (UIOs) to access Strategic National Stockpile (SNS) and other federal public health response supplies under a variety of legal instruments and emergency response authorities; describes the factors driving both the request processes themselves and medical countermeasure deployment methods used by SNS; and recommends strategies for accessing supplies that can support native communities, prevent supply shortages, and reduce health disparities.
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Administration for Strategic Preparedness and Response. (2025). Strategic National Stockpile (SNS) SharePoint. (Free registration required.) U.S. Department of Health and Human Services.
The SNS SharePoint offers technical assistance and resources to tribal nations and Urban Indian Organizations (UIOs) to ensure systems for requesting, receiving, and distributing stockpiled medicines and supplies are functioning well before they are needed in an actual emergency.
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Institute of Medicine of the National Academies. (2017). Improving Rural Mass Casualty Response in the United States. Chapter 7 of Preparedness and Response to a Rural Mass Casualty Incident: Workshop Summary.
These workshop proceedings discuss several aspects of rural mass casualty planning and response: rural health grants; Medicare reimbursements; funding sources and transportation improvements; the lack of consistent funding sources; and the role of government (including leadership, workforce, and education that can help responders train and prepare for mass casualty incidents in rural locations).
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Meit, M., Briggs, T., and Kennedy, A. (2008). Urban to Rural Evacuation: Planning for Rural Population Surge. NORC Walsh Center for Rural Health Analysis.
The authors conducted a literature review and a quantitative analysis of survey data to assess the likelihood of urban evacuation to rural areas and to provide recommendations for rural planning and response. The last section of the report contains a set of policy and planning recommendations.
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Rural Domestic Preparedness Consortium. (2025). Rural Emergency Preparedness and Response Training.
This website provides resources and links to numerous online training courses for rural first responders and healthcare workers. The site also includes a "responder toolbox" which includes links to additional resources.
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Rural Health Information Hub. (2025). Rural Emergency Preparedness and Response.
This topic guide includes links to resources, including the Rural Emergency Preparedness and Response Toolkit, and provides answers to frequently asked questions specific to rural health preparedness and response.
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Rural Health Information Hub. (2025). Rural Emergency Preparedness and Response Toolkit.
This evidence-based toolkit was developed in collaboration with the NORC Walsh Center for Rural Health Analysis. It provides practical guidance for planning for, responding to, and recovering from disasters and emergencies in rural communities. It also includes guidance and resources for different types of emergencies and considerations for special populations.
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Critical Access Hospitals and Rural Emergency Hospitals


This document combines excerpts from the Final Rule and the recently released Interpretive Guidelines from CMS to provide a consolidated overview of emergency preparedness requirements for Critical Access Hospitals.
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This document combines excerpts from the Final Rule and existing Interpretive Guidelines from CMS to provide a consolidated overview document of requirements for Rural Emergency Hospitals.
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Backer, H. Smiley, D., and Schoenthal, L. (2014). Implementing HICS Off Hours and at Small/ Rural Hospitals. Chapter 9 of the Hospital Incident Command System Guidebook.
In this chapter, the authors share how Hospital Incident Command System (HICS) positions can be staffed by smaller/rural hospitals and during non-peak hours. They include steps for combining HICS positions and include a sample form that can be used to track activity throughout the response and recovery phases.
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Centers for Medicare & Medicaid Services. (2025). Rural Emergency Hospitals.
In 2022, CMS published a final rule establishing Rural Emergency Hospitals as a new Medicare provider type to facilitate access to needed services for those living in rural communities. This webpage describes services provided, eligible facilities, steps facilities can follow to enroll, and how to receive technical assistance.
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Colorado Department of Public Health & Environment. (2017). Emergency Preparedness Guidance for Critical Access Hospitals (CAHs).
This state-specific guidance highlights how Critical Access Hospitals can interpret and comply with the four components of the CMS Emergency Preparedness Rule.
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Rural Health Information Hub. (2025). Critical Access Hospitals.
This webpage provides links to frequently asked questions and resources specific to critical access hospitals. The information covers many key questions regarding these types of facilities; related emergency preparedness information can also be found on the website.
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University of North Carolina. (2025). Rural Emergency Hospitals.
This webpage includes a map that depicts the number of hospitals that have converted to Rural Emergency Hospitals since January 2023. It also includes links to related resources.
