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Preparedness & Response Resources

Wildfires can have a devastating impact on physicians and healthcare organizations as they strive to deliver safe patient care. Administrators and providers also need to be concerned about having complete medical records and ensuring that access to records is handled appropriately and protects patient confidentiality.

Depending on the circumstances and your current resources and capabilities, you may be unable to accomplish activities as you would during normal daily operations. NORCAL Group offers the following resources and strategies as part of a risk management approach to encountering fire-related issues. The main objective is to provide safe and appropriate care to your patients.

Policyholders should not hesitate to contact NORCAL Group’s Risk Management department at 855.882.3412 with a specific issue or concern.

Staying Informed in Uncertain Conditions

The Federal Emergency Management Agency (FEMA) site contains updated information about the federal resources available to those affected by the wildfires.

Keep up with information from the command centers at the national, state, county, and municipal levels.

The American Hospital Association (AHA) Emergency Readiness site provides robust resources across multiple topic areas for those affected and access to government, professional, private and academic organizations.

According to the Insurance Information Institute, the top 10 states for wildfires in 2020 (ranked by number of fires) are California, Texas, North Carolina, Oregon and Washington. 

Several states that have been affected by wildfires post current information about fires in impacted counties. Here are links to access state specific information for some states that are frequently affected:

Preparedness and Response Resources for Healthcare Organizations

The Department of Homeland Security Ready website contains a variety of practical emergency preparedness information, tools, and resources for responding to wildfires. Although these are intended for use by the general public, healthcare organizations can adapt these tools to ensure emergency preparedness.

The Centers for Disease Control and Prevention (CDC) website offers information on preparing for wildfires and staying safe during and after a wildfire, as well as additional links for guidance for health professionals.

State resources include:

Power Outages

Wildfires, like many natural disasters, often cause widespread power outages. Additionally, local utility companies often preemptively shut off power in high fire-risk areas to protect the infrastructure. The Department of Homeland Security Ready site includes extensive information on the potential effects of power outages, and how to prepare, survive and remain safe during outages.

The Federal Emergency Management Agency (FEMA) offers their “Healthcare Facilities and Power Outages” document with guidance and resources on improving healthcare facility resilience to power outages and challenges to maintaining healthcare operations during a power outage.

The U.S. Department of Health and Human Services (HHS), Assistant Secretary for Preparedness and Response (ASPR), Technical Resources, Assistance Center, and Information Exchange (TRACIE) released the EXCHANGE Newsletter, Issue 10, 2020, which discusses lessons learned from recent wildfires, evacuating and receiving patients, and preparing for power outages.

The U.S. Department of HHS, Office of ASPR Public Health Emergency site addresses emergency preparedness.

The Arizona Emergency Information Network (azein) Power Outage site offers general information and resources about power outages.

The California Riverside County Medical Association’s “Key Steps to Take in Your Practice During a Power Outage” offers detailed suggestions on what your practice can do to prepare for a power outage, whether planned or unexpected, including recommendations for protecting refrigerated vaccines.

The Florida Department of Health’s “When the Lights Go Out: Keeping Your Family Healthy and Safe During Power Outages” offers information on staying safe during power outages.

Contact your local utility for additional information on planned power outages in your area.

Patient Care

Typical patient care concerns following a disaster include follow-up, hand-offs/transfers, and medication management.


As you are able, review schedules to determine which patients have acute issues and upcoming or missed appointments. Attempt to contact patients, prioritizing by urgency. Document the communication and resulting action/status. If your office is unable to see patients, document where you instructed patients to go (e.g., shelter, clinic, urgent care, emergency department), or if other arrangements were made (e.g., home health visit, telehealth visit).


