Emergency preparedness refers to precautions taken before an emergency or disaster happens to help lessen damage and effects on people and property. Emergency preparedness is the first step in emergency management. It can be subdivided into two phases, mitigation and direct preparedness.
Emergency preparedness is distinct from emergency response and recovery, which refers to measures taken after an event. It is important to distinguish among emergencies, disasters, and catastrophes, even though the words are often used interchangeably in ordinary speech, because different types of planning and preparation are required to prevent or respond to these situations. The definitions used most often by emergency management professionals are as follows:
- Emergency: A localized unplanned event with the capacity to endanger life or property, disrupt business and other community activities, damage the environment, or threaten public safety, and which requires a comprehensive community-wide response. Examples of emergencies include such events as fires, plane crashes, workplace or school shootings, and storms or other weather events that affect a relatively small area.
- Disaster: A large-scale event that differs from a local emergency in several respects: local organizations lose some of their capacity to respond; a greater degree of coordination among public- and private-sector organizations is needed; and standards of performance change (such as normal speed of response or standards of care). Examples of disasters include chemical spills or explosions; disease epidemics; dam or power plant failures; major floods, tornadoes, or forest fires; and large-scale terrorist attacks. Attacks also can come in the form of cybersecurity, which are attacks on technology, especially critical systems that maintain a country's power grid or communications.
- Catastrophe: Catastrophes are distinguished from disasters in that most or all structures and functions are destroyed or interrupted simultaneously over a wide area; first responders and other personnel are themselves injured or affected by the event; and help from outside the affected area is not immediately available. Examples of catastrophes include major earthquakes followed by tsunamis, acts of warfare involving nuclear weapons, and disease pandemics.
Emergency preparedness entails a cycle of planning, training, and equipping first responders and volunteer emergency workers, stockpiling necessary equipment and supplies, establishing and maintaining an emergency communication system, and taking additional measures that might be needed to prevent, respond to, lessen the impact of, and recover from natural or human-made disasters. In actual practice these stages or phases overlap; emergency preparedness is an ongoing set of activities rather than a final goal.
Mitigation is the first stage or phase of emergency preparedness. It is defined by the Federal Emergency Management Agency (FEMA) as “the effort to reduce loss of life and property by lessening the impact of disasters.” It can also be defined as taking action in the present before a disaster occurs to prevent human and financial losses later. Mitigation is undertaken at the community, state, and federal levels in the United States.
Mitigation has four major aspects:
Community emergency preparedness
- Hazard identification. A hazard is defined as any agent or structure, whether biological, chemical, mechanical, or other, that is likely to cause harm to humans or the environment in the absence of protective measures. Hazards might be either natural or human-made; they include geographic features or weather patterns that increase the risk of natural disasters; methods of transportation (which are all inherently risky); unstable structures (weak dams or bridges, poorly designed buildings, etc.); waste dumps; chemical plants and oil refineries; biological disease agents or vectors; and others. Hazards are sometimes categorized as dormant (potentially dangerous but inactive at present) or active (the hazard is at present causing harm). Hazard identification is the process of detecting and evaluating the natural or human-made hazards present in the local community.
- Risk assessment. Risk assessment is the process of calculating the probability that a specific hazard will endanger the community and the extent of damage that is likely if the hazard becomes active. Risk is defined as the probability that exposure to a hazard will lead to a negative consequence (physical harm or death, property damage). A mathematical equation that is commonly used in risk assessment is as follows: Risk = Hazard x Dose (Exposure).
- Risk reduction. Risk reduction refers to strategies undertaken to lower the chance that a dormant hazard will become active or to remove the hazard altogether. Risk reduction may include building codes, land use regulations, public health surveillance, measures to control air pollution, relocation of hazardous materials, strengthening of bridges and dams, and similar measures.
- Insurance. FEMA provides insurance against flood damage at the state and community level. Individuals and homeowners may purchase insurance to protect themselves against financial loss in the event of illness, injury, or property damage.
FEMA identifies five stages in emergency preparedness at the community level following mitigation and risk assessment:
- Planning. Planning involves establishing procedures for operating during an emergency, including coordinating the activities of such different groups as firefighters, law enforcement, search and rescue personnel, emergency medical technicians, and the like. Planning also includes the identification of schools or other large buildings that could serve as emergency shelters. Another important part of planning is the establishment and maintenance of an effective emergency communication network. The Chemical Safety and Hazard Investigation Board (CSB) has repeatedly found that communication is one of the weakest aspects of many community emergency plans.
- Organizing and equipping. This stage involves the purchase and maintenance of emergency response equipment and the stockpiling of food, water, medicines, vaccines, batteries, generators, and other supplies that are usually required in emergencies.
- Training. Training involves providing first responders, civilian volunteers, military personnel, public health officials, and others with the information they need to respond effectively to different types of emergencies. The Centers for Disease Control and Prevention (CDC) classifies emergencies under six major categories: natural disasters and severe weather; bioterrorism; chemical emergencies; extreme heat and wildfires; mass casualty incidents (explosions, blasts, terrorist attacks); and radiation emergencies. Each of these requires specific understanding of the types of injuries most likely to result from the emergency, the possible scale of the emergency, and the most effective ways to coordinate responses to the emergency. There are training institutes at the national level for some groups of emergency workers, such as the National Fire Academy and the Emergency Management Institute.