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Education and Training


Federal Emergency Management Agency. (n.d.). Identifying Community Preparedness Resources for Tribal Nations. (Accessed 11/20/2025.)
This virtual course is geared towards Tribal leaders and emergency managers and provides an overview of federal resources available to Tribal Nations, including tools, programs, and additional support mechanisms designed to enhance emergency preparedness and response.
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This webinar provides a demonstration of the free, online CONVERGE Indigenous Sovereignty in Disasters Training Module, which is comprised of four lessons: 1) Settler Colonial Systems; 2) Social Vulnerability, Disaster, and Indigenous Communities; 3) Indigenous Sovereignty in Disasters; and 4) Engaging in Ethical Partnerships and Respecting Indigenous Data Sovereignty. Attendees can click on the following link to register: https://converge.colorado.edu/resources/training-modules/
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This webinar is geared towards the farm, ranch, and rural population and the emergency medical providers who serve them. Speakers discuss the challenges unique to rural areas (e.g., the scope and nature of disability in rural areas and basic emergency management issues that may develop for individuals with disabilities living in rural communities).
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Mountain Plains Regional Disaster Health Response System. (2025). Rural EMS Education Series.
This webpage includes links to recorded live training sessions that can help pre-hospital providers in rural areas learn more about treating patients with specific conditions (e.g., toxicologic emergencies, OB/GYN emergencies, cardiac arrythmias). Videos that focus on rural trauma support, pediatric considerations, Disaster Medical Assistance Teams and prehospital disaster management, and conditions experienced by special populations (e.g., older patients) are also provided.
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Rural Domestic Preparedness Consortium. (2025). Emergency Operations Plans for Rural Jurisdictions.
This 8-hour in-person course can help rural planners develop plans suited to their jurisdictions.
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Rural Domestic Preparedness Consortium. (2025). Isolation and Quarantine for Rural Communities.
This self-paced course focuses on the legal and ethical issues associated with isolation and quarantine in rural areas. Students will also learn about communication strategies and isolation and quarantine resources.
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Rural Domestic Preparedness Consortium. (2025). Rural Emergency Preparedness and Response Training.
This website provides resources and links to numerous online training courses for rural first responders and healthcare workers. The site also includes a "responder toolbox" which includes links to additional resources.
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Guidance


This document: outlines current request processes for federally recognized tribes and Urban Indian Organizations (UIOs) to access Strategic National Stockpile (SNS) and other federal public health response supplies under a variety of legal instruments and emergency response authorities; describes the factors driving both the request processes themselves and medical countermeasure deployment methods used by SNS; and recommends strategies for accessing supplies that can support native communities, prevent supply shortages, and reduce health disparities.
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This set of tip sheets highlights strategies for healthcare leaders faced with a variety of emergencies (e.g., natural disasters, cyberattacks, mass casualty incidents). Each tip sheet presents relevant examples to enhance the preparedness and response capabilities of hospitals and health systems.
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Health Resources & Services Administration. (2024). Telehealth for Rural Areas: Introduction to Rural Telehealth. U.S. Department of Health and Human Services.
Telehealth can help address the healthcare needs of the 1 in 5 Americans who live in rural areas. This best practice guide for healthcare providers can help develop a workflow for rural patients, provide information on billing, prepare people who live in rural areas to access the internet and use telehealth services as needed.
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Health Resources & Services Administration. (2026). Telehealth Community Stories. U.S. Department of Health and Human Services.
This webpage includes information and videos on how providers and patients use telehealth to improve access to quality health care for rural and urban residents.
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Institute of Medicine of the National Academies. (2017). Improving Rural Mass Casualty Response in the United States. Chapter 7 of Preparedness and Response to a Rural Mass Casualty Incident: Workshop Summary.
These workshop proceedings discuss several aspects of rural mass casualty planning and response: rural health grants; Medicare reimbursements; funding sources and transportation improvements; the lack of consistent funding sources; and the role of government (including leadership, workforce, and education that can help responders train and prepare for mass casualty incidents in rural locations).
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Iowa State University, Center for Food Security and Public Health. (2025). All Hazards: Resources to Help Communities Prepare for Disasters and Other Hazards.
This website provides links to resources that can help residents of rural agricultural communities prepare for and recover from natural, biological, and human-caused threats. Resources that address family members, pets, farms/livestock, and businesses are provided under each tab.
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This policy brief lists several guiding principles and policy recommendations for rural emergency medical preparedness that can help ensure effective preparedness and response to all types of hazards.
