Healthcare Facilities 

and Power Outages

Guidance for State, Local, Tribal, Territorial, and 

Private Sector Partners

August 2019 
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Table of Contents

INTRODUCTION.....................................................................................................................1

Purpose ........................................................................................................................................ 1

Background ................................................................................................................................. 1

HEALTHCARE FACILITY PREPAREDNESS.....................................................................3

Challenges to Healthcare Resilience During Power Outages..................................................... 3

Good Practices to Overcome Challenges .................................................................................... 5

Overview of Emergency Preparedness Regulations, Codes, and Standards ............................. 8

Considerations Regarding Regulations..................................................................................... 10

INTEGRATING EMERGENCY PREPAREDNESS EFFORTS ......................................... 13

Integrated Community-Based Planning ................................................................................... 13

Additional Opportunities for Collaboration............................................................................. 15

PRIORITIZING ASSISTANCE TO HEALTHCARE FACILITIES DURING RESPONSE

................................................................................................................................................. 17

Roles and Responsibilities in Assistance Prioritization ............................................................ 17

Using the Community Lifelines to Prioritize Assistance .......................................................... 19

Conclusion ................................................................................................................................. 20

APPENDIX A. BASICS OF UTILITY AND STANDBY POWER IN HEALTHCARE..... 21

Overview of Utility Power Transmission and Distribution Systems........................................ 21

Overview of Temporary Power................................................................................................. 22

APPENDIX B. EXCERPTS FROM THE POWER OUTAGE INCIDENT ANNEX.......... 26

Federal Government Initial Objectives .................................................................................... 26

Federal Operational Phases ...................................................................................................... 26

Facts, Planning Assumptions, and Critical Considerations to Aid in Planning for Prioritizing 

Assistance................................................................................................................................... 29

Critical Information Requirements and Essential Elements of Information for Prioritizing 

Assistance................................................................................................................................... 31

APPENDIX C. RESOURCES ................................................................................................ 33

Healthcare Emergency Preparedness Regulations and Standards.......................................... 33

Guidance.................................................................................................................................... 34

Information................................................................................................................................ 35

Training ..................................................................................................................................... 36

Modeling Tools.......................................................................................................................... 38

APPENDIX D. ACRONYM LIST.......................................................................................... 40
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Healthcare Facilities and Power Outages

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Introduction

Purpose

This document provides guidance and resources on improving healthcare facility resilience to 

power outages. Resilience is the backbone of emergency management. The Nation’s ability to 

weather storms and disasters without experiencing loss significantly reduces our risk. The 

Federal Emergency Management Agency (FEMA) developed this guide in collaboration with, 

and support from, the U.S. Department of Health and Human Services’ (HHS) Office of the 

Assistant Secretary for Preparedness and Response (ASPR) and other partners to meet, in part, 

the requirements of Section 1208 of the Disaster Recovery Reform Act.

1 This document informs 

state, local, tribal, and territorial governments, first responders, utility companies, and healthcare 

facilities on: 

• Healthcare facility preparedness standards and challenges;

• Ways to integrate emergency preparedness efforts throughout the whole community; and

• Methods for prioritizing assistance to hospitals, nursing homes, and other long-term care 

facilities during power outages.

Background

Across the Nation, in every community, there are individuals in hospitals, nursing homes, and 

other long-term care facilities dependent on power for their well-being. A wide range of facilities

provide care in the United States. A portion of these facilities fall within the seventeen provider 

and supplier types2 regulated by states and the Centers for Medicare and Medicaid Services

(CMS), including emergency preparedness regulations.

3 A portion (e.g., assisted living facilities, 

board and care homes, individuals living at home) are not regulated by CMS but still may have

electrically-dependent residents.

Individuals rely on electricity in a number of ways. Patients of some facilities, such as hospitals, 

receive acute medical care that relies on electricity. Other individuals with access and functional 

needs4 or chronic health conditions rely on power-dependent durable medical equipment (e.g., 

 

1 The Disaster Recovery Reform Act is part of H.R. 302 – FAA Reauthorization Act of 2018. 

https://www.congress.gov/bill/115th-congress/house-bill/302/. 2 The 17 provider and supplier types identified by CMS are: Religious Nonmedical Health Care Institutions, 

Ambulatory Surgical Centers, Hospices, Psychiatric Residential Treatment Facilities, Programs for All-Inclusive 

Care for the Elderly, Hospitals, Transplant Centers, Long-term Care Facilities, Intermediate Care Facilities for 

Individuals with Intellectual Disabilities, Home Health Agencies, Comprehensive Outpatient Rehabilitation 

Facilities, Critical Access Hospitals, Providers of Outpatient Physical Therapy and Speech-Language Pathology 

Services, Community Mental Health Centers, Organ Procurement Organizations, Rural Health Clinics and Federally 

Qualified Health Centers, and End-Stage Renal Disease Facilities. 3 81 Federal Register (FR) 63859: Medicare and Medicaid Programs: Emergency Preparedness Requirements for 

Medicare and Medicaid Participating Providers and Suppliers. 4 Access and Functional Needs: Individuals having access and functional needs may include, but are not limited to, 

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

transportation, and/or limited access to financial resources to prepare for, respond to, and recover from the 

emergency.
Healthcare Facilities and Power Outages

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powered wheelchairs, ventilators), but may reside in an assisted living facility, board and care 

home, or their own home. Individuals also may have an implanted cardiac device that must be 

plugged in to recharge. Some individuals cannot regulate their own body temperatures and are 

vulnerable to a lack of environmental controls such as air conditioning.

Healthcare facility buildings also rely on electricity for many operations, including lighting, 

security systems, fire alarm and egress systems, environmental controls (e.g., air conditioning), 

electronic health records, and an array of electricity-dependent durable medical equipment and 

devices to provide care. In addition, resident populations require daily support (food, water, and 

transportation) all of which require an intact electrical supply. These requirements, and the fact 

that healthcare facilities generally cannot temporarily suspend operations, make healthcare 

facilities uniquely susceptible to power outages. Without power, facilities may require 

evacuation, and evacuation carries significant dangers for specific populations such as those with 

access and functional needs. 

All levels of government and the private sector have long recognized the importance of power at 

healthcare facilities, and yet challenges occur with almost every major disaster. One of the more 

frequent response stabilization activities is providing temporary power (e.g., generator) support 

for hospitals and skilled nursing facilities. This phenomenon recurs for a multitude of reasons, 

and although healthcare facility leaders are responsible for preparing their facilities for power 

outages in accordance with applicable regulation, the whole community (to include all levels of 

government and utility operators) can help improve these facilities’ resilience to power outages. 
Healthcare Facilities and Power Outages

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Healthcare Facility Preparedness

Resilience to power outages begins with the facility and its leadership. Facilities that prepare and 

plan for the unexpected will be less likely to have catastrophic failures and will be able to request 

and receive temporary assets faster, if needed. 

This section discusses challenges to maintaining healthcare operations during a power outage, 

good practices to increasing facility resilience, regulations requiring healthcare emergency 

preparedness, and areas of consideration with regards to regulations.

Challenges to Healthcare Resilience During Power Outages

Generating standby power during a power outage is a complex undertaking. Numerous 

challenges can impact the ability of a facility to provide adequate emergency power.

Increased Facility Reliance on Electrical Power

The electrical dependence of an organization increases as its functions become more complex. At 

the most basic level, standard building operations such as lighting, security systems, and 

elevators require electricity. Fire alarm and suppression systems are essential and require not 

only electricity but backup power supplies.

Since many healthcare facilities have resident populations, hygiene and feeding capabilities are 

also part of the electrical demand. Environmental controls, such as heating and air conditioning, 

are very important as patient populations are often susceptible to temperature changes. At higher 

levels of care, other important electrical loads include life-support systems, monitoring 

capabilities, diagnostic capabilities (e.g., radiology, laboratory), blood banking and transfusion 

services, morgue operations, and pharmaceutical and other supply storage. 

Regulations do not mandate that emergency standby power generation be available for all 

existing functions. Regulations5 do require emergency standby power to particularly sensitive 

areas in hospitals, including operating rooms and critical care units where even a momentary 

interruption in power could mean life or death for an individual patient.

Scientific and technological advancements have both improved the care patients receive and 

increased healthcare facilities’ reliance on electricity. One example of increased electrical load in 

healthcare facilities relates to electronic health records and other computer controlled systems 

(e.g., voice over internet phones). Electronic health records are now found in most major 

healthcare facilities6 and are critical to the care delivered. A patient’s clinical status, medications, 

treatments, and other important parameters are all stored and ordered through these systems. 

 

5 81 FR 63859: Medicare and Medicaid Programs: Emergency Preparedness Requirements for Medicare and 

Medicaid Participating Providers and Suppliers

6 In 2015, 84 percent of all non-federal acute care hospitals had adopted a Basic Electronic Health Record with 

clinician notes. Office of the National Coordinator for Health Information Technology. “Non-Federal Acute Care 

Hospital Electronic Health Record Adoption,.” Health IT Quick-Stat #47. 

https://dashboard.healthit.gov/quickstats/pages/FIG-Hospital-EHR-Adoption.php. 
Healthcare Facilities and Power Outages

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Given the increase in reliance on computer-controlled 

systems, some facilities have complex server rooms which 

require their own environmentally controlled support 

systems.

Standby Power Generation Issues

In the event of power interruption, emergency power 

supply systems provide emergency standby power to 

facilities. These systems are susceptible to design, capacity, 

and maintenance issues. Recurring challenges and themes 

are discussed below, and general information about standby power generation and utility power is available in 

Appendix A. 

Design Issues

Emergency power supply systems are complex. When evaluating standby power capabilities, 

consider that each component of the system can have independent vulnerabilities. Example 

design issues include:

• System components (e.g., fuel pumps) located in a position where they are vulnerable to 

hazard impacts, such as flooding or wind.

• System components not designed to withstand hazard impacts. For example, battery-starting 

mechanisms and exhaust stacks not secured properly to withstand earthquake impacts.

• System components and required transfer switch not appropriately installed to safely remove 

the facility from grid to emergency backup power and vice versa when the power is restored. 

• Untested components impacting a facility’s ability to operate, for example: 

‒ An organization moving into a new facility and not discovering that the fuel pump for the 

generator was not on backup power; and

‒ New facilities discovering in an emergency that red outlets (a standard indicator of 

outlets connected to emergency backup power) are actually not connected. 

Case Study: Superstorm Sandy

During Superstorm Sandy in 2012, a large hospital lost emergency power because the fuel pumps 

were located in the basement and under water. Without emergency power, they were unable to 

operate the pumps to fill storage with potable water. When the storage tanks drained, the hospital 

lost potable water and the patients and staff had to be evacuated. Two patients could not be 

evacuated, and members of the National Guard had to hand-carry fuel to the higher floors for 

weeks to enable portable generator power for the remaining patients.

