NEMT Emergency Plan Template: Storms, Breakdowns, Medical Emergencies, and Evacuations

A storm, a dead alternator, or a rider who collapses can happen on any shift. The plan below settles the hard calls ahead of time: who decides to slow down or stop, which riders go first, who calls the broker, and what the driver does at the roadside. Part 14 is a one-page card for every van, and the sections after the template show which broker and state rules each part answers.

How to use this template

1. Fill in Parts 1 and 2 first. Name who decides and who calls whom, with a backup for each role, and write every broker’s dispatch and after-hours numbers.
2. Set your weather levels in Part 3. Match them to each broker’s own levels. CareOregon’s brokerages define severity levels and trip categories, and they announce the current level to providers as an event starts and changes (manual version 1.3, February 2024).
3. Build the priority list in Part 4. It holds riders whose care cannot wait, such as dialysis and chemotherapy. Update it whenever a standing order changes.
4. Line up backup in Part 5 before you need it. MTM Health’s standard agreement requires a specific backup plan for every trip you accept.
5. Stock every van from Part 12, and check the kit on each daily inspection.
6. Train every driver on Parts 6 to 9 and the card before the first trip and again every year, and record it in Part 13 and the driver training log.
7. Print the card in Part 14, fill in the numbers, and keep it in the visor with the vehicle papers and blank incident report forms.
8. Review the plan every year and after every real event. Give each broker a copy when it asks. CareOregon requires providers to supply their policies on request.

For how to decide when to cancel and how to tell riders, see NEMT in bad weather. The plan fits inside your wider policies and procedures manual.

The template

Part 1: Who is in charge

Role	Name and phone	Backup name and phone
Plan owner (sets the weather level and approves cancellations)
Dispatcher on duty
After-hours manager on call
Person who calls each broker
Person who calls riders, families, and facilities
Fleet, towing, and repairs
Records and computer backups

Plan approved by (signature)	Date approved	Next review date

Part 2: Emergency numbers

Who	Main number	After-hours number	Account or contract number
Police, fire, or ambulance	911	911
Broker 1 dispatch
Broker 2 dispatch
Health plan or state transportation line
Towing company
Mechanic and lift repair shop
Insurance claims line
Backup transportation company (credentialed with your brokers)
Local emergency management office
Electric utility outage line
Office landlord or building manager

Part 3: Weather levels

Level	Starts when	What we run	Who we call
1. Normal	No weather alert for our service area	All trips	No one
2. Caution	A watch or an advisory, such as a winter weather advisory, heat advisory, or flood watch	All trips, with extra time. Fuel every van and charge every phone.	Riders with early pickups. The broker, if delays are likely.
3. Limited	A warning in part of our area, such as a winter storm warning, flood warning, or extreme heat warning	Part 4 riders first. Other trips only on roads we judge safe:	The broker right away with every trip we cannot cover, so it can reassign them. Each rider with a new time.
4. Stop	A blizzard, ice storm, tornado, or flash flood warning where we drive, or roads closed	No trips until the plan owner says so, except:	The broker and each rider, for every cancelled trip, right away
Back to normal	The warning ends and roads are passable	Resume, oldest missed trips first	Drivers, the broker, and riders whose trips were moved

Who watches the forecast, and when	Where alerts come from	How drivers hear the level

Part 4: Priority riders (care that cannot wait)

Rider (initials or ID)	Care and schedule	Center, main phone, and alternate emergency phone	Backup center the rider’s center uses	Mobility and equipment (wheelchair, oxygen, power chair)	Rider or caregiver phone	Broker standing order number

This list holds health information. Keep it where only dispatch and managers can see it, and share only what each person needs.

Part 5: Backup coverage

If this happens	First backup	Second backup	When we call the broker
A van breaks down or its lift fails
A driver calls out sick or does not show
A pickup is running late
Weather takes vans off the road
The office loses power, phones, or internet

Spare vans (numbers and types)	On-call drivers (names and phones)	Partner companies credentialed with the same broker

A partner company takes a broker trip only when the broker reassigns it or gives written consent. MTM Health’s standard agreement bars subcontracting any service without MTM’s express written consent.

