[ BASED ON DATA AS OF DECEMBER 31, 20 22]
2023 National Preparedness Report 

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Foreword 

2023 National Preparedness Report 1 

I am pleased to announce the release of the 2023 National Preparedness Report (NPR). The 2023 

NPR is the 12th report released by the Federal Emergency Management Agency (FEMA) on the state 

of the nation’s preparedness for all threats and hazards. Since FEMA began reporting over a decade 

ago, disasters like hurricanes Sandy, Irma, Maria, Harvey, and Ian, the coronavirus disease 2019 

(COVID-19) pandemic, the 2020 California wildfires, and the 2023 Hawaii wildfires have disrupted the 

lives of Americans across the nation and drastically increased the demands placed on the emergency 

management community. Climate change has led to more frequent and severe weather including heat 

and cold waves, hurricanes, droughts, and wildfires, among other hazards. In the face of these 

challenges, emergency managers must continue to adapt, forge new partnerships to mitigate threats

and hazards, and anticipate post-disaster challenges to help individuals and communities.

This year’s report provides a data-driven picture of 

national preparedness and emergency 

management trends. This includes focused 

discussions on four core capabilities (Fire 

Management and Suppression; Logistics and 

Supply Chain Management; Public Health, 

Healthcare, and Emergency Medical Services

[EMS]; and Long-Term Vulnerability Reduction) that 

continue to challenge emergency managers, as 

well as concrete recommendations that partners 

and stakeholders across the whole community can 

take to increase their resilience. In our new normal, 

where disasters are more commonplace and 

devastating than ever, we must all identify targeted 

hazard mitigation investments, leverage historic 

and future risk data, and provide equitable disaster 

risk reduction for socially vulnerable populations.

Though these efforts can sometimes be challenging 

to implement in the short-term, they will lower the

nation’s collective risk and bolster our long-term resiliency. We have a responsibility to one another to 

ensure everyone has the help they need before, during, and after disasters. While work remains, I am 

confident that we will continue to grow ever more resilient as a nation. 
Introduction & Executive Summary

2023 National Preparedness Report 2 

Through the NPR, FEMA assesses the nation’s emergency management posture and identifies 

challenges and opportunities for improvement. FEMA has developed the NPR for the past eleven years 

as an annual requirement of Presidential Policy Directive 8 and in alignment with the Post-Katrina 

Emergency Management Reform Act. The NPR provides partners across the nation with insights about 

risks and associated capabilities to support decisions about program priorities, resource allocations, 

and community actions. Whole community partners are the intended audience of the NPR—including 

all levels of government, individuals and families, community organizations and nonprofits, and 

businesses.

The 2023 NPR outlines the nation's progress towards achieving the National Preparedness Goal of “A 

secure and resilient nation with the capabilities required across the whole community to prevent, 

protect against, mitigate, respond to, and recover from the threats and hazards that pose the greatest 

risk” as well as recommendations for closing remaining gaps. This annual report draws upon various

data sources, including open-source data, FEMA and community preparedness data sets, and

submissions from federal departments and agencies. FEMA also recognizes critical infrastructure 

owners and operators as important partners in emergency management and community resilience,

but did not collect insights into preparedness from this group, as such research presently extends

beyond the scope of this report.

The NPR covers the domestic preparedness and emergency management challenges facing the 

nation. For information regarding international threats and hazards, refer to the 2023 Office of Director 

of National Intelligence Annual Threat Assessment. For information regarding homeland security 

threats and hazards, refer to the 2023 Quadrennial Homeland Security Review and the Department 

of Homeland Security’s (DHS) 2023 Homeland Threat Assessment. 

The following sections provide an executive summary of the 2023 NPR key findings, 

recommendations, and structure.

1. Findings

The nation continues to face several challenges and an evolving threat and hazard landscape, 

including:

Increasing Frequency, Severity, and Cost of Disasters: From January 2020 to December 2022, 60

climate-related disasters caused 1,460 fatalities and 2,939 injuries.1,2 These disasters have all

cost at least $1 billion each, marking a significant increase in costly climate-related disasters from 
 

2023 National Preparedness Report 3 

decades prior.1 Calendar year 2022 accounted for 18 climate-related disasters that cost at least 

$1 billion.3 Additionally, in 2016 at the peak of hurricane season, FEMA was managing 30 major 

disasters in 18 joint field offices (JFO). At the same point in 2023, FEMA was managing over twice 

the number of major disasters (i.e., 71) in 25 JFOs. FEMA is now in its sixth year of operating with 

higher average daily deployments, which have doubled from 3,331 responders pre-2017, to 7,113 

responders post-2017.

High Community-Level Risk: In 2022, communities identified cyberattacks, pandemics, and floods

as most likely to occur and cyberattacks, pandemics, and earthquakes as most stressful for one 

or more capabilities.4 In higher-risk areas throughout the nation, communities report lower target 

achievement in capabilities like Long-Term Housing, Relocation Assistance, and Community 

Sheltering than the rest of the nation.4 Compounding this finding, these communities’ most 

stressing natural hazards (i.e., earthquakes, wildfires, and floods) significantly impact disaster 

survivors’ access to housing or shelter.

Ongoing Individual and Household Preparedness Gaps: The 2022 National Household Survey on 

Disaster Preparedness found that 42 percent of respondents plan to prepare for identified threats 

and hazards in the future but have not started.5 The percentage of survey participants indicating 

they did not intend to prepare decreased from 17 percent in 2017 to 9 percent in 2020 but 

rebounded to 14 percent in 2022.5

Lack of Standardized Building Code Adoption: The inconsistent adoption of building codes is one 

of the most significant factors that compounds risk and increases costs from natural hazards. Two 

out of three communities in the United States need to incorporate the latest building codes.6

However, since the federal government does not have the authority to enforce building codes 

outside of tying incentives for adoption to federal funding requirements, and since no federal 

agency is responsible for administering building codes at the national level, the responsibility for 

adopting the latest building codes falls to state, local, tribal, and territorial (SLTT) governments.7

This decentralization results in a wide variation in the adoption of model building codes and 

retention of hazard-resistant provisions in these model codes, code enforcement and 

administration mechanisms, and funding for enforcement, administration, outreach, and support.7

2. Recommendations

The whole community can drive resilience in the face of our nation’s evolving threat and hazard 

landscape through the following actions:8

Target Investments towards Particular Core Capabilities and Mission Areas: In the Response 

mission area, communities report low levels of grant investment (less than $7 million) and lower 

target achievement (less than 65 percent) in Mass Care Services and Logistics and Supply Chain 

Management. Communities also consider Mass Care Services a high priority capability. These

capabilities, along with three of the four Recovery core capabilities, fall within these ranges and 

may warrant that communities increase grant investments.

Reduce All-Hazards Challenges through Targeted Actions and Increased Coordination: These

include expanding guidance on addressing climate impacts and conducting educational 
 

2023 National Preparedness Report 4 

awareness campaigns for SLTT governments to help share existing resources for building code 

and infrastructure upgrades, cybersecurity, and training. Incorporating the needs of individuals 

with disabilities, older adults, and individuals with limited English proficiency, limited access to 

transportation, and limited access to financial resources, among others, remains essential to 

ensuring equitable access to disaster risk reduction resources and advancing environmental 

justice as a core part of disaster preparedness. In addition, federal agencies’ goals should align to 

and support long-term mitigation efforts addressing communities’ top five most challenging 

threats and hazards: cyber-attacks, pandemics, floods, active shooters, and earthquakes.4

Address National Gaps to Prepare for Catastrophic Disasters: Through the National Stakeholder 

Preparedness Review, FEMA has drawn qualitativei conclusions about the nation’s capability gaps 

and ability to manage catastrophic disasters and their impacts. These steps include investing more 

in coordination and communication systems with private sector entities, improving federal

interagency coordination and data collection, providing systems for sharing data across the 

government, and increasing collaboration opportunities with SLTT governments, such as through 

more frequent, higher-quality exercises.

The National Climate Resiliency Framework and Defining Resilience 

The 2023 National Climate Resiliency Framework defines resilience as “the ability to prepare for 

threats and hazards, adapt to changing conditions, and withstand and recover rapidly from 

adverse conditions and disruptions.”8 The Framework outlines six key objectives and actionable 

strategies to enhance and expedite progress in the realm of climate resilience:

• Embed climate resilience into planning and management.

• Increase resilience of the built environment to both acute climate shocks and chronic 

stressors.

• Mobilize capital, investment, and innovation to advance climate resilience at scale. 

• Equip communities with information and resources needed to assess their climate risks 

and develop the climate resilience solutions most appropriate for them.

• Protect and sustainably manage lands and waters to enhance resilience, while providing 

numerous other benefits.

• Help communities become not only more resilient, but also more safe, healthy, equitable, 

and economically strong.

3. Report Structure

The 2023 NPR summarizes the progress made towards building and sustaining the capabilities 

required to prevent, protect against, mitigate, respond to, and recover from the threats and hazards 

that pose the greatest risk to the nation. This annual report offers practical insights into preparedness 

and capabilities at the federal, state, local, tribal, and territorial levels to support decisions about 

program priorities, resource allocations, and actions for increasing whole community resilience. The 
2023 National Preparedness Report 5 

NPR pulls from open-source data, FEMA community preparedness data, and a federal interagency 

data call with submissions from departments and agencies across the federal government.

The 2023 NPR covers calendar year 2022 and builds on content from previous NPRs to analyze trends 

over time. The report contains the following key sections:

A Risks section that outlines the nation’s most challenging threats and hazards, high-risk community 

target achievement, and levels of risk across the country.

A Capabilities section that describes trends at the individual and community levels based on data from 

the 2022 National Household Survey on Disaster Preparedness, Threat and Hazard Identification and 

Risk Assessment (THIRA), Stakeholder Preparedness Review (SPR), and National Stakeholder 

Preparedness Review (National SPR).

A Focus Areas section that examines a subset of core capabilities chosen for discussion based on 

preparedness assessment findings developed using THIRA/SPR and National SPR information. These

four areas continue to challenge emergency management partners working to build and sustain 

capability and capacity. These focus areas include:

 Fire Management and Suppression

 Logistics and Supply Chain Management

 Public Health, Healthcare, and EMS

 Long-Term Vulnerability Reduction

Each Focus area contains more detailed information on risk, capabilities, and management 

opportunities related to the core capability, which whole community partners can utilize to develop 

strategies to reduce risk and bolster disaster resilience.

A Conclusion that summarizes the report’s key findings and recommendations.
2023 National Preparedness Report 6 

Table of Contents

Foreword ................................................................................................................................... 1

Introduction & Executive Summary .......................................................................................... 2

1. Findings ................................................................................................................................... 2

2. Recommendations .................................................................................................................. 3

3. Report Structure ...................................................................................................................... 4

Risks .......................................................................................................................................... 7

4. Most Challenging Threats and Hazards .................................................................................. 9

5. Risk and Social Vulnerability Intersections .......................................................................... 11

Capabilities.............................................................................................................................. 13

6. Individual and Household Preparedness ............................................................................. 13

7. Community Preparedness .................................................................................................... 15

8. National Preparedness ......................................................................................................... 16

Focus Areas ............................................................................................................................. 19

9. Fire Management and Suppression ..................................................................................... 19

10. Logistics and Supply Chain Management ............................................................................ 23

11. Public Health, Healthcare, and Emergency Medical Services .............................................. 28

12. Long-Term Vulnerability Reduction ...................................................................................... 33

Conclusion ............................................................................................................................... 40

References .................................................................................................................................. i
Risks

2023 National Preparedness Report 7 

Key Findings

• The nation has experienced a rise in the frequency, severity, and cost of climate-related 

disasters. From January 2020 to December 2023, 60 climate-related disasters caused 1,460

fatalities and 2,939 injuries.1,2 These climate-related disasters have all cost at least $1 billion 

each, marking a significant increase in costly disasters from decades prior.1 Calendar Year 

2022 accounted for 18 climate-related disasters that cost at least $1 billion.3

• In 2016 at the peak of hurricane season, FEMA was managing 30 major disasters in 18 JFOs. 

At the same point in 2023, FEMA was managing over twice the number of major disasters (i.e., 

71) in 25 JFOs. FEMA is now in its sixth year of operating with higher average daily deployments, 

which have doubled from 3,331 responders pre-2017, to 7,113 responders post-2017.

• In 2022, communities most frequently reported cyberattacks, pandemics, and floods as most 

likely to occur, and cyberattacks, pandemics, and earthquakes as most stressing for one or 

more capabilities.4

• Through 2022 THIRA/SPR submissions, Western communities have identified specific 

challenges related to long-term housing, relocation assistance, and community sheltering. 

These challenges are noteworthy because Western communities report lower target 

achievement levels in these critical areas than other communities across the nation.4

Additionally, the Western U.S. faces unique natural hazards, including earthquakes, wildfires, 

and floods, which significantly impact disaster survivors' access to housing and shelter.4 This 

assessment focuses on the Western U.S. as a case study. While this assessment focuses on 

the Western U.S., it may not fully represent the broader housing issues faced by communities 

across the nation.4

In 2022, the President declared 47 major climate-disasters, 10 emergencies, and 33 Fire 

Management Assistance Grants (FMAG).9 These 57 major climate-related disasters and emergencies 

resulted in 474 deaths and a total cost of $165 billion—the third costliest year on record behind 2005 

and 2017 (Figure 1).1
 

2023 National Preparedness Report 8 

Figure 1: The number of billion-dollar climate-related disasters (adjusted by the Consumer 

Price Index, “a measure of the average change over time in the prices paid by urban 

consumers for a market basket of consumer goods and services. Indexes are available for the 

U.S. and various geographic areas”) in the U.S. from 1980-2022. The y-axis indicates the 

number of disasters and the x-axis indicates the calendar year.1 The data highlighted is 

current as of 9/11/2023. 

In 2022, the National Oceanic and Atmospheric Administration (NOAA) identified that 18 incidents

resulted in losses exceeding $1 billion each.1,ii These 18 incidents included one drought, one flood, 

one wildfire, one winter storm, three tropical cyclones, and 11 severe storms (Figure 2).1 NOAA 

reported that from 2020 to 2022, 60 climate-related disasters caused 1,460 fatalities and 2,939

injuries.1,2 These disasters have all cost at least $1 billion each, marking a significant increase in costly 

climate-related disasters from decades prior.1 Previous decade totals for billion-dollar climate-related 

disasters (inflation-adjusted) were 33 (1980-1989), 57 (1990-1999), 67 (2000-2009), and 131 

(2010-2019). Over these first three years of the current decade (2020-2029), the United States has 

already surpassed the total number of billion-dollar disasters from each decade between 1980 and 

1999. Additionally, over the last three years (2020-2022) the United States has already experienced 

approximately half of the total number of billion-dollar climate-related disasters that occurred in the 

previous decade (2010-2019).
 

2023 National Preparedness Report 9 

Figure 2: 2022 billion-dollar weather and climate disasters.1

Additionally, in 2016 at the peak of hurricane season, FEMA was managing 30 major disasters in 18 

JFOs. At the same point in 2023, FEMA was managing over twice the number of major disasters (i.e., 

71) in 25 JFOs. FEMA is now in its sixth year of operating with higher average daily deployments, which 

have doubled from 3,331 responders pre-2017, to 7,113 responders post-2017.

FEMA leverages data from the THIRA and SPR process to better understand the complex challenges 

communities face before, during, and after disasters, as well as their capability to manage them.iii The 

following sections explore key findings related to risk from the THIRA/SPR data, as well as from FEMA’s 

National Risk Index (NRI). 

4. Most Challenging Threats and Hazards

From 2019 to 2022, the five threats and hazards communities reported as most likely included 

cyberattacks, pandemics, floods, active shooter incidents, and earthquakes.4 Starting in 2020, 

communities reported pandemics as a likely hazard more often than flooding and earthquakes. 

Communities also report on the threats and hazards that are most stressing for their capabilities.4

From 2019 to 2021, communities chose cyberattacks and flooding as the two most stressing threat 

and hazard types for their capabilities, while in 2022, communities chose cyberattacks and 

pandemics.4
 

2023 National Preparedness Report 10 

THIRA/SPR Terminology 

• Threat: Indication of potential harm to life, information, operations, the environment, and/or 

property.4

• Hazard: A source or cause of harm or difficulty. A hazard also differs from a threat in that a threat 

is directed at an entity, asset, system, network, or geographic area. A hazard is not directed.4

• Core Capability: The distinct critical elements necessary to achieve the National Preparedness 

Goal. There are 32 core capabilities organized under five mission areas.4

• Core Capability Target: A goal to manage the impact of a threat or hazard in a desired amount of 

time that is associated with each core capability. Communities create core capability targets using 

standardized target language.4 Core capability targets are used interchangeably with “capability 

goals” throughout this report.

• (Capability) Target Achievement: The extent to which a community has achieved (as a percentage) 

a core capability target. This report uses the terms “high-achieving capabilities” and “low-achieving 

capabilities” to indicate whether a community is closer to or further away from achieving a core 

capability target.4

• High-Risk Community: A community that is more vulnerable to, and less prepared for, the impacts 

of disasters, as assessed through FEMA’s National Risk Index. Conversely, a low-risk community is 

less vulnerable and more prepared.10

Figure 3 depicts the most challenging threats and hazards for communities. A total of 137 

communities reported this data through THIRA/SPR in 2022.4

Figure 3: Number of communities identifying specific threats and hazards as most likely to occur 

(blue) and most stressing (orange)—organized from greatest cumulative total (likely + stressing) to 

least—through the THIRA/SPR process in 2022.iv 
 

2023 National Preparedness Report 11 

2022 THIRA/SPR data shows regionalv differences in the types of disasters communities report as 

most challenging. For example, communities across the West most frequently reported wildfires, 

cyberattacks, and earthquakes as their top threats and hazards of concern. Communities in the 

Northeast and South most frequently reported cyberattacks, pandemics, and hurricanes/typhoons, 

whereas Midwest communities most frequently reported cyberattacks, tornadoes, and pandemics as 

their top threats and hazards of concern. Additionally, with regard to the lowest achieving capability 

targets, communities in the West reported being further away from their capability goals than 

communities in the South, Midwest, and Northeast (Figure 4). 