Capacity Issues

Emergency power supply systems have a maximum electrical load that they can carry. Few 

facilities, especially large ones, have full redundancy of power for their total operating capacity 

supplied through the emergency standby generator capability. Facility administrators and 

Generator System Components

 Motor and alternator

 Transfer switches

 Electrical lines

 Battery-starting mechanisms

 Fuel storage

 Fuel pump

 Fuel line

 Exhaust
Healthcare Facilities and Power Outages

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emergency managers should have a detailed account of which systems are and are not intended 

to draw on backup power supply. 

Air conditioning systems are often not connected to backup power. Air conditioning consumes a 

tremendous amount of electricity. By some estimates, for the average facility, adding air 

conditioning to the backup electrical load will approximately double the required generator 

support needed. However, in some climates, lack of air conditioning7 is a serious threat to patient 

populations, particularly those with conditions that affect their ability to regulate body 

temperature. 

A number of other systems also may not be covered by 

backup power: 

• Environmental control for server rooms

• Diagnostic equipment including radiology

• Morgue 

• Lab

• Blood bank, transfusions service, and human tissue 

storage

• Food preparation areas

• Elevators

• Pharmacy/floor prescription dispensaries. 

Additionally, many facilities do not have enough 

generator capacity to continue supplying the facility in the event of a generator mechanical 

failure (i.e., if the facility has one generator down for repair, the remaining generators are not 

able to fully supply the usual power demand). 

Maintenance and Resupply Issues

Even with proper preventative maintenance, mechanical failure of standby generators occurs, 

requiring special expertise and sometimes difficult-to-obtain critical components. Additionally, 

generators require a constant supply of fuel. While fuel can and often is required to be stored on

site, fuel can degrade if stored for lengthy periods. Post-impact road conditions and availability 

of relevant resources (e.g., specialized repair personnel, critical components, fuel) all impact 

generator operations. 

Good Practices to Overcome Challenges

A healthcare facility can take multiple measures to improve the resilience of its standby power 

operations. Good practices to consider are listed below.

 

7

 Many larger facilities use chillers to supply air conditioning, which also depend on an intact water supply.

Generator Loads

The load on a generator is determined 

by the various power-consuming 

devices attached to the emergency 

power supply system. Generators 

have a maximum load and a rated 

load. The rated load is lower and is the 

load a generator can carry for 

extended periods. 

For any given electrical device, the 

load it places on a generator will vary. 

The highest load, the startup load, 

occurs when a device is turned on. 

All devices supplied by the generator 

need to be accounted for in 

determining overall load.
Healthcare Facilities and Power Outages

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Systems Analysis

Facilities should undertake a vulnerability assessment of their standby power systems, to include:

• All system components and hazards likely to impact the facility. 

• A detailed accounting of what electrical devices are and are not supplied by the backup 

power. 

• The portions of the facility that will be supplied with standby power during a power 

interruption, as well as the portions that will not. 

• A list of backup requirements from all licensing and accreditation agencies.

• A critical component – a clear understanding of fuel consumption rates while generators are 

on their rated load, and a conservative estimate of when refueling will be necessary. 

• A load-shedding scheme in which less vital systems are powered down (load shed) to provide 

power to more critical systems. Appendix A outlines the three branches within an emergency 

distribution system (i.e., life safety, critical, equipment), which can be a method for facilities 

to assess the most critical functions that need to remain powered by a diminished emergency 

power supply.

• An advanced lifecycle analysis in which individual components are evaluated based upon life 

expectancy. In this manner, predicted replacement schemes can be developed.

A template assessment survey can be found at

https://www.poweredforpatients.org/resources/reference-materials/.

Case Study: Protecting Patients When Disaster Strikes

A Playbook for Safeguarding Emergency Power Systems for Rhode Island’s Critical 

Healthcare Facilities during Extended Power Outages

Recognizing the crucial importance of assisting critical facilities that depend on power to provide 

support to the most vulnerable populations, the Rhode Island Emergency Management Agency 

and the Rhode Island Department of Health worked closely with the nonprofit organization 

Powered for Patients to develop a guide for safeguarding emergency power systems and 

expediting power restoration for critical healthcare facilities during and following disasters that 

trigger extended power outages. The Playbook includes inventory material, emergency power 

supply contacts, facility manager checklists, and reporting systems, along with a four-phase 

planning process. The phases are:

• Assessing potential power vulnerabilities and how to address them.

• Ensuring facilities have reliable emergency power, should the grid go down.

• Operating under emergency power and sustaining efforts during emergency power operations 

for four days or longer.

• Managing the post-disaster recovery process, and learning as an organization to prepare for 

subsequent emergencies.

This guide is available at https://www.poweredforpatients.org/riema-announces-power-resiliencyinitiative-for-rhode-islands-critical-healthcare-facilities/. 
Healthcare Facilities and Power Outages

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Generator Maintenance 

Generator maintenance is a complex topic, largely beyond the scope of this guide. However, 

general good practices include regular servicing, regular load tests to gauge performance, and 

taking steps to preserve the on-site fuel supply and prevent its degradation. 

Some facilities, including hospitals and skilled nursing facilities, are required by regulation to 

test their generators on a regular basis. These regular tests provide healthcare facilities and local 

emergency managers an opportunity to complete an assessment during this process. Detailed 

information on generator maintenance can be found in National Fire Protection Association 110: 

Standard for Emergency and Standby Power Systems.

8

Disconnect test

Some facilities test their standby power systems by completely disconnecting from the grid. This 

test accurately identifies areas that are not clearly supplied by backup power and provides an 

effective simulation of power outage. NOTE: A disconnect test has associated challenges and is 

best conducted with extensive preparations.

Vendor Supplier

Many inoperable emergency power supply systems require repair from an outside vendor. 

Evaluate vendors for maintenance and fuel for their ability to respond post-impact, especially 

when transportation routes may be affected. Additionally, consider obligations the vendors may 

have to other organizations during an incident to ensure they can fully support all customers.

U.S. Army Corps of Engineers (USACE) Emergency Power Facility Assessment 

Tool (EPFAT) 

Following a disaster, it can take USACE many hours, possibly days, to deploy assessment teams 

to all of the impacted critical public facilities. However, USACE provides a free web-based selfassessment tool that permits facilities to input, store, and update standby power data prior to a 

disaster, which expedites the process if additional generator power from FEMA’s temporary 

power assets is ever required for a facility.9 By some estimates, it can reduce the time to 

establishing additional standby power by up to 30 percent. 

Uninterruptible Power Supply (UPS) Systems

Some electronic devices are very sensitive, and even the brief time to switch to backup power 

can causes malfunctions in equipment (e.g., reboot). UPS systems provide continuous 

(uninterruptible) power, often for brief periods, and typically supply critical equipment that can

be adversely affected by even momentary power outages. Consider UPS systems for particularly 

sensitive areas (e.g., interventional cardiology).

 

8 National Fire Protection Association 110: Standard for Emergency and Stand-by Power Systems 

https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=110. 9 Emergency Power Facility Assessment Tool: https://epfat.usace.army.mil/. 
Healthcare Facilities and Power Outages

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Generator Quick-Connect Tap Boxes

Even if a facility believes its capabilities are enough for anticipated loads, pre-establishing 

generator quick-connect tap boxes, also known as generator inlet boxes or docking stations, will

help in the event that generators fail or additional power is ultimately needed. Generator quickconnect tap boxes provide a permanent connection point for temporary mobile power. Establish 

pre-determined areas to place external generators and their fuel supply. 

Remote Monitoring

Some systems permit remote monitoring devices. These devices provide a constant status of 

generator function and early warning of malfunction. With advance warning of a potential 

failure, deploying government and private sector resources to repair a failing generator can be 

accelerated. Additionally, if the threatened emergency power supply system cannot be repaired, 

an early warning of pending failure can give government officials a significant head start and 

reduce the amount of time needed to deploy temporary generators to replace the failing ones.

The N+1 Principle

N+1 is a strategy providing redundancy to safeguard against a single component failure. In N+1 

terminology, “N” stands for the minimum number of devices, such as modules, power sources, 

and pumps, required to perform the intended function. “N+1” stands for the minimum plus one 

redundant unit. For example, one large generator may supply critical loads in a building. 

However, when called upon, a simple failure will prevent it from operating when needed. 

Instead, a strategy involving two smaller generators to supply the load, with a third generator of 

equal size in parallel, provides N+1 redundancy. This strategy also allows a facility to take single 

units offline for preventative maintenance without sacrificing operations protection.

Appendix B provides a detailed list of resources to help understand and prepare for power outage 

incidents. 

Overview of Emergency Preparedness Regulations, Codes, and 

Standards 

Healthcare facilities are required to follow a number of regulations, codes, and standards to 

ensure the safety of their patients during a power outage incident. Appendix C contains links to 

the full text of the regulations described below, along with other pertinent standards. 

Emergency Preparedness Requirements for Medicare and Medicaid Participating 

Providers and Suppliers (3178-F)

On September 16, 2016, the U.S. Department of Health and Human Services CMS posted the 

final rule titled “Emergency Preparedness Requirements for Medicare and Medicaid 

Participating Providers and Suppliers (3178-F)”10 in the Federal Register with an effective date 

of November 16, 2016. The rule required 17 categories of participating Medicare and Medicaid 

healthcare providers and suppliers to comply with and implement all of the emergency 

preparedness regulatory requirements within a year after the effective date, on November 15, 

 

10 81 FR 63859: https://www.federalregister.gov/documents/2016/09/16/2016-21404/medicare-and-medicaidprograms-emergency-preparedness-requirements-for-medicare-and-medicaid.
Healthcare Facilities and Power Outages

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2017. The final rule outlines four core 

elements which apply to all 17 provider 

types, with a degree of variation based on 

inpatient versus outpatient. This rule requires 

providers and suppliers to plan adequately 

for both natural and manmade disasters and 

coordinate with Federal, state, tribal, 

territorial, and local public health and 

emergency management agencies and 

systems. Based on lessons learned from prior disasters and current best practices, this final rule 

established a comprehensive, consistent, flexible, and dynamic regulatory approach to develop 

an integrated emergency preparedness program. The emergency preparedness program is 

comprised of four required core elements:

• Risk assessment and emergency planning: Facilities are expected to develop a risk 

assessment using an “all-hazards” approach. The risk assessment will allow planners to 

develop emergency preparedness plans based on facility-specific risks.

• Policies and procedures: Facilities are required to develop and implement policies and 

procedures that support the successful execution of the emergency plan. Certain hospital and 

skilled nursing facilities are also required to have procedures regarding alternate sources of 

energy to maintain the following:

‒ Temperatures to protect patient health and safety and for the safe and sanitary storage of 

provisions;

‒ Emergency lighting;

‒ Fire detection and extinguishing, and alarm systems; and

‒ Sewage and waste disposal.