Part 6: Van breakdown or lift failure

1. Signal, and get off the road as far as you safely can. Turn on the hazard flashers.
2. On a highway shoulder at night, set out the warning triangles.
3. Call dispatch with your location, the riders on board, and their appointment times.
4. Dispatch calls the broker right away and starts the backup in Part 5.
5. Dispatch tells each rider, and the facility waiting for them, the new time.
6. Decide with dispatch whether riders wait in the van or at a safe place away from traffic. Never leave a rider alone in a parked van in heat or cold.
7. If the lift stops, use its emergency controls the way the maker’s manual shows. Never lift or carry a rider out.
8. Write down the time of the breakdown, the tow, and the backup’s arrival. Fill out an incident report when the trip was interrupted.
9. The van carries no riders until it is repaired. After any damage, have an ASE-certified mechanic check it first.

Where the lift’s emergency controls are	Where the lift maker’s manual is kept	Who is trained to use them

Part 7: Medical emergency on a ride

1. Pull over where it is safe, and look at the rider.
2. Call 911 right away for any of these: not breathing or not waking, chest pain or pressure, signs of a stroke (loss of balance, vision changes, a drooping face, a weak arm, or slurred speech), a seizure that lasts more than 5 minutes, a second seizure, heavy bleeding, or a hard fall.
3. Give first aid or CPR only as you were trained.
4. For a seizure, ease the rider down or to one side if you can, keep the space around them clear, and time it. Do not hold them down or put anything in their mouth.
5. Stay with the rider until emergency medical services take over. Write down the times, what you saw, the ambulance agency, and the hospital.
6. Call dispatch. Dispatch calls the broker right away, and tells family or the facility as the broker directs.
7. Dispatch sends backup for any other riders on board.
8. Write the incident report the same day.

Part 8: Crash

1. Stop, turn on the hazard flashers, and set out the triangles.
2. Check every rider and yourself. Call 911 if anyone is hurt.
3. Call dispatch. Dispatch calls the broker right away.
4. Take photos, and get the other driver’s name, license, plate, and insurance, and each witness’s name and phone number.
5. Complete the incident report form, and take the post-accident drug test if your broker requires one.

Part 9: Getting everyone out of the van

Field	Our plan
When drivers get everyone out (fire, smoke, fuel smell, rising water, danger from traffic)
Order riders leave the van
Exit for wheelchair riders if the lift will not work
Where the strap cutter is kept
Where the fire extinguisher is kept
Safe place to gather, away from traffic

1. Stop, set the parking brake, turn off the engine, and turn on the flashers.
2. Get everyone out in the order above. Cut belts or straps that will not release.
3. Use the extinguisher only on a small fire, and only when you can do it safely.
4. Move everyone well away from the van and from traffic. Count riders.
5. Call 911, then dispatch.

Part 10: Office, phones, and records

If this fails	Our backup	Where it is, or who has it
Office phones	Forward calls to:
Internet or the trip system	Tomorrow’s trips printed or saved offline each evening. Paper trip logs in every van.
Computers and rider records	A backup copy kept at:
Power at the office or garage
Fuel
Van keys and fuel cards	Spare set kept at:
Paper or electronic records damaged by fire or flood	List what was lost and the dates of service it covers, take photos, and report the loss where your state requires it

Part 11: Facility and community evacuations

Facility or agency	Contact name and phone	Our role (primary or backup)	Vans and drivers promised	How fast we arrive	Date confirmed

Part 12: Van emergency kit (check on every daily inspection)

Item	Van 1	Van 2	Van 3	Van 4
Fire extinguisher, charged, gauge in range, within the driver’s reach
First aid kit
Body fluids spill kit and gloves
Three reflective warning triangles
Seat belt and strap cutter
Seat belt extenders
Flashlight with working batteries
Blanket
Phone charger and a working phone or radio
Spare tire or tire repair kit, and a jack
Ice scraper and traction aids (winter)
Water and snacks
Registration, insurance card, accident procedures, and blank incident forms
This plan’s driver card

Part 13: Training and drills

Date	Topic (weather levels, breakdown, medical emergency, getting riders out, the driver card)	Who attended	Trainer	Next due

Part 14: Driver card (print one for every van)