 

Figure 4: Target achievement percentages across communities in the Western United States 

(left) and for all other communities besides those in the Western United States (right) 

associated with the lowest achieving capability targets of Long-Term Housing, Resource 

Restoration, Relocation Assistance, Public Risk Awareness, and Community Sheltering. Dark 

gray indicates 0-29 percent of target achievement; a greater percentage of communities in the 

Western United States reported this level of target achievement. 

5. Risk and Social Vulnerability Intersections

Every community across the nation includes populations that are more vulnerable to the impacts of 

disasters than others. Social factors such as high rates of poverty, lack of access to transportation, 

and limited housing options already make life difficult for individuals living in these communities. The 

impacts of disasters compound these vulnerabilities, causing additional difficulty for these 

communities as they work to respond to and recover in the aftermath of catastrophe. Emergency 

managers should consider the intersection between risk and social vulnerability to ensure the meeting 

of all people’s needs equitably.

The NRI provides insights into which areas of the country (at the census tract level) are more vulnerable 

and less prepared based on the potential environmental, social, and economic effects of 18 natural 

hazards.10 According to the NRI, many very high-risk census tracts are heavily concentrated in the 
2023 National Preparedness Report 12 

Western United States due to high population density along coastlines, high expected annual

economic losses (in dollars) as a result of natural hazards, and elevated levels of social vulnerability.10

In this region, communities often cite wildfires and earthquakes as their most likely and stressing

natural hazards within their THIRA/SPR submissions.4 Wildfires and earthquakes can significantly 

impact housing, leading many disaster survivors to become displaced or require alternative shelter, 

which can be a challenging prospect for communities in the Western United States that already 

possess lower capability compared to the rest of the country in areas like long-term housing, 

community sheltering, and relocation assistance.4

The South, Midwest, and the states of Florida and Hawaii face similarly high-risk levels as the Western 

United States (Figure 5).10 These high-risk rankings are attributable to natural hazards such as 

hurricanes/typhoons, tornadoes, and severe weather (e.g., strong winds, heat waves, and winter 

weather), along with the high population density along coastlines and elevated levels of social 

vulnerability in these regions.10 Emergency managers across the whole community can use the NRI 

and THIRA/SPR data to target support and investments to reduce risk, lessen the impact of disasters, 

and improve resilience. Emergency managers may also use FEMA's Resilience Analysis and Planning 

Tool and Climate Risk and Resilience Tool to assess community preparedness against several 

resiliency indicators and climate change data.11 When merged, these tools can provide comprehensive 

climate analysis contextualized at the community level.11

 

Figure 5: Variation in risk across the U.S. by census tract, based on March 2023

data. A color scale denotes levels of risk, with dark red indicating very high-risk

areas, yellow indicating relatively moderate risk areas, and dark blue indicating 

very low risk areas.vi

National Risk Index
Capabilities

2023 National Preparedness Report 13 

• According to data from FEMA’s 2022 National Household Survey on Disaster Preparedness, 42 

percent of respondents intend to prepare for identified threats and hazards sometime in the 

future but have not yet started, and 14 percent do not intend to prepare.5 The percentage of 

survey participants indicating they did not intend to prepare decreased from 17 percent in 

2017 to 9 percent in 2020 but rebounded to 14 percent in 2022.5

• Communities report devoting most of their grant funding to specific core capabilities, including

Planning, Operational Coordination, Physical Protective Measures, Intelligence and Information 

Sharing, and Interdiction and Disruption. Communities report high levels of funding and 

capability overall in the Cross-Cutting, Protection, and Response mission areas.4

• In the Response mission area, communities report low levels of grant investment (less than $7 

million) and lower target achievement (less than 65 percent) in Mass Care Services and 

Logistics and Supply Chain Management. Communities also consider Mass Care Services a 

high priority capability. These capabilities and three of the four Recovery core capabilities fall 

within these ranges and may warrant increased grant investments.

• Federal subject-matter experts (SME) identified the most gaps in areas like planning and 

organization, as well as financial and resource capacity across core capabilities during the first 

phase of the National SPR, which focused on Response and Recovery mission area 

preparedness for a catastrophic incident.

As demonstrated by the THIRA/SPR and NRI, threat and hazard impacts vary by location, and 

capabilities to manage associated risk can differ based on communities’ and individuals’ access to 

resources and levels of vulnerability. This section describes some of the tools and resources that the 

emergency management community uses to assess capability across the nation, and outlines 

individual, community, and national preparedness trends.

6. Individual and Household Preparedness

Preparedness starts at the individual and household level and can serve as a benchmark for capability

trends in communities and regions across the nation. Since 2013, FEMA has collected information on 

individual preparedness actions, attitudes, and motivations across the United States through its 

annual National Household Survey on Disaster Preparedness.5 In 2022, FEMA conducted the survey

from February 10, 2022 to April 20, 2022, in both English and Spanish, and collected data from 7,145 

Key Findings 
 

2023 National Preparedness Report 14 

survey respondents across the country (Figure 6).5 FEMA weighted responses by key demographic 

variables to enhance the national representativeness of the data.5

Figure 6: Demographic communities analyzed by FEMA in the 2022 National 

Household Survey on Disaster Preparedness. 

Over the past six years, FEMA has asked survey respondents to assess their preparedness (Figure 7) 

to obtain insight into actual and perceived preparedness.5 The survey includes questions related to 

preparedness actions taken and self-assessed preparedness. From 2017 to 2020, a greater 

percentage of respondents indicated that they had taken three or more preparedness actions, but this 

percentage dropped below 2018 levels by 2022. In 2022, 55 percent of adults surveyed stated they 

had pursued three or more of the twelve preparedness actions.vii Similarly, from 2017 to 2019, FEMA 

observed a steep increase in the percentage of respondents who indicated (self-assessed) that they 

were prepared for a disaster. However, by 2022, this percentage had dropped back to the level it was 

in 2017. In 2022 only 45 percent of survey respondents indicated that they were prepared for a 

disaster. Moreover, 42 percent of respondents indicated that they intended to prepare sometime in 

the future but have not yet started. The percentage of survey participants indicating they did not intend 

to prepare decreased from 17 percent in 2017 to 9 percent in 2020, but rebounded to 14 percent in 

2022.5
 

2023 National Preparedness Report 15 

Figure 7: Findings from the 2022 National Household Survey on Disaster 

Preparedness on adult preparedness actions (left) and adults’ self-assessed 

preparedness (right). All responses are self-reported.5

Although a variety of factors may be contributing to the changes in preparedness that FEMA has 

recorded over time, one of the most significant factors was the COVID-19 pandemic. The World Health 

Organization declared the coronavirus disease outbreak a public health emergency of international 

concern in January 2020, and a pandemic in March 2020. Respondents' resources may have 

decreased due to the COVID-19 pandemic, and real-world emergencies could have altered their 

estimations of emergency preparedness. It is notable that the percentage of adult respondents who 

reported pursuing three or more actions dropped after 2020, and that the percentage of adult 

respondents who reported being prepared for a disaster began to drop sharply after 2019.5 Reduced 

preparedness—whether actual (preparedness actions) or perceived (self-assessed)—indicates 

potentially reduced capability at the individual and household level, which in turn impacts community 

preparedness. 

7. Community Preparedness

SLTTs leverage federal grants to reduce risk, mitigate disaster impacts, and bolster capabilities. Figure 

8 displays the distribution of FEMA preparedness grants (i.e., non-disaster grants) by core capability in 

2022 alongside average core capability target achievements across 2022 THIRA/SPR submissions to 

help correlate funding allocations’ implications on capability achievement.viii,ix

The highest preparedness grant investments (by total invested amount) are in the Cross-Cutting, 

Protection, and Response mission area core capabilities, which correspondingly include four of the 

core capabilities that communities report as being closest to achieving their goals. The highest 

achieving core capabilities include Situational Assessment, Threats and Hazards Identification, 

Operational Communications, Operational Coordination, and Planning.x Some of these core 

capabilities were identified as national priority areas for FEMA in FY2022.12

The lowest preparedness grant investments are in the Recovery mission area, which likewise includes 

two of the core capabilities in which communities report being furthest away from achieving their goals

– Housing and Natural and Cultural Resources. The five lowest achieving capabilities overall include 
 

2023 National Preparedness Report 16 

Housing, Natural and Cultural Resources, Mass Care Services, Risk Management for Protection 

Programs and Activities, and Logistics and Supply Chain Management. 

Figure 8: The relationship between grant program investments and average THIRA/SPR 

capability target achievement in 2022, organized by core capabilities and mission area.xi,xii 

In the Response mission area, communities report low levels of grant investment (less than $7 million) 

and lower target achievement (less than 65 percent) in Mass Care Services and Logistics and Supply 

Chain Management. Communities also consider Mass Care Services a high priority capability. These

capabilities, along with three of the four Recovery core capabilities, fall within these ranges and may 

warrant that communities increase their grant investments.

8. National Preparedness

In 2022, FEMA, in coordination with SMEs from across the federal government, completed an 

assessment of its capabilities to respond to catastrophic threats and hazards. Known as the National 

SPR, this assessment summarizes high-level trends in capability gaps—determined by these SMEs—

across planning, organization, equipment, training, exercise, capacity, and coordination areas for the 
 

2023 National Preparedness Report 17 

selected core capabilities and national capability targets. Table 1 summarizes high-level gaps and 

recommendations at the national level across all core capabilities.

Table 1: National-Level Capability Gaps and Recommendations Identified by National SPR 

Working Groups 

Planning 

Preparing for Multi-State/Regional Incidents: Plans should address state and regional 

planning and decision-making silos; competition for limited available resources; and 

population and commodity movements across borders. Plans should be inclusive of nontraditional partners to ensure a whole community planning approach and establish/maintain 

unified operations and partnerships.

Exploration of Cascading Impacts and Dependencies Within Communities: Plans should 

address populations dependent on public transportation; public infrastructure dependencies

across SLTTs; loss of tax base; panic buying/hoarding; and surrounding states receiving 

overwhelming amounts of evacuees. 

Policy, Guidance, and Governance: Plans should include frameworks for senior leadership on 

how to handle complex barriers during incidents; solutions to address evacuation hesitancy; 

and more federal guidance on 1) how to report information to senior leadership 2) hazardous 

materials (HAZMAT) detection and protective procedures for responders, and 3) evacuee 

tracking and reunification.

Continuity Planning: Develop in-depth continuity planning between the multiple phases of 

emergency management. 

Organization 

Adequate Staffing: Federal, State, Local, Tribal, and Territorial (FSLTT) governments face 

challenges in employing and retaining enough skilled staff in a post-pandemic, resourceconstrained environment, particularly for catastrophic incidents. 

Better Decision-Making: Increase training for senior leaders across FSLTT governments on 

how to make data-informed decisions using available and useful datasets. 

Strengthening Structures: Ensure unified command structures can address the size and 

scope of a multi-state catastrophic incident. 

Program Innovation: Ensure current programs are flexible and new programs incentivize 

FSLTT governments to participate in national-level exercises. 

Equipment 

Specialized Equipment: SLTTs should review and ensure their access to medical, HAZMAT, 

urban search and rescue, and dredging equipment, even if this equipment is rarely used. Law 

enforcement partners who have seen growth in their role in emergency management should 

acquire specialized equipment to assist in response missions. 

Power: FSLTT governments should examine short-term power contingencies and innovate 

other solutions for long-term power outages. 

Training 

Communications: Update communications-focused training programs to address gaps and 

ensure personnel are proficient in operational communications capabilities used during 

incidents and planned events. 
 

2023 National Preparedness Report 18 Exercises 

Preparing for Multi-State/Regional Incidents: Exercises should include competition for limited 

available resources across multiple impacted states, territories, and regions in conjunction 

with concurrent incident operations; en masse population and commodity movements across 

borders; evacuation route support; surrounding community reception, tracking, and 

reunification; and establishing and maintaining unified operations and partnerships across 

state lines. 

Communications: Exercises should assess and document operational communications 

functions, systems, and personnel to ensure the ability to communicate (e.g., alerts, 

warnings, notifications, emerging technologies, and backup communications systems) during 

incidents and planned events. 

Capacity 

Economic Challenges: Pre-existing or recent economic challenges or vulnerabilities exist 

nationwide (e.g., the ongoing housing crisis, depletion rate of resources during the pandemic, 

and increasing requirements for sheltering). 

Complex Incidents: Expand capacity for catastrophic incidents and augment resources via 

funding or contracts. 

Coordination 

Cross-Sector Partnerships: FSLTT governments and private and nonprofit sectors should 

strengthen coordination efforts for disaster response and recovery. These groups should 

coordinate with local level emergency management SMEs and partners who may not normally 

play a role in emergency management. 

Limited Capability or Adequacy: Increase storage in some areas for hazardous waste, build 

stockpiles for Protection or Prevention resources for responders, and upgrade equipment to 

advance capability and preparedness. 

The key capability gaps and recommendations listed above represent some of the most pressing areas

identified by federal emergency management SMEs for the federal government to address to better 

prepare the nation for catastrophic disasters.

The following sections of this report similarly focus on several pressing emergency management 

challenges and corresponding recommendations, but for the whole community. The “Focus Areas” 

section examines a subset of four core capabilities: Fire Management and Suppression; Logistics and 

Supply Chain Management; Public Health, Healthcare, and Emergency Medical Services; and LongTerm Vulnerability Reduction. Each core capability focus area includes an overview of associated risks, 

capabilities, and gaps. Each focus area also provides recommendations for FSLTT governments, nongovernmental organizations (NGO)/Voluntary Organizations Active in Disaster (VOAD), the private 

sector, and individuals/households to help close capability gaps and build national resilience. These 

focus areas represent areas where: a) low average levels of capability target achievement exist,

according to community SPR assessments, b) low levels of capability exist, according to the National 

SPR assessment, and c) disasters consistently challenge FSLTT capabilities.
Focus Areas

2023 National Preparedness Report 19 

9. Fire Management and Suppression

Fire Management and Suppression “provide[s] structural, wildland, and specialized firefighting 

capabilities to manage and suppress fires of all types, kinds, and complexities while protecting 

the lives, property, and environment in the affected area.”13

9.1. Risk

This core capability encompasses wildland and structural firefighting. Wildfires were the sixth-most 

frequently identified hazard in 2022 THIRA/SPR community submissions (communities could choose 

more than one threat or hazard).4 In 2022, 35 percent of communities included wildfires in their THIRA 

submissions.4 In 2022, wildfires caused $3.1 billion in damages to infrastructure including public 

facilities and private residences, communication towers, power grids, water utilities, and modes of 

transportation.14,15

Many regions across the United States are experiencing hotter and more intense wildfires, driven by 

the effects of prolonged drought and climate change.16 Wildfires have resulted in “more than double 

the average annual acreage burned in the 1990s.”17 From 2013 to 2022, an average of 61,410 

wildfires occurred annually, impacting an average of 7.2 million acres annually.18 In 2021, over seven 

million acres burned across nearly 60,000 wildfires.17 Between 2018 and 2021, wildfires caused 

approximately $22 billion in property damage and over $257 million in crop damage across several 

states.19 The majority of these wildfires were avoidable; according to the Department of the Interior, 

nearly nine out of 10 wildfires are caused by human actions.20

More than 46 million individuals in 72,000 communities are vulnerable to significant wildfire 

exposure.14 Wildfires create challenges for all forms of infrastructure, especially for residential areas 

in the wildland-urban interface (WUI). The WUI is where structures and undeveloped wildland often 

merge through the development of suburbs. WUI regions are more likely to experience property 

damage and wildfire safety risks.14 WUI regions represent less than one-tenth of the U.S. land area, 

but are the site of 43 percent of new home development in recent years.14 In 2021, nearly 6,000 

structures burned because of wildfires,18 and 60 percent (3,577) of these burned structures were 

residential.21 The WUI is where structures and undeveloped wildland merge, and WUI regions are more 

likely to experience property damage and wildfire safety risks. The two types of WUI are defined by 

housing density interface (high-density development adjacent to undeveloped wildlands); and intermix 

(lower-density housing intermingled with undeveloped wildland).14
2023 National Preparedness Report 20 

9.2. Capabilities and Gaps

In 2022 THIRA/SPR submissions, communities identified and associated numerous planning, 

organization, equipment, training, and exercise (POETE) gaps with wildfires.xiii These gaps include:23

 Limited inventory available for response efforts

 Staffing challenges

 Limited tracking data on fire parameters

 Lack of consistent public warning tools (i.e., alert systems) across jurisdictions

 Limited widely accepted interoperable (the ability of anyone to talk with whomever they need 

to, whenever they need to, when properly authorized) data standards24

 Difficulties tracking evacuation route status efforts

Between 2018 and 2022, the number of communities reporting that they were closer to achieving 

their capability goals to manage fires decreased from 66 to 64 percent.4 Fire Management and 

Suppression was not a reporting requirement for communities in 2020 and 2021, but was required in 

2022.xiv Despite this reported decrease in capability achievement in 2022, grant investments in Fire 

Management and Suppression declined overall between 2017 and 2022.xv,xvi Decreased grant 

investments may pose challenges for SLTTs. These communities increasingly encounter far more 

equipment, cost, training shortfalls, and resource constraints when compared to federal firefighting 

agencies.21,25 However, the recently enacted Bipartisan Infrastructure Law (BIL) aims to address 

climate change and enhance wildfire-resilient communities. The BIL allocates $5 billion over the next 

five years for federal wildland fire management. This funding is designated for both the Interior and 

Agriculture departments, both of which oversee wildland fire programs. Under BIL, USDA's Forest 

Service is allotted an extra $3.5 billion, while the Interior Department will receive about $1.5 billion 

for wildland fire management in the next five years starting in 2022.26

While the federal government holds responsibility for fire suppression, management, and mitigation 

across federal lands, SLTT governments are accountable for all non-federal lands.21 In 2022, the Biden

Administration implemented the Wildland Fire Mitigation and Management Commission, established 

under the BIL. The Commission convened for its inaugural meeting in Salt Lake City, Utah, to formulate 

federal policy recommendations and strategies for addressing wildfires in the Western U.S., with a 

mandate to submit a report to Congress within a year.27 SLTT partners have jurisdiction over 

municipalities, WUI communities, and state and local forests or grass/rangeland on non-federal lands. 