• Communication plan: Facilities are to develop and maintain an emergency preparedness 

communication plan. This plan must comply with Federal and state law and ensure facilities 

have a system to contact staff (including patients’ physicians), other necessary persons, and 

state and local public health and emergency management agencies to coordinate in the event 

of an emergency. 

• Training and testing: Facilities are required to develop and maintain a well-organized, 

effective training and testing program.

Appendix C contains links to the full text of this and other healthcare requirements.

Case Study: Florida Preparedness Requirements

In addition to Federal rules, many states have regulations around preparedness. In the State of 

Florida, as a result of Hurricane Irma in 2017, skilled nursing facilities must provide their 

comprehensive emergency management plan to their local emergency management agency for 

review. Skilled nursing facilities and assisted living facilities also must have generators to power 

air-conditioning systems that can maintain an ambient temperature of no more than 81 degrees for 

96 hours after an outage. NOTE: This temperature requirement does not necessarily apply to 

entire facilities, as facilities could move patients into key areas with cooling capabilities.

Emergency Preparedness Checklist

CMS produced an emergency preparedness 

checklist intended to aid all healthcare facilities, 

including long-term care facilities, determine their 

level of preparedness and action steps.

The checklist is available at https://www.lifespannetwork.org/sites/default/files/EmergencyPrepare

dnessChecklist.pdf
Healthcare Facilities and Power Outages

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National Fire Protection Association (NFPA) 99: Health Care Facilities Code 

NFPA 99 establishes criteria for levels of healthcare services or systems based on risk to 

patients, staff, or visitors in healthcare facilities to minimize the hazards of fire, explosion, and 

electricity. This code is commonly, but may not be fully, included in other Federal, state, local, 

tribal, or territorial regulations or building codes. The electrical systems chapter of this code 

outlines the performance, maintenance, and testing of electrical systems, both normal and 

essential, in healthcare facilities. Appendix A contains a list of the specific equipment that the 

code requires to be connected to standby emergency power. Appendix C provides a link to the 

full text of this and other NFPA codes.

Hospital Accreditation Programs

Several hospital accreditation programs (e.g., Joint Commission, Norske Veritas Healthcare, 

Healthcare Facilities Accreditation Program) set standards on patient, individual, or resident 

care, as well as organizational functions that are essential to safe high-quality care. Healthcare 

facilities subject to survey and certification for CMS’ Medicare and Medicaid Programs may 

elect to participate in one of these programs to meet Federal and state regulatory program 

requirements. The following standard is a specific example of an applicable standard from the 

Joint Commission: 

• Standard EC 02.05.07 addresses hospitals’ requirements to inspect, test, and maintain 

alternate power systems that are activated in emergencies. Electrical power supply systems 

may fail during a power disruption, which could leave the hospital unable to deliver safe 

care, treatment, and services to patients. Testing these systems increases the chances of 

detecting reliability problems and reduces the risk of losing this critical resource when it is 

most needed. Under Standard EC.02.05.07: 

‒ Hospitals must perform a functional test of battery-powered lights required for egress 

every 12 months. 

‒ Every quarter, hospitals should perform functional tests of stored emergency power 

supply systems. 

‒ Twelve times a year, hospitals should test emergency generators. 

Considerations Regarding Regulations

Facilities Not Covered by CMS Regulations

Although the emergency preparedness requirements from CMS apply to a wide variety of facility 

types,

11 some facilities are not covered. 

 

11 The emergency preparedness requirements apply to all 17 provider and supplier types: Religious Nonmedical 

Health Care Institutions, Ambulatory Surgical Centers, Hospices, Psychiatric Residential Treatment Facilities, 

Programs for All-Inclusive Care for the Elderly, Hospitals, Transplant Centers, Long-term Care Facilities, 

Intermediate Care Facilities for Individuals with Intellectual Disabilities, Home Health Agencies, Comprehensive

Outpatient Rehabilitation Facilities, Critical Access Hospitals, Providers of Outpatient Physical Therapy and 

Speech-Language Pathology Services, Community Mental Health Centers, Organ Procurement Organizations, Rural 

Health Clinics and Federally Qualified Health Centers, and End-Stage Renal Disease Facilities.
Healthcare Facilities and Power Outages

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Non-Medical Care Providing Facilities 

Facilities that do not provide skilled nursing and medical care are commonly not subject to 

Federal and/or state regulatory survey, certification, and oversight. Many of these facilities do 

not adopt or implement emergency preparedness requirements. These facilities include, but are 

not limited to, assisted living facilities, non-skilled nursing homes, and board and care homes.

The populations of these facilities, however, can include individuals with access and functional 

needs and should be included in community preparedness activities and response priorities. 

Small Residential Facilities

The emergency preparedness regulations apply to all 17 provider and supplier types. Some of 

these facilities, however, may not be subject to all of the requirements due to their size and the 

administrative burden. These facilities include: 

• Intermediate Care Facilities for Individuals with Intellectual Disabilities; 

• Psychiatric Residential Treatment Facilities; 

• Programs of All-Inclusive Care for the Elderly; 

• Religious Nonmedical Health Care Institutions; and

• Inpatient Hospices. 

Restrictions of Use of Grant Dollars

HHS’ Hospital Preparedness Program (HPP) is the only source of Federal funding specifically 

for healthcare delivery system readiness. HPP provides funding and leadership to states, 

territories, and eligible municipalities to improve patient outcomes, minimize the need for 

Federal and supplemental state resources during emergencies, and enable rapid recovery from

catastrophic events through the development of healthcare coalitions (HCCs) 12. 

HCCs incentivize and support diverse and often competitive healthcare organizations with 

differing priorities and objectives to work together to save lives during disasters and emergencies 

that exceed the day-to-day capacity and capability of individual healthcare and emergency 

response systems. HPP funding must primarily support strengthening healthcare system 

preparedness through collaborative development of HCCs that prepare and respond as an entire 

regional health system, rather than individual healthcare organizations. 

The HHS Office of the Assistant Secretary for Preparedness and Response permits providing 

direct funding from the recipient or the HCC to individual healthcare entities for regional 

preparedness efforts. This funding, though, is not permitted to be used to meet CMS conditions 

of participation, including Emergency Preparedness Requirements. 

 

12 An HCC is a group of individual healthcare and response organizations (e.g., hospitals, emergency medical 

services [EMS], emergency management organizations, public health agencies, etc.) in a defined geographic 

location. HCCs play a critical role in developing healthcare delivery system preparedness and response capabilities. 

HCCs serve as multiagency coordinating groups that support and integrate with Emergency Support Function (ESF) 

#8 activities in the context of incident command system responsibilities. See 

https://www.phe.gov/Preparedness/planning/hpp/reports/Documents/2017-2022-healthcare-pr-capablities.pdf
Healthcare Facilities and Power Outages

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HCCs are permitted to use HPP funding to: 

• Develop the staffing capacity and technical expertise to assist their members with the 

development of their emergency plans; 

• Develop the staffing capacity and technical expertise to assist their members with the 

development of policies and procedures; 

• Fund the costs associated with adding new providers and suppliers who are seeking to join 

coalitions to coordinate patient care across providers, public health departments, and 

emergency systems to their HCC; 

• Assist members with the development of a communication plan that integrates with the 

HCC’s communications policies and procedures; and

• Plan and conduct trainings and exercises at the regional or HCC level.
Healthcare Facilities and Power Outages

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Integrating Emergency 

Preparedness Efforts

During a power outage, the assistance that emergency managers and public health officials can 

provide to healthcare facilities is limited. Therefore, preparedness is critical. This section 

outlines the importance of integrated plans, methods for integrating plans, and additional 

preparedness opportunities. 

Integrated Community-Based Planning

Planners achieve unity of purpose by coordinating and integrating plans across all levels of 

government, nongovernmental organizations, the private sector, and individuals and families. A 

shared planning community makes planning cycles more efficient and effective and can also 

make plan maintenance easier.

Vertical and Horizontal Integration

To be effective, organizations must integrate plans both vertically and horizontally. 

• Vertical integration incorporates planning through various scales within a specific function. 

For example, healthcare facilities work with local public health and emergency managers to 

ensure common planning expectations. Similarly, local public health and emergency 

managers coordinate with state public health and emergency managers.

• Horizontal integration incorporates planning across various organizations and jurisdictions. 

For example, healthcare facilities coordinate plans with other healthcare facilities and with 

local utilities. The local emergency management agency, in collaboration with local public 

health, can facilitate this process. 

Both vertical and horizontal integration build unity of effort through a common understanding of 

relevant capabilities, relationships, objectives, and resource requirements.

Case Study: Jacksonville-Area Hospitals in Northeast Florida in 

Response to Hurricane Irma

In 2017, Hurricane Irma impacted Florida counties, creating issues ranging from fuel availability to 

closed Interstate Highways, flooding, and power outages. However, Northeast Florida hospitals had 

used the lessons learned from the 2016 hurricane season to strengthen their preparedness 

measures and improve the response framework within the healthcare community.

Collective preparedness and response as well as detailed emergency plans helped hospitals in the 

Jacksonville area maintain continuity of service during Irma. Hospitals prepared in advance to 

maintain patients’ health and well-being, focusing on emergency services as a top priority. 

Emergency preparedness resources, such as electrical generators, specially trained administrators 

and staff, and local government emergency operation centers were verified and readied to respond. 

Memorial and Orange Park hospitals had the resources of corporate parent Hospital Corporation of 

America to assist. Fuel tanks staged near Memorial Hospital were ready to refuel gas tanks of 
Healthcare Facilities and Power Outages

14

generators when necessary. Further preparations, such as backup generators and water tankers, 

were deployed to hospitals as well. Lastly, additional pharmaceutical and medical supplies, along 

with food and essentials, were stockpiled to ensure hospitals were self-sufficient for days. 

These preparations lessened the impact of Irma on emergency services. The advance planning 

allowed hospitals to respond rapidly to changing patient needs during Irma. Furthermore, the 

advance planning ensured that critical needs patients did not experience an interruption of care. The 

dedication of hospital staff, the planning of administration, and the resource sharing made available 

by local government emergency operators made all of this possible.

Integrating Plans through Synchronization

The process of integrating plans is as important as the integrated plans themselves. Integration 

allows organizations to know their roles, understand how plans fit together, identify and address 

gaps execute their plans, and coordinate activities in the event of an emergency. Plans are not 

scripts organizations should follow to the letter, but are flexible to adapt to actual situations. 

Effectively integrated plans convey the goals and objectives of the intended operation and the 

actions needed to achieve them. The process of integrating and synchronizing plans also builds 

and develops working relationships across organizations. The existence of pre-established 

relationships is a valuable asset in emergency incidents.

