Docstoc

I. INTRODUCTION

Document Sample
I. INTRODUCTION Powered By Docstoc
					EMERGENCY OPERATIONS PLAN                                                             August 2007
NETWORK


                                          FOREWORD

A critical element of the Network organization is an effective emergency management program
that addresses the emergency missions of the Department of Veterans Affairs. The VA
Southwest Health Care Network – VISN 18 must be prepared to respond to disasters that may
strike one of our member facilities or a neighboring network, as well as a VA/DoD contingency
system activation in time of war. As a partner in the National Response Plan, the Department of
Veterans Affairs (VA), and therefore the Network, may be called upon to provide resources as
part of a national response and/or recovery effort in the aftermath of a catastrophic disaster.

This updated Emergency Operations Plan (EOP) outlines the policies and procedures that the
Network will follow in the event of an emergency. It provides standards that facilities should
follow in their local planning efforts. The Plan is based on the proven concepts of the National
Incident Management System (NIMS), all-hazard-based planning, Comprehensive Emergency
Management and the Incident Command System.

The Network could be faced with a natural or man-made disaster affecting lives and property at
any time. We are committed to be prepared for that eventuality through effective planning and
training. With the added commitment of each facility within the Network, we can be assured that
when the time comes, we will be ready.




/S/
Patricia A. McKlem                   Date: _09-25-07_____________________
Network Director




                                                         Severe – Red

                                                         High – Orange

                                                         Elevated – Yellow

                                                         Guarded – Blue

                                                         Low – Green



                                                i
EMERGENCY OPERATIONS PLAN                                                      August 2007
NETWORK


                               PLAN DISTRIBUTION LIST

1.    Network Director
2.    Deputy Network Director
3.    Director, New Mexico VA Health Care System, Albuquerque
4.    Director, Amarillo VA Health Care System. Amarillo
5.    Director, West Texas VA Health Care System, Big Spring
6.    Director, El Paso VA Health Care System
7.    Director, Carl T. Hayden VA Medical Center, Phoenix
8.    Director, Northern Arizona VA Health Care System, Prescott
9.    Director, Southern Arizona VA Health Care System, Tucson
10.   Each Facility Emergency Management Coordinator
11.   Chief Consultant, Emergency Management Strategic Healthcare Group, Martinsburg, WV
12.   Western District Manager, Emergency Management Strategic Healthcare Group,
      Martinsburg, WV




                                             ii
EMERGENCY OPERATIONS PLAN                                                  August 2007
NETWORK



                                 TABLE OF CONTENTS

                                                                           Page
Foreword                                                                      i
Plan Distribution                                                             ii
Table of Contents                                                             1
Introduction
    Policy                                                                     2
    Scope                                                                      2
    Philosophy                                                                 2
    Emergency Operations Plan Design                                           3
    Plan Review                                                                3
Basic Plan
    Responsibilities                                                           3
    Concept of Operations
       General Concepts                                                        5
       Implementation                                                          5
       Continuity of Operations                                                6
       Support to National Programs                                            7
    Training, Education and Exercises                                          8
Annexes
    Network Emergency (Annex A)                                                A-1
    Network Emergency Operations Center (Annex B)                              B-1
    Network Alternate Emergency Operations Center (Annex C)                    C-1
    Network EOC Job Action Sheets (Annex D)                                    D-1
    Incident Report (Annex E)                                                  E-1
    Operating Status Capability Assessment Report (OSCAR) (Annex F)            F-1
    Situation Report (SITREP), Incident Action Plan & Issue Brief Format
    (Annex G)                                                                  G-1
    After Action Report (AAR) (Annex H)                                        H-1
    Emergency Contacts & Communications (Annex I)                              I-1
    Hazards Vulnerability Analysis (Annex J)                                         J-1
    Facility Emergency (Annex K)                                               K-1
    VA/DoD Contingency Operations (Annex L)                                    L-1
    National Response Plan Activation (NRP) (Annex M)                          M-1
    National Disaster Medical System Activation (NDMS) (Annex N)               N-1
    Emergency Management Program Assessment (Annex O)                          O-1
    Cascade Alert Plan (Annex P)                                               P-1
    NDMS & VA/DoD Contingency Bed Report (Annex Q)                                   Q-1
    Disaster Emergency Medical Personnel System (DEMPS) (Annex R)              R-1
    Network Continuity Of Operations Plan (COOP) (Annex S)                     S-1
    Large Scale Evacuation of VAMCs by Commercial Contract (Annex T)           T-1




                                             1
EMERGENCY OPERATIONS PLAN                                                       August 2007
NETWORK




INTRODUCTION

A. Policy – The VA Southwest Health Care Network – VISN 18 will maintain a comprehensive
emergency management program that ensures an effective response to a wide range of
emergencies affecting individual facilities, the Network or the nation. The program is
documented in this Network Emergency Operations Plan. This Emergency Operations Plan and
all Network facility emergency plans will incorporate the principles and policies of the National
Incident Command System (NIMS), Comprehensive Emergency Management Program (CEMP)
and the Incident Command System (CIS).