If your facility had to evacuate patients, or needs to do so, tracking those patients is a key risk management measure. Documentation to accompany patients should ideally include critical information to support continuity of care and treatment, such as:

  • Patient name and date of birth
  • Allergies
  • Medications
  • Problem list
  • Emergency contact
  • Copy of Medication Administration Record (MAR)
  • Copy of most recent discharge or care summary
  • Copies of latest lab reports
  • Primary care physician information

Source: Minnesota Department of Public Health. Emergency Sheltering, Relocation, and Evacuation for Healthcare Facilities 

Considerations for medical record documentation include:

  • Evacuation/triage level
  • Patient Condition
  • Availability of medical record
  • Disposition (e.g., home, shelter, transfer)
  • Accepting location and physician
  • Arrival confirmation
  • Medications, personal belongings, equipment accompanying patient
  • Times (departure, arrival)
  • Family notification
  • Communication with local, regional, and federal authorities

Medication Management

Patients may need replacement prescriptions for medications that they left behind, or they may be due for refills. You may also encounter patients who have been displaced and are seeking care in your community. The prescription management process should be handled carefully and in compliance with law and regulation. For example, the California Medical Association published their Guide for Patients Impacted by Wildfires with helpful information and resources.

The State Board of Pharmacy for individual states can be a reliable resource in a state of emergency:

Check with your patients’ insurance companies to see if they are able to facilitate patients obtaining replacement medications in the event that your systems for prescribing are not functioning.

Damaged or Destroyed Medical Records

Many healthcare facilities and physician offices will be trying to recover and restore damaged paper and electronic records in the weeks and months following the wildfires. Before investigating potential damage to medical records:

  • Make sure the PHI storage location is safe to enter.
  • Call your general liability/property insurer for directions and recommendations.
  • Execute business associate agreements with any vendor hired to help recover PHI.

Records may not only sustain fire damage, but water damage from fire-fighting efforts. Please see NORCAL Group’s recommendations and resources regarding water-damaged records (paper and electronic).

Damaged Electronic Drives and Devices Resources

Reconstructing the Medical Record

State Medical Boards require a physician to maintain adequate and accurate records. Failure to do so may represent unprofessional conduct.

If you cannot salvage medical records or otherwise reconstruct them via electronic data recovery, you should recreate them to the best of your ability. Approach the various other entities that are storing your patients’ PHI in their own databases and record-keeping systems. For example, pharmacies, consultants, prior treating physicians, third-party insurers, transcription services, and hospitals most likely have PHI they can provide. The following strategies can facilitate the reconstruction process:

  • Inform patients in writing of their PHI destruction.
    • Include the date and circumstances.
    • Describe attempts to reconstruct their records.
    • Send the patient a history form.
    • Invite the patient to contact you to provide additional information.
    • Keep a copy of the patient record in the patient’s new file.
  • Date the reconstructed record with the current date.
  • Identify the record as reconstructed PHI so there is no question as to whether the record is reconstructed or original.
  • Contact third party insurers as soon as possible to determine whether they require attestation forms.

The American Health Information Management Association (AHIMA) also offers guidance on this process. See the section “What to do if a Record is Lost, Destroyed or Stolen” in AHIMA’s Long-Term Care Health Information Practice and Documentation Guidelines: Practice Guidelines for LTC Health Information and Record Systems.

Documentation of Medical Record Destruction/Recovery Efforts

Document the PHI record/data damage recovery efforts, including:

  • Describe the event (date, severity, duration, etc.).
  • Describe the loss of PHI.
  • Construct a log of damaged or destroyed records.
  • Include photograph/video records of the damage and copies of property insurance claims documentation.
  • Describe efforts to reconstruct PHI.
  • Enter a description of the event and reconstruction efforts into reconstructed patient record.

If affected PHI is requested, include documentation of PHI damage and recovery efforts with your response to the PHI request.

Privacy of Medical Information

See the following resources regarding medical information privacy following a disaster:

While the HIPAA Privacy Rule is not suspended during a public health or other emergency, if the Secretary of HHS declares a public health emergency in your state, then HHS may exercise its authority to waive sanctions and penalties for certain HIPAA violations. Check with the U.S. Department of Health & Human Services.

Following are additional state specific resources for hospital response in times of disasters:

The information provided on this website is intended as risk management advice. It does not constitute a legal opinion, nor is it a substitute for legal advice. Legal inquiries about topics covered on this website should be directed to an attorney.

Reference herein to any specific product, process, service, or entity does not necessarily constitute or imply the endorsement, recommendation, or favoring by the NORCAL Group of companies.


Medical Societies throughout California can often provide localized and relevant disaster recovery updates and information to medical professionals.