Organizations can synchronize a number of aspects of healthcare facility, utility operator, and 

emergency plans. Emergency management and public health agencies, healthcare facilities, and 

utility companies should consider making the following items common or agreed upon:

• Triggers for activating emergency response plans; 

• Roles and responsibilities for all organizations; 

• Operational goals and objectives; 

• Pre-identified critical and co-dependent facilities13; 

• Triggers for providing early warning at the first sign of a threat to emergency power;

• Communication methods; and

• Facts and planning assumptions. 

Overview of the Power Outage Incident Annex to the Response and Recovery 

Federal Interagency Operational Plans (POIA)

The Power Outage Incident Annex: Managing the Cascading Impacts from a Long-Term Power 

Outage guides federal level responders in response and recovery support to state, local, tribal, 

territorial, and insular area efforts while ensuring the protection of privacy, civil rights, and civil 

liberties.14 The annex provides incident-specific information to the basic concept of operations 

described in the Response and Recovery Federal Interagency Operational Plans.

 

13 Healthcare has transitioned from an inpatient facility setting (e.g., hospitals) to outpatient and community-based 

settings. Although a patient may no longer be in a hospital, they may still be receiving life-saving and 

life-maintaining services (e.g., at a dialysis center, as an outpatient, at the patient’s home). 14 Power Outage Incident Annex: https://www.fema.gov/media-library/assets/documents/154058. 
Healthcare Facilities and Power Outages

15

The primary audience for the POIA is Federal departments and agencies that lead or support 

response and recovery activities in an emergency or disaster. However, much of the information 

in the annex is beneficial for and can be adopted or considered by planners at all levels of 

government and in the private and non-profit sectors. The annex provides an approach that can 

support integration from the Federal to local levels and inform facility planning activities in 

advance of a widespread or severe power outage. 

Appendix B contains Federal objectives, tasks, planning assumptions, critical information 

requirements, and essential elements of information pertinent to prioritizing assistance to 

healthcare facilities during a power outage. Appendix C contains a link to the full POIA.

Additional Opportunities for Collaboration

Many ongoing community preparedness efforts could benefit by involving healthcare facilities 

and utilities. Including a wide range of stakeholders (e.g., government officials, first responders, 

utility companies, and healthcare facilities) improves overall community preparedness. Below 

are several examples. 

Threat and Hazard Identification and Risk Assessment (THIRA) and Stakeholder 

Preparedness Review (SPR)

Communities use the THIRA/SPR15 to answer the following questions:

• What do we need to prepare for?

• What level of capability do we need to be prepared?

• What are our current capabilities?

• What gaps exist between the capabilities we need and the capabilities we currently have?

• How can we address our capability gaps?

By involving healthcare facilities, utility companies, and first responders in the THIRA/SPR

process, emergency managers can gain a better understanding of the risks their communities face 

as well as the capabilities they possess.

Energy Assurance Planning

The goal of energy assurance planning is to achieve a robust, secure, and reliable energy 

infrastructure that is also resilient—i.e., able to restore services rapidly in the event of any 

disaster. Utility owners and operators are responsible for their energy infrastructures and delivery 

systems, but state and local officials have the responsibility to work with energy providers and 

stakeholders from other jurisdictions, government agencies, businesses, and related organizations 

to reduce consequences and provide for rapid recovery. Governments achieve this through the 

energy assurance planning process. More information about the energy assurance planning 

process if available from the National Association of State Energy Officials.

16

 

15 THIRA/SPR guidance: https://www.fema.gov/threat-and-hazard-identification-and-risk-assessment. 16 State Energy Assurance Guidelines; https://www.naseo.org/eaguidelines. 
Healthcare Facilities and Power Outages

16

Mitigation Planning

Mitigation planning17 identifies policies and actions that local governments can implement over 

the long term to reduce risk and future losses from hazards. Healthcare facilities and utility 

operators benefit mitigation planning in two ways. First, they can serve on the planning team 

itself. Second, they can participate in a smaller way, providing subject matter expertise to the 

planning team on specific topics such as certain protocols around power restoration. 

As part of mitigation planning, jurisdictions and organizations may explore Federal, state, tribal, 

territorial, or other funding opportunities to develop new or upgrade existing infrastructure, 

research other power generation options, and enhance community power resilience. One such 

program is the Rural Utility Program18 from the U.S. Department of Agriculture that helps 

develop new and upgrade current electrical infrastructure in underserved areas.

Training and Exercise Program Workshops

Annual Training and Exercise Program Workshops19 are a chance to identify multi-year program 

priorities as well as the participate in training offerings and exercises necessary to accomplish 

these priorities. Training and Exercise Program Workshops, a requirement of several 

preparedness grant programs from the U.S. Department of Homeland Security (DHS), should 

include representatives from across the whole community. Each participating organization may 

also be able to provide potential training and exercise opportunities. Jurisdictions and 

organizations can combine many of these events for cost savings and increased coordination.

Training

Training builds the collective knowledge of the community. Training events that involve 

multiple stakeholder groups have significant advantages as they allow a broad range of 

stakeholders to meet and interact in a casual environment, share best practices and prior 

experiences, and gain a mutual understanding of a training topic. Appendix C lists online and 

in-person training opportunities available at no cost.

Exercises

Exercises are required for regulated healthcare facilities (as part of the Emergency Preparedness 

Requirements for Medicare and Medicaid Participating Providers and Suppliers) and for many 

state and local governments (as part of various grant programs). Well-designed exercises provide 

a low-risk environment to test capabilities, acquaint personnel with roles and responsibilities, and 

foster meaningful interaction and communication across organizations. Including a variety of 

stakeholders in exercises enables the testing and validation of plans and capabilities, and it 

allows for the identification of current strengths as well as capability gaps and areas for 

improvement.

 

17 Local Mitigation Planning Handbook: https://www.fema.gov/media-library/assets/documents/31598. 18 Rural Utility Program: https://www.rd.usda.gov/files/RD-RUS-RBSEnergyEfficiencyComparisonChart2016.pdf. 19 Information on Training and Exercise Program Workshops and exercise design: https://www.fema.gov/hseep. 
Healthcare Facilities and Power Outages

17

Prioritizing Assistance to 

Healthcare Facilities During 

Response

Healthcare facilities should be a priority for all levels of government and the private sector 

during a power outage event. Patients and residents in these facilities depend on others for 

medical care or assistance with activities of daily living and are vulnerable to environmental 

changes. Prioritizing resources is a complicated, interdependent process, and should be part of 

the integrated planning process well in advance of an incident. This section identifies roles and 

responsibilities for various organizations during the response to a power outage incident. It also 

discusses the community lifelines construct as a method to support rapid decision making and 

resource prioritization during a response.

Roles and Responsibilities in Assistance Prioritization

A common understanding of the roles and responsibilities of the organizations is vital to a 

successful operation. All organizations need to understand the plan, their role in the plan, and the 

roles of other organizations in the plan. Some of the responsibilities of organizations involved in 

prioritizing assistance to healthcare facilities during a power outage are outlined below. 

Healthcare Facilities

• Primarily responsible for the health and safety of their patients and residents, including

during a power outage.

• Should register in the USACE EPFAT prior to a power outage to shorten the timeline to 

temporary power support in an emergency. 

Healthcare Coalitions (HCCs)

Responsibilities vary by coalition but may 

include: 

• Sharing information between HCC 

members and with other jurisdictional 

partners;

• Maintaining situational awareness;

• Sharing and coordinating resources;

• Coordinating patient movement and 

evacuation;

• Assisting with coordination of mass 

shelter operations;

USACE EPFAT

USACE is often called upon to help provide 

temporary emergency power at critical public 

facilities identified by state officials. Facility 

assessment data is required before a generator 

can be sourced and installed. 

Healthcare facilities and other critical 

infrastructure operators can use the secure 

web-based EPFAT to input, store, update, 

and/or view temporary emergency power 

assessment data. Having pre-installation 

assessment data well in advance expedites 

USACE’s ability to provide temporary power.

Access EPFAT at: https://epfat.usace.army.mil/
Healthcare Facilities and Power Outages

18

• Tracking patients and supporting family reunification;

• Coordinating assistance centers and call centers; and/or

• Providing staff to support emergency operations centers (EOCs). 

Energy Sector

• Facility owners and operators are responsible for stabilizing and restoring normal operations 

at energy facilities.

State, Local, Tribal, and Territorial Governments 

• Responsible for the health and welfare of their residents, communities, lands, and cultural 

heritage.

• Conduct pre-event identification of potential critical facilities. This identification should 

consider that some facilities may warrant higher prioritization than others based on factors 

such as patient criticality and difficulty moving patients. 

• Encourage or assist licensed electricians or other appropriate personnel to perform facility 

assessments and enter the data into the Emergency Power Facility Assessment Tool.

• Prioritize temporary power resources.

• Primarily responsible, in coordination with energy asset owners and operators, for 

prioritizing the restoration of critical infrastructure (CI). 

• While restoration of power is the responsibility of electric companies, electric companies 

may request that governments provide services to enable the power restoration process. 

Examples include, but are not limited to:

‒ Enforcement of road closures, public safety, and security at access points;

‒ Debris removal, if warranted, to enable utility companies to more quickly access 

damaged equipment; and

‒ Logistical support for mass care and emergency assistance services and power generation 

equipment to enable continuity of essential services.

Federal Government

Emergency Support Function (ESF) # 3—Public Works and Engineering

ESF Coordinator and Primary Agency: USACE

• Coordinate Emergency Power Team missions with power system stabilization and restoration 

activities to establish priorities for emergency generator installation.

ESF #6—Mass Care, Emergency Assistance, Temporary Housing, and Human 

Services 

ESF Coordinator and Primary Agency: DHS/FEMA and American Red Cross

• Coordinate with ESF #8 and Healthcare Coalitions to obtain status of medical facilities, 

maintain awareness of medical needs of any survivors being transported from medical 
Healthcare Facilities and Power Outages

19

facilities, and develop plans to meet their needs, to include electricity-dependent medical and 

assistive equipment and devices and higher-level medical care staff and services.

• Provides life-sustaining services to the affected population, including hydration, feeding, and 

sheltering, as well as support for reunifying families. 

ESF #8—Public Health and Medical Services

ESF Coordinator and Primary Agency: HHS 

• Assess and prioritize healthcare facilities’ reliance on power to sustain ongoing operations.

• Provide Federal assets and capabilities to support time-sensitive, life-saving, and lifesustaining public health and medical infrastructure, as well as stabilization missions to 

supplement state, local, tribal, territorial, and insular area response and recovery capabilities. 

ESF #12 – Energy

ESF Coordinator and Primary Agency: Department of Energy (DOE)

• Assist private sector energy asset owners and operators with restoring infrastructure-related 

services after an incident occurs.