B. Scope - The elements of the VISN program will pertain to all medical centers, outpatient
clinics and community-based clinics within the Network and will be characterized by close
coordination among the VISN office and member facilities. The program will address all the
Department of Veterans Affairs (VA) emergency missions:

      Network-level emergencies
      facility-level and community emergencies
      activation of the VA/Department of Defense contingency system in wartime
      activation of the National Response Plan (NRP)
      activation of the National Disaster Medical System (NDMS).

C. Philosophy - The Network’s emergency management program is based on the concepts of
Comprehensive Emergency Management (CEM) which recognizes that emergency management
is divided into four phases: mitigation, preparedness, response, and recovery.

   Mitigation can occur both during recovery from a past emergency and during preparedness
   for a potential one. It involves taking anticipatory actions in light of the hazards vulnerability
   analysis that attempt to prevent the occurrence of an emergency or lessen its impact.

   Preparedness is undertaken before an emergency occurs to build emergency management
   capacity. It focuses on the development of emergency operations plans, systems and training.

   Response takes place immediately before, during and directly after an emergency occurs.
   The purpose of response is to minimize injury and property damage through emergency
   functions such as warning, evacuation, search and rescue, and provision of shelter and
   medical services.

   Recovery begins immediately following an emergency with efforts to restore minimum
   services to the stricken facility or community with longer-term efforts to return the facility
   and/or community to normal.

Facilities should not concentrate only on preparedness and response but should actively seek
opportunities for mitigation and should critically evaluate their ability to recover from a
catastrophic event.

                                                 2
EMERGENCY OPERATIONS PLAN                                                       August 2007
NETWORK


Each Network facility is required to adopt principles and practices of the National Incident
Management System (NIMS). Since the Hospital Incident Command System (HICS) is
considered NIMS compliant, the Network facilities may choose to also adopt HICS. NIMS and
HICS are widely accepted incident management systems that provide a solid framework on
which to build a well-organized response to an emergency.

Facilities are encouraged to take an all-hazards approach to local planning. An all-hazards plan
is very flexible and allows a facility to respond to a wide variety of emergencies.

Network emergency planning will also be based on an analysis of the hazards most likely to
threaten member facilities with planning designed to address those hazards. Each Health Care
System within the Southwest Health Care Network will maintain a Hazards Vulnerability
Assessment (HVA).

D. Emergency Operations Plan Design - This Emergency Operations Plan (EOP) is designed
to provide guidance for all facilities within the Network. It contains a Basic Plan in which
general responsibilities are outlined, a concept of operations is described and training, education
and exercise requirements are specified. It also contains annexes that address more specific
issues.

E. Plan Review - The Plan is a dynamic document that will be reviewed annually by the
Emergency Management Subcommittee (EMSC) and the Area Emergency Managers (AEMs)
and updated, as necessary.

II. BASIC PLAN

A. Responsibilities

Network Director

       The Network Director is responsible for the development, coordination, implementation,
maintenance and evaluation of a Network Office Emergency Operations Plan and to ensure this
program adequately supports other Network EOP's. The Network Director will assure that a
Comprehensive Emergency Management (CEM) program and the National Incident Management
System (NIMS) is implemented and maintained at all facilities within the Network and that
responsibilities are delegated to the appropriate officials.

Network Emergency Program Coordinator

        The Network Emergency Program Coordinator (VISN EPC) is a generic term referring to
the individual responsible for ensuring that the Network Office’s Emergency Management
Program is fully operational. The Network Emergency Program Coordinator is Tommy Ragan,
Capital Assets Manager.

     In a national emergency the Emergency Management Strategic Healthcare Group
(EMSHG) in Martinsburg, WV, the VA’s primary emergency program coordinating office, may
                                                 3
EMERGENCY OPERATIONS PLAN                                                     August 2007
NETWORK


contact the Network to request resources during activation of the National Response Plan. The
Network Office will coordinate all such requests with the respective facilities and EMSHG.

