Hospital Emergency Management: The Anatomy of Growth

For more than a century, the “emergency manager” of a U.S. hospital or any of the nation’s other healthcare facilities was seldom if ever identified by that specific job title. The reason was simple: Almost all of the nation’s hospitals usually planned – and developed their response capabilities – for a one-time disaster that would result in the unexpected delivery of one patient (or sometimes several) to that hospital – more specifically, to the hospital’s Emergency Department. For that reason alone it is not surprising that the person or persons charged with emergency (or disaster) planning for hospitals held more general job titles such as director of emergency medicine, or emergency department nurse manager, or security director, or the director of facilities management. 

Some of the nation’s more forward-looking hospitals, though, created the role of emergency manager after the 11 September 2001 terrorist attacks. To date, however, most of the nation’s healthcare facilities have not yet made any major changes to their emergency-management plans, nor have they assigned the “emergency manager” title to one of their senior healthcare officials – who in most if not all facilities would be responsible for emergency planning as well as emergency management.

On 11 September 2001 itself many if not all hospitals throughout the country, not knowing if and where additional attacks might take place, had those officials responsible for their emergency planning immediately activate some level of the hospital’s emergency plan. The typical account of what happened that day would often start with a statement that “My CEO called me and said to meet him in his office immediately.”  In the weeks immediately after 9/11, hospitals reacted to the terrorist attacks more carefully, more thoughtfully, and in much greater detail – and also were making a major effort to find the additional funds needed to prepare for the next possible terrorist incident that might eventually affect their institution.

A More Than Tenfold Increase in Three Years

In a survey (Emergency Preparedness Funding) of New York City metropolitan area hospitals carried out last year by the Greater New York Hospital Association (GNYHA), the hospitals participating in the survey estimated that they had spent, on average, $126,215 for emergency preparedness in 2000.  By 2003 that bottom-line total had increased to $1,355,744 on average, but only a very small percentage of that sum came from federal grant funding – which means that the average hospital participating in the survey had increased its emergency-preparedness funding more than tenfold in only three years. Whether the much larger financial resources being allocated for emergency preparedness are now sufficient has yet to be determined, but it is obvious that the city’s hospitals are today much more prepared to handle mass-casualty incidents then they had been prior to the 9/11 attacks.

Given the major financial problems facing most of the nation’s healthcare facilities today, one can easily understand how difficult it is for hospital administrators to allocate additional resources for a major contingency situation that: (a) is not a “profit center” per se; (b) is minimally paid for through federal grants; and (c) quite possibly may never be needed.  Over the past few years most U.S. hospitals, with the possible exception of very large healthcare systems or trauma centers, tapped existing personnel to supervise the emergency planning required for the management of mass-casualty incidents and events.  With the list of needs and requirements still increasing annually, though, many – probably most – of these hospital support people have felt overwhelmed by the planning and emergency-management tasks that have been added to their previous workloads. 

The Joint Commission (JC – the organization responsible for the accreditation of U.S. hospitals and other healthcare facilities*), recently strengthened and increased the emergency-planning standards required for accreditation and, according to current plans, will publish even more rigorous requirements sometime next year.

The commission’s actions, although both necessary and understandable, are forcing the nation’s hospitals to ask themselves who, specifically, should be their new emergency managers, what his or her duties will be, and how much administrative and budgetary authority they will be given. The answers to those questions will be a reasonably accurate reflection of how seriously a task emergency management is considered to be by a specific hospital or other healthcare organization.

*The commission, founded in 1951 as the Joint Commission on Accreditation of Hospitals (JCAH), changed its name to JCAHO (Joint Commission on Accreditation of Healthcare Organizations) in 1987, but is now usually referred to simply as the Joint Commission. For more information on the Joint Commission see the commission’s website:

Theodore Tully
Theodore Tully

Theodore (Ted) Tully, AEMT-P, is President of STAT Healthcare, an Emergency Management consulting group. He previously served as Administrative Director for Emergency Preparedness at the Mount Sinai Medical Center in New York City, as Vice President for Emergency Services at the Westchester Medical Center (WMC), as Westchester County EMS (emergency medical services) Coordinator, and as a police paramedic/detective in Greenburgh, N.Y. He also helped create the WMC Center for Emergency Services, which is responsible for coordinating the emergency plans of 32 hospitals in the lower part of New York State.



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