They also support federal wildland fire operations for fire suppression and containment on federal 

lands. SLTT fire departments deal with increased economic expenses to procure the resources 

necessary for wildland fire management. These resources include the tools, expertise, and personnel 

to make wildland landscapes more resilient to increasingly common climate stressors such as drought 

or extreme heat.28

The U.S. Forest Service (USFS) encourages communities that actively manage wildlands to use 

methods such as chemical, biological, or mechanical fuel treatments or planned grazing to control and 

prevent fire spread and for WUI fires including urban fires or conflagrations.29 The costs of active 
2023 National Preparedness Report 21 

landscape management have increased over the past several decades as the wildfire season grows 

longer and wildfires become more severe.30 Managing large wildfires can require millions of dollars in 

equipment, hundreds of personnel, and adequate knowledge of terrain and local or invasive 

vegetation.28 The risk of simultaneous or unanticipated, human-caused wildfires can further 

exacerbate funding and resource limitations. Challenges also exist with funding for local structural 

firefighting. Local fire departments handle multiple other duties, including search and rescue and postdisaster operations, and funding is vital for those initiatives to continue.

In recent years, SLTT governments have also faced challenges with planning efforts to address the 

access and functional needs (AFN) of individuals with disabilities, individuals with limited English 

proficiency, older adult, and those with limited access to transportation and/or limited access to 

financial resources for emergencies. Populations with AFN are at increased risk of death, injury, and 

disproportionately higher material losses during emergencies and will therefore continue to be an 

important area of focus for emergency managers.xvii,32 Certain populations, including people with 

disabilities and people with limited English proficiency, have civil rights protections and require 

accessible and actionable emergency communication.32,33 In addition, the percentage of the 

population who are older adults (who may not have access to the Internet or use technology as much 

as others) and individuals with disabilities will increase worldwide in the next decade.34,35 By 2034, 

adults 65 and older will outnumber those under 18 in the United States for the first time, creating 

profound and unique challenges for the emergency management community.36 For example, older 

adults are much more likely to die in disasters; more often have impaired mobility, cognition, or senses; 

have uneven access to resources such as the internet and income, and often have more limited social 

networks than younger populations.37

Given the complexity of challenges surrounding wildfire management, the federal government has 

played a large role in bolstering SLTT capabilities. In 2022, the U.S. Department of Defense (DoD) 

finalized the National Defense Strategy (NDS). The NDS directs DoD to prioritize closer coordination 

with interagency, private sector, and SLTT partners to enhance resilience at all levels. In 2022, over 

half the nation’s National Guard members, operating in their state-status, responded to multiple 

incidents including wildland fires.38 This transition will reduce interagency reliance on Defense Support 

of Civil Authorities and help build resilience across the firefighting community.

DoD Joins the Wildfire Coordinating Group 

DoD joined the National Wildfire Coordinating Group (NWCG) as a member on December 1, 2022. 

Including DoD as an NWCG member is a critical step to enhancing interagency collaboration to 

prepare fire-adapted communities, provide safe and effective wildfire response, and increase 

mission and landscape resilience. In support of the NWCG mission, DoD and the National 

Geospatial-Intelligence Agency (NGA) are developing a plan to transition the FireGuard program—

a tool developed by the NGA for DoD missions—from the National Guard and NGA to the National 

Interagency Fire Center. NGA implemented FireGuard to facilitate the analysis, sharing, and use of 

data from multiple sources and sensors, including imagery from satellites and unmanned aircraft, 

to produce sanitized, unclassified products for firefighters.
 

2023 National Preparedness Report 22 

Another federal government initiative was the development of the Wildfire Risk to Communities

website.39 Wildfire Risk to Communities is a free, easy-to-use website with interactive maps, charts, 

and resources to help communities understand, explore, and reduce wildfire risk. Under direction from 

Congress, the USFS designed a tool to help community leaders, such as elected officials, community 

planners, and fire managers.39 For the first time, the USFS mapped wildfire risk for communities 

nationwide.39

9.3. Management Opportunities 

Table 2 summarizes the opportunities that FSLTT governments, NGOs, VOADs, the private sector, and

individuals/households can leverage to manage risk, build Fire Management and Suppression 

capability, and address capacity gaps to increase their overall resilience.

Table 2: Fire Management and Suppression – Management Opportunities.

Stakeholder 

Group Management Opportunities 

Federal 

Government

• Continue access to funds for wildfire resiliency-building efforts through programs 

such as FEMA’s Building Resilient Infrastructure and Communities (BRIC) program 

and the USFS Community Wildfire Defense Grant program.40

• Leverage the establishment of the Wildland Fire Mitigation and Management 

Commission, to coordinate and generate comprehensive federal policy 

recommendations and strategies aimed at effectively addressing wildfires in the 

Western United States.27

• Continue funding for FMAG. Requests for FMAG declarations may be approved by 

a Regional Administrator on an expedited basis (i.e., while a fire is actively burning

and threatening such destruction as would constitute a major disaster).9

• Strengthen federal coordination by better aligning agencies’ goals for wildfire risk 

mitigation, which would support air quality improvements and reduced risks to 

public health from wildfire smoke over the long term.41

SLTT 

Governments

• Adopt stricter building codes and zoning across residential developments and 

commercial power (electrical utility) infrastructure, to include mandatory use of 

fire-adapted materials (depending on the level of risk).6

• Invest in more training and specialized programs for firefighting and rescue 

operations.4

• Increase communication and collaboration efforts with volunteer and career fire

departments to promote a whole community approach to plan for, mitigate, and 

respond to high wildfire risks and support more fire-adapted communities.4

• Engage with the DHS Office for Civil Rights and Civil Liberties for guidance on 

addressing the needs of vulnerable populations during wildfires and promoting 

community resilience.42,43

• Encourage individuals and households to take research-based protective actions

on FEMA’s Protective Actions Research site to safeguard themselves and their 

property.44

• Use data from the 2022 National Household Survey on Disaster Preparedness to 

better understand gaps and opportunities for wildfire preparedness.5
 

2023 National Preparedness Report 23 

Stakeholder 

Group Management Opportunities 

• Apply for Hazard Mitigation Grant Program (HMGP) Post Fire assistance for fire 

mitigation projects. States, federally recognized tribes, and territories affected by 

fires resulting in a FMAG declaration are eligible.45

NGOs, 

VOADs, and 

the Private 

Sector

• Protect critical transportation and communications infrastructure by replacing 

plastic culverts with concrete ones, and by completing proper defensible spaces 

around assets like cell towers.46,47

• Form public-private partnerships with local governments, investors, and utilities 

to help invest in forest management, such as the Forest Resilience Bond, which 

assists in funding land management restoration projects.xviii,48

• Mitigate power line vulnerability by removing trees near them and burying lines in 

high fire risk areas.49

• Conduct thorough and regular inspections of all rail components and follow 

inspector recommendations to reduce rail-caused fires.50

• Communicate risks associated with the improper use of portable generators to 

the public.

Individuals 

and 

Households 

• Avoid activities involving fire or sparks when hot, dry, and windy conditions exist.20

• Work together with neighbors to ensure that leaves, debris, or other flammable 

materials are not around homes. FEMA’s Wildfire Protective Actions webpage

provides more information on creating a defensible space around your home.47 

• Create a household evacuation plan and follow evacuation orders from 

emergency management and FSLTT government officials.51

• Do not park in tall grass if authorities have issued a “fire weather watch” or “fire 

weather/red flag warning.” Vehicles’ exhaust systems are hot and can cause dry 

grass to catch on fire.52

• Create copies of your documents and save them in a fire- and water-proof location 

or electronically.52

• Gather supplies so that you have at least three days of emergency provisions on 

hand, including particulate respirator masks; non-perishable food; bottled, boiled, 

or purified water; weather-appropriate clothing; flashlights; first aid supplies; and 

prescription needs.52

10. Logistics and Supply Chain Management

Logistics and Supply Chain Management aims to “deliver essential commodities, equipment, and 

services in support of impacted communities and survivors, to include emergency power and fuel 

support, and the coordination of access to community staples; and synchronize logistics 

capabilities and enable the restoration of impacted supply chains.”13

10.1. Risk

In previous years, communities identified Logistics and Supply Chain Management as a capability with 

middling target achievement. This continued in 2022, as slightly more than half (52 percent) of 

communities reported increasing their Logistics and Supply Chain target capabilities.4 However, fewer 

communities identified this capability as a high priority than in prior years. 85 percent of communities 
2023 National Preparedness Report 24 

considered Logistics and Supply Chain Management a high priority in 2021 but only 58 percent of 

communities considered it a high priority in 2022.4

Activities under Logistics and Supply Chain Management include:4

 Managing transportation of materials from storage facilities and vendors to incident survivors

 Providing logistical support to firefighters and other first responders

 Coordinating the procurement of communications equipment and services

 Managing electronic data interchanges to allow for end-to-end visibility and tracking of 

response resources

Two ongoing challenges impede these activities—more destructive and frequent threats and hazards 

exacerbated by climate change and pre-existing vulnerabilities including aging infrastructure and a 

lack of storage space. Both factors can impede delivery of goods and services to emergency managers 

and disaster survivors.

In recent years, some of the most challenging threats and hazards to this core capability have included 

drought, flooding, and rising sea levels.53 In 2022, abnormal drought conditions combined with record 

heat waves caused the Mississippi River’s water levels to recede, nearly approaching the record low 

set in 1988.54 The river receded to levels low enough for barges to get stuck in mud and sandbars, 

jeopardizing millions of tons of critical supplies that are transported via water from states in the upper 

and lower Mississippi River watershed. Ultimately, the U.S. Army Corps of Engineers had to conduct 

emergency dredging at points where as many as 2,000 barges plateaued.54

Since climate change will continue to make droughts along the Mississippi River more frequent, supply 

chain disruptions are likely to increase as well.53,54 Rising sea levels associated with climate change 

will potentially expose other transportation and logistics infrastructure, such as seaports, to damage, 

disruptions, and delays. However, in a survey of 85 U.S. maritime infrastructure engineers, only 29 

percent said their organization had a sea level rise policy or document.53 This may indicate that 

nationally, many organizations have not planned for impacts related to sea level rise.

Navigable waterways and viable port infrastructure are both vital components of the nation’s 

transportation and logistics infrastructure. If a catastrophic disaster occurred in the Mississippi River 

watershed region (e.g., a New Madrid seismic incident), FEMA could face logistical challenges in 

delivering supplies to survivors. Moreover, a disaster in this region impacting several states can create 

resource competition, leading to unequal distributions of supplies, delayed deliveries, and increased 

community vulnerability. In addition to these natural hazards, FEMA may face challenges with 

transportation and logistics due to vulnerabilities stemming from aging infrastructure, which are more 

susceptible to damage during disasters.55

The U.S. population has more than doubled since the 1960s when most of the nation’s major 

infrastructure systems were designed and built.56 Many systems are reaching the end of their lifespan 

and are dangerously overstretched.56 Aging rail infrastructure, roads, locks and dams, and bridges can 

become slow-moving disasters that cause shipping delays, longer commutes, and pose risks to local 
2023 National Preparedness Report 25 

populations when they fail. For example, damaged and overcrowded transportation infrastructure can 

hinder first responders from delivering critical supplies and conducting lifesaving support activities—

including evacuations and search and rescue operations—in a timely fashion. Similarly, failing 

infrastructure can cause cascading impacts that require first responders to transport and supply 

critical resources like generators and potable water for extended periods of time. For example, the 

August 2022 flooding incident in Jackson, Mississippi contributed to equipment failures at one of the 

city's two main water treatment facilities, leading to supply and sanitation challenges.57 During this 

incident, the city's 150,000 residents faced several weeks without access to safe drinking water.57 As 

a result, federal, state, and local government agencies distributed more than 11 million bottles of 

water to residents and brought resources in to complete emergency repairs to the plant and restore 

safe, reliable drinking water to the city.58,59

When disasters impact a large geographic area, states may find themselves competing with 

neighboring states to procure these critical supplies, prolonging response and recovery efforts. 

Furthermore, as more disasters occur at the same time in different parts of the country, otherwise 

distant states contend for the same limited resources. Hurricane season for the Gulf and Atlantic 

states in August and September overlaps with peak wildfire season for Western states during the fall 

months. This overlap can delay already scarce resources like generators.60 In 2020, demand for 

portable air cleaners due to the COVID-19 pandemic reduced their availability for heavy wildfire smoke 

on the West Coast.61 Simultaneous large-scale disasters with anticipated timeframes, like hurricanes 

or wildfires, can also divert supplies from less anticipated incidents and disasters, such as the severe 

flooding in Missouri and Kentucky at the end of July 2022.62

Another vulnerability in the U.S. supply chain is a lack of warehouse storage. U.S. storage facility space 

has decreased over the past several decades.63 In recent years, warehouse storage reached near 

capacity because the COVID-19 pandemic contributed to a drastic increase in e-commerce, online 

shopping, and costs for transporting goods in the United States. All these factors drove companies to 

lease more warehouse space for storage.64 Limited available storage and warehouse space can 

impact capacity building to respond effectively to disasters. Limited storage capacity can also increase 

costs and timelines for transporting critical supplies to impacted communities, exacerbating 

inequities, and prolonging recovery efforts. Finally, limited storage facilities around the United States

can lead to emergency management budgetary strains, as renting additional storage space or 

transporting supplies over long distances can become expensive.

10.2. Capabilities and Gaps

In their 2022 THIRA/SPR submissions, communities reported that training and exercises related to 

Logistics and Supply Chain Management often lack local and federal partners who can identify internal 

and external capabilities and know how to request them.4 For example, SLTTs need more federal 

guidance on how to incorporate impacts to U.S. ports stemming from sea level rise into trainings and 

exercises.4 Doing so will help SLTTs better understand risks to their ports and surrounding 

communities and plan for how to mitigate or respond to these risks accordingly. Sea ports are subject 

to storm surges, ocean and river flooding, high winds, and tsunamis.65 Adapting to the changing 
2023 National Preparedness Report 26 

climate requires increasing funding for port construction and repairs, which would increase resilience. 

In 2022 THIRA/SPR submissions, several states set goals to develop further exercises and training on 

distribution and stockpile management, procurement processes, sheltering, and resource 

management.4

Communities also reported gaps associated with standardizing training plans across jurisdictions and 

states that face similar disaster-related issues.25 In the 2022 THIRA/SPR, 69 communities out of 130

(53 percent) reported training gaps, and 56 communities reported both planning and training gaps 

related to this capability.4 Many SLTTs are working to create in-state Emergency Management 

Assistance Compact exercises but currently lack resources to do so. Emergency management 

workforces exhibit limited operational capacity and require additional funding to develop training and 

exercises. Many jurisdictions also have limited staff capacity, which creates issues with disaster 

response.25 Limited workforce capacity can delay delivery of time-sensitive relief supplies to survivors 

and supply and equipment shortcomings compound this gap.

In the 2022 THIRA/SPR, communities commonly identified storage capability gaps due to limited 

warehouse capacity throughout the nation.4 These capability gaps, coupled with more recent inflation 

and the increasing cost of renting storage, led to resource limitations for domestic supply chains. As 

U.S. industrial construction decreases annually due to increased interest rates, FSLTT solutions for 

expanding supply chain capacity will grow more important.66 Inventory management negatively affects 

this core capability, especially for jurisdictions with limited financial resources.25 Inventory limitations 

have an array of consequences for nearly all supply chain sectors. Underreporting and incomplete data 

availability impact the accuracy of inventory management.

Federal initiatives such as the 2022 Infrastructure Investment and Jobs Act and the Creating Helpful 

Incentives to Produce Semiconductors and Science Act showcase a growing push for revitalizing 

domestic production and strengthening supply chains.67 Nevertheless, domestic manufacturing 

challenges highlight many of the national supply chain capacity gaps. Ongoing manufacturing gaps 

nationwide lead to inventory management, transportation, and capacity-building challenges. While 

accounting for around 20 percent of global consumption, U.S. raw and technological production has 

decreased steadily since the 1990s.68 Today, the United States produces 10 percent of electric 

vehicles, 7 percent of lithium-ion batteries, 12 percent of semiconductors, and 4 percent of printed 

circuit boards globally.69 Limited domestic production of these goods impacts supply chain resiliency 

and critical infrastructure systems. Increasing domestic production and capacity of consumer goods 

and advanced technology can minimize the disaster-related damages impacting the public and private 

sectors.69

Supporting measures that advance domestic technology production can help build capacity.

Increasing domestic production can improve logistics capacity and lead to faster response times for 

the delivery of goods and services to affected areas. The increased availability of these critical goods

like food, medical supplies, and water can help ensure the meeting of demands for natural hazards

and limit associated long-term impacts on the private and public sectors.
 

2023 National Preparedness Report 27 

10.3. Management Opportunities

Table 3 summarizes the opportunities that FSLTT governments, NGOs, VOADs, the private sector, and 

individuals/households can leverage to manage risk, build Logistics and Supply Chain Management 

capability, and address capacity gaps to increase their overall resilience.

