EMS Downtime Exercise Guide: Test the Decisions Before Systems Fail

An EMS downtime is not only an IT problem. If dispatch, radio, mapping, ePCR, hospital notification, or a billing interface is unavailable, crews and supervisors still have to protect patient care, document what happened, communicate across agencies, and recover records safely. This guide is a planning aid for a discussion-based exercise, not an operational protocol. Use your agency’s approved clinical, dispatch, privacy, and incident-command procedures as the authority.

Need the written procedures first? See EHR Downtime Procedures: What to Put in Writing.

Choose a narrow exercise objective

Pick one or two capabilities to test: accepting and dispatching calls, maintaining field-to-dispatch communications, documenting care during ePCR loss, coordinating destination and handoff, or restoring accurate records. Name an exercise sponsor, facilitator, evaluator, and the people empowered to answer policy questions. Decide whether the scenario includes a cyber incident; a simple system outage can reveal just as much about dependencies.

If the agency first needs to map its systems and vendor exposures, start with an EMS cybersecurity assessment.

Set the scenario and boundaries

Example: the ePCR platform becomes unavailable near shift change while call volume is high. Dispatch and radio still function initially, but crews cannot retrieve previous records and the vendor has not supplied a restoration estimate. Thirty minutes later, a second communications path becomes unreliable. Do not make the scenario needlessly catastrophic; give players enough information to make real decisions and note assumptions.

Before the exercise, assemble current downtime forms, dispatch and communications procedures, medical-control contacts, hospital handoff process, vendor escalation path, retention/entry-backlog rules, and a method to capture exercise observations. Avoid placing real patient identifiers or sensitive system details in an unsecured exercise package.

Discussion prompts by phase

Detection and activation. Who confirms an outage, and what threshold activates downtime procedures? How do crews learn the current status? Who is incident lead, and who contacts IT, dispatch, vendor support, medical direction, hospitals, or mutual-aid partners?

Sustained operations. How are calls assigned and unit status tracked if a primary workflow fails? What approved paper or alternate documentation is available? Where are forms stored and who replenishes them? What information must accompany patient handoff when the usual electronic channel is missing? How are errors, duplicate entries, and priority calls flagged?

Communications degradation. Which backup paths are approved, and when do teams switch? How are changes communicated to people who are already in the field? What happens when a hospital, dispatch center, or outside partner has a different view of the incident?

Recovery and reconciliation. Who decides that the system is reliable enough to return to normal use? How are paper records secured, entered, reconciled, and checked for omissions or duplicates? Who preserves an incident timeline and decides when the downtime period is closed?

Leadership and public messaging. What does leadership need to know, when, and from whom? Who may make an external statement? Avoid speculating about breach, cause, or restoration time before the responsible team confirms it.

Run a 60- to 90-minute tabletop

Spend 10 minutes on objectives and ground rules; 15 on initial outage; 15 on a complication; 15 on restoration and backlog; and the remainder on a hotwash. Adjust for the agency. The facilitator asks what the team would do, who owns it, what resource they would use, and what the current written procedure says. The evaluator records decisions and evidence of gaps, not a score for individuals. A short exercise can be valuable if it produces owned improvements.

Record an actionable improvement plan

For each observation, record the capability tested, what happened in the discussion, the consequence, a corrective action, an owner, and a target date. Separate a missing policy from a training problem or an untested technology dependency. Revisit owners and due dates after the exercise. FEMA’s HSEEP improvement-planning resources provide an AAR/IP template and emphasize tracking corrective actions; adapt the format to your organization rather than claiming HSEEP compliance from a single meeting. FEMA HSEEP improvement planning.

Scope a facilitated exercise

FSL can help design and facilitate a bounded downtime tabletop and organize observations into an after-action/improvement plan. Your clinical, dispatch, privacy, and technology owners remain responsible for agency-specific decisions and implementation. See emergency preparedness consulting, tabletop exercise consulting, and the healthcare ransomware tabletop checklist. Discuss an EMS downtime exercise.