Rural Barriers to Emergency Preparedness and Response

Rural communities may face barriers as they prepare for, respond to, and recover from emergencies. Barriers vary from community to community. Rural communities should work with partners and collaborators to identify potential barriers and to develop plans and approaches for addressing them. For planning information, considerations, and resources, see Rural Community Planning for Emergency Preparedness and Response.

Resources and Funding

Resource and funding limitations are common challenges for rural communities, including preparedness and response agencies. When agencies involved in emergency response, such as emergency medical services (EMS), fire departments, and rural public health agencies, are underfunded, response capacity is impacted because of limited resources, including equipment, staff, and training; limited laboratory services; and limited capacity for assessment and evaluation. For more information, see Module 6: Funding, Resources, and Support for Rural Emergency Preparedness and Response.

Geography and Transportation

Rural communities are often spread out over large geographical areas. Rural residents have a longer distance to travel to access healthcare, population centers, and businesses. During an emergency response, this might mean:

• Longer response times by emergency medical services
• Transportation barriers for those without access to vehicles or with special transportation needs
• Geographic obstacles, such as mountains or rivers, during evacuation

Demographics

Some rural areas have concentrations of residents who need to be given special considerations. These include, for example, older adults, disabled residents and residents with special healthcare needs, and people with limited English proficiency.

Communications Infrastructure

Rural areas may not have adequate systems in place to communicate with first responders, emergency managers, and the public in a timely and efficient manner during an emergency. This includes public warning systems and communication channels that can reach all residents. Many rural areas also have limited or spotty service coverage for internet and cell phones. During power outages, power is typically restored first in areas that are more densely populated. For more information on emergency communication, see Public Safety and Crisis Communication in an Emergency or Disaster.

Complex Networks of Governing Bodies

Navigating the complex network of tribal, local, state, and federal agencies to effectively cooperate and coordinate a response can be challenging. The general framework of the emergency management system is that local governments and tribal communities are mostly responsible for their own safety, including their own first responders, such as police and fire departments. Generally, communities are expected to exhaust local resources first, then state resources, and then federal resources, in that order.

Information Sharing

Access to data is a crucial component of responding well to an emergency. Hospitals, local and tribal health departments, state health agencies, and other agencies and organizations involved in emergency response should be prepared to make relevant data available. This includes, for example, sharing information on hospital bed availability and staffing levels, particularly during evacuation scenarios, as well as timely data collection and reporting. Rural communities can support information sharing by designating a liaison or point of contact who will communicate with others during an emergency or disaster.

Supply Chain Management

A well-managed and integrated supply of medications, equipment, and other resources is essential in emergency preparedness and response. Rural communities often experience supply chain issues in acquiring and accessing these supplies because states are often the gatekeepers of resources. Urban areas may be prioritized in resource distribution, and when rural areas are provided resources, they might face communication issues with the state and lack of training. For example, following 9/11 and the anthrax attacks that occurred in the weeks and months after, significant funding went into preparedness. A lot of this funding went to resources and supplies — hospitals all over the country received trailers equipped with preparedness resources. At one Mississippi hospital, administrators were not notified that this resource would be arriving and needed to figure out where to put it. Additionally, there was no follow-up or training and no indication of how this resource would fit into the larger hospital preparedness system. Communication is crucial to successful supply chain management, and a lack of communication can create confusion, even when useful resources and supplies are provided.

Access to Healthcare Services

Rural areas often have healthcare provider shortages in primary and specialized care services. This is a barrier during emergency response, particularly for addressing surge capacity. Rural residents also are impacted by social determinants of health, such as transportation, that make it more difficult to access healthcare services, including during an emergency or disaster. For more information, see The Role of Public Health and Health Systems, Facilities, and Providers in Emergency Preparedness and Response.

Social Determinants of Health

Rural communities commonly experience barriers and challenges related to the social determinants of health. These include, for example, access to clean water, healthy food, safe housing, reliable and affordable transportation, healthcare services, and employment. During an emergency or disaster, these types of resources and services may become even more limited in rural communities. It is important that rural emergency preparedness and response programs acknowledge and plan to address social determinants of health, which have a substantial impact on rural communities.

Laboratory Services

Rural areas are often underserved by laboratory testing services. Public health laboratories, which operate at the federal, state, and local levels, are a shared resource, and rural areas may experience challenges with sending specimens and receiving results in a timely manner during an outbreak. Other local labs in rural areas may not have sufficient surge capacity for testing during emergency response. Local labs may be small and understaffed, as laboratory workforce is limited and under-resourced; larger labs are often prioritized for resources. In addition to testing, rural labs have less capacity to support research and training and therefore may not be familiar with organisms of concern and may not know which tests to run. Other local labs may be part of a hospital system that conducts basic, routine testing and sends out most tests rather than completing those tests in-house.