• Help coordinate Federal assistance and resources for timely restoration of energy services 

following an incident that requires a coordinated Federal response.

Using the Community Lifelines to Prioritize Assistance

In addition to having a mutual understanding of organizational roles and responsibilities during a 

response, all stakeholders benefit from having a common lexicon with which to describe the 

status of disaster impacts and a common framework for making resource prioritization decisions. 

The community lifelines transcend public and private sector boundaries and reframes incident 

information to provide decision-makers with key impact data.20

By considering interdependent impacts across the lifelines, decision-makers can:

• Rapidly determine whether an incident is complicated or complex; 

• Prioritize and focus response efforts to maintain or restore the most critical services and 

infrastructure; 

• Ensure limited resources can go toward a common goal that requires involvement across the 

whole community; and

• Promote a response that fosters better integration and communication across the whole 

community since lifeline management transcends public and private sector boundaries.

There are seven lifelines: Safety and Security; Food, Water, Shelter; Health and Medical; Energy 

(Power & Fuel); Communications; Transportation; and Hazardous Material (Figure 1). 

 

20 Information on Community Lifelines: https://www.fema.gov/media-library/assets/documents/177222
Healthcare Facilities and Power Outages

20

Figure 1: The Seven Community Lifelines

These lifelines enable the continuous operation of government functions and critical business and

are essential to human health and safety or economic security. Each lifeline is comprised of 

multiple components and subcomponents. 

Conclusion

A wide variety of natural, technological, and human-caused threats and hazards cause power 

outages. Patients in hospitals, skilled nursing facilities, and long-term care facilities are at 

heightened risk during a power outage event. By aiding these facilities to adequately prepare for 

power outages, coordinating emergency response plans, and prioritizing assistance to these 

facilities during a power outage, communities can increase their resilience and protect lives.
Healthcare Facilities and Power Outages

21

Appendix A. Basics of Utility and 

Standby Power in Healthcare

This appendix provides a basic understanding of utility and temporary power (e.g., battery, 

generator power). Understanding the basics of utility and temporary power, and its limitations, is 

important when interfacing with utility companies, vendors, and facility engineers. The below 

information is from FEMA P-1019: Emergency Power Systems for Critical Facilities: A Best 

Practices Approach to Improving Reliability. Appendix C contains a link to the full text of the 

guide. 

Overview of Utility Power Transmission and Distribution Systems

Two basic systems, referred to as transmission and distribution, carry electrical power supplied 

by utilities from the point of generation to the end user (Figure 2). The transmission system is the 

backbone of the utility grid and carries power at the wholesale level. Utility power plants connect 

directly to this backbone to transport power to local distribution systems and then on to the user. 

Transmission lines, which operate at very high voltages that range between 69,000 and 765,000 

volts, carry electricity to distribution substations. Distribution lines then disperse the power to 

commercial, industrial, and residential customers. At the boundaries of utility coverage areas, the 

transmission lines connect to transmission systems of adjoining utilities. 

Figure 2: Illustration of a Simplified Utility Transmission and Distribution System

Failures of Transmission Systems

Similar to the inertia of a large oceangoing vessel moving at top speed, the collective inertial 

energy of the generators and turbines at each power plant on the utility grid stabilizes the 

transmission system. This is due to the enormous net inertial energy of all the connected sources. 

As a result, the transmission system can absorb minor disturbances from individual power plants 

or retail distribution load points with almost no impact to the overall utilities system.
Healthcare Facilities and Power Outages

22

Failures of transmission systems are unlikely but have occurred. Rare natural hazard events that 

spread damage over a wide geographic area have caused failures to transmission systems. When 

enough damage accumulates, the overall transmission system goes down, taking with it 

neighboring utilities in a cascading sequence of failures. Automatic protective systems may trip 

generating stations offline and isolate ties to neighboring utilities as network operators race to 

protect their systems. Recovering from such a massive outage takes days to restart power plants, 

reconnect major system elements, and pick up loads from local distribution systems.

Overview of Temporary Power

Power sources are devices that create (or store) electricity and ancillary equipment needed for 

power production and storage. The sources include stored energy devices, generators, fuel 

supplies, and controls for operating them. Power distribution systems deliver power from the 

power source to the critical equipment. The distribution system consists of switchgear or 

switchboards, feeders, distribution panels, panelboards, protective devices, and transfer switches.

Emergency Power Sources

In general, critical facilities employ two common methods of providing emergency power: stored 

energy devices, such as battery and inverter systems, and standby/emergency generators. Facility 

personnel must properly size, install, and maintain both types to be reliable and effective. 

Personnel must also supply fuel-fired generators with appropriate fuel from a reliable source.

Stored Energy Devices

Facilities frequently use stored energy devices to provide short-duration emergency power. 

When used alone, they often are sized to supply loads for 90 minutes, which allows safe egress 

from the facility. When used in conjunction with standby or emergency generators, facilities 

often use stored energy systems to supply power only during the time required to start an 

emergency or standby generator, stabilize its operation, and transfer critical load to the generator.

Emergency and Standby Generators

Emergency and standby generators serve a wide range of 

applications. Emergency generators consist of an engine 

(often called a prime mover), a synchronous generator, 

monitoring equipment, and controls. Generators require 

cooling to remove heat created by the prime mover and the 

generator and ventilation for the combustion air required by 

the prime mover.

The vast majority of emergency and standby generators 

operate on fossil fuels. Fuel delivery systems are critical to 

the reliability of fuel-fired generators. Selecting the proper 

fuel source is important, and many factors play into that 

decision, including generator consumption rates, the 

availability of fuels, and the ability to replenish the fuel 

supply after a natural hazard that blocks roads or disrupts 

infrastructure. Fuel sources for generators are either liquid 

(i.e., gasoline, diesel) or gas (i.e., propane, natural gas).

Battery Starting System

The battery starting system for a 

generator is an often-overlooked, 

critical component of the total 

system. The single most frequent 

reason for generator failure to 

start is its battery system. 

 Install battery systems in 

conditioned space to avoid 

extreme temperatures.

 Use proper design and 

installation of interconnecting 

cables to compensate for 

voltage drop. 

 Conduct routine maintenance 

to verify proper charging and 

that cable connections remain 

tight and corrosion free.
Healthcare Facilities and Power Outages

23

Emergency Power Distribution

The emergency power distribution system includes all wiring and equipment between the 

emergency or alternate power sources and the critical equipment that the sources supply. Upon 

sensing normal power loss, an automatic transfer switch automatically sends a start signal to the 

generator and monitors power quality. When the generator produces power within acceptable 

voltage and frequency limits, the automatic transfer switch automatically switches from normal 

to emergency power source.

The NFPA 99: Health Care Facilities Code defines three branches within an emergency 

distribution system: 

• Life-safety branch; 

• Critical branch; and

• Equipment branch. 

The life-safety branch is the most important and given highest priority. Table 1–Table 4 detail 

the equipment that emergency power must support in each branch. 

Table 1: Life-Safety Branch Equipment

Number Item

A. Egress lighting

B. Exit signs and exit directional signs

C. Hospital communications systems where used for issuing emergency-related instructions

D. Generator set location as follows: 

a. Task illumination

b. Battery charger for emergency battery-powered lighting unit(s)

c. Select receptacles at the generator set location and essential electrical system transfer 

switch locations

E. Elevator cab lighting, control, communications

F. Electrically powered doors used for building egress

G. Fire alarms and auxiliary functions of fire alarm systems complying with NFPA 72
Healthcare Facilities and Power Outages

24

Table 2: Critical Branch Equipment

Number Item

A. Task lighting and select receptacles in anesthetizing gas locations

B. Isolated power systems in special environments

C. Task illumination and select receptacles in patient care rooms, including infant nurseries, 

selected acute nursing areas, psychiatric bed areas (omit receptacles), and ward treatment 

rooms, medication preparation areas, pharmacy dispensing areas, and nurses’ stations 

(unless adequately lighted by corridor luminaries)

D. Additional specialized patient care task illumination and receptacles, where needed

E. Nurse call systems

F. Blood, bone, and tissue banks

G. Telephone equipment rooms and closets

H. Task illumination, select receptacles, and select power circuits for general care beds with at 

least one duplex receptacle per patient bedroom, and task illumination as required by the 

governing body of the healthcare facility, angiographic labs, cardiac catheterization labs, 

coronary care units, hemodialysis rooms or areas, emergency room treatment areas, human 

physiology labs, intensive care units, and postoperative recovery rooms

I. Additional task illumination, receptacles, and select power circuits needed for effective 

facility operation, including single-phase fractional horsepower motors, which are permitted 

to be connected to the critical branch

Table 3: Equipment Branch (Automatic Connection) Equipment

Number Item

A. Central suction systems serving medical and surgical functions

B. Sump pumps and other equipment required to operate for the safety of major apparatus, 

including associated control systems and alarms

C. Compressed air systems serving medical and surgical functions

D. Smoke control and stair pressurization systems

E. Kitchen hood supply or exhaust systems, or both, if required to operate during a fire in or 

under the hood

F. Supply, return, and exhaust ventilating systems for airborne infections/isolation rooms, 

protective environment rooms, exhaust fans for laboratory fume hoods, nuclear medicine 

areas where radioactive material is used, ethylene oxide evacuation, anesthetic evacuation

G. Where delayed automatic connection is not appropriate, ventilation system shall be 

permitted to be placed on the Critical Branch
Healthcare Facilities and Power Outages

25

Table 4: Equipment Branch (Automatic or Manual Connection) Equipment

Number Item

A. Heating equipment for operating, delivery, labor, recovery, intensive care, coronary care, 

nurseries, infection/isolation rooms, emergency treatment spaces, and general patient 

rooms; and pressure maintenance (jockey or make-up) pump(s) for water-based fire 

protection systems

B. Heating of general patient rooms during disruption of the normal source shall not be 

required under any of the following conditions 

a. Outside design temperature is higher than 6.7oC (+20oF)

b. Outside design temperature is lower than 6.7oC (+20oF), where selected room(s) is provided 

for the needs of all confined patients [then only such room(s) need be heated]

C. Elevator(s) selected to provide service to patient, surgical, obstetrical, and ground floors

D. Supply, return, and exhaust ventilating systems for surgical and obstetrical delivery suites, 

intensive care, coronary care, nurseries, and emergency treatment spaces

E. Hyperbaric facilities

F. Hypobaric facilities

G. Autoclaving equipment, which is permitted to be arranged for either automatic or manual 

connection to the alternate source

H. Controls for equipment listed in NFPA 99, 6.4.2.2.4

I. Other selected equipment
Healthcare Facilities and Power Outages

26

Appendix B. Excerpts from the 

Power Outage Incident Annex

The POIA provides guidance for Federal-level responders for response and recovery support to 

state, local, tribal, territorial, and insular area efforts while ensuring the protection of privacy, 

civil rights, and civil liberties. The annex adds incident-specific information to the basic concept 

of operations described in the Response and Recovery Federal Interagency Operational Plans. 

