Emergencies don't always come from disasters or cyberattacks. "One company I knew had clinics in strip malls," says Jeff Dance, MBA, executive director of Kassouf Healthcare Solutions that manages 16 healthcare locations. "They had several incidents where cars accidentally went through the front window into the waiting room. They were down for a month. Not only did they have to rebuild, but there was an emotional piece to handle when folks were coming back to work. Most places do not plan for something like that."

More importantly, clinics do not take seriously some pieces of plans that make it viable in the moment. "They may know where to turn off the gas or, but there will be crowds," Dance says. "Everybody is going to come to look, but also people come to help, and somebody on your staff has to manage that."

Besides determining who is in charge overall in a crisis--generally the administrator or a doctor--and who handles crowd control, emergency plans should specify a spokesperson for the media. Even a fire can have media converging on a clinic during the crisis. "Don't let staff get picked out for their side of the story," Dance says. "Just because the media sticks a microphone in your face doesn't mean you have to say something. Insurance and law enforcement are the only people you have to talk with unless your attorney tells you otherwise.

"Someone also needs to be designated to shelter patients from media and, unless warranted for health concerns, kept onsite. Don't let them go right away. Have them wait until the authorities have talked to everyone."

They will also need to talk with your documenter. This designated staff person takes photos, videos, and voice recordings or notes of everything about the incident, including the structure, people's health status and their experience, to help recreate a chronological record of the event. "Because your insurance, the police, and your risk manager are all going to ask," Dance says. "And take pictures of everyone at the rendezvous spot." The recordings and photos of each person who was in the practice, including family in the waiting room and all staff, can also avert lawsuits.

The importance of designated evacuation points is important in these localized disasters. There should be one gathering spot for each exit. "This is where we all meet to take a head count," Dance says. "And make a plan for when you're missing someone."

Have staff phone numbers accessible to leadership so that calling trees and group texts can be put in play immediately after evacuating or during any disaster to track staff endeavoring to get home safely, such as during the 2014 Birmingham snow-pocalypse.

If cell towers are down, have a predetermined contact point for staff to stay in touch. "Staff should know that you will meet back at a certain parking lot at 4:00 p.m. every day for updates or to listen to a certain TV channel or radio station," Dance says.

That meeting point offers practices a way to keep payroll going during down times as well. "Which is why you need to be close with your banker. Have their cell number," Dance says. "So can get a cash withdrawal to meet payroll if needed. Meet staff at the clinic or contact point, hand out cash, keep records, and get signatures. Have all your controls in place, so it's not just one person doing the withdrawal or disbursement."

Payroll may need to be available for over a year with the growing intensity of disasters these days. When the EF4 multiple-vortex tornado swept through Tuscaloosa in 2011, clinics were ready to rebuild in less than a year. "But they couldn't rebuild in that time frame," says Greg Mikos with MK Insurance, "because the city administration was not up and running enough to issue the building permits. The normal 12 months of loss-of-income insurance wasn't enough. They needed 15 to 16 months. If you were a one-man shop, you could have been out of business."

Emergency plans may need to be broadened, too, to not only cover extensive disasters, but more diverse situations, such as an employee being robbed in the parking lot and peaceful protests morphing into riots. "Before the election last fall, we had clinics on a call with experts on what to think about for any kind of post-election civil unrest," Dance says.

To learn more about disaster protection, visit Infragard Birmingham Members Alliance, which is a partnership between the FBI and the private sector to prevent hostile acts against our infrastructure and communities, at infragardbirmingham.org.