- Exercising. Exercising refers to regularly scheduled events at the local and regional level in which first responders and civilian volunteers practice and rehearse lifesaving skills, search and rescue procedures, triage and trauma treatment, use of firefighting and other emergency equipment, and other skills that are needed in the event of an actual emergency. The goal is for these skills to become virtually automatic. Simulated accidents and emergencies are commonly included in these exercises.
- Evaluating and improving. This stage involves regular inspection of emergency equipment and facilities as well as evaluation of training programs and postevent critiquing of practice exercises.
Household emergency preparedness
Military personnel involved in emergency preparedness often include units of the National Guard as well as members of the various branches of the armed forces from nearby bases or installations. They may serve as instructors as well as participants in training exercises and CERT programs.
- Get a kit. Sometimes called a 72-hour kit, the kit is a collection of food, water, and other supplies sufficient for survival for three days. FEMA recommends the following contents for the kit: one gallon of water per person per day for three days, nonperishable food items for each person for three days, a battery-powered or hand-crank radio and extra batteries, a flashlight for each person and extra batteries, a cell phone and charger, first aid kit, whistle, filter mask or cotton T-shirt for each person, moist towelettes, garbage bags and plastic ties, wrench or pliers, manual can opener, plastic sheeting and duct tape, important family documents, daily prescription medicine, emergency blankets, a map of the area, and special-needs items for infants, pets, and disabled family members.
- Make a plan. Planning includes discussing emergency plans with all family members on a regular basis, and assigning roles and responsibilities; setting up places to meet if the family is separated during an emergency; practicing evacuating (including traveling the evacuation route twice a year) if evacuation is necessary; setting up a safe room (a room that is tornado- or hurricane-proof) in the house if sheltering in place is necessary; and deciding on a contact person outside the area who can be notified in the event of an emergency.
- Be informed. This step includes familiarizing family members with local communications networks and procedures for notifying residents of an emergency; knowing the differences between various types of weather alerts and watches; finding out what (if any) hazards are present in the area; and ideally, having at least one member of the family trained in first aid and CPR.
The Red Cross and CDC offer additional information about emergency preparedness for vulnerable family members, such as the elderly, children, people with disabilities, and pets.
Public health role and response
The effects of emergency preparedness on public health include closer coordination of local boards of public health and public health workers with emergency management experts and first responders. Increasing numbers of public health personnel participate in CERT programs and region-wide disaster simulations. Courses on emergency preparedness are offered in most schools of public health, and there were as of 2018 several public health journals in the field, such as Disaster Medicine and Public Health Preparedness, published by the American Medical Association.
Efforts and solution
One important aspect of the relationship between public health and emergency preparedness is the matter of ethics. The health emergencies associated with disasters require triage and setting priorities and might require overriding the rights of individuals and property owners. Given the American tradition of respect for the individual, public health workers should take the ethical and social values of a community into account before approving coercive measures; should identify the persons or groups most likely to bear the burdens of government use of power or coercion; and monitor the use of power when emergency plans must be carried out.
In the field of public health, training programs and communications networks specific to the CDC and the Food and Drug Administration (FDA) help to ensure emergency preparedness. The CDC website contains information regarding programs in disease surveillance, emergency preparedness for healthcare facilities, and training in risk communication and trauma management. The Health Alert Network (HAN) is a national program that provides emergency alerts, advisories, updates, and other public health-related information to state and local public health officers and epidemiologists.
The FDA Center for Drug Evaluation and Research (CDER) assists public health workers in preparing medicines and vaccines against various forms of bioterrorism, radiation emergencies, and emerging diseases. The FDA also provides information about medication availability and safety during human-made and natural disasters, and coordinates responses to emergencies requiring large amounts of prescription medications or other regulated products. The National Cybersecurity and Communications Integration Center is the nation's coordinator of cyber defense, operational response, and preparedness for cyberattacks.
McKinney, Suzet, and Mary Elise Papke. Public Health Emergency Preparedness: A Practical Approach for the Real World, 3rd ed. Nurlington, MA: Jones and Bartlett Learning, 2018.
Makin, S., L. Smith, and K. McDevitt. “How a Major Incident Plan Can Be Used in an Acute Care Setting.” Journal of the Royal Army Medical Corps. Published electronically April 6, 2018. doi: 10.1136/jramc-2018000926.
TariVerdi, M., E. Miller-Hooks, and T. Kirsch. “Strategies for Improved Hospital Response to Mass Casualty Incidents.” Disaster Medicine and Public Health Preparedness 19 (March 2018): 1–13.
Centers for Disease Control and Prevention (CDC). “Emergency Preparedness and Response.”
(accessed April 11, 2018).
American Red Cross, 431 18th St. NW, Washington, DC, 20006, (202) 303-4498, (800) 733-2767),
Chemical Safety and Hazard Investigation Board, 1750 Pennsylvania Ave. NW, Ste. 910, Washington, DC, 20006, (202) 261-7600, Fax: (202) 261-7650,
Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD, 20993-0002, (888) 463- 6332,
National Institute of Environmental Health Sciences, 111 T. W. Alexander Dr., Durham, NC, 27709, (919) 5413345, Fax: (919) 541-4395,
This information is not a tool for self-diagnosis or a substitute for professional care.
Rebecca J. Frey, PhD
Revised by Teresa Odle, BA, ELS