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U.S. Department of Health and Human Services

Coalition Emergency Management Program

The backbone of the healthcare coalition (Tier 2) is a comprehensive EMP that formally defines the mitigation, preparedness, response, and recovery efforts of participating HCOs. The preparedness and response architecture of the coalition EMP differs significantly from that found in individual HCOs (Tier 1) and at the jurisdiction level (Tier 3). For example, the Tier 2 leadership during an emergency or disaster response does not have an incident commander's decision authority for the coalition. Instead, the leadership acts to ensure optimal coordination and information sharing among participants. In this fashion, the coalition (Tier 2) functions like a MACS. If leadership decisions are necessary, the MAC Group component of Tier 2 should be activated.

Several important considerations for the coalition EMP include:

  • Establish an emergency management committee that includes representatives of each participating facility. These individuals should be knowledgeable in their respective organization's EMP and Emergency Operations Plan (EOP).
  • Address relevant issues related to mitigation, preparedness, response, and recovery. An example would be clearly defining the processes for how the Tier 2 leadership (the Tier 2 MAC Group) will be designated and activated during an incident response, or identifying how major decisions will be made on issues that affect all coalition participants. The MACC component must also be clearly delineated, for both the "clearinghouse" information function, as well as mutual aid and other important coordination tasks. This involves specifying during preparedness planning which personnel will perform these functions, the location where coordination will occur, the procedures for receiving, processing, and disseminating information, and the processes by which mutual aid will occur.
  • Develop formal processes to administer the coalition EMP and to conduct emergency management committee meetings:
    • The committee should meet regularly (at least once a month during startup and at times of high threat, or immediately after a response to receive input from all participants).
    • An agenda should be distributed to participants before all meetings, and minutes should be recorded for future reference.
    • An official vote should be taken to decide issues that affect all members.
    • Meeting locations may be rotated among participating HCOs to promote familiarity with each other's response plans and facilities, to encourage sharing of best practices, and to distribute costs.
  • Involve jurisdictional (Tier 3) authorities (e.g., EMS, public safety, emergency management, public health) in Tier 2 proceedings to ensure a close partnership between Tiers 2 and 3. Similarly, a Tier 2 liaison should participate in jurisdictional preparedness meetings and represent the Tier 2 coalition in the jurisdiction's EOC and (ideally) within the Tier 3 incident management team (if one exists separate from the EOC).

The coalition EMP should be sponsored by an established entity that can provide the administrative infrastructure (clerical support, meeting space, etc.) for the EMP. This "sponsor" must promote equal participation among member HCOs and should not convey a competitive business advantage to any coalition member. Potential sponsors may include local hospital associations, local or regional EMS councils, and Local Emergency Planning Committees (LEPCs).[5]

The Tier 2 coalition may include HCOs from beyond a single jurisdiction. This may be desirable especially in rural areas, where health and medical assets are scattered, or in complex metropolitan areas with overlapping hospital catchment areas. In such cases, the Tier 2 coalition should closely coordinate its preparedness planning with each Tier 3 jurisdiction covered by the coalition's resources. During response, the jurisdiction that is primarily responsible for the medical incident response (i.e., for the victims generated within its boundaries) would be the primary support to the Tier 2 coalition, ideally in close coordination with other involved jurisdictions.

It is important for the coalition to retain the responsibility and authority for the Tier 2 response infrastructure. This helps to maintain the private sector perspective and ensures that the coalition has priority access to resources (e.g., radio, telecommunications) during response

Early in the development of the Washington, DC Hospital Association-based Hospital Mutual Aid System (HMAS), the District Government offered the use of its 800-megahertz radio system and the Mayor's conference-call resource to hospitals for use in times of crisis. HMAS participants declined, recognizing the need to establish communications to which HCOs always had primary access, regardless of the evolving circumstances. The HMAS low-tech radio system worked exceptionally well on 9/11, when other radios were committed or overwhelmed. The privately established conference-call service also worked well during subsequent weeks of the 9/11 recovery effort and the anthrax crisis.[6]

For reasons explained earlier (section 1.3.1), preparedness committees, processes, and procedures should be distinguished from those used during response. For example, the Tier 2 emergency management/preparedness committee would not be the appropriate structure for managing Tier 2 during an actual event.


  1. LEPCs are mandated by the Superfund Amendments and Reauthorization Act (SARA Title III) for communities with risk of hazardous material incidents from local industry.
  2. Gursky, E, Inglesby, T V, and O'Toole, T. "Anthrax 2001: Observations on the Medical and Public Health Response." Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, Volume 1, Number 2, 2003; 97-110.

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  • This page last reviewed: February 14, 2012