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Rural Health Redesign Center. (2023). Rural Emergency Hospital Technical Assistance Center.
This center provides technical assistance to rural hospitals interested in assessing their feasibility of the new Rural Emergency Hospital provider designation. The website includes links to information on current initiatives and related resources.
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Lessons Learned


Administration for Strategic Preparedness and Response. (2026). HHS emPOWER in Action.
From severe flooding in Nevada to blizzards in Wyoming, the HHS emPOWER Program has emPOWERed communities in all 50 states, 5 territories, and the District of Columbia to strengthen emergency preparedness and take action to protect at-risk populations prior to, during, and after emergencies, incidents, and disasters. Check out the emPOWER in Action page to learn more about how communities, including those in rural and frontier areas, have used HHS emPOWER Program data and tools to advance emergency preparedness, response, recovery, and mitigation activities.
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This case study describes a coordinated rapid response in Graves County, KY following a tornado in December 2021. The lessons learned from this event are invaluable due to the unique features of this tornado event, including its severity and destruction of the emergency medical system's headquarters.
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American Hospital Association. (2023). When Disaster Strikes: How Rural Hospitals Respond.
This moderated discussion is the final video in a five-part series designed to equip healthcare executives with key leadership skills and competencies in crisis management. Speakers share their experiences responding to public health emergencies in a rural community.
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This blog highlights the benefits of using simulation trainings for emergency response and medical surge management, particularly in more rural settings. A related podcast is also included in the blog.
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This issue of The Exchange covers the challenges associated with providing healthcare during mass shootings in Las Vegas, Orlando, Aurora, and Sutherland Springs (a rural community in Texas).
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This resource highlights the challenges of mass fatality management in rural areas by examining experiences and lessons learned in Texas. In Texas, Justices of the Peace conduct inquests into cause of death. ASPR TRACIE interviewed Judge Eulalio “Lalo" Diaz Jr. to learn about his experience as the on-call coroner for the elementary school shooting in Uvalde, Texas on May 24th, 2022. Dr. Kimberly Molina, Bexar County's Chief Medical Examiner, also shared some lessons learned following their experience with two school shootings and an incident involving 53 immigrants deceased in an 18-wheeler.
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Public health emergencies can challenge all aspects of healthcare, and rural areas can be hit particularly hard. Many rural hospitals do not have the capacity to accommodate patient surge, may not have the on-site capabilities to treat very ill patients, and may be challenged with providing care in place versus transferring patients, especially during a pandemic. ASPR TRACIE met with subject matter experts from California who helped manage the response to the pandemic across the state to learn more about how they worked with hospital staff particularly in Imperial County (a rural area bordered by San Diego, Riverside, and Yuma [Arizona] counties, and Mexico) to augment capacity and accommodate patient surge.
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In rural areas, patient transfer is a common practice, often strained by various factors (e.g., distance to receiving hospitals, geography, available mode of transport, and available staff to treat, transport, and receive patients). ASPR TRACIE met with Dr. Emily Bartlett, an emergency medicine physician who has worked at the Gallup Indian Medical Center in New Mexico (GIMC) since 2020, to learn more about how the center determined which patients to transport and which to treat in place as they overcame related challenges (e.g., no available beds in the region, not enough staff to accomplish patient transport). She was joined by Brandon Wyaco, Public Information Officer from the Navajo Area Indian Health Service.
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DeAnn Brown, CNM, DNP; Susan Harris, LPN, MSN; Steve Ikuta, BS, HcEM-M, MEP, UCEM; and Steven Rossberg, BS, CHEC III, MEP share their experiences responding to the mass casualty incident that ensued when a bus transporting Chinese tourists overturned on a highway en route to Bryce Canyon, Utah.
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This issue of The Exchange focuses on the many ways healthcare provided continuity of care to isolated rural areas after Hurricane Helene from the local, state, and healthcare system perspectives. Another article covers the hospital recovery and reopening process after a fire decimated Signature Health in Brockton, Massachusetts.
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Burch, H. (2025). Mercy Hospital’s Transformation to a Rural Emergency Hospital. National Rural Health Association.
The author notes how becoming a rural emergency hospital helped Mercy Hospital overcome financial losses while better addressing patient needs in Moundridge, Kansas, to include creating a walk-in clinic and providing 24/7 emergency medical services, laboratory testing, physical therapy, radiology, and outpatient treatments.
