American College of Healthcare Executives

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Approved by the Board of Governors Dec. 8, 2025

Statement of the Issue

Due to the constantly evolving nature of threats and the complex requirements of emergency management, healthcare executives should ensure their organizations develop an all-hazards emergency management program and plan tailored to their location and organization type.

Hospitals and other healthcare delivery organizations must be prepared to care for those in need of medical services and, to the extent possible, protect staff and patients from further exposure to risk. The organization’s emergency operations plan should recognize that a disaster may directly impact a healthcare organization and continue to operate, providing care to victims of the event. Such disasters include incidents of terrorism and natural occurrences such as hurricanes, tornados, floods, earthquakes, epidemics and pandemics. Organizations should recognize that disasters such as pandemics may be long-lasting, and multiple disasters may occur simultaneously, such as a cyberattack and a wildfire.

It is vitally important that healthcare organizations develop an emergency management program to support the development and maintenance of critical emergency operations components such as the emergency operations plan, training, exercises and collaborative relationships. Healthcare organizations must continually monitor and update their emergency operations plans to maintain a state of constant preparedness, ensuring appropriate response and recovery within the shortest possible time frames. Such plans should be developed to include long-term disasters.

Without proper planning, an incident involving the organization may result in either a temporary or permanent failure, thus disabling a crucial community resource. The emergency operations plan also should be fully integrated with that of other organizations and appropriate agencies at the local, state, regional and national levels. This is particularly important in situations such as a pandemic that may simultaneously impact large geographic areas for several months and disrupt national and international supply chains.

Policy Position

The American College of Healthcare Executives believes healthcare executives should actively lead and participate in disaster planning and preparedness activities, striving to ensure that their emergency operations plan aligns with overall community plans and represents a responsible approach to the risks an organization may face. CEOs should lead efforts to ensure that the plan is comprehensive, including establishing board policy that delineates the organization’s responsibilities and procedures to be followed. Healthcare executives also have a unique opportunity to help educate the community about infectious disease prevention and control efforts that may mitigate large-scale death during events such as a pandemic.

In developing a comprehensive emergency operations plan, ACHE encourages healthcare executives to pursue the following actions on an ongoing basis:

• Maintain a Current Emergency Disaster Plan: Establish a process to understand and stay current regarding applicable state and national standards for emergency preparedness. In addition to changes in standards, the organization’s emergency/disaster plan should be updated based on after-action reviews of disasters or full-scale exercises. Healthcare executives should also participate in training and educational programs to stay informed about evolving disaster management systems. Organizations must keep up to date with local, state and federal regulations, including those dictated by the Centers for Medicare & Medicaid Services. During and after the crisis, organizations should conduct an after-action plan and prepare a list of lessons learned that can then be used for future disasters or as a disaster develops.
• Protect Staff, Patients and Families: Develop policies and processes to ensure that all reasonable efforts are made to protect employees, patients and families, as well as facilities, while maintaining the highest quality patient care within the organization’s ability during a crisis. Include plans to mitigate the impact on staffing of likely scenarios such as schools closing; public transportation stopping; roads closing; damage to bridges, tunnels and other access points; and patients presenting with contagious or potentially lethal illnesses. Ensure that staff members receive education that allows them to make informed decisions and understand the organization’s measures to protect them and their families. Organizations should maintain an adequate inventory/stockpile of personal protective equipment that includes some surge capacity for staff and patients. Some types of emergencies can be traumatizing for patients, their families and staff. Incorporate disaster mental health services in the planning process to address needs that emerge during response and over prolonged recovery periods. Organizations should make every effort to support leaders and staff during a crisis and after, including considerations for childcare, pet care and other daily activities.
• Address Disaster Scenarios: Adopt an all-hazards framework to analyze the operational issues that would arise in relevant emergency situations to cover applicable responses to a natural disaster as well as potential chemical, biological, radiological, nuclear and explosive emergencies and sustained events such as pandemic influenza.
• Develop an Incident Command System: Adopt an incident command system and support the integration of a nationwide standardized approach to incident management and response (e.g., the National Incident Management System). Ensure frequent and consistent training and drilling on the activation and implementation of the incident command system. Secure telephones should be part of standard preparedness equipment. The system should be used routinely, even for low acuity incidents. This provides leadership and front-line staff the experience to scale for larger and more complex incidents.
• Assess Resource Availability: Coordinate and integrate organizational resources to address a full spectrum of actions (mitigation, preparedness, response and recovery), and ensure that the organization has the appropriate programs, trained and credentialed staff, staff personal protective equipment, and other supplies and equipment in place to quickly respond to events that the organization might face, as identified by the organization’s all-hazards analysis. Include a determination of the impact on hospital services of a scenario that requires maximum surge capacity.
• Plan for Continuity of Operations: Ensure that the hospital can be self-sustaining for at least 96 hours and that plans are in place to obtain critical resources such as medications, oxygen, food, water, electricity, fuel for electric generators, and just-in-time supplies that may not be available due to the emergency. Maintain an updated roster of a multidisciplinary team available to stay at the facility for the first 72 hours of the emergency. Plan for long-term resources and staffing support as needed, including contingency plans for supply-chain disruptions or potential competition with other organizations for resources. Review suppliers' capacity and vulnerability of their supply chain to ensure their reliability during a disaster. Communicate in advance with local utilities, telecommunications companies, transportation providers and other essential vendors to plan for uninterrupted or redundant services that support continuity.
• Develop Protocols to Ensure Appropriate Resource Allocation: Ensure that services are provided equitably and impartially, consistent with ethical and legal standards relevant to a mass casualty event and based on the vulnerability and needs of the individuals and communities affected by a disaster. To mitigate or manage surges to hospital emergency departments, include in the pre-planning process any providers or agencies with expertise serving vulnerable populations in the community, particularly individuals with disabilities, severe chronic conditions and needs (e.g., dialysis or ventilator-dependent, seriously mentally ill), low-English proficiency, or access and functional needs. Work with other community and regional hospitals to build healthcare coalitions to deal with mass-casualty incidents and other community disasters, and to reduce the duplications of responses and resource competition.
• Strengthen Communication and Coordination: Communications failures should be anticipated and planned for during disasters. Forge and maintain strong relationships, ensuring active involvement in interagency planning efforts with all relevant organizations. Develop an integrated communication plan and communitywide exercises and drills to assess effectiveness and implement improvements.
• Enhance Surveillance and Reporting: Partner with clinicians to recognize and report early signs of public health threats.
• Integrate Cybersecurity Preparedness: Include protocols for responding to cyberattacks that could disrupt clinical operations, data access or patient safety.

As essential pillars of community infrastructure, healthcare organizations must be prepared for all-hazards events. Executives should lead the development of systems and processes to ensure emergency and contingency plans can be executed swiftly and efficiently when needed.

Policy created: November 2006
Last revised: December 2025

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