Area Emergency Manager

        The Area Emergency Managers (AEM), located at the Tucson and Albuquerque VA
medical centers serve as consultants to both the Network Director and Medical Center Directors
for the purpose of developing EOP’s. The Tucson AEM is the liaison AEM for the VISN and is
the primary point of contact for the Phoenix, Prescott and Tucson facilities on emergency
management. The Albuquerque AEM is the point of contact for the Albuquerque, Amarillo, Big
Spring and El Paso facilities. The AEMs are delegated the responsibility for the routine
oversight and maintenance of the program. The AEMs are also responsible for assisting all
Network facilities with local program development, staff training and exercise planning and
evaluation. The VISN Liaison AEM will also serve as the Network’s Emergency Management
Subcommittee’s chairperson.

Facility Directors

         Facility Directors will assure that their local emergency management programs reflect the
CEM and NIMS concepts, address all VA emergency missions and meet JCAHO Environment
of Care standards. They will also appoint an Emergency Management Coordinator (EMC) who
will be the primary contact person at each facility for emergency management issues. Each
facility’s EMC will serve on the Emergency Management Subcommittee.

Emergency Management Subcommittee

       The Emergency Management Subcommittee will assist the Network Director and the
VISN staff with the implementation, maintenance, and evaluation of the program. The
Emergency Management Subcommittee plans and sponsors appropriate training and conducts
annual exercises to evaluate the Network’s plan. The Emergency Management Subcommittee
membership includes the AEMs and each facility’s Emergency Management Coordinator (EMC).
The Emergency Management Subcommittee reports to the Network Health Care Environment
Committee. The Network’s Executive Support staff and the designated Health Care
Environment Committee champion will serve as Ex-officio members of the Emergency
Management Subcommittee.

The functions of the VISN EM Subcommittee include:

   Develop planning initiatives to address the emergency management plans,

   Plan and conduct Network exercises,

   Coordinate VA Central Office required emergency management programs, reports, surveys
    and bed reports


                                                4
EMERGENCY OPERATIONS PLAN                                                       August 2007
NETWORK



   Provide assistance and guidance in implementing the Disaster Emergency Medical Personnel
    System (DEMPS) throughout all Network facilities.

B. Concept of Operations

    1. General Concepts

        If a warning or notification is received that a situation threatens to disrupt continuity of
patient care operations, and/or poses a risk to patients, visitors and staff, the VISN Director and
Key Operations Managers will take appropriate action(s) to protect patients, visitors, employees,
resources and property based upon the threat information received and validated.

        Emergency contact with the Network will be initiated by telephone and followed by e-
mail messages or other means of communication as directed by the Network. E-mail messages
will be sent to the VHA V18 Emergency Team distribution group found in Outlook Global
Address Directory. Acronyms will not be used until after they have been spelled out in the text
of emergency messages. This especially applies to bed categories and/or patients’ diagnosis.
Detailed information will be provided to the Network so the staff will be able to better meet the
patients’ transportation and/or medical treatment needs.

        During the period immediately following the occurrence of an emergency situation which
affects the VISN Office, the surrounding community or another Network Division; the VISN
Director and /or staff will take the necessary action(s) to assess, organize, mobilize, and deploy
the organization necessary to manage the response and recovery activities.

       The Network Order of Succession is:

       Network Director
       Deputy Network Director
       Chief Medical Officer (CMO)
       Chief Fiscal Officer (CFO)
       Chief Logistics Officer (CLO)

C. Implementation

     An incident that threatens the safety and welfare of VISN office staff, such as a fire, bomb
threat or a shooting, the individual “in charge” may initially be any staff person on duty who first
recognizes the danger and assumes responsibility to manage the situation. This person remains
in charge until “command” is transferred to the appropriate responding VA or community public
safety agency. The Network’s NIMS and ICS assignments are:

         NIMS/ICS ASSIGNMENTS
             HICS/ICS TITLE                            JOB TITLE

AGENCY EXECUTIVE                            Network Director


                                                  5
EMERGENCY OPERATIONS PLAN                                                    August 2007
NETWORK


COMMAND STAFF
  INCIDENT MGMT TEAM COMMANDER            Chief Medical Officer
  SAFETY OFFICER                          VISN 18 IH/Safety
  PUBLIC INFORMATION OFFICER              Staff Assistant/Network Director
  LIAISON OFFICER                         Capital Asset Manager

GENERAL STAFF
  OPERATIONS SECTION CHIEF                Acting Deputy Network Director
  PLANS SECTION CHIEF                     Health System Specialist
  LOGISTICS SECTION CHIEF                 Chief Logistics Officer
  FINANCE/ADMIN SECTION CHIEF             Chief Financial Officer

    The Network Emergency Operations Center (NEOC) may establish all or a part of the five
essential functions mentioned in Annex S, page S-3. See Annexes:

       Annex A defines a Network emergency and outlines actions to be taken.