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Clements, B. (2013). Public Health Response to the Fertilizer Plant Explosion in West, Texas. University of Washington, Northwest Center for Public Health Practice.
The speakers in this hour-long webinar discuss the West, TX public health and hospital communities’ response to the April 2013 fertilizer plant explosion. In particular, they share how emergency preparedness program capabilities were successfully operationalized during the response, and list lessons learned.
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Eighmy,M., Hall, T., Sahr, E., et al. (2012). The Extension Service and Rural/Frontier Disaster Planning, Response, and Recovery. Journal of Extension. 50(4).
The authors of this study examined the response of Extension Service personnel to flooding events in eight rural/frontier counties in North Dakota. The authors discussed gaps in existing disaster training program and clarified the role of the Extension Service in emergency planning, with the goal of preparing Extension staff to better respond to the specific needs of rural citizens.
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The authors provide two case studies of grantees in rural communities (Missouri Center for Public Health Excellence and the Hmong American Center) who tracked their "experiences, challenges, and strategies for overcoming barriers during the implementation of COVID-19 vaccine acceptance projects."
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Institute of Medicine of the National Academies. (2011). Preparedness and Response to a Rural Mass Casualty Incident: Workshop Summary.
Healthcare facilities in rural areas can be particularly challenged during a mass casualty incident (MCI) as local emergency medical service providers may be overwhelmed by 911 responses and unable to assist with patient forward movement. This summary reviews some of the contributing issues and potential solutions and highlights a broader range of issues for rural MCI response.
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Kyum Yang, B., Carter, M., and Nelson, W. (2021). Trends in COVID-19 Cases, Deaths, and Staffing Shortages in US Nursing Homes by Rural and Urban Status. Geriatric Nursing. 42(6): 1356-1361.
Using publicly available datasets, the authors reviewed trends to determine the effect of rurality on infection, death, and staffing shortages in nursing homes. They found more changes in staffing shortages over time (particularly among rural nursing homes), suggesting these structures were challenged by the prolonged, intense nature of caregiving during the pandemic.
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This report highlights how rural healthcare facilities can prepare for natural and human-caused disasters and the importance of flexibility. The author also shares lessons learned from rural communities and providers who responded to a tornado in Iowa, an earthquake in Alaska, and an armed hostage standoff in South Dakota.
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Mason, W., Randolph, J., Boltz, R., et al. (2014). Rural Coalition Development and Immediate Bed Availability. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This 90-minute webinar reviews the unique challenges of building and operating healthcare coalitions in rural settings. Speakers discuss policy and partnership lessons learned from a disaster in Arkansas; bed surge and mass fatality support and coordination best practices from a Greyhound bus disaster in Pennsylvania; Community Assessment Tool (CAT) implementation in Nebraska; and rural healthcare coalition development strategies used in Missouri.
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Murphy, J., Bergström, C., and Gyllencruetz, L. (2025). Rural Hospital Incident Command Leaders’ Perceptions of Disaster Preparedness. BMC Emergency Medicine. 25(45)
In this qualitative study, hospital incident command group members from three emergency rural hospitals in Sweden were interviewed to understand their level of confidence in handling major incidents. Variables associated with higher levels of confidence included hands-on preparation; similarity with daily activities; personal mental preparedness; understanding of the interconnectedness of operations, hospital, and the region; confidence in the role, situation, and context; adaptability, flexibility, and stability; situational awareness and the amount of information; and the level of uncertainty surrounding the incident.
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* National Association of County & City Health Officials. (2018). Rural and Frontier Healthcare Coalitions: A Preparedness and Response Snapshot.
This fact sheet describes characteristics of healthcare coalitions (HCCs) located in more rural areas in nine states.
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Pamplin, J., Gray, B., Quinn, M., et al. (2024). National Emergency Tele-Critical Care in a Pandemic: Barriers and Solutions. Critical Care Explorations. 6(5).
This article highlights the key barriers related to the development of the National Emergency Tele-Critical Care Network including licensing, credentialing, care models for emergency expansion of tele-critical care services, and financial services. Expert statements regarding each barrier are groups as “minimum,” “better,” and “best” with the authors concluding that a national emergency telemedicine system is feasible and can build resilience, increase bed capacity, and reduce costs during a disaster or public health emergency.
