Emergency Operations Plan: 6 Key Elements Checklist for Hospitals

An emergency helicopter flies over a smoking wildfire

When disaster strikes, clinicians and hospitals stand ready to receive patients in need of care. U.S. hospitals are fundamental in providing emergency care support for communities during crises that arise due to our changing climate — such as fires and hurricanes — as well as during singular, catastrophic events such as 9/11.

In fact, the ways hospital emergency planning evolved in response to 9/11 have shaped how hospitals are responding to the COVID-19 crisis. The National Incident Management System, created in 2003, links federal, state, and local agencies to coordinate a thorough response to disaster. Local first responders are now recognized as the front line operatives of any disaster response.

Hospitals are among those first responders. Administrators and clinicians cannot afford to underestimate the risk a novel crisis will pose to public health. They must act quickly and decisively when a threat appears. That’s why, before disaster strikes, effectively administered healthcare facilities and businesses take proactive steps to ensure their services are not interrupted.

A well-designed emergency operations plan makes all the difference.

What Is an Emergency Operations Plan?

Emergency preparedness is vital to ensure a disaster response is not impeded by disorganization or miscommunication. Remaining calm and moving confidently through the wilds of a crisis are much easier when you have a map. And that is exactly what an emergency operations plan (EOP) is — a mapping of the best course of action during an emergency.

Most businesses with employees are required by the Occupational Safety and Health Administration to have a plan for evacuation and emergency procedures on site. Different sectors have different standards for emergency planning. For example, the Department of Homeland Security, which advises businesses on disaster preparedness, derives its emergency management standard from the National Fire Protection Association (NFPA). Hospitals and healthcare organizations use The Joint Commission’s standard.

Scenarios That May Require an Emergency Response

Regardless of the standard used, an EOP concretely defines what an organization will do to minimize disruptions in services when a disaster occurs. The potential disasters an administrator must consider when planning vary depending on the location of the organization.

In the West, wildfire evacuation routes or smoke mitigation strategies might be in an emergency operations plan, while the Gulf Coast states need to include procedures for evacuation in case of a hurricane. Some threats loom over all locations: a viral pandemic, acts of terror, political unrest, and natural disasters. Planning for all of these events, even if the chances of their occurrence seem remote, should be viewed as an investment in the future.

The Role of Public Health and Public Safety Agencies

An EOP includes a written plan for communications and obtaining accurate information. An incident command structure should be established describing roles and responsibilities and defining to whom staff should report. For hospitals, the structure must be congruent with the command structures of local public health and safety agencies, which will notify healthcare organizations of potential threats and coordinate relief efforts after a disaster occurs.

Regulations will also shape an emergency operations plan, as some businesses may need to notify government officials if an emergency has occurred on site. Following these regulations could save lives — not to mention money in fines — so businesses should know the agencies that govern emergency planning for their industry.

The Importance of Emergency Response Rehearsals

A good EOP will document, in detail, the resource needs of the organization in each of six key areas, and describe how these will be managed if the community cannot provide support for at least eight days. Conserving resources, curtailing services, obtaining supplies from outside the community, and evacuation are among the acceptable responses.

Once an emergency operations plan has been written, it must be practiced and, if necessary, modified in response to feedback. Drills are a key component of emergency preparedness. Members of the organization should run through every disaster scenario the plan covers and evaluate its performance. These “dry runs” identify pitfalls and areas where improvement is needed.

Additional Resources: What Is an Emergency Operations Plan?

A list of the six events that require an emergency operations plan

Many events can cause the activation of an emergency operations plan to minimize negative impacts and save lives. Some of these events include floods, earthquakes, wildfires, hurricanes, terrorist attacks, and pandemics.

Hospital Emergency Operations Plan: 6 Key Elements

Since the healthcare system itself forms part of any crisis response, administrators of healthcare facilities and hospitals must formulate a comprehensive disaster plan detailing their organization’s intended course of action in the case of any kind of catastrophe. The complexities of ensuring continuity of services throughout the myriad disasters that can occur puts hospitals at the forefront of emergency planning.

Hospital emergency operations plans cover “all hazards.” This includes mass casualty events, where loss of life and need for medical attention is so high that the medical system is overwhelmed, and mass effect events, or direct disruptions to the medical system’s ability to deliver care. An example of a mass casualty event would be the COVID-19 pandemic, while an example of a mass effect event would be Hurricane Katrina. This approach allows the hospital to act nimbly in crises of varying causes, durations, and scopes.

As mentioned earlier, the standard hospitals follow when it comes to emergency planning is The Joint Commission’s Emergency Management Standard. The Joint Commission is a nonprofit organization that sets standards for and issues accreditation to healthcare organizations. To be certified as meeting The Joint Commission’s standard, facilities must undergo an evaluation every three years.

The Joint Commission has identified a hospital emergency operation plan’s six key elements: communication, resources and assets, safety and security, staff responsibilities, utilities, and clinical and support activities. Read on for a look at these components, along with a checklist of steps administrators can take to begin crafting each part of their emergency plan.