Company dispatch	After hours	Broker	Van number

If this happens	Do this
Anyone is hurt or in danger	Call 911 first. Then call dispatch.
Rider stops breathing, has chest pain, stroke signs, or a seizure over 5 minutes	Pull over. Call 911. Stay with the rider. Give first aid or CPR only as trained. Call dispatch.
Crash	Flashers and triangles. Check everyone. Call 911 if anyone is hurt. Call dispatch. Photos and names.
Van breaks down	Get off the road. Flashers and triangles. Call dispatch with your location and riders’ appointment times.
Lift fails	Use the lift’s emergency controls. Never carry a rider. Call dispatch.
Fire or smoke	Stop. Engine off. Everyone out. Extinguisher only on a small fire. Call 911.
Flooded road	Turn around. Never drive around barriers or into water.
Tornado warning	Drive to the nearest sturdy shelter. If you cannot, everyone gets down and covers their head, or leaves the van for a ditch or other low spot.
Stuck in snow	Stay in the van. Run the engine about 10 minutes each hour, with a window cracked and the exhaust pipe clear of snow. Call dispatch.
Very hot day	Never leave a rider in a parked van, even with the windows down.
After any of these	Call dispatch. Write the incident report the same day.

What brokers and states require in an emergency plan

Most rules come from your broker contracts and your state’s NEMT rules. Some bind the health plan or broker, which passes them to you through its provider agreement. These are the clearest written requirements as of September 2026.

Rule	What it requires	Where it fits
CareOregon, Oregon (manual version 1.3, February 2024)	Brokerages and their ride providers keep policies for adverse weather, disasters, business continuity, and disaster recovery, covering staff training, how people are notified, and what members are told. Providers plan to keep running trips when possible, keep a backup plan for pickups running very late, and tell the brokerage right away about reduced capacity.	Parts 1, 3, 5, 13
CareOregon	Written procedures for drivers when a rider needs emergency care. Call 911 when an ambulance is needed, tell brokerage dispatch right away, and send a written incident report within 24 hours.	Parts 7, 14
TennCare health plan contract (Amendment 25, July 1, 2026, Attachment XI)	Each health plan must have adverse weather procedures for members who need critical care, including renal dialysis and chemotherapy, in extreme heat, extreme cold, flooding, tornado warnings, and heavy snowfall. It must also have backup plans for a vehicle more than 20 minutes late, and train drivers in handling accidents and incidents and in emergency evacuation.	Parts 3, 4, 5, 9
MTM Health standard agreement (January 1, 2023 version posted by Pennsylvania)	A specific backup plan for every trip you accept. Immediate notice to MTM of significant delays, with alternate plans when the appointment can still be kept. Immediate notice to the member and MTM when weather makes a trip unsafe.	Parts 3, 5
MTM Health, Virginia (handbook, May 2026)	Emergency situation training, basic first aid, and defensive driving before a driver carries members	Part 13
Minnesota Rules 8840.5950 and 8840.5910	A written policy on what drivers and attendants do after an accident or emergency, with retraining for anyone who does not follow it. Training before the first trip in what to do and whom to call in a medical emergency or accident, including the fire extinguisher and triangles.	Parts 6 to 9, 13
Louisiana Medicaid (chapter 10, issued July 14, 2025)	In an emergency, the driver decides whether to stop and help, go to the nearest medical facility, or call 911. A rider taken to an emergency medical facility means immediate notice to the state, the broker, and a family member.	Part 7
Georgia (NEMT manual, July 1, 2026)	Accident procedures and forms kept in each vehicle’s information packet. The broker must have a backup vehicle in place within 30 minutes once a vehicle is unavailable.	Parts 5, 12
Texas health plans (Uniform Managed Care Manual 16.4)	The health plan must arrange backup vehicles when told a vehicle is more than 30 minutes late for a pickup, or more than 30 minutes after the member calls for a return ride	Part 5
New Jersey, N.J.A.C. 8:40-3.5	A standard operating procedures manual for mobility assistance vehicle and ambulance services that covers vehicle breakdowns, kept where each vehicle is garaged	Part 6

Minnesota’s rules reach nearly every NEMT provider there, because state law makes NEMT providers follow Minnesota Rules chapter 8840. Only public transit, volunteers, and not-for-hire vehicles are exempt (Minnesota Statutes 256B.0625, subdivision 17).

Weather alerts and what they mean for your trips

Your local National Weather Service office issues winter watches, warnings, and advisories using local criteria, so the snowfall that triggers a winter storm warning in one region may not in another. Tie your levels in Part 3 to the alert names, not to inches of snow.