       Annex B describes the actions to be taken to activate and manage the Network
       Emergency Operations Center (NEOC) at the Network Office. It includes the NEOC
       activation checklist.

       Annex C outlines the procedures for establishing an alternate NEOC at the Carl T.
       Hayden VA Medical Center in Phoenix.

       Annex D contains the incident command Job Action Sheets (JAS) for the positions that
       may be assigned at the NEOC during an emergency activation.

       Annex E provides VHA instructions and format for reporting an emergency incident.

       Annex F provides an operating status checklist and report.

       Annex G provides the format for the facility and VISN Situation Report (SITREP).

       Annex H provides the After Action Report (AAR) format.

       Annex I provides the Network emergency communications plan and covers the activation
       and operations of the amateur radio emergency support program. It also provides
       guidance on Emergency Communications within the Network.

       Annex J contains hazards analysis instructions for completing the Hazards Vulnerability
       Analysis. This information is to be used by each facility for emergency planning
       purposes.

       Annex K addresses the response to a facility level emergency. Each facility Director will
       determine the need to activate the local emergency operations plan based upon the


                                               6
EMERGENCY OPERATIONS PLAN                                                       August 2007
NETWORK


       situation and the impact on the facility and to what extent assistance may be required
       from the Network.

D. Continuity of Operations

     For longer-term incidents that affect, or may affect, continuity of the Network office
operation and/or service delivery to veterans (e.g., severe weather, earthquake, terrorist attack),
the Network Director or designee will assess the situation and may activate the Network
Emergency Operations Center (NEOC). If the Network Office must be evacuated the Network
will implement the Continuity of Operations Plan (COOP) located in Annex S of this plan.
COOP activation will necessitate the simultaneous activation of the Alternate NEOC at the
Phoenix VAMC. The following list of steps can be used:

          Gather and validate information through ongoing assessments.
          Brief EOC staff.
          Establish shifts.
          Set overall objectives and establish priorities.
          Determine resource requirements.
          Develop communications and traffic plans.
          Keep complete documentation.
          Issue press releases

E. Support to National Programs

    1. The VISN Office may become involved in supporting various national emergency
management programs, including the VA/DoD Contingency Hospital System and the National
Response Plan (NRP). Once activated, the VISN responds in support of these requirements in a
manner similar to that described in the annexes listed below. The response to an actual
emergency by the Network will be dictated by the nature and magnitude of the emergency. The
annexes to the plan are designed to provide specific information on emergency planning and
response activities. The following paragraphs briefly describe each of the annexes.

       Annex L covers the response to a VA/DoD contingency plan activation during wartime.
       Facilities in Albuquerque, Phoenix and Tucson are designated Primary Receiving Centers
       and could actually receive wartime casualties from DoD. Amarillo, Big Spring and
       Prescott are designated Secondary Support Centers to support the primary facilities.
       VA/DoD plan activation will be a national event, which could have a significant impact
       on the Network.

       Annex M outlines the Network’s response to the National Response Plan activation due
       to a national catastrophic emergency. An emergency in a neighboring VISN might
       require the assistance from the Network and its member facilities. If that occurs, all
       communication with the affected VISN will be handled by the Network Office, which
       will coordinate resource requests with facility Directors. Network AEMs may be made
       available for deployment to the affected Network at the Network Director’s request.

                                                  7
EMERGENCY OPERATIONS PLAN                                                    August 2007
NETWORK



       Annex N describes the response to an activation of the National Disaster Medical
       System.

       Annex O provides an emergency management program assessment tool for facility
       management, emergency management coordinators and the Area Emergency Manager to
       use in assessing each facility’s emergency management program.

       Annex P is the Network emergency call-down chart.