Hospitals rely on efficient communication even in nonemergency situations. During a crisis, the execution of an emergency operations plan can hinge on communication. Internal lines of contact must be clearly documented in any hospital emergency operations plan. Procedures for disseminating information to staff should also be outlined.

An effective disaster response will involve communication with other local first responders. When formulating an emergency operations plan, a hospital administrator/manager should ascertain exactly which agencies will be handling an emergency and identify appropriate contacts there. Having contact information for other groups and officials in the community who may act as sources of aid and information in a catastrophe is also useful.

Documenting attempts at making contact with outside agencies, as well as any conversations that take place, is a crucial step to meeting The Joint Commission’s standard for EOPs. Detailed records of incoming and outgoing communications must be kept throughout the emergency.

As with all aspects of an EOP, communication channels are reviewed and updated, with an eye on staff changes or agency responsibility shifts.

Steps to take toward meeting this requirement:

  • Expand communication procedures during an emergency; do not radically overhaul
  • Document communication protocols and channels
  • Identify and document which agencies will provide emergency information
  • Reach out to local first responders
  • Stay up to date on changes in official procedure
  • Capture the efficiency of plan metrics and evaluate

Resources and Assets

If an organization intends to be operational throughout an emergency, it needs to identify from where it expects to acquire and restore its stock of nonmedical supplies such as food, water, and clean bedding. Hospital administrators should document their inventory and its depletion rate to plan for lengthy periods without the ability to resupply.

Sufficient supplies to weather any catastrophe and effectively care for patients must be kept on site at all times. Administrators must avoid optimism about federal or local support. Disasters such as Hurricane Katrina have demonstrated that the government can itself be too overwhelmed by the crisis to effectively respond. A hospital emergency operations plan should assume that things will not go as planned.

Staff is considered an asset and must also be supported during an emergency. An EOP should document how staff will obtain transportation to and from work, appropriate shelter, and emotional counseling. Partnering with outside groups such as behavioral health agencies and volunteers who can lend their services in support of healthcare workers is a potential way to address this requirement.

Like every other aspect of the hospital emergency operation plan, resource and asset needs must be regularly revised to match current conditions. Continually monitoring demand on supply chains and finding alternate vendors will keep administrators ahead of the game.

Steps to take toward meeting this requirement:

  • Identify supplies that will be needed at the beginning of a crisis and for actions such as an evacuation
  • Determine how everyday supplies will be replenished if a disaster cuts off outside support
  • Consider asking existing vendors to insert a “surge clause” in supply contracts in case of emergency
  • Document procedures for conserving resources and assets
  • Evaluate current resource needs and external demands periodically

Safety and Security

Safety and security are even more important during a crisis, as everyday norms are upturned. A hospital emergency operations plan must detail exactly how the organization intends to maintain the safety and security of patients and staff. How this will be achieved can shift with each disaster.

Administrators must evaluate the potential safety and security hazards that may arise in any given disaster and document their mitigation plans. Hazardous and biological waste disposal instructions, biological/chemical decontamination procedures, and isolation protocols are all potential inclusions in a hospital EOP.

Contact information and command structures for local security agencies such as police and sheriffs should also be obtained and included in the EOP. Coordination with these agencies can be crucial for escorting staff members through disaster areas and managing unruly members of the public.

After a disaster occurs, the organization’s response should be evaluated for its efficiency and effectiveness. Organizational protocols must be reevaluated as new threats appear on the horizon.

Steps to take toward meeting this requirement:

  • Provide for disposal, decontamination, and isolation
  • Determine facility capabilities in case a lockdown is needed
  • Control and/or minimize points of access to the facility
  • Prioritize routes of internal traffic
  • Establish evacuation routes for different types of emergencies
  • Arrange for law enforcement to maintain order around the facility

Staff Responsibilities

Roles and responsibilities for staff and licensed independent contractors must be clearly established and understood if an emergency operations plan is to be effective. To meet The Joint Commission’s standard, a hospital emergency operations plan should document what staff will be doing in each of the six key areas.

All hospital staff on site during an emergency must be trackable. A system should be set up in advance of a catastrophe to keep tabs on the location of on-duty personnel; this may be something as simple as identification cards worn around the neck or an app for more well-funded organizations.

Staff support is an important aspect of this criteria. Staff must be trained in the roles they are expected to play during an emergency. Independent practitioners need to know who they will report to and what role they will occupy. Psychological counseling would ideally be provided to staff for stress incurred during the crisis as well.

Staff roles and responsibilities should be evaluated periodically for effectiveness. Rehearsals of disaster scenarios, aka drills, are a good way to determine whether a role is a good fit for a particular staff member.

Steps to take toward meeting this requirement:

  • Evaluate what staffing needs (and needs of staff) will be during an emergency
  • Develop a plan for meeting emergent psychological needs of staff
  • Determine how staff will be called in if telecommunications are down
  • Consider revising sick leave and vacation policies during a disaster
  • Implement a dynamic, scalable tracking system for on-site staff
  • Reevaluate and reorganize roles and responsibilities as needed


The hospital emergency operations plan should also document the essential utilities required for the smooth functioning of the organization. These can include water, electricity, telecommunications, fuel, ventilation, medical gas, and vacuum systems.