Alert	What the National Weather Service says
Watch (winter storm, flood, extreme heat)	Conditions are favorable for the hazard. Be prepared.
Winter weather advisory	Be prepared for winter driving conditions and possible travel difficulties. Use caution when driving.
Winter storm warning	Travel will become difficult or impossible in some situations. Delay travel until conditions improve.
Ice storm warning	Usually issued for about a quarter inch of ice or more. Travel is dangerous or impossible and strongly discouraged.
Blizzard warning	Frequent gusts of 35 mph or more with falling or blowing snow, often cutting visibility below a quarter mile for three hours or more
Flood warning or flash flood warning	Flooding is imminent or happening. For a flash flood warning in a flood-prone area, move to high ground right away.
Heat advisory and extreme heat warning	Dangerous heat, and for the warning, extremely dangerous heat

Three rules belong on every driver’s card:

• Flood water. Six inches of fast-moving water can knock over an adult, 12 inches of rushing water can carry away most cars, and 2 feet can carry away SUVs and trucks. The road under the water may be gone. Never drive around barriers.
• Tornadoes. A vehicle is not a safe place. Drive to the closest shelter. If you cannot reach one, get down in the vehicle and cover your head, or leave it for a low spot such as a ditch.
• Heat. Even on mild days in the 70s, a parked vehicle can quickly heat to a level dangerous for children, pets, and even adults, and leaving the windows slightly open does little to slow it.

If a van gets stuck in a winter storm, the weather service says to stay in the vehicle, run the motor about 10 minutes each hour for heat with a window open a little, keep the exhaust pipe clear of snow, and make the vehicle easy for rescuers to see.

Missing a pickup because of weather is not always held against you. CareOregon’s manual says unusual weather or traffic that affects all vehicles and keeps you from a scheduled pickup does not count as noncompliance, but you must tell dispatch right away so the trip can be reassigned. Winter prep for each van is in the winter vehicle checklist.

Dialysis and other care that cannot wait

CareOregon requires NEMT to continue during bad weather and disasters, as far as possible, for members who need critical medical care. It defines that as life-sustaining care, including renal dialysis and chemotherapy, and its brokerages set trip categories that include, at a minimum, life-sustaining trips, to decide which rides to limit as conditions worsen. TennCare’s contract requires its health plans to keep adverse weather procedures for the same riders.

Dialysis centers have their own federal emergency rules, and they help you build Part 4 (42 CFR 494.62):

• Each center’s plan must cover arrangements with other dialysis facilities or providers to take its patients if it has to limit or stop operations. Ask each center you serve which facility that is.
• Each center must tell patients whom to contact in an emergency, including an alternate emergency phone number for when the center cannot take calls. Put that number in Part 4.
• Each center’s communication plan lists other dialysis facilities, emergency officials, and other sources of help. Ask the center to list you as a transportation contact.

Get the broker’s approval before you take a rider to a different center. In New York, any change to trip details such as the location or day must be approved before the trip, or it may not be paid (transportation manual, effective August 25, 2023). Riders on oxygen or ventilators need their own plan for power outages and long waits. Georgia’s NEMT manual (July 1, 2026) says its vehicles and drivers are not equipped to supply or run oxygen or life-sustaining equipment, so riders must travel with portable, fully charged, battery-operated equipment and a trained escort when needed. For the recurring schedule behind these rides, see dialysis transportation and the standing order form.

Breakdowns, medical emergencies, and getting riders out

Breakdowns. Federal ADA rules require you to keep lifts and securement devices working, repair them promptly, and take reasonable steps to serve riders who would use a broken feature. Brief interruptions for repairs are allowed (49 CFR 37.161). ADA vehicle standards require a lift to have an emergency way to lower an occupant to the ground and stow the empty lift if power fails (49 CFR 38.23). Louisiana’s broker inspection checks that each lift’s backup mechanisms work. CareOregon bars drivers from carrying riders up or down stairs, and from transferring riders into or out of a wheelchair unless they are licensed, trained, and authorized by the brokerage. TennCare’s contract counts a breakdown that interrupts a trip as an incident its health plans must document. See when a NEMT van breaks down for the full routine.

Warning triangles. Minnesota’s rule shows where to put them. When a van is stopped or disabled on a roadway or shoulder outside a business or residential district when headlights are required, place one triangle 10 feet from the van on the traffic side and a second about 100 feet back toward approaching traffic. On a one-way road, add a third about 200 feet back.

Medical emergencies. CDC says to call 911 right away for stroke signs, and not to drive the person to the hospital, so medical staff can start treatment on the way. It says to call 911 at once for heart attack symptoms too. For a seizure, CDC says to call 911 when it lasts longer than 5 minutes, another follows soon after, the person has trouble breathing or waking, is injured, is pregnant, has never had a seizure before, or has diabetes and loses consciousness. CareOregon requires Red Cross first aid and CPR, or an equivalent, before a driver carries members, and Minnesota requires four hours of first aid within 45 days of starting. See a medical emergency during a ride and CPR and first aid requirements.

