9/11 Marked the Beginning of Major Changes to Health-Care Emergency Management

How the last 10 years impacted the future of health-care emergency management.

by Mitch Saruwatari / September 9, 2011
A Public Service Health Disaster Medical Team member helped with the medical needs of workers at Ground Zero on Sept. 21, 2001. Photo courtesy of Andrea Booher/FEMA Andrea Booher/FEMA

This fall marks 10 years since 9/11. I vividly recall that morning when I turned on the news and the horror that soon unfolded. My telephone rang continuously over the next few days, as we hospital administrators scrambled to ensure the safety of our hospitals, staff and patients — while concurrently resolving the business impacts related to the Federal Aviation Administration flight restrictions and helping our stranded staff return home.

Little did we know the event would mark the beginning of several major changes destined to impact the future of health-care emergency management.

Soon after the attacks, Homeland Security Presidential directives 5 and 8 were signed. These were the forces that brought the new U.S. DHS together and developed a National Response Plan. These directives also provided definitions for planning and response standards for all organizations, including private health-care providers.

After that, hospitals became eligible for significant emergency management grant funds and resources made available through the Health Resources and Services Administration (HRSA).

As the events of this 10-year period unfolded, we saw the following:

  • In 2005, hurricanes Katrina and Rita provided one of the first tests of health-care preparedness. Following this disaster, several reports highlighted gaps between preparedness and planning with response capabilities.


  • In 2006, then-President George W. Bush signed the Pandemic and All-Hazards Preparedness Act, amending the Public Health Service Act and establishing the new Office of the Assistant Secretary for Preparedness and Response (ASPR). Subsequently the Hospital Preparedness Program grant funds were realigned from the HRSA to this new department under the U.S. Department of Health and Human Services.


  • In the wake of the 2005 hurricane season was the creation of the National Response Framework (NRF). In 2008, the NRF replaced the National Response Plan and now directed all levels of domestic response partners to prepare for and provide a unified national response to disasters and emergencies. By engaging partnerships, using tiered and flexible response capabilities, and implementing a unified command, all agencies became better equipped to respond more efficiently and recover more quickly.


In addition to aligning with the NRF, health-care organizations began to see additional changes in emergency management. In 2008, The Joint Commission created a new and separate chapter for emergency management, highlighting the importance of maintaining patient care services and safety during any hazard. Also, the Hospital Preparedness Program had evolved under ASPR to require greater alignment with other response organizations through joint patient surge, mass fatality and evacuation planning. In addition, coalitions continue to build better relationships, resource sharing and joint exercises using national standards such as the target capabilities to help demonstrate incremental but continuous improvements individually and as a community.

Last year, the U.S. Department of Health and Human Services published the National Health Security Strategy and earlier this year, the Centers for Disease Control and Prevention released the Public Health Preparedness Capabilities. Both documents strongly emphasize the importance of working together to achieve the best outcomes for protecting our family and friends as well as the businesses and services within our communities.

As a nation, we are not only resilient, but also innovative, committed and dedicated to protecting the things we cherish. After the 9/11 attacks and over the past 10 years, that trend has never lapsed. Whether it’s hunting those who intend to harm us, building new levies, or preparing for earthquakes or wildfires, we will continue to mitigate, plan and practice. We are always improving. I’m thankful that health care has become an indispensible partner in these endeavors.

Mitch Saruwatari is the vice president of quality and compliance at LiveProcess in Verona, N.J. Saruwatari also co-chaired the development of the Hospital Incident Command System, which is compliant with the National Incident Management System.