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Pamplin, J., Quinn, M., and Little, J. (2025). Experience of The National Emergency Tele-Critical Care Network. Telemedicine and e-Health.31(5)
When critical access and smaller hospitals in rural areas were overwhelmed by patient surges and/or boarding critical care patients during the COVID-19 pandemic, the National Emergency Tele-Critical Care Network (NETCCN) provided free, ad hoc advice to clinicians who needed help. The authors review the effect NETCCN had on patient care, facility capacity, and costs and close with recommendations for integrating telemedicine into rural health during disasters and public health emergencies.
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Rural Health Information Hub. (2025). Rural Emergency Preparedness and Response.
This topic guide includes links to resources, including the Rural Emergency Preparedness and Response Toolkit, and provides answers to frequently asked questions specific to rural health preparedness and response.
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The objective of the study was to investigate the types of workplace health and safety issues rural community nurses encounter and the impact these issues have on providing care to rural consumers.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2025). Health Care Readiness In Action: Stories from the Field.
Many of the posts on this webpage include lessons learned from health practitioners and emergency managers in rural areas and American Indian/Alaskan Native communities.
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United States Global Change Research Program. (2016). Following a Devastating Tornado, Town and Hospital Rebuild to Harness Wind Energy. U.S. Climate Resilience Toolkit.
This article highlights how the city of Greensburg (KS) and its hospital Kiowa County Memorial recovered and rebuilt after a 2007 tornado that damaged or destroyed more than 90% of the structures in the community.
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University of North Dakota Center for Rural Health. (2025). Rural Health Research Gateway.
This website provides access to research conducted by the Rural Health Research Centers. Users can click on tabs to access research recaps, alerts, publications, information on research centers, and a dissemination toolkit.
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The authors developed a federated data network in March 2020 using electronic health record (EHR) data from 8 multispecialty health systems in Minnesota to track COVID-19 positivity rates by various demographic variables, including rurality, ethnicity, and language. This process demonstrated the ease and importance of developing similar syndromic surveillance systems using EHR data and identifying trends in rural health.
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Plans, Tools, and Templates


Administration for Strategic Preparedness and Response. (2025). Strategic National Stockpile (SNS) SharePoint. (Free registration required.) U.S. Department of Health and Human Services.
The SNS SharePoint offers technical assistance and resources to tribal nations and Urban Indian Organizations (UIOs) to ensure systems for requesting, receiving, and distributing stockpiled medicines and supplies are functioning well before they are needed in an actual emergency.
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Administration for Strategic Preparedness and Response. (2026). HHS emPOWER Emergency Planning Dataset.
The HHS emPOWER Emergency Planning Dataset is updated monthly and provided to public health authorities to help anticipate, plan for, and address the needs of community-based at-risk populations. Public health authorities and their partners, as appropriate, can use this data to develop and enhance emergency systems, plans, and processes to support data-driven decision-making regarding potential shelter and evacuation assistance needs, response asset and resource allocation, and power restoration prioritization.
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Administration for Strategic Preparedness and Response. (2026). HHS emPOWER Emergency Response Outreach Dataset.
In the event of an incident, emergency, or disaster, statutorily authorized state or territorial public health authorities that meet certain requirements may submit a disclosure request for official review and approval of a minimum necessary HHS emPOWER Emergency Response Outreach Dataset to support critical life-saving assistance and response outreach public health activities. The HHS emPOWER Emergency Response Outreach Dataset has been officially requested and used by public health authorities to activate emergency plans and communications, deploy response assets and resources, and conduct life-saving outreach with authorized partners in the event of an incident, emergency, or disaster.
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Administration for Strategic Preparedness and Response. (2026). HHS emPOWER Map.
The publicly available and interactive HHS emPOWER Map displays de-identified totals at the national, state, territory, county, and ZIP Code levels for Medicare beneficiaries who rely on electricity-dependent durable medical equipment and devices and/or certain essential health care services. The map features different base map options and near-real time natural hazard data, including severe weather, hurricanes, flooding, wildfire and earthquakes. Communities can use the HHS emPOWER Map to anticipate, plan for, and address the needs of at-risk individuals prior to, during, and after an emergency. Partners can also use emPOWER AI, a public, voice-activated tool, to access HHS emPOWER Map data by voice and typed query.
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Administration for Strategic Preparedness and Response. (2026). HHS emPOWER REST Service.