Getting riders out. TennCare’s health plans must include emergency evacuation in driver training. Minnesota requires training on the fire extinguisher before a driver’s first trip, and CareOregon says drivers should be trained on the extinguisher in any vehicle they regularly drive. Walk every driver through Part 9 in the van they drive, with the strap cutter in hand.

Disasters, facility evacuations, and rider privacy

In a disaster, NEMT can move a Medicaid member out of a nursing facility or other medical facility that is no longer safe to another facility, even in another state, and the state must cover it (CMS, SMD 23-006, September 28, 2023). It does not cover moves between community settings for personal reasons, such as to be closer to family.

Hospitals and long-term care facilities must plan for safe evacuation, and their plans must address transportation (42 CFR 483.73, 42 CFR 482.15). If a facility names you in its plan, write what you promised in Part 11 and put the terms in writing with the facility transportation agreement. Promise only the vans and drivers you can send on a bad day.

HIPAA allows limited sharing in a disaster. A covered entity may tell a family member or caregiver a rider’s location and general condition, as long as a rider who is present and able to decide agrees or does not object, and may work with a public or private disaster relief organization to make that notice (45 CFR 164.510). Share only what the notice needs. See HIPAA for NEMT for when HIPAA applies to your company.

Keeping records, phones, and trips running

If HIPAA applies to your company, its Security Rule requires a contingency plan for emergencies that damage systems holding electronic rider information, such as a fire or a system failure (45 CFR 164.308). Three parts are required: a data backup plan that keeps exact, retrievable copies, a disaster recovery plan to restore lost data, and an emergency mode plan that keeps critical work going while the data stays protected. Testing the plan is addressable. Part 10 covers all three in plain terms.

Keep paper as a fallback for trips. MTM Health’s Rhode Island handbook (last updated July 1, 2026) requires every driver to keep paper copies of approved trip logs, even when using an approved app, in case the app has problems.

New York requires transportation providers whose paper or electronic records are damaged by fire, flood, or another disaster to notify the Office of the Medicaid Inspector General. The report covers the event, the types of records lost, the dates of service affected, and documents or photos that show the loss (transportation manual, effective August 25, 2023). Other states may have their own rule, so check your provider manual.

What each van should carry

Equipment rules differ by state and broker. These examples show what the Part 12 kit is built from.

Item	Examples of rules that require it
Fire extinguisher	Minnesota: dry chemical, at least a 5B:C rating, with a charge gauge, mounted in a bracket within the driver’s reach in vans. Georgia: one 5-pound or two 2.5-pound extinguishers with a current inspection tag, within the driver’s reach. Louisiana: gauge reading in the maker’s range, secured in the vehicle. CareOregon: the right type for the vehicle, with a visual check recommended monthly and done at least once a year.
First aid kit	Minnesota, Georgia, and CareOregon. Georgia lists band aids, gauze, sterile pads, antiseptic pads, scissors, tweezers, gloves, antibiotic cream, an instant cold pack, and tape.
Body fluids spill kit	Minnesota, Georgia, and CareOregon
Reflective warning triangles	Three in Minnesota and Georgia, and Georgia bans flares. CareOregon requires roadside reflective or warning devices.
Seat belt or strap cutter	Minnesota (with no exposed sharp edge), Georgia (mounted above the driver’s door), Louisiana (within the driver’s reach), and CareOregon
Seat belt extenders	Minnesota (when needed), Georgia (two), and CareOregon
Flashlight	Minnesota and CareOregon
Blanket and ice scraper	Minnesota: a blanket at all times and a scraper from October 1 to April 30
Two-way radio or phone	Minnesota (hands-free if a phone) and Georgia
Spare tire or repair kit, jack, and traction devices when needed	CareOregon
Accident procedures and forms	Georgia’s vehicle information packet, CareOregon’s required incident forms, and Modivcare’s 2025 attestation, which has drivers keep its accident and incident form in the vehicle

For winter trips, CDC’s emergency car kit list (December 2, 2025) adds a phone charger and extra batteries, warm hats, coats, and blankets, water and snacks, a shovel, jumper cables, and sand or cat litter for traction. Check the kit on every daily vehicle inspection, and build the medical supplies from the first aid kit checklist.