Health Departments – local, county, regional, and state – are an essential component of public-health as well as public-safety systems. As such, well-researched all-hazards Emergency Operations Plans (EOPs) that detail various overarching emergency preparedness and response issues are an operational necessity. At a minimum, an effective and well articulated EOP will include not only a base plan but also a number of functional annexes and hazard-specific appendixes.
It is important to note, though, that there is no one-size-fits-all approach to developing an effective EOP, primarily because jurisdictional needs and operations vary so significantly across the United States. However, there are certain fundamental components that should form the foundation of every EOP.
Two Definitions & Some Pointed Reminders
Prior to delving into specifics, it is important to understand what might be considered the generic definition of an EOP. In its Comprehensive Preparedness Guide, CPG 101: Developing and Maintaining EOPs, the Federal Emergency Management Agency (FEMA) defines an EOP as “the ongoing plan maintained by various jurisdictional levels for responding to a wide variety of potential hazards. It describes how people and property will be protected; details who is responsible for carrying out specific actions;entifies the personnel, equipment, facilities, supplies, and other resources available; and outlines how all actions will be coordinated.”
Another definition – from Project Public Health Ready, a National Association of County and City Health Officials (NACCHO) initiative – defines an EOP as “an all-hazards plan developed to describe the system of operations that will be used in an emergency event. It defines who, when, with what resources, and by whose authority individuals and groups will act before, during, and immediately after an emergency. An EOP should be tailored to each community’s own potential hazards and resource base.”
There are a few key points, and helpful suggestions, to keep in mind before writing an EOP. The first and arguably most important point is that, except in very unusual circumstances, planning should not start from scratch. It should begin, rather, with existing plans already in the organization’s department or jurisdictional files (even if they are outdated). It also should focus on (and possibly incorporate) nationwide best practices – such as those provided by FEMA, NACCHO, the Association of State and Territorial Health Officials (ASTHO), and the Centers for Disease Control and Prevention (CDC). Last but not necessarily least on the list are the EOPs of neighboring jurisdictions as well as memorandums of understanding (MOUs), mutual-aid agreements (MAAs), and legislation that might directly affect the new EOP being drafted.
Planning the Plan – Plus a Few Relevant Questions
Planning should not be done in a silo – an EOP that is written in a vacuum with no community or stakeholder involvement will seldom if ever be accurate, useful, or operationally effective. Jurisdictional needs and resource availability necessarily dictate how planning should begin and progress, as well as which stakeholders should and will be involved. Some jurisdictions decide to put together a planning committee that is directly involved in research, writing, and/or reviewing the plan. Others rely on a primary public health planner who at least begins the writing process and then strategically uses any number of partners, particularly those with special expertise, throughout its development and review.
A project management and implementation plan also should be developed – this plan should follow the essentials of the generic “Preparedness Cycle”: plan, organize/equip, train, exercise, and evaluate/improve. Among the numerous questions that should be asked are the following:
- What are the plan’s goals and objectives?
- What and how many stakeholders and partners are involved?
- What population groups are represented and what are their needs? (Here it is particularly important to ask what groups are not represented – and why not?)
- What resources (time, people, technology, access to previous and/or current plans) are available to devote to the process?
- How will the EOP be integrated with other departmental or jurisdictional plans?
- Finally, how is the plan likely to be received by leadership, partners, and staff?
The Basic Anatomy of an EOP
The first section of an effective EOP provides a synopsis of the Mission, Purpose, Scope, Planning Assumptions, and Organization of the plan. The mission can be a simple re-stating of the local Health Department’s mission statement. The purpose should articulate the rationale behind writing the plan, including a list of relevant emergencies that the plan will cover – e.g., terrorist acts or threats, health facility emergencies, nuclear power plant or radioactive material incidents, infectious disease emergencies, contaminated drugs or medical devices, food or waterborne disease outbreaks, the contamination of a public water supply.
The scope section should explain the department’s general responsibilities during response and recovery efforts, how they tie in with other agencies in the jurisdiction, and the geographic areas to which the plan applies. The planning assumptions section should provide the facts taken into consideration when writing the plan and in executing the EOP. Finally, the organization section will spell out the EOP’s operational specifics and advise the reader of any functional or hazard-specific annexes and appendixes that are included.
The next step in writing the plan is to carry out a Situation and Hazards Analysis – which examines not only various geographic and political specifics but also: (a) a Hazardentification and Threat Analysis; and (b) a listing of the health and medical assets existing to meet those threats. Here it should be noted that, in many cases, hazard and threat analyses have already been conducted by the local or state Office of Emergency Management, a regional FEMA office, one or more state homeland-security agencies, and sometimes by local universities that already serve the region and/or have been designated as a Homeland Security Center of Excellence or CDC Center for Public Health Preparedness. (If any of the preceding departments, agencies, or other entities have not conducted an assessment – and/or if that assessment is outdated – the writing of the new plan would be aneal way to form or leverage existing partnerships to ensure that the new EOP is collaborative, comprehensive, and totally accurate.)