The publicly available HHS emPOWER REST Service allows users to consume HHS emPOWER Map data layers in their own geospatial information systems (GIS) or applications. Users can compare, analyze, and visualize this de-identified Medicare data along with their other community resource and asset data layers (e.g., hospitals, shelters) to better inform emergency preparedness, response, recovery and community mitigation decision-making and actions prior to, during and after an incident, emergency, or disaster.
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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 of emergency preparedness requirements for Critical Access Hospitals.
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This document combines excerpts from the Final Rule and existing Interpretive Guidelines from CMS to provide a consolidated overview document of requirements for Rural Emergency Hospitals.
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Dvorak, G. and Williamson, B. (Eds.). (2011). All-Hazards Preparedness for Rural Communities.
This guide can help emergency planners, families, and individuals who live in rural communities prepare businesses to take the necessary steps to prepare for, respond to, and recover from natural disaster and human-caused events. While not geared towards healthcare practitioners, it does include threat-specific information templates, checklists, and links to related resources for families and businesses.
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Rural Health Information Hub. (2023). Rural Community Paramedicine Toolkit.
This toolkit can help rural areas build community paramedicine and related health programs. Its seven modules cover community paramedicine in the U.S., models for paramedicine programs (e.g., programs that focus on prevention and health education, reducing use of emergency resources), examples of successful rural paramedicine programs, potential issues with these programs, evaluations, funding, and sustainability.
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Rural Health Information Hub. (2025). Am I Rural? –Tool.
Users can enter their address into this online tool to determine whether their location is classified “rural” and if it qualifies for certain programs.
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Rural Health Information Hub. (2025). Rural Emergency Preparedness and Response Toolkit.
This evidence-based toolkit was developed in collaboration with the NORC Walsh Center for Rural Health Analysis. It provides practical guidance for planning for, responding to, and recovering from disasters and emergencies in rural communities. It also includes guidance and resources for different types of emergencies and considerations for special populations.
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Small Water Supply. (2015). Emergency Response Plan.
This response plan template can be used to plan for, respond to, and recover from an incident that affects the water supply.
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Research


Betka, A., Dewey Bergren, M., and Rowen, J. (2021). Improving Rural Disaster Response Preparedness. (Abstract only.) Public Health Nursing. 38(5): 856-861.
Students from nursing, medicine, public health, and social work (N=40) demonstrated statistically significant increases in self-confidence, disaster confidence, and interpersonal collaboration after participating in a rural agricultural disaster scenario.
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Croll, Z., Jewell, C., and Gale, J. (2024). Critical Access Hospital-Local Health Department Partnerships to Address Rural Community Needs. Flex Monitoring Team.
The authors interviewed representatives from critical access hospitals and local health departments and found three areas of activity that could promote collaboration: emergency preparedness planning, addressing emergent public health crises, and community health needs assessments. These partnerships can boost State Flex Programs and the health of rural communities.
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The authors interviewed senior health care coalition (HCC) leaders at the state or regional levels to better understand how they helped critical access hospitals (CAH) in their jurisdictions with emergency preparedness planning. Findings indicated that levels of assistance varied by location and partnerships boost engagement of CAHs in HCC activities and resource acquisition in more rural communities.
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Health Resources & Services Administration. (2024). Telehealth Research Recap: Telehealth for Rural Areas. U.S. Department of Health and Human Services.
Telehealth can help address the health care needs of the 1 in 5 Americans who live in rural areas. This best practice guide for health care providers can help develop a workflow for rural patients, provide information on billing, and prepare people who live in rural areas to access the internet and use telehealth services.
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Kappel, R., Chavez, A., Melnick, M., et al. (2024). Supporting Rural Community Emergency Planning, Response, and Recovery. (Abstract only.) Journal of Public Health Management and Practice. 30(1):130-132.
The authors describe the development of the Rural Emergency Preparedness and Response Toolkit, highlighting preparedness frameworks, population considerations, plan and assessment examples, and funding support.
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* National Association of County & City Health Officials. (2018). Rural and Frontier Healthcare Coalitions: A Preparedness and Response Snapshot.
This fact sheet describes characteristics of healthcare coalitions (HCCs) located in more rural areas in nine states.
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Ward, M., Carter, K., Bhagianadh, D., et al. (2023). Comparison of Telehealth and In-Person Behavioral Health Services and Payment in a Large Rural Multisite Usual Care Study. (Abstract only.) Telemedicine and e-Health. 29(11).