       Annex Q provides emergency contact information and instructions for the Albuquerque
       National Disaster Medical System (NDMS) Federal Coordinating Center (FCC) and
       VA/DoD Patient Reception Center (PRC), Tucson FCC and PRC and the Phoenix PRC.

       Annex R describes the Network’s implementation of the Disaster Emergency Medical
       Personnel System (DEMPS).

       Annex S describes the implementation and activation of the Network’s COOP.

       Annex T describes the process for obtaining commercial aircraft to evacuate veteran
       patients to other cities.

       Annex U provides the Hospital Incident Command System (HICS) forms to be used
       during a disaster or emergency response.

    2. Reporting Requirements: Emergency reporting requirements are delineated in each
       Annex, as appropriate. VHA requires Incident and Situation reports as indicated in
       Annexes E, F and G. The VA medical centers are required to report to the Network who
       is then required to report the VHA Central Office (the VHA Joint Operations Center).

    3. Emergency Financial Management: Since much of the costs associated with the response
       to an emergency are normally reimbursed, the Network Office and all VISN facilities will
       assure that accurate documentation is maintained on related expenditures.

F. DEMPS

The Disaster Emergency Medical Personnel System (DEMPS) was established under the
authority of VHA Directive 97-046, dated October 7, 1997. DEMPS was developed to
streamline the process of identifying and training VA medical facility personnel willing to
volunteer for emergency/disaster response deployment. Personnel may be asked to provide
assistance within their own VISN or they may be asked to deploy to support another VISN. In
addition, should a major disaster occur with activation of the National Response Plan, staff may
be asked to deploy nationally. Each VISN, through their associated emergency management
programs, have responsibility for establishing, recruiting, validating, and maintaining a Network
DEMPS volunteer database and training program. (See Annex R)


                                               8
EMERGENCY OPERATIONS PLAN                                                    August 2007
NETWORK



G. Training, Education and Exercises

A critical element of an effective emergency management program is providing pertinent training
and education to staff members. While facility-level education and training should be an
ongoing part of the local program, the Emergency Management Subcommittee has been charged
with looking at these needs from a Network perspective. Additionally, a major part of the Area
Emergency Managers’ responsibilities is to be available to assist the local facilities with
education and training needs.

The Emergency Management Subcommittee will conduct at least one Emergency Operations
Center (EOC) exercise each year that will involve the Network Office and at least one of the
Network facilities to evaluate the effectiveness of the Network program. Additionally,
semiannual exercises of the NEOC will be conducted in accordance with department policy.

H. REFERENCES:

JCAHO 2006 Environment of Care Standards
National Fire Protection Agency (NFPA)
Federal Preparedness Circular 65, Federal Executive Branch Continuity of Operations (COOP)
VA Emergency Management Program Guidebook
VHA Directive 2003-052, dated September 23, 2003
Network Policy #27, dated March 7, 2001




                                               9
EMERGENCY OPERATIONS PLAN                                                      August 2007
NETWORK                                                                           Annex A

                                    NETWORK EMERGENCY

1. Definition - An emergency occurring at a Network facility that is of sufficient magnitude that
facility management will require support from the Network to respond and/or recover.

2. Policy - The Network Office will coordinate VA assistance requested by a Network facility
experiencing an emergency beyond their ability to effectively respond.

3.   Facility Actions:

     _____     Contact the Network Office as soon as feasible to inform them of the situation.

     _____     As soon as a determination is made by local management that support will be needed
               from the Network, complete the attached Operating Status Report (Annex E, F & G)
               and fax, telephone or e-mail to the Network Office.

     _____     Maintain routine contact with the Network Office during the course of the emergency.

     _____     Submit follow-up Operational Status Reports as directed by Network Office.

     _____     Submit an after-action report to the Network Office within 14 days after the
               conclusion of the emergency.

4.   Network Actions:

     _____     Receive call from VA facility concerning the existence of an emergency.

     _____     Activate Network Emergency Operations Center (NEOC), if necessary.

     _____     Assess need to deploy Area Managers to the site of the emergency and/or to the NEOC

     _____     When request for support from facility is received, activate the Network cascade call
               plan to inform VISN facilities of the emergency.

     _____     Inform Deputy Under Secretary for Health for Operations & Management (DUSH
               O&M) of the existence of an emergency.