Table 3: Logistics and Supply Chain Management – Management Opportunities. 

Stakeholder 

Group Management Opportunities 

Federal 

Government 

• Develop new guidance—and review existing guidance—to address the impact of 

sea level rise on port and other supply-chain infrastructure.70 For example, the 

U.S. Climate Resilience Toolkit and the accompanying Technical Application 

Guide provide guidance on supply chain risks and resilience topics.71,72

• Continue federal investments in U.S. ports, like the Port Security Grant Program 

and the Port Infrastructure Development Program (PIDP) administered by FEMA 

and the Maritime Administration respectively.73 The PIDP is the largest 

investment in port reliability and efficiency in U.S. history, and such efforts 

continue to ensure the protection of port infrastructure and supply chain 

readiness.62

• Promote water management practices that increase drought resilience among 

farmers and food supply chains.75

SLTT 

Governments 

• Create training opportunities and partnerships with federal partners to fund 

whole-community initiatives and develop actionable projects, including 

leveraging existing resources like the Department of Energy’s (DOE) Energy 

Emergency Assurance Coordinators (EEAC) program.76 The EEAC program 

involves stakeholders from all levels of government and public utilities to share 

information with each other and their communities before and during energy 

emergencies.76

NGOs, 

VOADs, and 

the Private 

Sector 

• Develop supply chain tools integrating real-time data that companies can 

leverage to facilitate coordination with partners and gain better visibility of all 

aspects of their products’ lifecycles. This would enable companies to identify 

disruptions, mitigate impacts, and improve productivity.77

• Improve data sharing capabilities with SLTT agencies to allow for timely 

responses to supply chain and logistics disruptions.78

• Take FEMA’s Organizations Preparing for Emergency Needs training to learn 

more about how organizations can identify risks, locate resources, and take 

preparedness actions, including how to mitigate disruptions to the supply 

chain.44

Individuals 

and 

Households 

• Consider federal and state funding (e.g., Small Business Administration loans) for 

individuals and households that own small businesses to mitigate the impacts of 

supply chain bottlenecks.79

• Obtain business insurance; insurance may be available from federal sources.80

• Identify supplies already on hand, then gather enough supplies to last several 

days in the event of supply chain disruptions. Buy supplies slowly and do not buy 

more than you need.81

• Use FEMA’s Are You Ready? Guide, which offers comprehensive information and 

recommendations on preparing for different types of disasters.81
 

2023 National Preparedness Report 28 

11. Public Health, Healthcare, and Emergency Medical 

Services

Public Health, Healthcare, and EMS aim to “provide lifesaving medical treatment via [EMS] and 

related operations and avoid additional disease and injury by providing targeted public health, 

medical, and behavioral health support, and products to all affected populations.”13

11.1. Risk

In their 2022 THIRA/SPR community submissions, 52 percent of communities identified pandemics 

as a hazard of concern.4 COVID-19 remained the most significant hazard through 2022, with the 

highest recorded case count of the entire pandemic peaking the second week of January 2022.4,82

COVID-19 was either the underlying cause or a contributing factor in approximately 245,000 deaths 

between January and December, making it the fourth leading cause of death that year.83 New and 

emerging diseases are also an area of concern. Antimicrobial resistant organisms continue to rise and 

threaten human, animal, and environmental health.84 Increased use of antibiotics during COVID-19 

led to an increase in healthcare-associated, antimicrobial resistant infections in U.S. hospitals.85 In 

May of 2022, the world witnessed a global outbreak of monkeypox (Mpox), a rare disease endemic to 

several central and western African countries but previously unrecognized as a potential source of a 

global outbreak.86 The Biden Administration implemented a targeted national Mpox vaccine strategy, 

scaled up decentralized testing, and continued provider education and community engagement across 

the country in response.87 The U.S. Department of Health and Human Services (HHS) “communicated 

public health information about the virus to patients and health care providers, provided access and 

substantially increased supply of vaccines and treatments, and significantly expanded the availability 

of tests.”88

Climate change can increase the likelihood of pandemics and epidemics.89 Some studies estimate 

that the likelihood of a pandemic with a similar impact as COVID-19 increases by about 2 percent each 

year.90 As climate change modifies natural resource availability and alters ecosystems, wildlife and 

pathogens share progressively limited spaces and interact in new and different ways. These 

increasingly shared habitats, coupled with impacted and limited resources, elevate infectious disease 

outbreak risks. These risks exist whether people have direct contact with animals or indirect contact 

through shared environments.91 Existing infectious diseases, such as the rabies virus, are more likely 

to spread to new regions of the nation.92 These areas may be unaware of prevention tactics and 

unprepared to respond or adequately contain these outbreaks. Novel interactions between animals 

and humans can also lead to existing diseases from other countries making their way to the United 

States.92 Milder winters and extremely hot summers create the perfect conditions for insects like 

mosquitoes and ticks to reproduce, expand their habitats and spreading diseases, such as Lyme and 

West Nile virus disease.88

Besides its impact on infectious diseases, climate change can also stress public health sectors by 

creating or compounding chronic illnesses and emerging health challenges. Drought, flooding, and 
2023 National Preparedness Report 29 

algal blooms can all contaminate and pollute water sources, impacting water safety requirements and 

causing illness among individuals in affected regions.93 Every year, waterborne diseases cause 7.2 

million illnesses and $3 billion in healthcare costs.94 Likewise, poor air quality and extreme heat can 

increase airborne allergens and pollutants, elevating the risk and severity of respiratory diseases like 

asthma, cardiovascular diseases, and type 2 diabetes.95,96 Climate change can also affect the air we 

breathe indoors, where people spend about 90 percent of their time.97 Severe weather and flooding 

may increase the number of homes affected by water damage and mold growth, and wildfire smoke 

can reduce indoor air quality.98 Furthermore, inadequate ventilation indoors can promote the spread 

of infectious diseases, including the virus that causes COVID-19.99

The impacts of climate change can cause dramatic shifts in regional healthcare needs and exacerbate 

health and medical care inequities between advantaged and disadvantaged groups. For example, 

regions experiencing higher levels of air pollution could face higher demand for respiratory care. In 

southern California, a 2021 study concluded that exposure to elevated levels of PM2.5 (fine particulate 

matter in the air that is 2.5 microns or smaller in diameter) from wildfire smoke can lead to increased 

respiratory hospitalizations from 1.3 percent to up to 10 percent, compared to 0.67 percent to 1.3 

percent associated with non-wildfire smoke PM2.5 exposure.100 Similarly, regions experiencing more 

extreme heat may witness an increased demand for heat-related illness treatments. In Washington 

state, extreme heat in the summer of 2021 correlated with a “69-fold increase in emergency 

department visits for heat stroke, heat exhaustion, and exacerbation of chronic medical conditions.”101

Shifting demands on healthcare personnel may hinder access to services through longer wait times

and higher costs for care. Reduced access to healthcare services may heighten health disparities and 

diminish quality of care, resulting in poor health outcomes.102 Weather-related hazards such as poor 

air quality and extreme heat disproportionately impact populations that already face inequitable health 

care access, lower access to public and human services, and poorer health outcomes before, during, 

and after disasters (i.e., underserved communities, communities with environmental justice concerns,

and other at-risk individuals).32 Vulnerable populations, especially the unhoused, elderly, very young, 

and those without access to air conditioning are more at risk of experiencing adverse impacts.

Healthcare Staffing Challenges and Impacts 

The persistent shortage of physicians and healthcare professionals compounds these climate 

change-related challenges. By 2034, the Association of American Medical Colleges estimates a 

projected shortage of 37,800 to 124,000 physicians.108 In addition, the American Association of 

Colleges of Nursing has identified a scarcity of nursing faculty due to limited higher education 

capacity as a contributing factor to the nursing shortage.108 Pandemic-induced burnout among 

clinical staff contributes to this shortage, with 40 percent of doctors reporting burnout in 2022.108

Nurses also experience burnout at nearly 49 percent.108 Emotional exhaustion leads to medical 

errors, care delays, and professionals leaving the field. Hospital closures worsen the shortage, 

particularly in rural areas, limiting healthcare access for economically disadvantaged residents.108
2023 National Preparedness Report 30 

In addition to climate change-related hazards, threats such as cyberattacks can also threaten public 

health. In particular, attacks against hospital systems hinder medical care.103 For example, a 2020 

cyberattack against the University of Vermont Medical Center necessitated surgery rescheduling, and 

delayed radiation treatments.104 For a month afterward, employees did not have access to electronic 

medical records and other vital digital tools, and the attack cost an estimated $50 million. Over several 

months in 2022, the Federal Bureau of Investigation conducted a disruption campaign against the 

Hive ransomware group which attacked school districts, financial firms, hospitals, and critical 

infrastructure; impacting over 1,500 victims in 80 countries.106 “In one case, a hospital attacked by 

Hive ransomware had to resort to analog methods to treat existing patients and was unable to accept 

new patients immediately following the attack.”106

11.2. Capabilities and Gaps

In the 2022 SPR, communities identified gaps related to medical transportation, use of technology, 

equipment and staffing availability, communication and coordination, funding availability, and capacity 

building.25 Communities frequently report medical staffing shortages; 62 out of 84 communities with 

public health organizational gaps identified staffing challenges, and seven of these specifically 

mentioned EMS understaffing. Several communities also reported healthcare staffing to be a 

widespread problem. In March 2022, 23 percent of hospitals across the nation reported a critical 

staffing shortage and a decrease of nearly 105,000 employees since February 2020.107,108 Such 

understaffing at medical, EMS, and long-term care facilities can lead to poor patient care and 

outcomes, including a higher number of deaths.

FSLTT governments can leverage many different resources to expand public health sector capacity. 

These include federal resources available to SLTTs through HHS’ Administration for Strategic 

Preparedness and Response (ASPR). Programs that augment staffing include the National Disaster 

Medical Systems, Disaster Medical Assistance Teams, and the U.S. Public Health Service

(USPHS).109,110 The Medical Reserve Corps (MRC) is another community-based, volunteer program that 

is supported at the national level by the MRC Office within HHS ASPR.111 Multiple other HHS ASPR 

offices and components—including the Biomedical Advanced Research and Development Authority, 

the HHS Coordination Operations and Response Element, and the Office of Industrial Base 

Management and Supply Chain—support the development, procurement, and distribution or 

coordination of medical countermeasures, and the Strategic National Stockpile as part of the federal 

medical response infrastructure.

Furthermore, The Center for Disease Control and Prevention (CDC) has existing resources that SLTT 

officials can use when responding to public health emergencies. Specifically, the Community 

Assessment for Public Health Emergency Response (CASPER) offers real-time insights to inform public 

health officials and emergency managers regarding impacted communities during disasters.112

CASPER provides household-level data which helps identify information gaps, allocate resources, and 

initiate public health action; facilitate disaster planning, response, and recovery activities; and assess 

community needs. Additionally, CDC's National Environmental Public Health Tracking site provides upto-date data on real-time factors, including wildfire smoke and hurricane overlays, further enhancing 
2023 National Preparedness Report 31 

the agency's emergency response capabilities.111 Public Health Emergency Preparedness (PHEP) 

grants are another critical source of funding for SLTT public health departments, which use PHEP 

grants to fund staffing and obtain technical assistance to build and enhance public health 

preparedness and operational capabilities. The CDC administers annual PHEP funding to all 50 states, 

eight U.S. territories, all freely associated states, and four large cities or counties.113,114 Between 2021 

and 2022, PHEP funding increased by 2.2 percent for a total of $651,488,620.113 The American 

Rescue Plan also provides funding through the CDC for states and local communities to hire personnel, 

enough for 8,600 staff.115 The federal government can support and collaborate with SLTTs by 

continuing to provide these and other targeted grant funds to enhance SLTT public health 

preparedness efforts.

Communities identified equipment as a persistent challenge for public health facilities in their 2022 

THIRA/SPR submissions.4 Public health facilities frequently face severe equipment shortages. 

Currently, the U.S. Food and Drug Administration (FDA) medical device shortage tracker predicts that 

cardiac equipment, intensive care unit supplies, blood testing supplies, and laboratory storage devices 

will be in short supply in public health facilities during the first two quarters of FY2023.116 The FDA 

partners with state and local officials to mitigate medical equipment shortages.116 Through the Federal 

Food, Drug, and Cosmetic Act, the FDA created a new supply chain program to try to help prevent 

shortages of medical equipment.117

Beyond physical equipment challenges, hospitals face increasing cybersecurity vulnerabilities as a 

result of unpatched medical devices, outdated software, and inadequate security features.118 In 2022, 

U.S. healthcare organizations experienced an 86 percent increase in cyberattacks, averaging 1,410 

cyberattacks per organization per week.119 The “healthcare sector ranked second out of all sectors for 

the most cyberattacks in the U.S.”119 One of the ways hospitals can strengthen their cybersecurity 

resiliency—which was identified as a concern in 2022 THIRA/SPR submissions—is through federal 

grant programs. In September 2022, DHS released a Notice of Funding Opportunity detailing the State 

and Local Cybersecurity Grant Program, which provides targeted cybersecurity investments (including 

those in public health) for states, local governments, and U.S. territories.120 Among other outputs, this 

program will help states establish state cybersecurity plans and provide funding for training, thus 

increasing SLTT governments’ capabilities to protect against cyber threats.120 Using this grant 

program, states and local governments can assist healthcare organizations with increasing their 

cybersecurity resiliency.

Community-based disease countermeasures developed over time are successful at controlling the 

spread of many illnesses. For example, vector-borne diseases are those which are spread by animals 

and insects such as mosquitos, rats, ticks, and fleas. Individual or community protection measures 

include applying insect repellent, using environmentally benign pest control measures, and getting 

vaccinated against diseases common in the area in which one resides.121 CDC’s Division of VectorBorne Diseases assists with community-based countermeasures by discovering, detecting, and 

preventing vector-borne diseases; developing and improving diagnostic tests; funding state, local, and 

territorial health departments; and responding to threats.122 As diseases wax and wane, so too does 

the demand for new disinfectants. In 2021, researchers at the University of Central Florida developed 
 

2023 National Preparedness Report 32 

a nanoparticle-based disinfectant that can continuously kill viruses on a surface for up to seven 

days.123 Using the aforementioned community-based disease countermeasures, in addition to 

individuals masking in public when ill, can make the whole community safer from disease.

11.3. Management Opportunities

Table 4 summarizes the opportunities that FSLTT governments, NGOs, VOADs, the private sector, and 

individuals/households can leverage to manage risk, build Public Health, Healthcare, and EMS

capability, and address capacity gaps to increase their overall resilience.

Table 4: Public Health, Healthcare, and EMS – Management Opportunities.

Stakeholder 

Group Management Opportunities 

Federal 

Government

• Support programs like the USPHS and the Hospital Preparedness Program under 

the Administration for Strategic Preparedness and Response, and the CDC’s

PHEP Cooperative Agreement. These programs bolster preparedness efforts at 

all levels of government, aiding in readiness for various public health challenges, 

such as infectious diseases and other threats and hazards.124,114

• Review legislation to ensure that grants and federal programs account for the 

potential for emerging diseases, climate change impacts, and health equity.

Additionally, legislative updates could require enhanced coordination between 

public health and emergency management partners to effectively address 

interdependencies and disaster consequences.

• Leverage federal programs such as the FDA Resilient Supply Chain Program to 

prevent medical supply shortages in the future. This program increases FDA’s 

capacity to disseminate supply disruption notifications for critical devices when 

a potential shortage exists, removes time limitations in emergencies, and 

requires manufacturers to develop risk management plans and identify alternate 

suppliers.126

• Continue education and support for SLTTs to ensure awareness of the 

Cybersecurity and Infrastructure Security Agency’s Priority Services program and 

access to priority telecommunications and restoration services during an 

incident or event.

SLTT 

Governments

• Leverage federal grants to increase hospital capacity and address staffing needs

at public health departments.

• Strengthen partnerships and communication channels between public health 

officials and their emergency management counterparts to ensure effective 

coordination in disaster preparedness, response, and recovery efforts. 

• Provide cybersecurity training and resources for hospitals and include them in 

exercises.

NGOs, 

VOADs, and 

the Private 

Sector

• Use the HHS Security Risk Assessment Tool to identify potential cybersecurity 

risks.127

• Identify ways to mitigate staffing shortages at private healthcare centers, 

including hospitals, assisted living, and long-term care facilities.
 

2023 National Preparedness Report 33 

Stakeholder 

Group Management Opportunities 

Individuals 

and 

Households 

• Speak with a doctor about establishing a power outage plan for medical devices 

that need electricity and for refrigerated medicines.128

• Prepare an emergency supply of prescription medicines (including for pets), 

backup power sources, and personal supplies to last at least three days.129

• Follow public health guidance to decrease public health-related risks.128

• Take FEMA’s You Are the Help Until Help Arrives training, which prepares a person 

to act in emergency situations and provide lifesaving care before professional 

help arrives.130

12. Long-Term Vulnerability Reduction

Long-Term Vulnerability Reduction aims to “build and sustain resilient systems, communities, 

and critical infrastructure and key resources lifelines to reduce their vulnerability to natural, 

technological, and human-caused threats and hazards by lessening the likelihood, severity, and 

duration of the adverse consequences.”13

12.1. Risk

In 2022, 71 percent of communities identified Long-Term Vulnerability Reduction as a capability with 

higher target achievement in their 2022 THIRA/SPR submissions.4 Closing gaps related to Long-Term 

Vulnerability Reduction is a major challenge for communities, as it requires significant financial and 

political investment at all levels of government, spanning diverse, interconnected issues. Natural 

hazards such as winter storms, extreme heat waves, flooding, and human-caused threats like physical 

attacks and cyberattacks on critical infrastructure challenge Long-Term Vulnerability Reduction 

capabilities. Inconsistent adoption of updated building codes—combined with the increasing rate and 

longevity of severe disasters—compound these threats and hinder Long-Term Vulnerability Reduction.