Many different kinds of disasters can disrupt functioning in utilities, and multiple utilities can be impacted at a time. For example, an earthquake can affect both telecommunications and gas and a hurricane can cause flooding that renders potable water undrinkable and knocks out power lines. An EOP should consider the possibility of cascading crises.

To provide for these contingencies, organizations might consider obtaining generators, water filtration systems, and additional fuel sources, among other resources. Backup utilities, and any repair parts they may require, should be located in an area where they would remain safe during the initial disaster. An emergency operations plan may also include assistance from outside sources, though plans should take into consideration that access to the facility may be cut off.

New equipment and other changes in facility composition and protocol will require updates to the utilities portion of the EOP. As with other resources, organizational needs in this area must be regularly reviewed and revised.

Steps to take toward meeting this requirement:

  • Identify the essential utilities the organization requires for operation (e.g., internet service)
  • Investigate the potential disruptions essential utilities face in the region
  • Obtain backup generators and water reservoir tanks
  • Stock extra fuel and repair parts for generators and other essential equipment
  • Contact outside sources for support in providing utilities
  • Decide when to stop accepting patients or evacuate

Clinical and Support Activities

Meeting the clinical needs of patients remains the highest priority for a healthcare organization even during an emergency. Thus, a hospital emergency operations plan needs to document how clinical and support activities will be maintained. Administrators will need to consider how to provide patient care within the rapidly changing circumstances a disaster scenario presents.

Clinical activities that will need to be managed during a crisis include triage and addressing the needs of vulnerable populations such as elderly and disabled people. Providing for hygiene, sanitation, and mortuary services and documenting clinical information about patients are also crucial to fulfilling this standard.

Steps to take toward meeting this requirement:

  • Determine the clinical activities that must be maintained for the organization
  • Identify what additional areas of support will be needed in a crisis
  • Consult with clinical staff to formulate a scalable triage system
  • Establish a backup plan for providing critical support services such as sanitation and mortuary
  • Evaluate performance and make changes to the EOP as needed

Additional Resources: 6 Key Elements of a Hospital Emergency Operations Plan

A list of the six primary areas covered by a hospital emergency operations plan

According to The Joint Commission’s Emergency Management Standard, hospitals must focus on the following areas in an effective emergency operations plan: communication, resources and assets, safety and security, staff responsibilities, utilities, and clinical and support activities.

The Role of Hospital Emergency Management in Emergency Operations

Hospital administrators and managers, also known as healthcare executives or medical services managers,  are responsible for planning and overseeing the numerous administrative tasks involved in running a healthcare facility. Some hospital managers may further specialize in hospital emergency management, formulating EOPs and training existing staff on emergency procedures.

The primary duty of a hospital manager is to ensure the organization runs at optimal efficiency to maximize profit, while at the same time providing quality health care services. Among other tasks, hospital managers may sign off on departmental budgets, assign goals and objectives, formulate staff work schedules, train staff, maintain facility compliance with regulations, and act as a representative for the facility in shareholder meetings.

Hospital administrators typically hold at least a bachelor’s degree, preferably in healthcare administration. The position demands a candidate possess a few important qualities: refined leadership skills, for instance, along with interpersonal skills, the ability to communicate effectively, and analytical and technical aptitude.

In the context of emergency management, hospital administrators are responsible for the development, implementation, execution, and evaluation of the emergency operations plan, taking into consideration each of the six key elements. An administrator may choose to contract this work out to a hospital emergency management professional or may take it upon themselves. Either way, the emergency preparedness of the facility and staff depends on their initiative.

Practical execution of an EOP may have an administrator overseeing a return to normal operations shortly after an emergency or a long-term recovery project aimed at reopening a facility shut down by a disaster. The hospital manager is responsible for ensuring the facility is structurally sound after any disaster and able to safely accept patients. Mold remediation and other interventions may be required.

The Future of Emergency Operations Planning

As climate change accelerates the pace of catastrophes, emergency operations planning becomes more and more crucial to the long-term survival of any organization. Administrators must keep up with an ever-shifting number of threats: fires, floods, heat, and hurricanes, to name a few.

In the future, we may look back on this time as a period of relative calm before a never-ending storm. What new crises, as yet unimagined, will we face as the world continues to warm?

If anyone will be prepared to confront the disasters ahead, hospitals and hospital administrators will be, armed as they are with a comprehensive, all-hazards emergency operations plan.

Infographic Sources

California Hospital Association, Emergency Operations Plan (EOP)

Centers for Disease Control and Prevention, Emergency Preparedness and Response, Preparedness & Planning

Centers for Disease Control and Prevention, The National Institute for Occupational Safety and Health (NIOSH), Natural Disasters and Extreme Weather Topics

Centers for Disease Control and Prevention, The National Institute for Occupational Safety and Health (NIOSH), Terrorism Response

The Joint Commission, Emergency Management

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