August 3, 2010 Features

Emergency Planning for Your Clinic

Natural disasters or acts of violence have sudden and often unanticipated consequences on business operations. From 2000 to 2009, there were 257 catastrophes—both natural disasters and terrorism—in the United States; in 2009, three thunderstorms each caused insured losses of more than $1 billion in damage, according to data compiled by the Insurance Information Institute. When catastrophic events interrupt business operations, an established and well-executed emergency plan is essential.

Emergency management involves planning for both minor and catastrophic disruptions to business operations. To cover these events, clinics and other facilities should prepare a business continuity plan (BCP). Business continuity planning helps businesses to identify risk and prepare for events that may cause disruption to normal business operations.

Regardless of practice setting, a business must take into account a number of factors to preserve operations during times of minor disruption and to prepare for disaster recovery after catastrophic events. BCPs include a formal assessment of risk, communication plans, security considerations, emergency and contingency planning, and plans for return to normal operations.

Risk Assessment

Risk assessment requires an in-depth look at operations to identify threats and vulnerabilities. Considerations include: What can go wrong? What is the likelihood that it will go wrong? What are the consequences?

Examples of disasters or extended disruption include utility failures, information services disruption, weather emergencies, and attack or other violence. In the case of the audiology or speech-language pathology clinic, what happens when there is a power failure? Do you have access to emergency power? Are sound rooms or other patient care areas equipped with emergency lighting or flashlights? Is equipment surge-protected? Have you planned to prepare equipment for restart? Consider extended disruptions to business due to water failure, information service failure, heating and air conditioning failure, or telecommunication outage. What services could disrupt operations and how long can you be without services before the facility must close? Is the area in which you work or live vulnerable to natural disasters such as hurricanes, tornadoes, floods, or earthquakes? What clinic preparations must be made for these situations? In the event of a fire, is your staff prepared to carry out evacuation plans for patients?

Communications Planning 

Communications planning includes internal communications with staff and external communications with customers. Staff must have a clear understanding about who makes decisions, how decisions will be made, and when updates will occur during an emergency or disruption. For clinics with multiple locations, an interoffice communication plan is necessary.

External customers may include patients or clients, family members, vendors, and state or regulatory agencies. An organization's ability to provide accurate and consistent communications during and immediately following a disaster is critical to reducing the anxiety level of those involved and enhancing the public's perception of business stability.

For example, in the event of a power failure or information services outage that halts operations, can you access your schedule and the information needed to notify patients of your clinic closure? Have you prepared your computers for stand-alone hearing-aid programming applications in the event of an extended server disruption? If you use an electronic medical record (EMR), how long can you continue to see patients if your EMR is down? If you have a weather emergency, how will you communicate with your staff and patients? Does your staff know where to obtain information? Who will determine when the clinic reopens? What kind of lead time do you need to resume normal operations?

Security Considerations 

Security considerations include threats to protected information (e.g., patient or client files, personnel files), essential business records (e.g., financial, inventory, insurance), and threats to non-business-owned resources (e.g., patient-owned devices in for repair, equipment on loan). Plans should manage risk to essential records and should include secure storage, prevention of loss or compromise, and plans to salvage and repair records involved in catastrophic events. Identification of records that are essential to the process of restoring vital operations and ongoing business must occur in advance of an emergency.

Emergency Planning 

Businesses must plan ahead to be clear about what functions will continue during an emergency and which must be suspended. For suspended functions, are there customers (e.g., patients or clients, students, state agencies, vendors) that need to be informed of the operational shutdown? For example, if your clinic transmits data to the state as part of an infant hearing screening program, have you notified the recipient of the clinic's impending shutdown of services? Are there preparations to be made within the facility for weather emergencies? Have you made plans to move anything from the clinic, such as sending patient hearing aids for repair or returning them to the patient? Who will prepare the facility for inclement weather if storm warnings occur outside normal business hours? What plans are made for payroll or essential functions during extended suspension of operations?

Return to Normal Operations 

Advance planning to return to normal operations is critical to both staff and customer return. Is staff available to return? How much notice is necessary? How will information be communicated to customers? How much time is needed to prepare the office for patients to return? What functions will resume and in what timeframe? What information is critical to determine when it is safe to return to normal or limited operations? In the event of major catastrophe, what is the recovery plan?

Emergency planning takes considerable time and forethought. Although one cannot fully anticipate all aspects of business disruption, the process of business continuity planning will ensure that your clinic or facility is prepared for minor disruption in service and can survive catastrophic events.  

Deborah L. Carlson, PhD, CCC-A/SLP, is director of the Center for Audiology and Speech Pathology and associate professor of otolaryngology at The University of Texas Medical Branch (Galveston). She has expertise in emergency planning from working on an island and from dealing with the effects of Hurricane Ike in 2008. Contact her at

cite as: Carlson, D. L. (2010, August 03). Emergency Planning for Your Clinic. The ASHA Leader.


Hiles, A. (2003). Business Continuity: Best Practices—World Class Business Continuity Management (2nd ed.). Brookfield, CT: Rothstein Associates, Inc.

Insurance Information Institute. (n.d.). Castastrophes: U.S. Retrieved from

Salter, J. (July 2005).A Risk Management Self Assessment Framework. Retrieved from

ASHA Resources

Quality Improvement: Risk Management—manage risk in your audiology practice.  

 Professional Liability and Risk Management for the Audiology and Speech-Language Pathology Professions (ASHA technical report). 

Quality Indicators for Professional Service Programs in Audiology and Speech-Language Pathology—ASHA standards/quality indicators. 

Learn More about Business Continuity Planning

Author Deborah Carlson joins Mary Jo Schill, Earl Seaver, and Barbara Wendt-Harris for an ASHA Convention session on "When Disaster Strikes: Business Continuity Planning and Emergency Operations" on Saturday, Nov. 20 from 1 – 3 p.m. Learn more about possible interruptions in business, the recovery process, and elements of a business continuity plan. The presenters will share their personal experiences with different types of disaster to help you be better prepared.


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