Between 2018 and 2021, winter storms caused approximately $801 million in property damage 

across 35 states.19 In December of 2022, an arctic blast impacted large areas of the U.S., causing low 

wind chill values, blizzards, heavy snowfall, and record-cold temperatures. During the arctic blast, more 

than 200 million people—about 60 percent of the U.S. population—were under a Winter Weather 

Advisory. The National Weather Service reported this was “one of the greatest extents of winter 

weather warnings and advisories ever.”131 The Tennessee Valley Authority, which provides power for 

ten million people in seven Southeastern states, experienced the highest 24-hour demand in its 90-

year history on December 23, 2022. The peak demand that day was thirty-six percent higher than its 

average winter peak load of 22,600 megawatts.132 The storm resulted in the deaths of 100 people; 

41 deaths were recorded in the Buffalo, New York region, where snowfall exceeded 56 inches over 

five days.133 The storm also hindered mobility, transportation, and emergency services across 

communities, leaving vulnerable populations, including seniors, homeless populations, and lowincome families at risk.131
2023 National Preparedness Report 34 

In addition to winter storms, extreme heat can threaten aging infrastructure systems and increase 

community and individual vulnerability. Waves of extreme heat cause building materials to overheat, 

leading to building maintenance and cooling challenges. This drains power grid capacity and heightens 

the severity and frequency of blackouts.134 Concrete degradation on roads and runways due to

extreme heat can cause transportation challenges and result in issues with timely restoration of power 

grids.134 Extreme heat can increase crop mortality and decrease refrigeration capacity and water 

supplies, triggering increased food and health concerns for the general public.134 Extreme heat can 

also exacerbate preexisting chronic illnesses and health burdens, causing 700 deaths and 9,200 

hospitalizations annually, more than any other severe weather incident.135,136 During the recordbreaking 2022 heat waves, adverse health effects disproportionately affected individual 

vulnerability.135 Recent New York City focused studies concluded that black (non-Hispanic) individuals 

are more likely to lack access to air conditioning and perish from extreme heat twice as frequently as 

other racial and ethnic groups in the city.137,138 The ongoing threat of blackouts, limited air 

conditioning, and inaccessible water supplies caused by extreme heat can heighten vulnerability 

among individuals with chronic health conditions and increases risk of dehydration, heat exhaustion, 

and stroke for affected populations.136

Inland flooding, a byproduct of excessive rainfall that overflows rivers and damages communities, has 

become more common in the United States.139 In recent years, significantly more rainfall has occurred

in the Northeast and Midwest, leading to greater flood risks in those regions.140 Inland flooding can 

damage infrastructure and economies, and harm or displace individuals in communities that are not 

equipped for such hazards.141 According to the Fourth National Climate Assessment, inland flood 

damages cost more than any other severe weather incident, averaging $6.9 billion annually from 1964 

to 2006.142 In 2021, non-coastal flooding accounted for over $5.1 billion in property damage across 

all 50 states.19 In 2022, a major inland river flood in eastern Kentucky caused 39 deaths, decimated 

entire communities, and caused significant financial damage for both businesses and individuals.143

Evacuation efforts for displaced people necessitated over 600 helicopters and extensive swift water 

boat rescues. In Florida, inland flooding caused by Hurricane Ian cost insurers an estimated $57 billion 

and impacted communities miles from the coastlines.144

The nation’s energy sector infrastructure is particularly vulnerable to natural threats and hazards. 

Nearly 70 percent of the national electrical grid is over 25 years old.145 Record heat waves, winter 

storms, and drought are pushing aging electrical grids to their breaking points, impacting all regions 

of the United States.146,147 For example, the December 2022 arctic blast greatly impacted many powergenerating centers, leaving 6.3 million households without power during part of the storm.133 In 

September of 2022, California’s record-breaking heat waves sparked fears of blackouts and cascading 

impacts.148 The California state government imposed its highest level of energy emergency, urging 

consumers to halt energy consumption for extended periods of time.149 Power grids also remain 

vulnerable to physical attacks. In 2022, 163 physical attacks on U.S. electrical grids occurred, 

representing a 77 percent spike from 2021.150 These attacks caused substantial economic damages 

and left hundreds or thousands of individuals vulnerable to disasters.151
 

2023 National Preparedness Report 35 

As areas of the United States undergo desertification and experience rising sea levels and increasingly 

destructive storms, the most cost-effective way to safeguard people, livelihoods, and property from the 

effects of disasters is to adopt codes and standards—such as hazard-resilient building codes—that 

reduce risk, and promote smart land use to encourage development in safer locations, and save 

energy.152 Building codes can provide insurance benefits for residents and improve a community’s 

applications for federal mitigation grant funding, in addition to encouraging smart land use in highhazard areas.152 The United States spends billions of dollars each year rebuilding homes and other 

structures damaged or destroyed by hurricanes,153 sometimes rebuilding the same structure more 

than once. For this reason, the Government Accountability Office (GAO) recommends that FEMA 

explore possible options to enhance property acquisitionsxix in flood and other hazard-prone areas.154

The GAO also recommends that Congress consider providing FEMA with the authority or direction

needed to implement these options.154 The benefits of property acquisition include eliminating floodprone structures, reducing disaster response costs, and limiting the government's fiscal exposure to 

the flood insurance program.154

The inconsistent adoption of building codes is one of the most significant factors that compounds risk 

and increases costs from natural hazards. In the United States, two out of three communities need to 

incorporate the latest building codes.155 Responsibility for building code adoption falls largely on 

SLTTs.

Modernizing Building Codes 

While the federal government can recommend implementing and designing building codes and 

developing incentive programs to encourage hazard-resilient buildings for communities, it plays 

almost no primary role in building code enforcement. In 39 states, less than 25 percent of the 

state’s communities are covered by the latest hazard-resistant codes, which means that over 75 

percent of communities in these states have not adopted the latest 2018 building code 

standards.6 Modernizing building codes can lead to reductions averaging $162 annually on 

household utility and energy bills and promote long-term community resiliency.6 On average, 

communities save around $1.6 billion in hazard damages by adopting modern building codes.6

Communities that adopted 2018 or newer building codes anticipate saving about $132 billion 

through 2040.6

Communities that do not implement current building codes face elevated natural hazard risk impacts. 

This is especially true in the Midwest, New England, the Mid-Atlantic, and across much of the South, 

where a significant portion of building infrastructure predates building code standards. Floodplain 

risks, especially inland flooding, are ever-growing in these regions as novel weather patterns, erosion, 

and severe weather increasingly threaten communities with outdated building infrastructure.156 Until 

recently, these regions’ flooding, tornadoes, and similar hazards were historically infrequent. A 2022 

study found that property and infrastructure damage increasingly occurs outside of the 100-year 

floodplain zones identified by federal mapping systems.157 Buildings in these areas lack designs to 

withstand flooding, tornado, or hurricane impacts.157
2023 National Preparedness Report 36 

12.2. Capabilities and Gaps

Building resilient systems, communities, and resources requires investing in capabilities to minimize 

long-term threat and hazard impacts at all levels of government. Some gaps in capability originate 

from jurisdictional limitations, especially with building codes and infrastructure. For example, the 

federal government can track building code adoption (e.g., FEMA’s Building Code Adoption Tracker

program)158 and provide incentives and recommendations for creating or strengthening resiliency 

measures for SLTTs. However, since the federal government does not have the authority to enforce 

building codes outside of tying incentives for adoption to federal funding requirements, the

responsibility to enforce building code adoption falls under the purview of SLTTs. This decentralization 

results in a wide variation in standards throughout regions and states.159,6 SLTTs also tend to lack a 

centralized, state-wide report on building codes, and many municipalities lack the personnel and 

budget to analyze their capabilities comprehensively.25 Some states have created mandates based on 

regional challenges. For example, California adopted building codes tailored for earthquake safety.160

However, as disasters become more geographically unpredictable, non-standardization creates 

disaster recovery challenges and resource competition between jurisdictions.

An additional factor that will complicate efforts to build resilience on a national level is climate change. 

Infrastructure, which is already vulnerable to climate change impacts, will become even more 

vulnerable in the future. Incorporating natural hazard risk assessments into mitigation strategies can 

aid in a proactive adaptation that anticipates future climate change impacts; reducing the costs of 

climate change for the United States’ road, rail, and coastal infrastructure by a factor of between three 

and six by 2090, compared with purely reactive adaptation.161,162 Since 2021, the federal government

has required federal agencies to reduce vulnerability to future climate change impacts such as flooding

by preparing for and protecting federally-funded buildings and projects from flood risks through the 

Federal Flood Risk Management Standard.163

In 2022, the Administration announced 20 new actions taken by federal agencies to bolster the 

government’s climate resiliency.164 For SLTTs, ongoing disasters of growing magnitude and duration 

will likely continue straining the financial and personnel capacities of state and local emergency 

management institutions as climate change impacts increase. The federal government should define 

specific funding priorities to financially assist and support SLTTs in their climate transition planning.

In addition, state mitigation plans are now required to consider equity and the impacts of climate 

change.165 FEMA strongly encourages SLTTs to develop and adopt updated building codes to enhance 

mitigation and resiliency.165 This holistic approach ensures that not only federal agencies but also 

state and local governments prioritize climate resilience and preparedness in building and 

infrastructure projects, acknowledging the crucial role of state-level mitigation efforts.165

Disasters can exacerbate long-term vulnerability for individuals and communities. In response, federal 

agencies created vulnerability reduction grant opportunities to strengthen recovery efforts for disasterimpacted communities. Grants developed by FEMA and the Department of Housing and Urban 

Development during the 1970s and 1980s, like the Community Development Block Grant Disaster 

Recovery (CDBG-DR) or HMGP, continue to be crucial programs for distributing funding to disasterimpacted communities.166,167 These grants allow communities to start their long-term vulnerability 
 

2023 National Preparedness Report 37 

recovery process and promote hazard-mitigation strategies to reduce future disaster-related 

risks.166,167

Grant activities include housing recovery, economic development, restoring impacted infrastructure, 

resiliency and mitigation activities, and equipment repairs and purchases.166 In FY2023, Congress 

appropriated $3 billion to assist in CDBG disaster incidents in 2022 or later, a $1 billion increase from 

FY2021.168 The HMGP encourages applicants to strengthen their mitigation strategies by incorporating 

actions that reduce long-term vulnerabilities and link proposed actions to available federal 

assistance.169 These grants highlight federal initiatives that attempt to remedy long-term vulnerability 

across communities and strengthen community-level preparedness. For detailed information on 

existing and currently available federal funding opportunities, please refer to Grants.gov.

Other disasters such as the COVID-19 pandemic have already complicated SLTTs’ ability to pursue 

long-term vulnerability reduction initiatives. For example, during the pandemic SLTT communities had 

limited access to Long-Term Vulnerability Reduction training and exercises. Communities also often 

lack state and federal resources to develop Long-Term Vulnerability Reduction training, policies, and 

resource distribution, and limited outreach with whole community input occurs across jurisdictions.25

There are limited Long-Term Vulnerability Reduction exercises at the state and local levels. These 

exercises include educating local critical infrastructure managers and engineers on the value of 

updating building codes through cost-benefit analysis, and building code regulatory engagement with 

feedback from nonprofit and private sectors.25

Data sharing and communication challenges across federal and SLTT agencies are common capacity 

gaps.170 Transparent, comprehensive, and timely communication, and data sharing between the 

public and private sectors remains important for preventing, protecting against, and mitigating the 

impacts of man-made threats such as active shooters and cyberattacks.171 Poorly timed emergency 

messages can hinder public and private institutions’ ability to ensure financial and personal 

information security across their enterprises.172 Agencies across the federal government frequently 

collaborate on improving interoperable and operable communication efforts. All levels of government 

strive to develop and fortify resilient communication systems and networks during emergencies.

The Emergency Communications Division of the Cybersecurity and Infrastructure Security Agency 

(CISA) plays a vital role in ensuring continuity of operations during conditions such as cyberattacks, 

mass gatherings, severe weather, or incidents caused by human error. CISA promotes communication 

systems used by government officials and emergency responders for the safety, security, and 

resilience of the United States. When networks are degraded or congested, CISA provides three priority 

telecommunications services that allow critical personnel to communicate: Wireless Priority Service 

for wireless voice communications, Government Emergency Telecommunications Service for wireline 

voice communications, and Telecommunications Service Priority for repair and installation of 

organizations’ critical voice and data circuits.173 These priority services mitigate communication 

problems during emergencies. Data sharing and communication efforts, as outlined in CISA’s Strategic 

Plan 2023-2025, should also continue to be pursued to close capability gaps.174
 

2023 National Preparedness Report 38 

12.3. Management Opportunities

Table 5 summarizes the opportunities that FSLTT governments, NGOs, VOADs, the private sector, and 

individuals/households can leverage to manage risk, build Long-Term Vulnerability Reduction 

capability, and address capacity gaps to increase their overall resilience.

Table 5: Long-Term Vulnerability Reduction – Management Opportunities. 

Stakeholder 

Group Management Opportunities 

Federal 

Government

• Require increased resiliency and energy efficiency standards across newly 

constructed residential properties under the CDBG-DR funds.175

• Continue to improve comprehensive extreme winter weather and extreme heat 

advisories that incorporate whole-community feedback and buy-in across federal 

agencies. 

• Develop and socialize existing resources to assist with building code and 

infrastructure upgrades, cybersecurity, and training.6

• Support state/local adoption of model building codes and retention of hazardresistant provisions in those codes.6

• Continue developing and enhancing environmental justice tools and initiatives

across all federal agencies through Executive Order 14008, including the 

Climate and Economic Justice Screening Tool and Environmental Justice 

Scorecard, and Executive Order 14096.176,32

SLTT 

Governments

• Adopt model building codes and retain hazard-resistant provisions in these 

codes.6

• Explore non-federal building code funding opportunities outside the scope of the 

BRIC program, including HMGP funding for retrofitting and construction projects 

and the Public Assistance Program for building code management and 

enforcement.177

• Continue to work with local communities and state partners to develop a building 

code outreach and training strategy.

• Explore funding opportunities to develop and strengthen technical assistance

programs at the SLTT level, which reduce vulnerabilities for small businesses, 

rural communities, and vulnerable populations. Potential programs include the

U.S. Department of Treasury’s State Small Business Credit Initiative, and the U.S. 

Department of Agriculture’s Rural Energy Pilot Program.178,179

• Provide FEMA’s Integrating the Needs of Children workshop, which promotes 

community planning, coordination, and integration of children’s needs during 

emergencies.180

NGOs, 

VOADs, and 

the Private 

Sector

• Private sector builders should encourage clients to utilize up-to-date, hazardresilient building codes, even when not required, to address consumers’ growing 

concerns over disaster damages due to climate change and establish mitigation 

as a standard practice.181 Furthermore, investing in up-to-date building codes 

saves money in the long-term by reducing disaster-related repairs.

• Collaborate with FSLTT partners to promote up-to-date technology and strategies 

to promote vulnerability reduction measures.

• Conduct vulnerability assessments and develop plans to mitigate gaps.
 

2023 National Preparedness Report 39 

Stakeholder 

Group Management Opportunities 

Individuals 

and 

Households 

• Become familiar with local risks (threats and hazards) before they occur and how 

to prepare for them. Leverage resources like Know Your Risk, Ready.gov, and the 

NRI. 

• Prepare a two-week emergency supply kit for all household members, including 

pets. Kits should include non-perishable food; bottled, boiled, or purified water; 

weather-appropriate clothing; flashlights and batteries; first aid supplies; thermal 

blankets; warming packs; prescription medicines; a battery-powered radio; and 

a small tool kit.182 

• When in doubt, throw it out. Discard food that has been exposed to temperatures 

40 degrees Fahrenheit or higher for two hours or more, or has an unusual odor, 

color, or texture.182,183

• Participate in a Community Emergency Response Team program, which educate 

volunteers about disaster preparedness for local threats and hazards.184

• If eligible, apply for the Low-Income Home Energy Assistance Program to assist 

with lowering energy costs and reducing the risk of health and safety problems 

that arise from unsafe heating and cooling situations.185

• Individuals and households that qualify should apply for the Weatherization 

Assistance Program, operated by DOE, to reduce energy costs by elevating the 

energy efficiency of their homes.186

• Invest in home improvements including installing storm shutters, reinforcing 

roofs, and adding insulation to reduce vulnerability to climate change and natural 

hazards.187 Talk with your local emergency manager and other community 

members to learn about local programs and funding.187

• Reduce energy consumption by incorporating energy-efficient appliances, 

unplugging electronics when not in use, and reducing water usage.188

Homeowners can apply for the Energy Efficient Home Improvement Credit for the 

two above recommendations, thus lowering costs for these improvements.189

• Download FEMA’s Emergency Financial First Aid Kit to help you organize 

important financial, medical, and household information.190
Conclusion

2023 National Preparedness Report 40 

The 2023 NPR provides an overview of the nation’s current disaster risk and capability landscape. 

Risks and capabilities inform emergency management decision-making and cannot be assessed 

independently in a vacuum. All levels of government need to work together to ensure disaster 

preparedness and resilience. Governments need to work with non-governmental partners and the 

private sector to ensure holistic preparedness and a full understanding of both the impacts of disasters 

and the capabilities needed to manage them. Through the National SPR, FEMA most frequently found 

that FSLTTs need to focus on areas like planning, organization, and financial and resource capacity. 