The authors found that when behavioral healthcare was provided by telehealth, there was a small but statistically significant finding in the amount and complexity of work required by the provider compared to in-person appointments.
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Surge Planning (from Urban to Rural Areas)


HHS emPOWER Program. (2026). HHS emPOWER Program Platform.
HHS emPOWER Program data and tools can be used nationwide to inform health care system surge planning before and during emergencies. The HHS emPOWER Map, emPOWER AI, HHS emPOWER REST Service, and HHS emPOWER Emergency Planning Dataset help partners understand at-risk populations’ needs before a disaster strikes. For example, Missouri integrated emPOWER REST Service data into a statewide dashboard, equipping public health partners with critical information to support risk-informed decision-making during emergencies like Winter Storm Blair in January 2025.
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Meit, M., Briggs, T., and Kennedy, A. (2008). Urban to Rural Evacuation: Planning for Rural Population Surge. NORC Walsh Center for Rural Health Analysis.
The authors conducted a literature review and a quantitative analysis of survey data to assess the likelihood of urban evacuation to rural areas and to provide recommendations for rural planning and response. The last section of the report contains a set of policy and planning recommendations.
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The authors highlight results from a national survey that measured urban residents’ plans to evacuate after two potential disasters. Responses differed by several variables; the potential effect of this movement on infrastructure in rural communities (including the healthcare system) is significant and plans must be adjusted.
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Meit, M., Redlener, I., Briggs, T., et al. (2011). Rural and Suburban Population Surge Following Detonation of Improvised Nuclear Device: A New Model to Estimate Impact. Disaster Medicine and Public Health Preparedness. 5. Supplement 1.
The authors describe a “push-pull” model that estimated the evacuation from Manhattan to counties within a 150 mile radius after a nuclear detonation. This model predicted that arriving evacuees could increase the population needing services by between 50 and 150 percent.
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University at Albany, State University of New York, School of Public Health and Health Professions, Center for Public Health Preparedness. (2007). Mass Evacuation to Rural Communities II.
The speakers in this webinar highlight concerns expressed by leaders in rural communities—areas to which large numbers of evacuees might travel in a disaster. Specific concerns included sustaining the water supply, septic systems, and receiving and treating people with special needs. One speaker shared lessons learned from a tabletop exercise, particularly managing self-deployed volunteers.
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Ye, Z. and Chaudhari, J. (2009). Use of Rural Transportation Infrastructure in Evacuation Operation for the North Gulf Coastal Region. Western Transportation Institute, College of Engineering, Montana State University.
The authors conducted a literature review to better understand rural transportation and evacuation issues, particularly the flow from urban to rural areas after a disaster. They note the lack of related planning, research, and exercises and note the importance of coordinating routes across boundaries, ensuring shelters are located appropriately and away from the location being evacuated, planning for construction around evacuation routes, managing evacuation (e.g., modifying routes as necessary), and identifying state and local public health capacities in rural areas as part of the planning process.
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Tribal Health Resources


In May 2020, ASPR TRACIE hosted the webinar COVID-19: Healthcare System Operations Strategies and Experiences to highlight pandemic response experiences from some of the hardest hit hospitals at the time. Commander Sara Jager, M.D., Chief Medical Officer with Tuba City Regional Health Care Corporation (Arizona), shared her experiences from a tribal hospital that serves Navajo Nation; she updated some of the information from the webinar in July 2020.
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In rural areas, patient transfer is a common practice, often strained by various factors (e.g., distance to receiving hospitals, geography, available mode of transport, and available staff to treat, transport, and receive patients). ASPR TRACIE met with Dr. Emily Bartlett, an emergency medicine physician who has worked at the Gallup Indian Medical Center in New Mexico (GIMC) since 2020, to learn more about how the center determined which patients to transport and which to treat in place as they overcame related challenges (e.g., no available beds in the region, not enough staff to accomplish patient transport). She was joined by Brandon Wyaco, Public Information Officer from the Navajo Area Indian Health Service.
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Bryan, R., McLaughlin Schaefer, R., DeBruyn, L., and Stier, D. (2009). Public Health Legal Preparedness in Indian Country.
This article describes how tribal laws impact public health preparedness. At the time it was published, a study of 70 tribal codes found that 14 (20%) had no clearly identifiable public health provisions and the remaining codes were rarely well-integrated or comprehensive.