The primary audience for the POIA is Federal departments and agencies with a role in 

emergency management. Much of the information contained in the annex, though, is beneficial 

to planners at all levels of government and the private and non-profit sectors. Below is a 

selection of information from the POIA that planners and emergency managers from all levels of 

government, utility companies, and healthcare facilities may find useful, both in integrating plans 

with Federal planning efforts and in developing jurisdictional and facility plans.

Federal Government Initial Objectives

For most incidents meeting the assumptions of the POIA, the Federal Government will initially 

prioritize core capabilities and resources to meet the following objectives:

• Facilitate power restoration and maintain other CI within geographic regions where it is 

anticipated power will be restored in two weeks or less; 

• Stabilize and sustain CI in geographic regions that suffer the next shortest duration of power 

outages; 

• Provide mass care services and resources to support states and tribal nations conducting the 

mass evacuation of survivors, including those with access and functional needs; 

• Provide mass care/emergency assistance services to those who are self-evacuating; 

• Selectively deliver emergency services to high-density areas or vulnerable populations who 

are unable to evacuate; and

• Provide law enforcement support to establish and maintain public safety and security to 

ensure a safe environment for infrastructure restoration.

Federal Operational Phases

Federal operations are broken into operational phases for providing coordinated Federal support 

to state, local, tribal, territorial, and insular area governments. To support synchronization of 

plans, Table 5 defines the Federal government operational phases, and the following sections list

a selection of Federal tasks in each phase. For a complete listing of the Federal tasks, see the link 

to the full POIA in Appendix C. 
Healthcare Facilities and Power Outages

27

Table 5: Federal Government Response Phase Definitions

Phase Definition

Phase 1a Normal operations

Phase 1b Elevated threat and the development of situational awareness

Phase 1c Credible threat of a known hazard; selected teams are alerted and resources may be 

pre-positioned in anticipation of support needed by the state/tribe/territory

Phase 2a Immediate response at the state/tribe/territory/local level (some initial response from 

Federal entities), gaining situational awareness, and activation of operations centers

Phase 2b Response at the Federal level, maintain situational awareness, 

deployment/employment of resources to incident support bases, Federal staging areas, 

and identified delivery sites, and the movement of resources to incident support bases

Phase 2c Sustained response, employment of resources at the incident site, saving lives, 

sheltering survivors and restoring critical systems such as power and communications

Phase 3a Recovery activities that occur as part of the response mission area to facilitate the 

transition and support to the recovery mission area

Phase 1a – Normal Operations

DOE, as the Sector Specific Agency (SSA) and lead Federal agency for the energy sector, 

coordinates the following preparedness actions within the energy sector:

• Assists the states in preparing state energy assurance plans to improve the reliability and 

resiliency of the nation’s energy systems, and maintains the Energy Emergency Assurance 

Coordinators (EEAC) Program, contact list, and database; 

• Conducts national security emergency preparedness planning, including developing 

capabilities, administering operational programs for all energy resources, and conducting 

energy emergency exercises with the energy industry, Federal partners, and state, local, 

tribal, territorial, and insular area governments; and

• Develops, tests, trains, and exercises continuity programs and plans, coordinating with whole 

community partners and stakeholders.

DOE coordinates the following activities with state, local, tribal, territorial and insular area 

governments:

• Conducts preparedness activities that support response and recovery to power outages, such 

as exercises, training, and plan development, consistent with their emergency operations and 

continuity plans; 

• Involves local disability stakeholders in emergency planning to accurately and adequately 

incorporate considerations of individuals with a disability21 during a long-term power outage; 

 

21 Individual with a Disability: Individual who has a physical or mental impairment that substantially limits one or 

more major life activities (an “actual disability”), or a record of a physical or mental impairment that substantially 

limits a major life activity (“record of”), or an actual or perceived impairment, whether or not the impairment limits 

or is perceived to limit a major life activity, that is not both transitory and minor (“regarded as”).
Healthcare Facilities and Power Outages

28

• Develops inclusive engagement strategies with the public and private utility companies in 

their state or jurisdiction; and

• Ensures local and state emergency operations plans include fuel action plans that identify 

priority users, staging areas, and daily fuel consumption by type of critical facility.

In preparation for power outages, utilities participate in preparedness activities such as: 

• Contingency and continuity planning and exercises for restoration; 

• Educating state EOC personnel on energy restoration and importance of right-of-way 

programs; 

• Validating contact information for state, local, tribal, territorial, and insular area partners; 

• Hardening infrastructure, inspections, and assessments; 

• Ensuring that standing contracts with diesel fuel suppliers are in place.; 

• Developing restoration priorities; 

• Developing smart grids and micro grids; 

• Developing contracts (e.g., for suppliers); 

• Improving resiliency; and

• Developing mutual assistance agreements.

Phase 1b and 1c – Elevated and Credible Threats

State, local, tribal, territorial, and insular area governments should: 

• Coordinate with their public utility commissions; 

• Identify potential waivers that may be required to expedite disaster response; and

• Review local and state plans for energy restoration and prioritization.

Utility owners and operators also take preventative actions depending on the credibility and 

likelihood of a threat to the electric grid. They: 

• Review and reassess their critical asset list and rank assets for restoration priority; and

• Identify and position resources to respond to an outage, and implement a plan to prioritize 

response actions (i.e., those that have immediate threat to life or property loss such as 

downed live wires, and restoring emergency and hospital services).

Phase 2a and 2b – Immediate Response and Deployment

Immediate response includes actions taken within 72 hours of a notice or no-notice incident 

resulting in a power outage.

State, local, tribal, territorial, and insular area governments: 

• Develop prioritized lists of CI for temporary emergency power.
Healthcare Facilities and Power Outages

29

During these subphases, public and private electric companies: 

• Request assistance from state, local, tribal, or territorial governments and health and human 

services, including stakeholders who can provide immediate real-time information and 

situational awareness about people with access and functional needs who may depend on 

power for life maintenance and/or to mitigate personal health and safety issues (such as those 

living independently and/or group or some facility settings); and

• Prioritize plans and actions to restore energy during response and recovery operations.

Phase 3 – Recovery

Recovery planning and coordination for all phases of recovery (short-term, intermediate, and 

long-term) begin with the event and response. Actions during this phase are likely to include

continuing to identify and facilitate Federal mechanisms to expedite CI restoration (e.g., Defense 

Production Act to prioritize contracts, regulatory relief, and restoration logistics support).

Facts, Planning Assumptions, and Critical Considerations to Aid 

in Planning for Prioritizing Assistance

The POIA contains facts, planning assumptions, and critical considerations that can aid all 

emergency managers in planning to prioritize assistance to healthcare facilities during a power 

outage. Below is a selection of the most pertinent of considerations. A link to the entire annex is 

in Appendix C. 

Facts

• People with disabilities comprise about 20 percent of the national population.

• People with access and functional needs generally comprise about 30 to 50 percent of the 

population (NOTE: This number includes the 20 percent of people with disabilities). 

Planning Assumptions

• Healthcare facilities consume fuel at approximately the rate listed in Table 6.

Table 6: Daily Fuel Consumption by Healthcare and Public Health Sector Facilities22

Type of Facility Generator Size Fuel Requirement in 

Gallons (low)

Fuel Requirement in 

Gallons (high)

Hospitals 800kW–2mW 1344 2000

Nursing Homes 100–200kW 168 336

Urgent Care 200–300kW 336 504

Dialysis Center 200–300kW 336 504

Medical Center 200–300kW 336 504

Morgue 100–200kW 168 336

 

22 Of note, these projected fuel requirements are for a single generator. Planners should identify the correct number 

of generators for specific facilities. Large hospitals could have dozens.
Healthcare Facilities and Power Outages

30

• Critical healthcare facilities, sites such as hospitals, may have difficulty maintaining 

sufficient temporary emergency power and will face stress from a surge in care needs and 

potential degradation of services.

• Restoration Priorities – Typically, utilities adhere to the following repair and restoration 

sequencing: 

‒ Power plants 

‒ Startup power

‒ Large transmission lines and substations

‒ Distribution substations and feeder lines

‒ Restoration to CI facilities

‒ Residential areas

Critical Considerations (for Crisis Action Planning)

General Consideration

• Lack of inclusion for people who depend on power to sustain life or to maintain quality of 

life, health, safety, and independence unnecessarily places people who need assistance in a 

higher category of risk and increases likely rescue and response requirements.

Continuity of Operations and Government 

• Robust continuity programs and capabilities mitigate impacts to the performance of essential 

functions, core capabilities, and critical services, as well as expedite the recovery and full 

resumption of impacted operations.

• Public and private sector organizations impacted by long-term power outages will require the 

activation of continuity plans to sustain essential functions and provide critical services to the 

affected population and to ensure continuity of government at all levels.

• Decision-making and coordination processes among government officials and with the heads 

of public and private CI sectors and other nongovernmental organizations are necessary to 

ensure support to response and recovery efforts. This coordination will require resilient 

communications capabilities.

Fuel/Generator Considerations 

• Fuel should be prioritized for distribution and use based on requirements, such as the number

of available generators, number of CI facilities requiring fuel or generators, and fuel 

consumption.

• Providing temporary emergency power to a CI facility is not the sole factor in returning the 

facility to normal operating status (e.g., lack of supplies, time to restart operations).

• The failure rate of backup generators will increase to approximately 15 percent after 24 hours 

of continuous use.

• Backup generators at some CI facilities may not be tested frequently or maintained 

consistently, which may result in equipment failures.

• Diesel fuel stored for more than 12 months begins to form sediments and gums. Diesel fuel 

used after it has exceeded its shelf life will increase the likelihood of damage to the generator.
Healthcare Facilities and Power Outages

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• Use of points of distribution (PODs) may not be a feasible approach for providing fuel to 

critical CI facilities at fixed locations. As a result, a fuel delivery strategy will need to take 

into account fuel transportation requirements.

Public Health and Medical Considerations 

• Healthcare services typically operate on just-in-time inventory, which may affect patient care.

• Individuals who rely on durable medical equipment and implantable devices requiring either 

electric power or battery recharging may lose their life-sustaining independence and 

overwhelm healthcare facilities if the power is out for more than a few days.

• Dialysis centers generally do not have backup generators, but often operate within a network 

and may shift patients to other local network facilities if the receiving facilities have power

and essential medical staff, accessible transportation services are available, and costs are not 

prohibitive. 

• Health systems must plan for crisis standards of care and scarce resource utilization during 

mass power outages.