FEMA identified several key findings impacting emergency management today, including the increased 

frequency, severity, and cost of disasters; high community-level risk; ongoing individual and household 

preparedness gaps; and lacking building code adoption. To help the emergency management 

community form a clearer picture of risks and capabilities, and provide more specific management 

opportunities, FEMA chose to focus discussion on a subset of four core capabilities this year. 

Discussions within the focus areas illustrate the interconnection of systems and the potential for stress 

in one area to cascade to others, especially during disasters. For instance, chronic health conditions 

within the population can worsen because of wildfires, pressure supply chains for medical supplies, 

and increase hospitalizations.

The 2023 NPR identifies potential management opportunities that the federal government, SLTTs, 

NGOs, VOADs, private sector, individuals, and households can use to build capability and address 

capacity gaps. These management opportunities, along with FEMA’s analysis of national preparedness 

data and capabilities, inform the recommendations presented in this report, which include: 

 Targeting investments towards Core Capabilities and Mission Areas

 Reducing all-hazards challenges through targeted actions and increased coordination

 Addressing national gaps to prepare for catastrophic disasters

Building community-wide resilience helps form the foundation for successful response and recovery 

efforts. By examining and approaching resilience holistically alongside partners, the emergency 

management community can increase disaster preparedness and take steps to decrease the impact 

of future incidents. 

Diverse perspectives from the whole community bring fresh ideas and add to the accuracy and 

credibility of the NPR. Please feel welcome to email npr@fema.dhs.gov to provide feedback on this 

report or make suggestions for future reports. Though FEMA will consider all comments, respondents 

may not receive a reply to their submitted feedback.
References 

2023 National Preparedness Report i 

1. NOAA. NOAA National Centers for Environmental Information (NCEI) U.S. Billion-Dollar Weather 

and Climate Disasters (2023). doi:10.25921/stkw-7w73

2. National Weather Service. Weather Related Fatality and Injury Statistics. Published 2021. 

Accessed February 9, 2023. https://www.weather.gov/hazstat/

3. NOAA. 2022 U.S. billion-dollar weather and climate disasters in historical context | NOAA 

Climate.gov. Accessed March 22, 2023. http://www.climate.gov/news-features/blogs/2022-

us-billion-dollar-weather-and-climate-disasters-historical-context

4. FEMA. 2022 THIRA/SPR. FEMA; 2022.

5. FEMA. National Household Survey. Published September 1, 2023. Accessed October 17, 

2022. https://www.fema.gov/about/openfema/data-sets/national-household-survey

6. FEMA. Building Codes Strategy. Accessed January 9, 2023. 

https://www.fema.gov/emergency-managers/risk-management/building-science/buildingcodes-strategy

7. NIST. Understanding Building Codes. NIST. Published online June 16, 2022. Accessed 

February 15, 2023. https://www.nist.gov/buildings-construction/understanding-buildingcodes

8. House TW. FACT SHEET: Biden-Harris Administration Hosts First-Ever White House Climate 

Resilience Summit and Releases National Climate Resilience Framework. The White House. 

Published September 28, 2023. Accessed October 6, 2023. 

https://www.whitehouse.gov/briefing-room/statements-releases/2023/09/28/fact-sheetbiden-harris-administration-hosts-first-ever-white-house-climate-resilience-summit-andreleases-national-climate-resilience-framework/

9. FEMA. Fire Management Assistance Grants | FEMA.gov. Published August 30, 2023. 

Accessed September 27, 2023. https://www.fema.gov/assistance/public/fire-managementassistance

10. FEMA. National Risk Index. Accessed October 17, 2022. https://hazards.fema.gov/nri/

11. Center for Climate Resilience and Decision Science. Climate Risk and Resilience Portal. 

Accessed July 27, 2023. https://disgeoportal.egs.anl.gov/ClimRR/

12. DHS. DHS Announces $1.6 Billion in Preparedness Grants. Published May 13, 2022. 

Accessed April 21, 2023. https://www.dhs.gov/news/2022/05/13/dhs-announces-16-

billion-preparedness-grants
2023 National Preparedness Report ii 

13. FEMA. Mission Areas and Core Capabilities. Published July 20, 2020. Accessed March 22, 

2023. https://www.fema.gov/emergency-managers/national-preparedness/mission-corecapabilities

14. USFA. Wildland Urban Interface (WUI) Issues and Resolutions Report. U.S. Fire Administration.

Published June 7, 2022. Accessed January 5, 2023. https://www.usfa.fema.gov/stories/wuireport/index.html

15. NOAA National Centers for Environmental Information. U.S. Billion-dollar Weather and Climate 

Disasters, 1980 - present (NCEI Accession 0209268). Published online 2023. 

doi:10.25921/STKW-7W73

16. EPA, OAR. Climate Change Indicators: Wildfires. Published July 1, 2016. Accessed July 5, 

2023. https://www.epa.gov/climate-indicators/climate-change-indicators-wildfires

17. EPA. Wildfire Smoke Preparedness in Community Buildings Grant Program. Published 

September 30, 2022. Accessed October 18, 2022. https://www.epa.gov/indoor-air-qualityiaq/wildfire-smoke-preparedness-community-buildings-grant-program

18. Hoover K, Hanson L. Wildfire Statistics. Congressional Research Service; 2022. 

https://crsreports.congress.gov/product/pdf/IF/IF10244

19. Arizona State University. SHELDUS. Arizona State University 

https://sheldus.asu.edu/SHELDUS/index.cfm?page=members

20. DOI. 10 Tips to Prevent Wildfires. Published May 3, 2021. Accessed March 21, 2023. 

https://www.doi.gov/blog/10-tips-prevent-wildfires

21. Hoover K. Federal Assistance for Wildfire Response and Recovery. Congressional Research 

Service; 2022. https://crsreports.congress.gov/product/pdf/IF/IF10732

22. National Incident Management System | FEMA.gov. Accessed March 30, 2023. 

https://www.fema.gov/emergency-managers/nims

23. FEMA. Wildland Urban Interface Fire Operational Requirements and Capability Analysis. 

FEMA; 2019. 

https://www.dhs.gov/sites/default/files/publications/wui_fire_report_of_findings_july_24_20

19v2_508.pdf

24. Communications Interoperability | Homeland Security. Accessed October 6, 2023. 

https://www.dhs.gov/science-and-technology/saver/communications-interoperability

25. FEMA. 2023 National Preparedness Report Data Call. FEMA; 2023.

26. Meet BIL: How the Bipartisan Infrastructure Law Supports Wildland Fire Management. 

Published January 24, 2022. Accessed October 6, 2023. 

https://www.doi.gov/wildlandfire/meet-bil-how-bipartisan-infrastructure-law-supportswildland-fire-management

27. DOI. Biden-Harris Wildland Fire Mitigation and Management Commission Charts Path Forward. 

Published September 14, 2022. Accessed September 27, 2023. 
2023 National Preparedness Report iii 

https://www.doi.gov/pressreleases/biden-harris-wildland-fire-mitigation-and-managementcommission-charts-path-forward

28. DOI. 7 Burning Questions: Wildfires & Public Lands. Published April 21, 2017. Accessed 

March 24, 2023. https://www.doi.gov/blog/7-burning-questions-wildfires-public-lands

29. Forests and Rangelands. Map 1. National Priorities for Broad Scale Fuels Management. 

Accessed March 24, 2023. 

https://www.forestsandrangelands.gov/strategy/nationalpriorities.shtml#map1

30. US Forest Service. Current Issues - Active Management. US Forest Service. Published 

November 7, 2017. Accessed March 24, 2023. https://www.fs.usda.gov/managingland/fire/wofambrief/current_issues

31. Vulnerable Populations. National Center for Disaster Preparedness | NCDP. Accessed 

November 9, 2022. https://ncdp.columbia.edu/research/vulnerable-populations/

32. Executive Office of the President. Revitalizing Our Nation’s Commitment to Environmental 

Justice for All. Federal Register. Published April 26, 2023. Accessed September 21, 2023. 

https://www.federalregister.gov/documents/2023/04/26/2023-08955/revitalizing-ournations-commitment-to-environmental-justice-for-all

33. DOJ Civil Rights Division, Disability Rights Section. ADA Requirements: Effective 

Communication. ADA.gov. Published October 6, 2023. Accessed October 6, 2023. 

https://www.ada.gov/resources/effective-communication/

34. NIH. World’s older population grows dramatically. National Institutes of Health (NIH). 

Published March 28, 2016. Accessed September 21, 2023. https://www.nih.gov/newsevents/news-releases/worlds-older-population-grows-dramatically

35. Administration for Community Living. Projected Future Growth of Older Population. Published 

May 4, 2022. Accessed September 21, 2023. http://acl.gov/aging-and-disability-inamerica/data-and-research/projected-future-growth-older-population

36. FEMA. FEMA, AARP Release New Resources to Help Local Communities Protect Older Adults 

Before, During and After Natural Disasters | FEMA.gov. Accessed March 2, 2023. 

https://www.fema.gov/press-release/20220713/fema-aarp-release-new-resources-helplocal-communities-protect-older-adults

37. FEMA, AARP. Guide to Expanding Mitigation Making the Connection to Older Adults. 

https://www.fema.gov/sites/default/files/documents/fema_mitigation-guide_older-adults.pdf

38. The National Guard. Guard Saved Lives, Property, Responding to 2022 Disasters. National 

Guard. Accessed July 21, 2023. 

https://www.nationalguard.mil/News/Article/3255837/guard-saved-lives-propertyresponding-to-2022-

disasters/https%3A%2F%2Fwww.nationalguard.mil%2FNews%2FArticle%2F3255837%2Fgua

rd-saved-lives-property-responding-to-2022-disasters%2F

39. USDA, US Forest Service. Wildfire Risk to Communities. Wildfire Risk to Communities. 

Accessed May 5, 2023. https://wildfirerisk.org/
2023 National Preparedness Report iv 

40. Mitigation Framework Leadership Group. PRE FINAL DRAFT Progress Report to the White 

House: National Initiative to Advance Building Codes MitFLG. Mitigation Framework 

Leadership Group; 2022.

41. GAO. Wildfire Smoke: Opportunities to Strengthen Federal Efforts to Manage Growing Risks | 

U.S. GAO. Published March 28, 2023. Accessed April 21, 2023. 

https://www.gao.gov/products/gao-23-104723

42. USFA. Mitigating Wildfire Losses Incurred by Vulnerable Populations. U.S. Fire Administration. 

Published October 28, 2022. Accessed January 5, 2023. https://www.usfa.fema.gov/blog/ci102822.html

43. DHS. Recommendations for Emergency Managers for Disaster Assistance to Survivors with 

Disabilities | Homeland Security. Accessed August 15, 2023. 

https://www.dhs.gov/publication/recommendations-emergency-managers-disasterassistance-survivors-disabilities

44. FEMA. Preparedness Community. Accessed July 25, 2023. 

https://community.fema.gov/PreparednessCommunity/s/open-training?language=en_US

45. FEMA. Hazard Mitigation Grant Program Post Fire | FEMA.gov. Accessed April 18, 2023. 

https://www.fema.gov/grants/mitigation/post-fire

46. Swanger B. Plastic Culverts in Fire-Prone Areas: Survey of State Practice. Published online 

July 29, 2019. https://dot.ca.gov/-/media/dot-media/programs/research-innovation-systeminformation/documents/preliminary-investigations/plastic-culverts-in-fire-prone-areas-pi0223-a11y.pdf

47. FEMA. Wildfire | Mitigation (Property: Defensible Space). Accessed July 21, 2023. 

https://community.fema.gov/ProtectiveActions/s/article/Wildfire-Mitigation-PropertyDefensible-Space

48. Blue Forest. Forest Resilience Bond. Blue Forest Conservation. Accessed July 10, 2023. 

https://www.blueforest.org/forest-resilience-bond

49. Associated Press. PG&E Will Bury 10,000 Miles of Power Lines So They Don’t Spark Wildfires. 

NPR. https://www.npr.org/2021/07/21/1019058925/utility-bury-power-lines-wildfirescalifornia. Published July 21, 2021. Accessed January 9, 2023.

50. Jennings J, Tuttle AE, Nichols MD, Davis G. Railroad Fire Prevention Field Guide. Published 

online April 1999. 

https://ia802309.us.archive.org/8/items/fppguidepdf100/fppguidepdf100.pdf

51. Evacuation | Ready.gov. Accessed March 24, 2023. https://www.ready.gov/evacuation

52. CDC. Safety During a Wildfire. Accessed March 21, 2023. 

https://www.cdc.gov/disasters/wildfires/duringfire.html

53. Leslie J. How Climate Change Is Disrupting the Global Supply Chain. Yale Environment 360. 

Accessed February 13, 2023. https://e360.yale.edu/features/how-climate-change-isdisrupting-the-global-supply-chain
2023 National Preparedness Report v 

54. McFall-Johnsen M, Rosa-Aquino P. Photos show the Mississippi River is so low that it’s 

grounding barges, disrupting the supply chain, and revealing a 19th-century shipwreck. 

Business Insider. Accessed February 13, 2023. https://www.businessinsider.com/photos-drymississippi-river-waters-ground-barges-reveal-old-shipwreck-2022-10

55. Martin B, Clark-Ginsberg A. Ohio’s Train Derailment—Not Spy Balloons—Is the Real National 

Security Threat. Published February 20, 2023. Accessed February 21, 2023. 

https://www.rand.org/blog/2023/02/ohios-train-derailment-not-spy-balloons-is-the-realnational.html

56. McBride J, Siripurapu A. The State of U.S. Infrastructure. Council on Foreign Relations. 

Accessed February 23, 2023. https://www.cfr.org/backgrounder/state-us-infrastructure

57. Pierson B. Jackson, Mississippi water crisis prompts lawsuit for city, Siemens | Reuters. 

Published September 19, 2022. Accessed February 21, 2023. 

https://www.reuters.com/legal/litigation/jackson-mississippi-water-crisis-prompts-lawsuit-citysiemens-2022-09-19/

58. FEMA. Mississippi Emergency Declaration. Published September 20, 2022. Accessed July 7, 

2023. https://www.fema.gov/fact-sheet/mississippi-emergency-declaration-1

59. JXN Water. Water system update: Thursday, September 1. City of Jackson. Published 

September 1, 2022. Accessed September 25, 2023. https://www.jacksonms.gov/watersystem-update-thursday-morning/

60. Koenig D. Supply chain issues could slow fix of Florida electric grid. AP NEWS. Published 

September 30, 2022. Accessed March 22, 2023. https://apnews.com/article/hurricanesfloods-storms-natural-disasters-climate-and-environment3ef6b6c508f75da6a5b12bd60b2b05c0

61. Indoor Air Quality Association. West Coast Wildfires and Pandemic Lead to an Increase in 

Demand for Air Purifiers. Accessed September 25, 2023. https://iaqa.org/west-coastwildfires-and-pandemic-lead-to-an-increase-in-demand-for-air-purifiers/

62. Kentucky and Missouri Devastated by Flash Flooding. National Environmental Satellite, Data, 

and Information Service. Accessed March 22, 2023. 

https://www.nesdis.noaa.gov/news/kentucky-and-missouri-devastated-flash-flooding

63. Selyukh A, Woods D. Full (ware)house. NPR. 

https://www.npr.org/2022/01/04/1070342216/full-ware-house. Published January 4, 

2022. Accessed February 23, 2023.

64. Monteiro A. Covid E-Commerce Boom Sees U.S. Retailers Hunt for Warehouses. 

Bloomberg.com. https://www.bloomberg.com/news/newsletters/2022-01-11/supply-chainlatest-covid-e-commerce-boom-sees-warehouse-demand-soar. Published January 11, 2022. 

Accessed September 25, 2023.

65. UNCTAD. Climate change impacts on seaports: A growing threat to sustainable trade and 

development | UNCTAD. Published June 4, 2021. Accessed March 14, 2023. 

https://unctad.org/news/climate-change-impacts-seaports-growing-threat-sustainable-tradeand-development
2023 National Preparedness Report vi 

66. LaRocco LA, Stanton A. There’s a new inflation warning for consumers coming from the supply 

chain. Published 1676294371. Accessed February 14, 2023. https://www.msn.com/enus/money/news/there-s-a-new-inflation-warning-for-consumers-coming-from-the-supplychain/ar-AA17qw3w

67. The White House. FACT SHEET: CHIPS and Science Act Will Lower Costs, Create Jobs, 

Strengthen Supply Chains, and Counter China. The White House. Published August 9, 2022. 