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Centers for Medicare and Medicaid Services. (2017). Tribal Nursing Home Best Practices: Emergency Preparedness.
This document highlights five nursing homes in Indian Country and provides information on their emergency preparedness plans, partners, training, and funding sources. It also includes recommendations from these facilities on what has worked well for them as it relates to emergency preparedness.
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Confederated Salish and Kootenai Tribes, Disaster and Emergency Services. (2024). Disaster Emergency Services.
This webpage provides links to plans and policy documents that can help tribal hospital and medical facility personnel prepare for, respond to, and recover from natural and human-caused disasters.
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Federal Emergency Management Agency. (2025). Tribal Affairs.
Tribal Affairs works with tribal governments to build emergency management capability and partnerships to ensure tribal nation and community resilience. The website provides links to brochures, public service announcements, and poster resources.
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Granillo, B., Renger, R., Wakelee, J., and Burgess, J. (2010). Utilization of the Native American Talking Circle to Teach Incident Command System to Tribal Community Health Representatives. (Abstract only.) Journal of Community Health. 35(6): 625-634.
The authors discuss the use of the Native American Talking Circle format as a culturally appropriate method to teach the Incident Command System (ICS), emphasizing that this format has been well received. The authors also discuss limitations of their evaluation and strategies for improving future research efforts.
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Groom, A., Cheyenne, J., LaRoque, M., et al. (2011). Pandemic Influenza Preparedness and Vulnerable Populations in Tribal Communities. American Journal of Public Health. 99:S2.
The authors highlight “trends of influenza in Indian Country,” and list potential issues that may increase some members of this population’s vulnerability, such as chronic disease and challenges associated with elderly community members. The authors share information on pandemic influenza preparedness resources available to tribal leaders and their partners in state and local health departments, academia, community-based organizations, and the private sector.
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This handbook can help tribes develop and implement their emergency preparedness plans. Section 2 provides information on working with state and federal governments, Section 3 includes information on developing plans, and Section 4 provides sample plans and products.
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Mountain West Preparedness & Emergency Response Learning Center. (2016). Strategies for Effectively Working with American Indian and Alaskan Native (AI/AN) Communities.
This report can help emergency health responders better understand: the history of American Indian and Alaskan Native (AI/AN) communities; how AI/AN governments are structured; strategies for communicating and establishing trust with AI/AN community representatives; the importance of soliciting tribal consultation; and key definitions that apply to AI/AN communities. Several helpful appendices are included.
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This plan provides a framework for the Squaxin Island Tribal Government to prepare for, respond to, and recover from natural and human-caused disasters.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2025). Health Care Readiness In Action: Stories from the Field.
Many of the posts on this webpage include lessons learned from health practitioners and emergency managers in rural areas and American Indian/Alaskan Native communities.
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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2022). Tips for Disaster Responders: Cultural Awareness When Working in Indian Country Post Disaster.
This tip sheet for behavioral health responders outlines the types of traumatic events that can occur in Indian Country and examples of effective response techniques such as use of traditional teachings and talking circles.
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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2022). Tips for Disaster Responders: Understanding Historical Trauma and Resilience When Responding to an Event in Indian Country. Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center.
This tip sheet for responders provides a description of the effects of historical trauma on American Indian/Alaska Natives, and tips for how responders can respond effectively to a disaster or other traumatic event in Indian Country.
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Urban Indian Health Institute, Seattle Indian Health Board. (2010). Evaluation and Assessment of H1N1 Outreach for Urban American Indians/Alaska Natives.
Researchers from the Urban Indian Health Institute (UIHI) hosted two community focus groups and led three key informant interviews with American Indians/Alaskan Natives living in the Seattle/King County area to understand their experience during the 2009 H1/N1 outbreak. The authors share findings and recommendations related to education, messaging, and addressing cultural barriers.
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Agencies and Organizations


Bureau of Indian Affairs. Office of Emergency Management.
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Centers for Disease Control and Prevention. Rural Health.
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Centers for Medicare & Medicaid Services. Stay Connected.
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Health Resources & Service Administration. Federal Office of Rural Health Policy.
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National Congress of American Indians. Emergency Management.
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National Organization of State Offices of Rural Health. NOSORH Members.
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Rural Health Information Hub. Rural Emergency Preparedness and Response.
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Universities of Minnesota, North Carolina at Chapel Hill, and Southern Maine. Flex Monitoring Team.
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