• A segment of the U.S. population operates power-dependent durable medical equipment and, 

as a result, is unable to self-relocate during a mass power outage.23

Critical Information Requirements and Essential Elements of 

Information for Prioritizing Assistance

To enable decision-making and prioritize assistance to healthcare facilities, leaders need access 

to key information. The POIA identifies the following critical information requirements24 and 

essential elements of information25 to help prioritize assistance during a power outage.

Critical Information Requirements 

• Incident Characterization: Demographic information of the affected population, including 

vulnerable populations on utility registries that may need assistance.

• Resource Availability: Generator/fuel status for critical assets across each of the 16 CI 

sectors and any additional interagency needs to support essential functions and services.

• Sheltering, Feeding, and Distribution of Emergency Supplies: Names and statuses of 

healthcare facilities (e.g., nursing homes, dialysis facilities) in the impacted area.

 

23 Beyond basic durable medical equipment, there may be many in the community receiving care by home health 

care providers and visiting nurses who rely on electrically powered equipment to assist with fluids, oxygen, feeding, 

medications and other required bodily functions. Many that fall into this group may not be mobile, and could not be 

transported via wheelchair lift onto a bus. When evacuation is required, may not have the healthcare provider 

support or have medical transport available.

24 Critical information requirements facilitate timely command, control, and coordination of decisions during 

disaster operations. They provide insight into important details that response personnel need to effectively make 

decisions and execute their operations.

25 Essential elements of information support the critical information requirements by providing more detail for 

situational awareness and decision-making.
Healthcare Facilities and Power Outages

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• Hospitals in Affected Area: 

‒ Patient counts and bed availability;

‒ Generator and fuel status to keep facilities running;

‒ Which departments are offline or hampered;

‒ Status of blood, tissue, and other biologics supply;

‒ Status of medications and medical supply;

‒ Staff availability and/or relocation;

‒ Status of health clinics in affected areas;

‒ Which hospitals are open and for what services; and

‒ Emergency communications and infrastructure restoration to maintain response 

capabilities.

• Additional Information: 

‒ Whether the needs of populations with medical, behavioral health, and social service are 

fulfilled;

‒ Whether people with access and/or functional needs have the resources required to 

maintain their independence and health and wellness;

‒ Whether jails and prisons can provide the necessary medical care;

‒ Status of Emergency Medical Services in the area, including response and transport times 

of patients;

‒ Fuel status;

‒ Availability of mental health resources;

‒ Status of oxygen producers in affected areas;

‒ Drug- and alcohol-dependent related arrests and disturbances; and

‒ Morgue availability.

Essential Elements of Information

Essential Elements of Information for the Government

• Maps/information on CI specific to the incident area.

• Location and status of critical healthcare facilities and services (e.g., hospitals, nursing 

homes, dialysis) and information on those with access and functional needs and their medical 

and social services needs.

• Areas with the projected shortest duration of power outage.

Essential Elements of Information for the Electricity Subsector 

• List of critical facilities to use in prioritizing restoration.

• Prioritization for state, local, tribal, territorial, insular area, or Federal governments.

• Identification of critical needs to aid in prioritizing restoration efforts (e.g., water, emergency 

services, hospitals, shelters).
Healthcare Facilities and Power Outages

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Appendix C. Resources

This appendix provides a detailed list of resources to help understand and prepare for power 

outage incidents.

Healthcare Emergency Preparedness Regulations and Standards

• CMS-3178-F: Medicare and Medicaid Programs: Emergency Preparedness 

Requirements for Medicare and Medicaid Participating Providers and Suppliers: 

Establishes national emergency preparedness requirements for Medicare and Medicaid

participating providers and suppliers to plan adequately for both natural and manmade 

disasters. It also requires providers and suppliers to coordinate with Federal, state, tribal, 

regional, and local emergency preparedness systems. 

(https://www.federalregister.gov/documents/2016/09/16/2016-21404/medicare-andmedicaid-programs-emergency-preparedness-requirements-for-medicare-and-medicaid)

• CMS-3277-F: Medicare and Medicaid Programs: Fire Safety Requirements for Certain 

Healthcare Facilities: Amended the fire safety standards for Medicare and Medicaid 

participating hospitals, critical access hospitals, long-term care facilities, intermediate-care 

facilities for individuals with intellectual disabilities, ambulatory surgery centers, hospices 

which provide inpatient services, religious nonmedical healthcare institutions, and programs 

of all-inclusive care for the elderly facilities. 

(https://www.federalregister.gov/documents/2016/05/04/2016-10043/medicare-andmedicaid-programs-fire-safety-requirements-for-certain-health-care-facilities)

• NFPA 99 – Health Care Facilities Code: Establishes criteria for levels of healthcare 

services or systems based on risk to the patients, staff, or visitors in healthcare facilities to 

minimize the hazards of fire, explosion, and electricity. (https://www.nfpa.org/codes-andstandards/all-codes-and-standards/list-of-codes-and-standards/detail?code=99)

• NFPA 101 – Life Safety Code: The most widely used source for strategies to protect people 

based on building construction, protection, and occupancy features that minimize the effects 

of fire and related hazards. (https://www.nfpa.org/codes-and-standards/all-codes-andstandards/list-of-codes-and-standards/detail?code=101) 

• NFPA 110 – Standard for Emergency and Standby Power Systems: Covers performance 

requirements for emergency and standby power systems providing an alternate source of 

electrical power in buildings and facilities in the event that normal electrical power source 

fails. (https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-andstandards/detail?code=110)

• International Building Code: The minimum requirements to safeguard the public health, 

safety, and general welfare of occupants of new and existing buildings. 

(https://www.iccsafe.org/codes-tech-support/codes/the-i-codes/) 
Healthcare Facilities and Power Outages

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Guidance

• Power Outage Incident Annex to the Response and Recovery Federal Interagency 

Operational Plan: Guidance for Federal-level responders to provide response and recovery 

support to state, local, tribal, territorial, and insular area efforts during a long-term power 

outage. Much of the information in this annex is beneficial to planners at all levels of 

government and the private and non-profit sectors. (https://www.fema.gov/medialibrary/assets/documents/154058)

• FEMA P-1019: Emergency Power Systems for Critical Facilities: A Best Practices 

Approach to Improving Reliability: Guidance on the design and operation of emergency 

power systems in critical facilities so that they will be able to remain operational for 

extended periods, as needed. (https://www.fema.gov/medialibrary/assets/documents/101996)

• FEMA 543: Design Guide for Improving Critical Facility Safety from Flooding and 

High Winds: Providing Protection to People and Buildings: Information and guidelines 

for building professionals and decision-makers to implement a variety of mitigation measures 

to reduce the vulnerability to damage and disruption of operations during severe flooding and 

high-wind events. (https://www.fema.gov/media-library/assets/documents/8811) 

• FEMA 577: Design Guide for Improving Hospital Safety in Earthquakes, Floods, and 

High Winds: Providing Protection to People and Buildings: State-of-the-art knowledge on 

the variety of vulnerabilities faced by hospitals exposed to earthquakes, flooding, and highwind risks, as well as the best ways to mitigate the risk of damage and disruption of hospital 

operations caused by these events. (https://www.fema.gov/medialibrary/assets/documents/10672)

• Continuity Guidance Circular: Outlines whole community continuity planning principles 

and guidance, inclusive of hospitals and nursing homes, to ensure the continuation of 

essential functions. (https://www.fema.gov/continuity-guidance-circular-cgc)

• Community Lifelines Implementation Toolkit: Information and resources for whole 

community partners to understand lifelines and coordinate with entities using lifelines. It

provides basic guidance for how to implement the lifeline construct during incident response. 

(https://www.fema.gov/media-library/assets/documents/177222)

• Comprehensive Preparedness Guide 101: Guidelines on developing emergency operations 

plans. It promotes a common understanding of the fundamentals of risk-informed planning 

and decision making to help planners examine a hazard or threat and produce integrated, 

coordinated, and synchronized plans. (https://www.fema.gov/medialibrary/assets/documents/25975) 

• Comprehensive Preparedness Guide 201: Guidance for conducting the three-step process 

for a THIRA and the three-step process for an SPR. (https://www.fema.gov/medialibrary/assets/documents/165308) 

• State Energy Assurance Guidelines: Informs governments on how energy assurance can 

improve planning for and response to energy emergencies, enhance the resiliency of response 

capability, reduce risks and vulnerability of critical energy infrastructure, and support 

investments in the resiliency of the energy infrastructure. 

(https://www.naseo.org/eaguidelines) 
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• National Institute of Standards and Technology Community Resilience Planning Guide 

for Buildings and Infrastructure Systems: A methodology for local government to bring 

together all of the relevant stakeholders to establish performance goals to maintain the social 

and economic fabric when disruptive events occur; in other words, to be resilient. 

(https://ws680.nist.gov/publication/get_pdf.cfm?pub_id=918551) 

• National Mass Care Strategy: National Mass Care Strategy provides a unified approach to 

the delivery of mass care services by establishing common goals, fostering inclusive 

collaborative planning and identifying resource needs to build the national mass care capacity 

engaging the whole community including under-served and vulnerable populations. 

(http://nationalmasscarestrategy.org/) 

Information

ASPR Technical Resources, Assistance Center, and Information Exchange 

(TRACIE) 

The HHS ASPR created the TRACIE to meet the information and technical assistance needs of 

regional ASPR staff, healthcare coalitions, healthcare entities, healthcare providers, emergency 

managers, public health practitioners, and others working in disaster medicine, healthcare 

systems preparedness, and public health preparedness. Resource collections include:

• Considerations for Oxygen Therapy in Disasters. Information on the types of oxygen 

therapy and the types of oxygen supplies generally available, as well as typical sizes and 

length of use of various oxygen storage methods.

(https://files.asprtracie.hhs.gov/documents/aspr-tracie-ta-oxygen-therapy.pdf) 

• Durable Medical Equipment in Disasters. Information on general durable medical 

equipment (DME) categories; focuses on electricity-dependent DME that may be affected by 

disasters and emergencies, including power failures. Includes information to help healthcare 

system preparedness stakeholders plan for medically vulnerable populations who rely on 

DME. (https://files.asprtracie.hhs.gov/documents/aspr-tracie-durable-medical-equipment-indisasters.pdf) 

• Emergency Preparedness Requirements for Medicare and Medicaid Participating 

Providers and Suppliers: Links to resources that can help providers and suppliers comply

with the CMS Emergency Preparedness Rule. (https://asprtracie.hhs.gov/cmsrule) 

• Going with No Flow: Coping with Hospital Water Supply Issues: Highlights MedStar 

Washington Hospital Center’s response to a 2018 water outage.

