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U.S. Department of Health and Human Services

2.1 The Healthcare Coalition Overview

The Healthcare Coalition is useful for all phases of Comprehensive Emergency Management, but its primary mission should be to support healthcare organizations during emergency response and recovery. An element of this mission is promoting integration of Coalition member organizations into the broader community response.

In emergency management, the response organization is typically described in an Emergency Operations Plan (EOP). The comprehensive EOP incorporates a System Description, which presents the elements of the response organization (including an organizational chart) and how they are related to each other. This chapter presents a System Description for the Healthcare Coalition response organization based on MAC System concepts summarized by NIMS (see Sections 1.4 and 1.5).

2.1.1 Healthcare Coalition Response Objectives

The specific objectives for a Healthcare Coalition during emergency response and recovery may vary from one Coalition to another. It is up to the healthcare system planners to establish what the Coalition should achieve during response. Therefore, response objectives may be simple or complex depending upon the individual Coalition. Sample response objectives for a robust Healthcare Coalition include:

  • Facilitate information sharing among participating healthcare organizations (Tier 1) and with jurisdictional authorities (Tier 3) to promote common situational awareness.[1]
  • Facilitate resource support by expediting the mutual aid process or other resource sharing arrangements among Coalition members, and supporting the request and receipt of assistance from local, State, and Federal authorities.
  • Facilitate the coordination of incident response actions for the participating healthcare organizations so incident objectives, strategy, and tactics are consistent for the healthcare response.
  • Facilitate the interface between the Healthcare Coalition and relevant jurisdictional authorities (Tier 3) to establish effective support for healthcare system resiliency and medical surge.

2.1.2 Healthcare Coalition Scope

Coalition Participants

The Healthcare Coalition may include the full range of healthcare assets that provide “point of service” medical care and other medically related services during a mass casualty and/or mass effect incident. Depending on how a particular Healthcare Coalition is constructed, this may include hospitals, community health centers, integrated healthcare systems, private physician offices, outpatient clinics, dialysis and other specialty treatment centers, and long-term care facilities (nursing homes, other skilled nursing facilities), and home care/hospice.

Coalition Activities

During emergency response, the Coalition’s response organization conducts a range of activities to achieve its stated objectives. Some examples of possible activities for the Coalition’s response organization are provided below.

  • Provide notification to member organizations that an actual or potential incident is developing. This allows for very rapid response (i.e., within minutes) on a 24/7 basis. The notification threshold is set by Coalition member organizations such that if one member knows an incident is happening, all learn of it rapidly.
  • Provide a mechanism to rapidly disseminate information from Incident Command and other authorities to Coalition member organizations so that they can effectively and safely participate in emergency response.
  • Rapidly disseminate information from Coalition member organizations to Incident Command and other authorities, at their request.
  • Convene (often virtually) specific personnel (senior executives, technical specialists, etc.) from Coalition member organizations at the request of incident command authorities to discuss strategic issues or make policy recommendations related to the healthcare response.
  • Help Coalition member organizations obtain incident-related information that is not otherwise readily available. The Coalition response organization can serve as the official representative of member organizations to seek incident details that are important to the healthcare response.
  • Disseminate resource needs to member organizations and help match organizations that request mutual aid or other assistance with organizations that can provide the needed assistance.
  • Facilitate the coordination of response actions among member organizations if this is requested by the Coalition’s responding members and/or by jurisdictional authorities.

Coalition Authorities

The Healthcare Coalition’s authority to operate is based on the voluntary endorsement and support of its member organizations and relevant Jurisdictional Agencies in its geographic area. It is primarily responsive to its member organizations’ concerns.

The Healthcare Coalition’s member organizations are responsible to the Jurisdictional Agency(s) in the geographic area in which each operates. Thus, if the Healthcare Coalition spans the borders of multiple jurisdictions, the Coalition’s response organization must coordinate closely with all relevant Jurisdictional Agencies. The Coalition’s actions supplement the authority of the local and State governments that are responsible for the geographic area covered by the Healthcare Coalition. In some situations, the Jurisdictional Agency may issue a “Delegation of Authority” that authorizes the Coalition on behalf of the jurisdiction to address medical and public health related response matters.

Because of these considerations, the emergency response and recovery authority of the Healthcare Coalition may be limited, but this does not obviate the importance of the Coalition’s mission.

2.1.3 Healthcare Coalition Assumptions

The design and function of the Healthcare Coalition response organization is based on the following assumptions:

  • Participating organizations maintain their respective decision-making sovereignty during incident response, except in unusual circumstances that warrant the implementation of local or state health authorities (e.g., enactment of isolation or quarantine).
  • Participating organizations determine individually how they will respond to an incident and whether they will activate any emergency response procedures. The Coalition does not supplant this responsibility.
  • The Healthcare Coalition response organization may convene (often virtually) representatives from its member organizations to discuss response issues. Decisions made by the Coalition during incident response are made on a consensus basis or are recommendations only.
  • Healthcare Coalition partners will work together for a common good despite day-to-day competition, especially if a fair platform with transparent decision-making is provided for this functional relationship.
  • Support from the administrative leadership of each participating organization can be achieved with proper attention to the design and function of the Coalition.
  • The use of NIMS-consistent concepts and procedures will promote integration with public sector response efforts; NIMS consistency is also required to be eligible for Federal funding.
  • During emergency response, personnel staffing the Healthcare Coalition Response Team (HCRT) are still employed by their “home” organization and often are responsible for some element of their home organization’s response. Therefore, HCRT staffing must be as lean and efficient as possible. In some Coalitions, this may mean enabling HCRT staff to conduct response tasks remotely rather than from one centralized location. In addition, personnel from the most affected organizations should be able to rapidly “hand off” Coalition duties to other qualified personnel.



  1. Throughout this handbook, emphasis is placed on the need for the Healthcare Coalition to integrate with public sector agencies at the local jurisdictional level (Tier 3). In areas of the country with limited or no local public health capabilities, the Healthcare Coalition may coordinate directly with the relevant State authorities (Tier 4).

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  • This page last reviewed: February 14, 2012