Special Needs & Special Circumstances Deserve Special Care
It is particularly important, of course, that traditional hazards, such as those listed in the Target Capabilities List, are not the only focus of the hazardsentification and threat analysis – which should also incorporate jurisdiction-specific hazards and threats such as major tourist attractions, the proximity of government research facilities as well as international or coastal borders, and a list of vulnerable populations. Included under the last heading should be the members of at-risk groups living within the plan’s jurisdiction who may have additional needs involving communications, medical care, independent living, supervision, and/or transportation.
The overall organization and various responsibilities of both the lead agency – e.g., the local health department – as well as associated agencies such as hospitals, law enforcement, fire/EMS, and emergency management provide the basis ingredients for the Organization and Assignment of Responsibilities section – which also can be organized by Emergency Support Functions. This section leads into the Concept of Operations, which follows the traditional emergency management paradigm of mitigation, preparedness, response, and recovery.
Although most health departments focus more attention on the preparedness and response phases of a situation, all phases should be addressed in the Concept of Operations section – which in most if not all health-specific emergencies may and should focus on: early detection, plan activation triggers, the deployment and use of rapid response teams, ICS (Incident Command System) activation schemata, the declaration of an emergency, and as much useful information as possible about the location and responsibilities of the Emergency Operations Center. Also included in this section should be such “household” information as the availability of interoperable communication methods and systems, administration – e.g., MOUs, record keeping, financial records – and plan development and maintenance (specifically including a sincere and public commitment to continuous process improvement).
There also must be a section – preferably placed at the beginning or end of the EOP – outlining the relevant local, state, and federal legal documents that give the department the various authorities referenced in the EOP: the state laws, statutes, and executive orders relevant to emergencies, for example; the Robert T. Stafford Disaster Relief and Emergency Assistance Act; and the National Emergencies Act.
The EOP attachments also should include, at a minimum, the following: the department organization chart and contact list; a list of local, state, and regional partners; an acronyms list and glossary; and applicable supplementary documents such as hazard and threat assessments and the specifics of shelter and evacuation operations.
Finalizing and Reviewing the Plan
After developing an acceptable working draft of the EOP, the authors and other participants should: (a) revisit the project management and implementation plan; and (b) forward the plan to a review committee – which should include both internal and external reviewers – to verify the accuracy of the content and determine the feasibility of its implementation during an emergency. The committee also should decide if the revised plan is consistent with existing governing plans and laws.
After these internal review processes have been completed, the EOP must go through the more formal (as well as legally more complicated) approval processes needed and then, finally, receive an official “buy-in” from all levels of leadership involved. History has shown, not incidentally, that common sense and common courtesy prove that it is particularly helpful, when disseminating the plan “in final,” to ask all of the departments and agencies involved to officially sign off that they received, reviewed, and approved the plan.
The final steps of implementation involve ensuring that staff members become operationally familiar with the plan’s contents through training programs and numerous exercises and drills. The training should be mandatory for current staff and required as part of the new employees’ orientation processes. The exercises and training needed can vary in complexity from impromptu drills on sections of the plan ranging from the use of a call-down list, which can happen anytime, to short tabletop exercises, to larger-scale departmental and/or jurisdictional-wide exercises. A combination of training and exercise methodologies will not only help all staff members understand all aspects of the plan but also have the potential to lead to regular reviews and/or revisions.
To briefly summarize: All of the nation’s health departments, whatever their size, should have a well-researched all-hazard plan that can and should be used when preparing for emergency situations. With detailed planning, review, and training, an effective EOP doctrine can be developed and tailored to the particular needs and operations of any given jurisdiction. Finally: Understanding the definition, and being familiar with the many sections of a well articulated EOP, is the first but by no means the last step toward reaching the goal of all-hazard emergency preparedness.
Raphael M. Barishansky, DrPH(c), is a consultant providing his unique perspective and multi-faceted public health and emergency medical services (EMS) expertise to various organizations. His most recent position was as the Deputy Secretary for Health Preparedness and Community Protection at the Pennsylvania Department of Health, a role he recently left after several years. He is also currently a doctoral candidate at the Fairbanks School of Public Health at Indiana University.
Audrey Mazurek, MS, has worked at all levels of government for nearly 20 years in public health and healthcare preparedness, emergency management, and homeland security. She was a program manager with the National Association of County and City Health Officials (NACCHO) Project Public Health Ready program. She supported the U.S. Department of Homeland Security in the development of an accreditation and certification program for private sector preparedness. She also served as a public health emergency preparedness planner for two local public health departments in Maryland, where she developed over 30 preparedness and response plans, trainings, and exercises. She is currently a director of public health preparedness with ICF, primarily supporting the U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response’s (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) program as the ICF program director.