(https://files.asprtracie.hhs.gov/documents/aspr-tracie-medstar-water-emergency-response2018.pdf) 

• Topic Collection: Continuity of Operations/Failure Plan: Highlights selected plans and 

planning guidance, lessons learned, tools, and promising practices for healthcare facility 

continuity of operations. (https://asprtracie.hhs.gov/technical-resources/17/continuity-ofoperations-coop-failure-plan/16) 

• Topic Collection: Utility Failures: Lessons learned from recent disasters, case studies, and 

toolkits to help healthcare planners prepare to respond to, continue functioning during, and 
Healthcare Facilities and Power Outages

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recover from post-disaster utility failures. (https://asprtracie.hhs.gov/technicalresources/35/utility-failures/27) 

Energy Assurance Reference Library 

The National Association of State Energy Officials, with the assistance of the National 

Association of Regulatory Utility Commissioners under the direction of the DOE, developed the 

State Energy Assurance Guidelines. This reference library provides key information to aid in 

drafting energy assurance plans.

• Documents and Reports: Energy assurance Federal resources and documents and reports 

relevant to energy assurance planning. (https://www.naseo.org/ea-documents-reports) 

• EA Documents – Cybersecurity: Energy assurance resources specific to cybersecurity. 

(https://www.naseo.org/ea-documents-cybersecurity) 

Other Informational Resources

• Continuity Resource Toolkit: A collection of online resources to help implement the 

concepts in the Continuity Guidance Circular. (https://www.fema.gov/continuity-resourcetoolkit)

• Continuity Risk Toolkit: General information on risk and techniques that organizations may 

use to perform risk analysis. (https://www.fema.gov/media-library/assets/documents/158254) 

• Temporary Emergency Power (video): Explains USACE’s temporary power mission 

during disasters. (https://www.youtube.com/watch?v=cOGaPwlxu0w) 

• Roadmap to Resiliency: Discusses emergency power best practices from the Healthcare 

Leadership Initiative on Maintenance of Power (from the American Society for Healthcare 

Engineering and Powered for Patients). (https://www.poweredforpatients.org/wpcontent/uploads/2017/03/Roadmap-to-Resiliency-ASHE-Powered-for-Patients-WhitePaper.pdf) 

Training

Online Training

• IS-815: ABCs of Temporary Emergency Power: Acquaints members of various 

communities of practice (e.g., emergency management, public works, water/wastewater, 

healthcare) with requirements related to providing temporary emergency power to their 

facilities following disruption of the commercial power grid. 

(https://training.fema.gov/is/courseoverview.aspx?code=IS-815)

• IS-547.A: Introduction to Continuity of Operations: A more in-depth introduction to 

continuity planning. (https://training.fema.gov/is/courseoverview.aspx?code=IS-547.a) 

• IS-368: Including People with Disabilities and Others with Access and Functional Needs 

in Disaster Operations: Increases awareness and understanding of the need for full inclusion 

of disaster survivors and staff who have disabilities or access and functional needs. 

(https://training.fema.gov/is/courseoverview.aspx?code=IS-368) 
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• IS-909: Community Preparedness – Implementing Simple Activities for Everyone: 

Presents a model program for community preparedness. It includes 16 Preparedness Modules 

ranging from 20 to 90 minutes that jurisdictions can deliver to community groups. 

(https://training.fema.gov/is/courseoverview.aspx?code=IS-909)

• HHS emPOWER Program Web-Based Training: Helps partners understand the HHS 

emPOWER Program and integrate its tools into their emergency preparedness, response, 

recovery, and mitigation activities. Provides a comprehensive introduction to the program, 

detailed overview of each of the mapping and dataset tools and examples of how public 

health authorities and their partners can use them, and case studies from real-world 

emergencies. (https://www.train.org/main/course/1083714) 

In-person Training

The National Training and Education Division within FEMA prepares state and local first 

responders to prevent, protect, respond to, and recover from manmade and natural catastrophic 

events. Training is also provided to the private sector and the general public. FEMA provides 

training throughout the year. To find out more information on the following courses, course 

eligibility, or registration, visit https://www.firstrespondertraining.gov/frts/npcc. 

• E/L/G 557: Mission Essential Functions Workshop (Continuity Guidance) (two days):

Assists participants in identifying essential functions, conducting a business process analysis, 

and conducting a business impact analysis. 

(https://www.firstrespondertraining.gov/frts/npccatalog?id=2153)

• MGT 454: Healthcare Coalition Response Leadership (three days): Instruction and 

facilitated discussion in best practices and lessons learned in establishing an effective 

healthcare-coalition framework and conducting healthcare-coalition planning, as well as

developing indicators, triggers, and tactics for proactive coalition planning. 

(https://cdp.dhs.gov/find-training/course/MGT-454)

• AWR 900: Framework for Healthcare Emergency Management (four days): For 

personnel who are responsible for developing, implementing, maintaining, and administering

emergency management programs and plans for healthcare facilities/systems. 

(https://cdp.dhs.gov/find-training/course/AWR-900) 

• MGT 317: Disaster Management for Public Services (two days): A unique chance for 

public service professionals to extend their knowledge and skills necessary for protecting 

their communities and infrastructure from potential or actual threats. Participants work 

together in multidisciplinary teams to apply the course information with their professional 

experience in a variety of hands-on, small group activities and disaster scenarios. 

(https://www.firstrespondertraining.gov/frts/npccatalog?id=256)

• MGT 341: Disaster Preparedness for Hospitals and Healthcare Organizations within 

the Community Infrastructure (two days): Brings together individuals from the hospital 

and healthcare community who ensure the resiliency of healthcare services during a high 

consequence or catastrophic event within a jurisdiction. Through a focus on preparedness 

processes and activities, this course provides a chance for participants to acquire the 

knowledge, skills, and abilities necessary to help them ensure the sustainability of their 

facilities and organizations during all types of disasters. 

(https://www.firstrespondertraining.gov/frt/npccatalog?courseId=401)
Healthcare Facilities and Power Outages

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• MGT 315: Critical Asset Risk Management (two days): Assists local emergency 

responders and stakeholders in identifying CI sectors that may be at risk in their jurisdictions 

and helps them develop mitigation strategies that can lessen jurisdictional impacts.

(https://www.firstrespondertraining.gov/frt/npccatalog?courseId=254)

• MGT 345: Disaster Management for Electric Power Systems (two days): Trains electric 

systems managers and employees to prepare for, protect against, respond to, recover from, 

and mitigate against natural disasters, technological disasters, and human-caused incidents 

that affect or threaten electric power facilities and systems. 

(https://www.firstrespondertraining.gov/frt/npccatalog?courseId=286)

• MGT 409: Community Healthcare Planning and Response to Disasters (two days): 

Provides medium- to high-level decision makers with comprehensive planning tools to 

mitigate impacts on communities during large-scale incidents. 

(https://www.firstrespondertraining.gov/frt/npccatalog?courseId=1083)

• MGT 439: Pediatric Disaster Response and Emergency Preparedness (two days): 

Prepares students to effectively, appropriately, and safely plan for and respond to a disaster 

incident involving children, addressing the specific needs of pediatric patients in the event of 

a community based-incident. 

(https://www.firstrespondertraining.gov/frt/npccatalog?courseId=1781)

• MGT 342: Strategic Overview of Disaster Management for Water and Wastewater 

Utilities (one day): A strategic overview of disaster management for water and wastewater 

professionals. It presents information regarding preparing for and responding to natural or 

human-caused disasters that threaten water and wastewater facilities and systems. 

(https://www.firstrespondertraining.gov/frt/npccatalog?courseId=283) 

• MGT 343: Disaster Management for Water and Wastewater Utilities (two days):

Training for water and wastewater professionals on issues concerning preparing for, 

mitigating against, responding to, and recovering from natural or human-caused disasters that 

threaten water and wastewater facilities and systems. 

(https://www.firstrespondertraining.gov/frt/npccatalog?courseId=284)

Modeling Tools

• HHS emPOWER Map and REST Service Tool: An interactive online mapping tool to help 

public health, healthcare, emergency management officials, and first responders better 

anticipate, plan for, and respond to the needs of at-risk individuals that rely on electricitydependent medical and assistive equipment and devices to live independently in their homes. 

(https://empowermap.hhs.gov/) 

• HHS emPOWER Map REST Service: Presents the de-identified Medicare data displayed 

on the HHS emPOWER Map as a Representational State Transfer (REST) Service via 

ASPR’s GeoHEALTH Platform. Users can readily access, consume, and apply the map data 

layer in their own geographic information system (GIS) application to support national, state, 

local, territorial, and community-based GIS analyses. Public health, healthcare, emergency 

management, first responders, utilities, health information technology professionals, and 

many other community partners can use the data layer to map the number of electricitydependent individuals in an area against hospital and shelter locations, evacuation routes, and 

more to inform emergency preparedness, response, recovery and mitigation efforts.
Healthcare Facilities and Power Outages

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(https://geohealth.hhs.gov/dataaccess/rest/services/HHS_emPOWER_REST_Service_Public/

MapServer) 

• USACE Emergency Power Facility Assessment Tool (EPFAT): A secure web-based tool 

used by critical public facility owners/operators or emergency response agencies to input, 

store, and update important details about a facility’s emergency power system to expedite 

deployment of temporary FEMA emergency power assets, which are available during 

Stafford Act Declaration events. (https://epfat.usace.army.mil/) 

• Renewable Energy Integration & Optimization (REopt) Lite: Helps commercial building 

managers estimate how long a system can sustain critical loads during a grid outage; evaluate 

the economic viability of grid-connected photovoltaic, wind, and battery storage at a site; and 

identify system sizes and battery dispatch strategies to minimize energy costs. 

(https://reopt.nrel.gov/tool) 
Healthcare Facilities and Power Outages

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Appendix D. Acronym List

ASPR HHS Office of the Assistant Secretary for Preparedness and Response

CI Critical infrastructure

CMS Centers for Medicare and Medicaid Services

CPG Comprehensive Preparedness Guide

DHS Department of Homeland Security

DME Durable medical equipment

DOE Department of Energy

EEAC Energy Emergency Assurance Coordinators

EOC Emergency Operations Center

EPFAT Emergency Power Facility Assessment Tool

ESF Emergency Support Function

FEMA Federal Emergency Management Agency

GIS Geographic Information System

HCC Healthcare coalition

HHS Department of Health and Human Services

HPP Hospital Preparedness Program

NFPA National Fire Protection Association

NIST National Institute of Standards and Technology

POIA Power Outage Incident Annex

REST Representational State Transfer

SPR Stakeholder Preparedness Review

SSA Sector Specific Agency

THIRA Threat and Hazard Identification and Risk Assessment

TRACIE Technical Resources, Assistance Center, and Information Exchange

UPS Uninterruptible Power Supply

USACE U.S. Army Corps of Engineers