Accessed October 14, 2022. https://www.whitehouse.gov/briefing-room/statementsreleases/2022/08/09/fact-sheet-chips-and-science-act-will-lower-costs-create-jobsstrengthen-supply-chains-and-counter-china/

68. Baily MN, Bosworth BP. US Manufacturing: Understanding Its Past and Its Potential Future. 

Journal of Economic Perspectives. 2014;28(1):3-26. doi:10.1257/jep.28.1.3

69. Paul S. Supply Chain Resiliency: Alleviating Backlogs and Strengthening Long-Term Security. 

U.S. Congress; 2022. https://www.finance.senate.gov/hearings/supply-chain-resiliencyalleviating-backlogs-and-strengthening-long-term-security

70. ASME. Defending Infrastructure Against Sea Level Rise - ASME. Accessed March 22, 2023. 

https://www.asme.org/topics-resources/content/defending-infrastructure-against-sea-levelrise

71. Sweet WV, Horton R, Kopp RE, LeGrande AN, Romanou A. Ch. 12: Sea Level Rise. Climate 

Science Special Report: Fourth National Climate Assessment, Volume I. U.S. Global Change 

Research Program; 2017. doi:10.7930/J0VM49F2

72. Collini R, Carter J, Auermuller L, et al. Application Guide for the 2022 Sea Level Rise Technical 

Report.; 2022:42. 

https://aambpublicoceanservice.blob.core.windows.net/oceanserviceprod/hazards/sealevelr

ise/noaa-nos-techrpt02-global-regional-SLR-scenarios-US-application-guide.pdf

73. FEMA. Port Security Grant Program | FEMA.gov. Accessed March 1, 2023. 

https://www.fema.gov/grants/preparedness/port-security

74. DOT. About Port Infrastructure Development Grants | MARAD. Accessed February 23, 2023. 

https://maritime.dot.gov/PIDPgrants

75. USDA. USDA Agri-Food Supply Chain Assessment: Program and Policy Options for 

Strengthening Resilience. U.S. Department of Agriculture; 2022. 

https://www.hsdl.org/c/abstract?docid=864506

76. DOE. State, Local, Tribal, and Territorial (SLTT) Program. Energy.gov. Accessed April 3, 2023. 

https://www.energy.gov/ceser/state-local-tribal-and-territorial-sltt-program

77. Lakovou E, White CC. A data-sharing approach for greater supply chain visibility. Brookings. 

Published September 14, 2022. Accessed February 17, 2023. 

https://www.brookings.edu/techstream/a-data-sharing-approach-for-greater-supply-chainvisibility/

78. Department of Homeland Security. State, Local, Tribal, and Territorial Information Sharing 

Program: Pilot Project Overview.; 2022. https://www.dhs.gov/sites/default/files/2022-

09/SLTT%20Information%20Sharing%20Program%20Pilot%20Project%20Overview.pdf
2023 National Preparedness Report vii 

79. Federal Register. Coronavirus State and Local Fiscal Recovery Funds. Federal Register. 

Published January 27, 2022. Accessed March 22, 2023. 

https://www.federalregister.gov/documents/2022/01/27/2022-00292/coronavirus-stateand-local-fiscal-recovery-funds

80. U.S. Small Business Administration. Get business insurance. SBA. Accessed March 22, 2023. 

https://www.sba.gov/business-guide/launch-your-business/get-business-insurance

81. FEMA. Are You Ready? - A Guide to Citizen Preparedness | FEMA.gov. Accessed July 25, 2023. 

https://www.fema.gov/related-link/are-you-ready-guide-citizen-preparedness

82. CDC. COVID Data Tracker. Centers for Disease Control and Prevention. Published March 28, 

2020. Accessed February 9, 2023. https://covid.cdc.gov/covid-data-tracker

83. Ahmad FB, Cisewski JA, Xu J, Anderson RN. Provisional Mortality Data — United States, 2022. 

MMWR Morb Mortal Wkly Rep. 2023;72. doi:10.15585/mmwr.mm7218a3

84. Manesh A, Varghese GM. Rising antimicrobial resistance: an evolving epidemic in a pandemic. 

The Lancet Microbe. 2021;2(9):e419-e420. doi:10.1016/S2666-5247(21)00173-7

85. CDC. COVID-19 Reverses Progress in Fight Against Antimicrobial Resistance in U.S. Centers for 

Disease Control and Prevention. Published September 9, 2022. Accessed July 7, 2023. 

https://www.cdc.gov/media/releases/2022/s0712-Antimicrobial-Resistance.html

86. CDC. Mpox in the U.S. Centers for Disease Control and Prevention. Published July 22, 2022. 

Accessed February 22, 2023. https://www.cdc.gov/poxvirus/monkeypox/about/index.html

87. The White House. FACT SHEET: Biden-Harris Administration’s Monkeypox Outbreak Response. 

The White House. Published June 28, 2022. Accessed February 22, 2023. 

https://www.whitehouse.gov/briefing-room/statements-releases/2022/06/28/fact-sheetbiden-harris-administrations-monkeypox-outbreak-response/

88. HHS. FACT SHEET: U.S. Department of Health and Human Services Response to the 

Monkeypox Outbreak. HHS.gov. Published July 21, 2022. Accessed February 22, 2023. 

https://www.hhs.gov/about/news/2022/07/21/fact-sheet-us-department-of-health-andhuman-services-response-to-the-monkeypox-outbreak.html

89. NSF. Study finds that climate change could spark the next pandemic | NSF - National Science 

Foundation. Accessed September 27, 2023. https://new.nsf.gov/news/study-finds-climatechange-could-spark-next

90. Duke University. What is the likelihood of another global pandemic like COVID-19? World 

Economic Forum. Published September 2, 2021. Accessed March 23, 2023. 

https://www.weforum.org/agenda/2021/09/pandemics-epidemics-disease-covid-likelyhood/

91. CDC. Zoonotic Diseases | One Health | CDC. Published March 16, 2023. Accessed March 23, 

2023. https://www.cdc.gov/onehealth/basics/zoonotic-diseases.html

92. CDC. Climate change and infectious diseases | What We Do | NCEZID | CDC. Published 

August 2, 2022. Accessed March 17, 2023. https://www.cdc.gov/ncezid/what-we-do/climatechange-and-infectious-diseases/index.html
2023 National Preparedness Report viii 

93. CDC. Causes and Ecosystem Impacts | Harmful Algal Blooms | CDC. Accessed March 21, 

2023. https://www.cdc.gov/habs/environment.html

94. CDC. Waterborne Disease | What We Do | NCEZID | CDC. Published March 9, 2022. 

Accessed March 21, 2023. https://www.cdc.gov/ncezid/what-we-do/2021-

highlights/waterborne-disease.html

95. Assistant Secretary for Health. Climate Change and Health Equity. HHS.gov. Published March 

30, 2022. Accessed March 21, 2023. https://www.hhs.gov/climate-change-health-equityenvironmental-justice/climate-change-health-equity/index.html

96. EPA, ORD. Research on Health Effects from Air Pollution. Published October 28, 2020. 

Accessed March 21, 2023. https://www.epa.gov/air-research/research-health-effects-airpollution

97. EPA, OAR. Indoor Air Quality and Climate Change. Published January 27, 2021. Accessed April 

21, 2023. https://www.epa.gov/indoor-air-quality-iaq/indoor-air-quality-and-climate-change

98. Liang Y, Sengupta D, Campmier MJ, Lunderberg DM, Apte JS, Goldstein AH. Wildfire smoke 

impacts on indoor air quality assessed using crowdsourced data in California. Proceedings of 

the National Academy of Sciences. 2021;118(36):e2106478118. 

doi:10.1073/pnas.2106478118

99. CDC. COVID-19 and Your Health. Centers for Disease Control and Prevention. Published 

February 11, 2020. Accessed September 21, 2023. https://www.cdc.gov/coronavirus/2019-

ncov/prevent-getting-sick/improving-ventilation-in-buildings.html

100. Aguilera R, Corringham T, Gershunov A, Benmarhnia T. Wildfire smoke impacts respiratory 

health more than fine particles from other sources: observational evidence from Southern 

California. Nat Commun. 2021;12(1):1493. doi:10.1038/s41467-021-21708-0

101. Silberner J. Heat wave causes hundreds of deaths and hospitalizations in Pacific north west. 

BMJ. 2021;374:n1696. doi:10.1136/bmj.n1696

102. Holmes TJ, Holt A, English DQ. Progress of Local Health Department Planning Actions for 

Climate Change: Perspectives from California, USA. International Journal of Environmental 

Research and Public Health. 2022;19(13):7984. doi:10.3390/ijerph19137984

103. Skahill E, West DM. Why hospitals and healthcare organizations need to take cybersecurity 

more seriously. Brookings. Published August 9, 2021. Accessed February 9, 2023. 

https://www.brookings.edu/blog/techtank/2021/08/09/why-hospitals-and-healthcareorganizations-need-to-take-cybersecurity-more-seriously/

104. Barry E, Perlroth N. Patients of a Vermont Hospital Are Left ‘in the Dark’ After a Cyberattack. 

The New York Times. https://www.nytimes.com/2020/11/26/us/hospital-cyber-attack.html. 

Published November 26, 2020. Accessed November 14, 2023.

105. Weiner S. The growing threat of ransomware attacks on hospitals. AAMC. Published July 20, 

2021. Accessed February 23, 2023. https://www.aamc.org/news-insights/growing-threatransomware-attacks-hospitals
2023 National Preparedness Report ix 

106. DOJ. U.S. Department of Justice Disrupts Hive Ransomware Variant. US Department of 

Justice. Published January 26, 2023. Accessed February 23, 2023. 

https://www.justice.gov/opa/pr/us-department-justice-disrupts-hive-ransomware-variant

107. COVID-19 Reported Patient Impact and Hospital Capacity by State Timeseries | 

HealthData.gov. Accessed March 21, 2023. https://healthdata.gov/Hospital/COVID-19-

Reported-Patient-Impact-and-Hospital-Capa/g62h-syeh

108. Hughes S. AHA Letter Re: Challenges Facing America’s Health Care Workforce as the U.S. 

Enters Third Year of COVID-19 Pandemic | AHA. Published March 1, 2022. Accessed March 

21, 2023. https://www.aha.org/lettercomment/2022-03-01-aha-provides-informationcongress-re-challenges-facing-americas-health

109. HHS. NDMS | Disaster Medical Assistance Teams. Accessed May 1, 2023. 

https://aspr.hhs.gov:443/NDMS/Pages/dmat.aspx

110. Commissioned Corps of the U.S. Public Health Service. Commissioned Corps of the U.S. Public 

Health Service. Accessed May 1, 2023. https://www.usphs.gov/

111. MRC | Home. Accessed April 26, 2023. https://aspr.hhs.gov:443/MRC/Pages/index.aspx

112. CDC. Overview of CASPER. Published August 20, 2020. Accessed September 21, 2023. 

https://www.cdc.gov/nceh/casper/overview.htm

113. Toles C (CDC/OPHPR/DSLR). PHEP Budget Period 4 (Fiscal Year 2022) Funding. Published 

online June 17, 2022:1-2.

114. CDC. Public Health Emergency Preparedness (PHEP) Cooperative Agreement | CDC. Published 

February 21, 2023. Accessed February 22, 2023. 

https://www.cdc.gov/orr/readiness/phep/index.htm

115. The White House. FACT SHEET: Biden-Harris Administration Announces American Rescue 

Plan’s Historic Investments in Community Health Workforce. The White House. Published 

September 30, 2022. Accessed April 17, 2023. https://www.whitehouse.gov/briefingroom/statements-releases/2022/09/30/fact-sheet-biden-harris-administration-announcesamerican-rescue-plans-historic-investments-in-community-health-workforce/

116. Center for Devices and Radiological Health. Medical Device Shortages During the COVID-19 

Public Health Emergency. FDA. Published online March 14, 2023. Accessed March 21, 2023. 

https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/medicaldevice-shortages-during-covid-19-public-health-emergency

117. Center for Devices and Radiological Health. Medical Device Supply Chain Notifications During 

the COVID-19 Pandemic. FDA. Published February 1, 2023. Accessed March 28, 2023. 

https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/medicaldevice-supply-chain-notifications-during-covid-19-pandemic

118. FBI PIN TLP White Unpatched and Outdated Medical Devices Provide Cyber Attack 

Opportunities Sept. 12, 2022 | AHA. Accessed July 6, 2023. 

https://www.aha.org/cybersecurity-government-intelligence-reports/2022-09-12-fbi-pin-tlpwhite-unpatched-and-outdated
2023 National Preparedness Report x 

119. Pollack R. Keeping Hospitals and Patients Safe against Cyberattacks | AHA News. Accessed 

March 30, 2023. https://www.aha.org/news/perspective/2023-02-03-keeping-hospitals-andpatients-safe-against-cyberattacks

120. FEMA. The Department of Homeland Security Notice of Funding Opportunity Fiscal Year 2022 

State and Local Cybersecurity Grant Program | FEMA.gov. Accessed March 1, 2023. 

https://www.fema.gov/fact-sheet/department-homeland-security-notice-funding-opportunityfiscal-year-2022-state-and-local

121. CDC. Detect & Prevent Vector-Borne Diseases. Division of Vector-Borne Diseases | NCEZID | 

CDC. Published August 11, 2022. Accessed April 21, 2023. 

https://www.cdc.gov/ncezid/dvbd/what-how/detect-prevent.html

122. CDC. What We Do & How We Do It - Division of Vector-Borne Diseases. Division of VectorBorne Diseases | NCEZID | CDC. Published April 13, 2022. Accessed April 21, 2023. 

https://www.cdc.gov/ncezid/dvbd/what-how/index.html

123. University of Central Florida. Long-lasting disinfectant promises to help fight pandemics. 

Phys.org. Published September 1, 2021. Accessed April 21, 2023. 

https://phys.org/news/2021-09-long-lasting-disinfectant-pandemics.html

124. Administration for Strategic Preparedness and Response. ASPR’s Hospital Preparedness 

Program (HPP). ASPR. Accessed March 27, 2023. 

https://aspr.hhs.gov:443/HealthCareReadiness/HPP/Pages/default.aspx

125. USDA. USDA Announces Proposed Framework for Advancing Surveillance for SARS-CoV-2 and 

Other Emerging Zoonotic Diseases through the American Rescue Plan. Accessed April 3, 

2023. https://www.usda.gov/media/press-releases/2021/08/24/usda-announcesproposed-framework-advancing-surveillance-sars-cov-2

126. Center for Devices and Radiological Health. Resilient Supply Chain Program for Medical 

Devices. FDA. Published online April 20, 2022. Accessed March 28, 2023. 

https://www.fda.gov/about-fda/cdrh-offices/resilient-supply-chain-program-medical-devices

127. Pino L. Improving the Cybersecurity Posture of Healthcare in 2022. HHS.gov. Published 

February 28, 2022. Accessed February 9, 2023. 

https://www.hhs.gov/blog/2022/02/28/improving-cybersecurity-posture-healthcare2022.html

128. Naveed MA, Shaukat R. Health literacy predicts Covid-19 awareness and protective 

behaviours of university students. Health Information & Libraries Journal. 2022;39(1):46-58. 

doi:10.1111/hir.12404

129. CDC. Take Action: Personal Needs | Prepare Your Health | CDC. Published February 7, 2022. 

Accessed March 21, 2023. 

https://www.cdc.gov/prepyourhealth/takeaction/personalneeds/index.htm

130. FEMA. You Are the Help Until Help Arrives. Accessed July 25, 2023. 

https://community.fema.gov/PreparednessCommunity/s/until-help-arrives?language=en_US

131. Ahn A. A huge storm brings icy temperatures and canceled flights to a majority of Americans. 

NPR. https://www.npr.org/2022/12/23/1145196907/a-huge-winter-storm-brings-icy-
2023 National Preparedness Report xi 

temperatures-and-snow-to-a-majority-of-americans. Published December 23, 2022. Accessed 

February 21, 2023.

132. Why Tennessee Valley Authority ordered rolling blackouts in Nashville. Accessed February 21, 

2023. https://www.tennessean.com/story/news/local/2022/12/23/why-tennessee-valleyauthority-ordered-rolling-blackouts-in-nashville/69754538007/

133. Deliso M. Buffalo’s deadly blizzard by the numbers: What made the storm so historic - ABC 

News. Accessed February 17, 2023. https://abcnews.go.com/US/buffalos-deadly-blizzardnumbers-made-storm-historic/story?id=95945684

134. CISA. Extreme Heat | CISA. Cybersecurity and Infrastructure Security Agency CISA. Accessed 

March 1, 2023. https://www.cisa.gov/topics/critical-infrastructure-security-andresilience/extreme-weather-and-climate-change/extreme-heat

135. Ross R. Effects of Heat Waves on Population Health: The Challenges Facing 

Socioeconomically Vulnerable Groups Living in Urban Areas Across Washington State. 

University of Washington; 2022. https://depts.washington.edu/uwchips/docs/hpwp-heatwaves.pdf

136. CSBG-DCL-2022-41 Mitigating Heat Stress in Vulnerable Populations FY 2022. Published July 

27, 2022. Accessed February 23, 2023. https://www.acf.hhs.gov/ocs/policy-guidance/csbgdcl-2022-41-mitigating-heat-stress-vulnerable-populations-fy-2022

137. Madrigano J, Lane K, Petrovic N, Ahmed M, Blum M, Matte T. Awareness, Risk Perception, and 

Protective Behaviors for Extreme Heat and Climate Change in New York City. IJERPH. 

2018;15(7):1433. doi:10.3390/ijerph15071433

138. NYC. 2022 New York City Heat-Related Mortality Report. NYC; 2022. 

https://nyccas.cityofnewyork.us/nyccas2022/report/1

139. Khalid A, Hersher R. Because of climate change, inland flooding is becoming more common. 

NPR. https://www.npr.org/2022/07/29/1114417118/because-of-climate-change-inlandflooding-is-becoming-more-common. Published July 29, 2022. Accessed March 14, 2023.

140. Hersher R. How climate change drives inland floods. NPR. 

https://www.npr.org/2022/08/03/1115384628/how-climate-change-drives-inland-floods. 

Published August 3, 2022. Accessed March 14, 2023.

141. EPA, OAR. Climate Change Indicators: River Flooding. Published July 1, 2016. Accessed March 

14, 2023. https://www.epa.gov/climate-indicators/climate-change-indicators-river-flooding

142. USGCRP. Fourth National Climate Assessment. U.S. Global Change Research Program, 

Washington, DC; 2018:1-470. Accessed March 15, 2023. https://nca2018.globalchange.gov

143. Department of Commerce, NOAA. Historic July 26th-July 30th, 2022 Eastern Kentucky 

Flooding. Accessed March 14, 2023. https://www.weather.gov/jkl/July2022Flooding

144. Nickel R. For flooded inland Florida, Hurricane Ian saved the worst for last. Reuters. 

https://www.reuters.com/business/environment/flooded-inland-florida-hurricane-ian-savedworst-last-2022-10-06/. Published October 6, 2022. Accessed March 14, 2023.
2023 National Preparedness Report xii 

145. Collaboration and New Technologies Critical for Grid Resilience, Stability and Renewable 

Energy Integration – AiDash and Schneider Electric. Published February 7, 2023. Accessed 

February 15, 2023. https://finance.yahoo.com/news/collaboration-technologies-critical-gridresilience-080000477.html

146. Office of Governor Newsom. As Heat Wave Grips Western U.S., Governor Newsom Takes 

Action to Increase Energy Supplies and Reduce Demand. California Governor. Published 

August 31, 2022. Accessed February 15, 2023. https://www.gov.ca.gov/2022/08/31/asheat-wave-grips-western-u-s-governor-newsom-takes-action-to-increase-energy-supplies-andreduce-demand/

147. Neuman S. As a heat wave blankets much of the U.S., utilities are managing to keep up, for 

now. NPR. https://www.npr.org/2022/07/22/1112724801/heat-warning-heat-waveadvisory-power-grid. Published July 22, 2022. Accessed February 15, 2023.

