On September 11, 2001, I lived roughly a mile from Ground Zero. At the time, I held leadership responsibilities across healthcare programs and hospital operations and was involved in emergency preparedness and response. Hospitals across New York City prepared for a massive influx of patients that, tragically, never came. But that day taught me something about emergency planning that has stayed with me ever since:

Having a plan and being prepared are not the same thing.

Hospitals had plans. Police and fire departments had plans. Emergency responders had plans. But a crisis has a way of breaking the assumptions those plans depend on.

Roads become impassable. Communications fail. People can’t get where they’re supposed to go. The person everyone depends on suddenly becomes the person who needs help.

I was recently discussing this with Dr. Richard Jones, a board-certified family physician and former U.S. Navy medical officer who has spent much of his career thinking about contingency planning.

“You’ve got Plan A, and Plan A works for about two minutes, and then you have to go to Plan B.”

That is as true for families as it is for hospitals.

The real question isn’t simply: Do you have an emergency plan?

It’s: What happens when your emergency plan doesn’t work?

Start With People, Not Disasters

Most emergency planning starts with the event: wildfire, earthquake, hurricane, flood.

I think it should start with the people.

That matters especially for older adults. In 2023, 93% of Americans age 65 and older reported at least one of 12 selected chronic conditions , and more than a quarter reported two or more.

In other words, for many families, an emergency plan cannot assume that everyone is healthy, mobile and able to simply grab a bag and leave.

I’ve written before about this in the aftermath of the Texas floods: effective emergency planning has to account for the real-life medical and logistical needs of the individual, not just generic advice about go-bags and evacuation routes.

Imagine a couple in their 70s. The wife is the primary caregiver for her husband, who has dementia. She manages the medications, appointments, meals and daily routine.

That may never make the news, but for that family, it is a major emergency.

Who takes over? Does anyone else know his medications? Can he safely be left alone? Who has access to his doctors? Where does he go if she is hospitalized?

The same applies to families dealing with mobility issues, oxygen, insulin, cancer treatment, serious mental illness or other chronic conditions.

Emergency preparedness has to reflect the people actually living the plan.

Put Your Medical Life On One Page

One of the simplest things a family can do is create a one-page medical summary.

In an emergency, your medical history should not depend on your memory.

Dr. Jones recommends keeping it short and practical: basic identifying information, emergency contacts, physicians, allergies, major medical conditions and current medications. If someone has a complicated history, summarize where things stand now rather than carrying around 50 pages of records.

Then make sure someone else can access it.

That matters because the person who knows the most may be the person who is unconscious, confused or otherwise unable to communicate.

A beautifully organized emergency plan locked on one person’s phone is not much of a plan.

Ask Two Questions: Can I Communicate? Can I Move?

When I asked Dr. Jones what people should think about during a crisis, two things came to mind immediately:

Communication and transportation.

If your mother has a stroke and four siblings are trying to figure out what is happening, establish one communication channel. One person can update the others. Everyone gets the same information. Nobody is independently calling the hospital, physicians and one another while the facts get distorted.

And don’t assume communication means a phone call. If calls are down, texts may work. Email may work. Another messaging platform may work. Your communication plan needs a backup plan too.

Transportation is just as important. If you need to leave, how will you leave? Where will you go? What happens if the highway is closed? What if public transit is down? What if the person you are moving cannot walk?

This is where Plan B becomes real.

Sometimes it may mean a second route. Sometimes a second destination. Sometimes a completely different mode of transportation.

And sometimes the smartest move is not to go very far at all.

During Hurricane Sandy, I was working in lower Manhattan, where parts of the healthcare infrastructure were under enormous strain. Yet not far away, other parts of the city were functioning almost normally.

We tend to think evacuation means getting out of town.

Sometimes it means getting two miles away.

Not every emergency requires evacuation. Sometimes the safest thing you can do is stay where you are.

Dr. Jones recommends being prepared to remain reasonably self-sufficient for about 72 hours.

That means the obvious basics: water, food, clothing and shelter.

But healthcare preparedness adds another layer.

Do you have enough essential medications? Can medical equipment keep operating if the power goes out? Can you charge your phone? Can you get reliable information about what is happening outside?

The point is not to become completely self-sufficient. The point is to buy yourself time.

Because the first few hours of a crisis are often the most chaotic. Three days later, roads may reopen. Power may return. Emergency services may become easier to access. The situation may simply be clearer.

Emergency Preparedness Means Practicing Failure

Hospitals conduct tabletop exercises for a reason.

FEMA’s 2023 National Household Survey on Disaster Preparedness found that just 51% of Americans believed they were prepared for a disaster, even though 57% had taken three or more steps to prepare during the previous year.

That distinction matters. Checking preparedness boxes is one thing. Knowing what you will do when the first plan fails is another.

Hospitals ask uncomfortable questions before the emergency arrives.

What if the ER becomes inaccessible? What if the power goes out? What if staff cannot get to work? What if the expected backup fails?

Families can do the same thing.

You do not need binders, laminated maps or a home command center.

Just sit down for 20 minutes and ask:

What if Dad has a stroke tonight?

What if the wildfire forces us to evacuate?

What if Mom, who manages Dad’s care, is the one who gets sick?

What if we cannot reach our preferred hospital?

What if the power is out for three days?

Then ask the question that matters most:

Emergency preparedness is not about predicting every crisis.

It is about making enough decisions in advance that you still have choices when the unexpected happens.

And make sure your Plan A has a Plan B.