The environment of care (EC) standard requires long term care organizations to develop a management plan that ensures effective response to emergencies affecting the environment of care. Other standards require the implementation of the emergency plan and the execution of emergency management drills. The JCAHO definition of an emergency is a natural or manmade event that suddenly or significantly disrupts the environment of care, disrupts care and treatment, and changes or increases demands for the organization’s services. The standard requires emergency management plans to address the four phases of emergency management activities of mitigation, preparedness, response, and recovery. The requirements of standards vary among the accreditation programs but organizations may be required to conduct a hazard vulnerability analysis, define a common command structure, or establish an orientation and education program for staff. Other processes that may be required are identifying personnel during emergencies, evacuating the facility, establishing backup internal and external communication systems, and clarifying alternate responsibilities of personnel. Standards also call for the management of staff activities -- including housing, transportation, and incident stress debriefing -- and staff and family support activities. Creating and implementing an emergency management plan is just the first step. Health care organizations are required to regularly test the emergency management plan through planned details. The plan must be executed twice a year, either in response to an actual emergency or in planned drills. Organizations are encouraged to create a wide variety of scenarios to test internal and external disasters and disasters that require extensive community cooperation.