148. Chinowsky P. Intense heat waves and flooding are battering electricity and water systems, as 

America’s aging infrastructure sags under the pressure of climate change. Published 

September 7, 2022. Accessed February 23, 2023. 

https://www.preventionweb.net/news/intense-heat-waves-and-flooding-are-batteringelectricity-and-water-systems-americas-aging

149. California Skirts Blackouts With Heat Wave to Test Grid Again. Bloomberg.com. 

https://www.bloomberg.com/news/articles/2022-09-06/california-power-use-to-hit-recordraising-chance-of-blackouts-l7qiuo5t. Published September 6, 2022. Accessed February 23, 

2023.

150. Pulver D, Hauck G. Power grid attacks on substations increase across US: What to know. 

Published December 30, 2022. Accessed February 17, 2023. 

https://www.usatoday.com/story/news/nation/2022/12/30/power-grid-attacksincreasing/10960265002/

151. ‘Extremely vulnerable’: Attacks on the US power grid spiked an alarming 77% in 2022 — here 

are 3 simple steps to prep for the next big outage. Published February 10, 2023. Accessed 

February 15, 2023. https://finance.yahoo.com/news/extremely-vulnerable-attacks-us-power140000578.html

152. Guide to Expanding Mitigation: Making the Connection to Codes and Standards. Published 

online August 5, 2021. Accessed May 8, 2023. 

https://www.fema.gov/sites/default/files/documents/fema_guides-expanding-mitigationcodes-standards_08052021.pdf

153. Lingle B, Kousky C, Shabman L. Federal Disaster Rebuilding Spending: A Look at the 

Numbers. Risk Management and Decision Processes Center. Published February 22, 2018. 

Accessed April 20, 2023. https://riskcenter.wharton.upenn.edu/lab-notes/federal-disasterrebuilding-spending-look-numbers/

154. GAO. Flood Mitigation: Actions Needed to Improve Use of FEMA Property Acquisitions | U.S. 

GAO. US Government Accountability Office. Published September 13, 2022. Accessed April 

20, 2023. https://www.gao.gov/products/gao-22-106037

155. FEMA. Building Codes Adoption Playbook. FEMA; 2022. https://www.fema.gov/emergencymanagers/risk-management/building-science
2023 National Preparedness Report xiii 

156. FEMA. Understanding Flood Zones and Maps.; 2023. https://www.floodsmart.gov/flood-mapzone

157. Study: U.S. Flood Damage Risk Is Underestimated. NC State News. Published February 22, 

2022. Accessed March 15, 2023. https://news.ncsu.edu/2022/02/study-u-s-flood-damagerisk-is-underestimated/

158. FEMA. Nationwide Building Code Adoption Tracking | FEMA.gov. Accessed February 15, 2023. 

https://www.fema.gov/emergency-managers/risk-management/building-science/bcat

159. Rowan L. Hazard-Resilient Buildings: Sustaining Occupancy and Function After a Natural 

Disaster. Congressional Research Service; 2022. 

https://crsreports.congress.gov/product/pdf/R/R47215

160. California Siesmic Safety Commission. Homeowner’s Guide to Earthquake Safety | Seismic 

Safety Commission. Accessed March 2, 2023. https://ssc.ca.gov/forms_pubs/hog/

161. Council of Economic Advisers. Economic Report of the President. Published online March 

2023. https://www.whitehouse.gov/wp-content/uploads/2023/03/ERP-2023.pdf

162. Neumann JE, Chinowsky P, Helman J, et al. Climate effects on US infrastructure: the 

economics of adaptation for rail, roads, and coastal development. Climatic Change. 

2021;167(3):44. doi:10.1007/s10584-021-03179-w

163. FEMA. Federal Flood Risk Management Standard | FEMA.gov. Accessed June 26, 2023. 

https://www.fema.gov/floodplain-management/intergovernmental/federal-flood-riskmanagement-standard

164. The White House. FACT SHEET: Biden-Harris Administration Strengthens the Federal 

Government’s Resilience to Climate Change Impacts. The White House. Published October 6, 

2022. Accessed April 26, 2023. https://www.whitehouse.gov/briefing-room/statementsreleases/2022/10/06/fact-sheet-biden-harris-administration-strengthens-the-federalgovernments-resilience-to-climate-change-impacts/

165. FEMA. State and Local Mitigation Planning Policy Guides: Summary of Changes. Published 

online April 2022. https://www.fema.gov/sites/default/files/documents/fema_mitigationpolicies-summary-changes_042022.pdf

166. HUD. Community Development Block Grant Disaster Recovery Grant Funds. HUD.gov / U.S. 

Department of Housing and Urban Development (HUD). Accessed April 13, 2023. 

https://www.hud.gov/program_offices/comm_planning/cdbg-dr

167. FEMA. Hazard Mitigation Grant Program (HMGP) | FEMA.gov. Accessed April 12, 2023. 

https://www.fema.gov/grants/mitigation/hazard-mitigation

168. HUD. CDBG-DR Active Disaster Grants and Grantee Contact Information. Accessed April 19, 

2023. https://www.hudexchange.info/programs/cdbg-dr/cdbg-dr-grantee-contact-information

169. FEMA. Hazard Mitigation Assistance Program and Policy Guide. Published online March 23, 

2023. https://www.fema.gov/sites/default/files/documents/fema_hma-program-policyguide_032023.pdf
2023 National Preparedness Report xiv 

170. The White House. Drought Resilience Interagency Working Group 1 Year Summary Report. 

The White House; 2022. Accessed October 14, 2022. https://www.whitehouse.gov/wpcontent/uploads/2022/05/DroughtIWGReport_Final_Embargoed-Until-June-1-at-6AM-ET.pdf

171. The White House. FACT SHEET: Biden-Harris Administration Announces National Cybersecurity 

Strategy. The White House. Published March 2, 2023. Accessed March 15, 2023. 

https://www.whitehouse.gov/briefing-room/statements-releases/2023/03/02/fact-sheetbiden-harris-administration-announces-national-cybersecurity-strategy/

172. Department of Energy. Cybersecurity Considerations for Distributed Energy Resources on the 

U.S. Electric Grid. Department of Energy; 2022. 

file:///C:/Users/Noah.Mulligan/Downloads/872040%20(1).pdf

173. CISA. Priority Services | Cybersecurity and Infrastructure Security Agency CISA. Accessed April 

19, 2023. https://www.cisa.gov/topics/emergency-communications/priority-services

174. CISA. CISA Strategic Plan 2023-2025. CISA; 2022. 

https://www.cisa.gov/sites/default/files/2023-01/StrategicPlan_20220912-V2_508c.pdf

175. The White House. FACT SHEET: Biden-Harris Administration Launches Initiative to Modernize 

Building Codes, Improve Climate Resilience, and Reduce Energy Costs. The White House. 

Published June 1, 2022. Accessed February 17, 2023. https://www.whitehouse.gov/briefingroom/statements-releases/2022/06/01/fact-sheet-biden-harris-administration-launchesinitiative-to-modernize-building-codes-improve-climate-resilience-and-reduce-energy-costs/

176. Environmental Justice. The White House. Accessed July 20, 2023. 

https://www.whitehouse.gov/environmentaljustice/

177. FEMA. Building Code Funding Opportunities | FEMA.gov. Accessed March 22, 2023. 

https://www.fema.gov/emergency-managers/risk-management/building-science/fundingopportunities

178. USDA. USDA Launches Pilot Program to Deploy Renewable Energy Infrastructure to People in 

Rural Towns. Accessed July 20, 2023. https://www.usda.gov/media/pressreleases/2022/01/19/usda-launches-pilot-program-deploy-renewable-energy-infrastructure

179. Department of Commerce. Treasury Announces Plans to Deploy $300 Million in Technical 

Assistance to Underserved Entrepreneurs and Very Small Businesses through the State Small 

Business Credit Initiative. U.S. Department of Commerce. Published April 28, 2022. Accessed 

July 20, 2023. https://www.commerce.gov/news/press-releases/2022/04/treasuryannounces-plans-deploy-300-million-technical-assistance

180. FEMA. Community Preparedness: Integrating the Needs of Children. Accessed July 25, 2023. 

https://community.fema.gov/PreparednessCommunity/s/communitypreparedness?language

=en_US

181. FEMA. 5 Reasons Building Codes Should Matter to You | FEMA.gov. Published September 29, 

2021. Accessed March 22, 2023. https://www.fema.gov/blog/5-reasons-building-codesshould-matter-you
 

2023 National Preparedness Report xv 

182. CDC. When the Power Goes Out | Natural Disasters and Severe Weather | CDC. Published 

September 9, 2021. Accessed March 21, 2023. 

https://www.cdc.gov/disasters/poweroutage/needtoknow.html

183. HHS. Winter Weather Food Safety. FoodSafety.gov. Published January 3, 2019. Accessed July 

25, 2023. https://www.foodsafety.gov/blog/winter-weather-food-safety

184. FEMA. Community Emergency Response Team (CERT) | FEMA.gov. Accessed July 25, 2023. 

https://www.fema.gov/emergency-managers/individuals-communities/preparednessactivities-webinars/community-emergency-response-team

185. Low Income Home Energy Assistance Program (LIHEAP). Published June 5, 2023. Accessed 

July 20, 2023. https://www.acf.hhs.gov/ocs/low-income-home-energy-assistance-programliheap

186. DOE. Weatherization Assistance Program - FACT SHEET. Published online 2022. 

https://www.energy.gov/sites/default/files/2022-06/wap-fact-sheet_0622.pdf

187. DOE. Home Energy Rebate Programs. Energy.gov. Published 2022. Accessed May 15, 2023. 

https://www.energy.gov/scep/home-energy-rebate-programs

188. DOE. Reducing Electricity Use and Costs. Energy.gov. Accessed March 21, 2023. 

https://www.energy.gov/energysaver/reducing-electricity-use-and-costs

189. Internal Revenue Service. Energy Efficient Home Improvement Credit. Published April 27, 

2023. Accessed May 11, 2023. https://www.irs.gov/credits-deductions/energy-efficienthome-improvement-credit

190. Emergency Financial First Aid Kit. Accessed July 25, 2023. 

https://community.fema.gov/PreparednessCommunity/s/emergency-financial-first-aidkit?language=en_US

i Qualitative means non-numeric data and methods that emphasize descriptions, interpretations, and meanings.

ii Billion-dollar disaster figures are adjusted for inflation.3

iii For additional information on the National Risk and Capability Assessment and data limitations, please refer to the 2022 

NPR Appendix C: National Risk and Capability Assessment and Methodology and Appendix D: Risk and Emergency 

Management. For information on risk and emergency management terminology, please refer to the 2017 DHS Risk Lexicon. 

iv The THIRA/SPR Overview and Methodology can be found at https://www.fema.gov/sites/default/files/2020-

06/fema_national-thira-overview-methodology_2019_0.pdf

v For the purposes of this report, geographic regions align to the parameters established by the U.S. Census Bureau for the 

2020 U.S. Census. The Northeast region includes the communities of Connecticut, Maine, Massachusetts, New Hampshire, 
2023 National Preparedness Report xvi 

New Jersey, New York, Pennsylvania, Rhode Island, Vermont, and cities and tribes within these states. The South region 

includes the communities of Alabama, Arkansas, Delaware, the District of Columbia, Florida, Georgia, Kentucky, Louisiana, 

Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia and cities 

and tribes within these states. The Midwest region includes the communities of Illinois, Indiana, Iowa, Kansas, Michigan, 

Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin, and cities and tribes within these states. The 

West region includes the communities of Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, 

Oregon, Utah, Washington, Wyoming, and cities and tribes within these states. For the purposes of this report, U.S. territories 

were excluded from this analysis.

vi These scales are based on a composite score that is determined by several factors, including expected annual loss (EAL), 

Social Vulnerability, and Community Resilience. Composite scores of risk are not yet available for Puerto Rico, the U.S. Virgin 

Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands, but will be available in the future. 

Census tracts and counties without Social Vulnerability or Community Resilience data are given a rating of “Data Unavailable.”

If a community has “Insufficient Data” to compute EAL or “Data Unavailable” for Social Vulnerability or Community Resilience,

the community is given a Risk Index rating of “Insufficient Data.” When a hazard type is not applicable or there are insufficient 

data for a community, EAL for that hazard type is simply not included in the community’s final summation and scoring. Refer 

to FEMA’s National Risk Index Technical Documentation for additional information.

vii The 12 preparedness actions and associated percent of survey respondents who took these actions include: Assemble or 

Update Supplies (33 percent), Document and Insure Property (25 percent), Get Involved in Your Community (10 percent), 

Know Evacuation Routes (28 percent), Make a Plan (41 percent), Make Your Home Safer (33 percent), Plan with Neighbors 

(12 percent), Practice Emergency Drills or Habits (16 percent), Safeguard Documents (29 percent), Save for a Rainy Day (36 

percent), Sign up for Alerts and Warnings (46 percent), and Test Family Communication Plan (17 percent).

viii To determine the average target achievement rate by core capability, FEMA first examined the data and capped all target 

achievement data values that were over 100 percent to a maximum value of 100 percent to avoid overestimations of target 

achievement capability. Afterwards, FEMA grouped actual community target achievement percentages by core capability, and 

then averaged those values to develop the average target achievement percentage for each core capability. Public Assistance 

and Individual Assistance are not factored into this graphic.

ix All core capabilities listed within the “Cross-Cutting” area of Figure 8 apply to at least two of the five mission areas.

x Intelligence and Information Sharing is not applicable across all mission areas, only Prevention and Protection. All other 

core capabilities with the highest grant funding fall under the Cross-Cutting or Response mission areas except Threats and 

Hazards Identification, which falls under the Mitigation mission area.

xi Target Achievement Percentage is calculated for each target and community by dividing the current capability of the 

community for that target by the capability target goal they have set for themselves. In Figure 8, the Target Achievement 

Percentage for each community is averaged together and presented by capability target. In some cases, communities 

exceeded their goals, leading to Target Achievement Percentages over 100%, which skewed the average and made Target 

Achievement Percentages by capability target falsely high. To correct this, Target Achievement Percentages over 100% were 

truncated to 100% prior to averaging by capability target.

xii This figure is based on an analysis of funding sources including the State Homeland Security Program (SHSP), Urban Area 

Security Initiative (UASI), Nonprofit Security Grant Program (NSGP), Emergency Management Performance Grant (EMPG), and 

Homeland Security Grant Program (HSGP). Some of the federal grant funding amounts in this graphic may appear low for 

several reasons. First, these grants do not necessarily focus on specific core capabilities. Second, not all grants (e.g., hazard 
2023 National Preparedness Report xvii 

mitigation grants) are included in this list and specific core capabilities may receive targeted funding from sources other than 

the grants listed above, which this graphic does not capture.

xiii Functional areas are a key component of emergency management operations and are organized around a specific set of 

activities. Functional areas are often used to group related activities and resources needed to accomplish emergency 

management objectives. The National Incident Management System (NIMS) framework identifies five functional areas: 1) 

Command and Management, which involves establishing an organizational structure and process for overall incident 

management, direction, and control; 2) Communications and Information Management, which encompasses managing 

information and communication systems, equipment, and protocols during an emergency; 3) Operations, which involves the 

coordination and management of the on-scene response activities, including resource management, logistics, and 

operational planning; 4) Planning, which focuses on developing and maintaining plans, collecting and analyzing data, and 

making decisions based on situational assessments; and 5) Logistics and Resource Management, which involves acquiring 

and allocating resources, maintaining inventories, and providing facilities and support services during an emergency. These 

functional areas provide a common language and structure for emergency management activities and help ensure that all 

necessary functions are covered during an emergency.22

xiv FEMA increased the number of targets states, territories, and UASIs were required to assess in the 2022 THIRA/SPR to 33 

(from 15 in 2021), including expanding some targets and/or decreasing capabilities. Tribal nations are only required to 

assess 12 targets.

xv FEMA funds fire management programs not included in THIRA/SPR reporting (i.e., the Staffing for Adequate Fire and 

Response [SAFER] and Assistance to Firefighters Grant [AFG] programs). As of July 31, 2023, from 2017 to 2022, the SAFER

grant program and the AFG program released $1,895,643,892.51 and $1,885,770,481.65 of funding, respectively.

xvi Grant funding sources for Fire Management and Suppression include the State Homeland Security Program, Urban Area 

Security Initiative, Operation Stonegarden, Nonprofit Security Grant Program, and Emergency Management Performance 

Grant.

xvii The term “vulnerable population” is defined by the same metrics present in the 2022 NPR: “Populations that are less likely 

to be able to prepare for hazards; less likely to receive or be able to respond to warnings; more likely to die, suffer injuries, 

and have disproportionately higher material losses; have more psychological trauma; and face more obstacles during phases 

of response and recovery.”31

xviii This statement does not constitute a federal endorsement of investment in this or any other particular financial 

instrument.

xix For property acquisitions, FEMA provides funding for communities to purchase flood-prone properties and convert the land 

to undeveloped/green spaces.