     _____     Coordinate the provision of needed resources to the affected facility.

     _____     Provide situation reports to DUSH O&M during course of the emergency.

     _____     Coordinate the after-action report at the conclusion of the emergency.




                                                  A-1
EMERGENCY OPERATIONS PLAN                                                            August 2007
NETWORK                                                                                 Annex B

                 NETWORK EMERGENCY OPERATIONS CENTER (NEOC)

1. Policy: The Network Director may activate the Network EOC to provide a coordinating center in
any emergency situation that involves a Network facility.

2. NEOC Organization: Once activated the NEOC will handle all emergency activity until the
Network Director deactivates it. It will be physically located within the Network Office and will have
necessary communications available to include telephone, fax and computer capability. The Network
Director may deploy an Area Emergency Manager (AEM) to the NEOC to provide professional
support. An Incident Command System (ICS) will be used to manage NEOC operations.

3. Network Actions:
   _____ Determine if an NEOC activation is appropriate based on the extent of the
           emergency.

   _____     If appropriate, activate NEOC and Incident Command System.

   _____     Notify VISN facilities of the NEOC activation via the cascade call plan and provide
             necessary instructions to facility Directors.

   _____     Notify Deputy Under Secretary for Health for Operations & Management (DUSH O&M)
             of NEOC activation.

   _____     Assess need to deploy an AEM to the NEOC.

   _____     Assign a Network facility Public Affairs Officer to the NEOC to coordinate information
             flow between the facility Director, the media and the VA Office of Public Affairs.

   _____ Manage all Network response activities through the NEOC for the duration of the
         emergency.

   _____ Deactivate the NEOC when the emergency is over and make appropriate notifications to
          VISN facilities and Deputy Under Secretary for Health for Operations and Management.

4. Facility Actions:
   _____ Receive notification from the Network that the NEOC has been activated.

   _____     Receive instructions from the Network on facility/NEOC coordination and
             communications.

   _____     Work through the NEOC on all response activities for the duration of the
             emergency.

   _____     Receive notification from the NEOC when it has been deactivated.




                                                  B-1
EMERGENCY OPERATIONS PLAN                                                            August 2007
NETWORK                                                                                 Annex C

                 ALTERNATE NETWORK EMERGENCY OPERATIONS CENTER

POLICY: If the Network Emergency Operations Center (NEOC) cannot be used, an alternate NEOC
will be established at the Carl T. Hayden VA Medical Center (CTHVAMC). The alternate NEOC will
be located in the Nursing Home Care Unit, Room K112, phone: (602) 277-5551, x7515; Fax: (602)
277-5551, x6559.

PROCEDURE: When the decision is made to relocate the NEOC to the CTHVAMC, the Network
staff in charge will perform or assign the following actions:

       a.     Contact the Carl T. Hayden VA Medical Center’s management, AOD or VA Police Officer
              on duty to let them know that the alternate NEOC will be established and to request that
              arrangements be made to have the room opened. Picture ID will be required to open or enter
              the NEOC.

              If possible, the Network Director, Deputy Network Director or Chief Medical Officer will
              confirm the need to open the alternate EOC. If necessary, any Network staff may open the
              NEOC. The first Network staff to arrive will be the Incident Commander until relieved by a
              higher Network authority.

       b.      Notify all of the Network staff of the relocation of the NEOC to the Carl T. Hayden VA
               Medical Center.

       c.      Notify the DUSH O&M’s office of the relocation of the NEOC and provide them the phone
               and fax numbers at the alternate NEOC.

       d.      Notify the Network facility Directors of the relocation of the NEOC and provide them the
               phone and fax numbers for the alternate NEOC.

EQUIPMENT: The CTHVAMC or the Network will furnish the following equipment and outlets:

     a.     Telephone outlets (3)
     b.     Fax outlet (1) & a fax machine from Maureen Dicker’s office
     c.     Computer data lines (2)
     d.     White boards
     e.     Cable television outlet
     f.     Emergency Power
     g.     Copy of the Network Emergency Operations Plan
     h.     Copies of the Job Action Sheets (JAS)
     i.     HEICS Vests

The CTHVAMC management will appoint a staff member to serve as the liaison between the Network
and VAMC staff. The Network staff will coordinate requests for additional supplies and equipment
through the facility point of contact.



                                                    C-1
EMERGENCY OPERATIONS PLAN                                                    August 2007
NETWORK                                                                         Annex C



The Network staff stationed at the Carl T. Hayden VA Medical Center are:

     Rick Jackson, VISN 18 Industrial Hygienist and Safety Coordinator
     Arnold Pfenninger, VISN 18, Imaging Coordinator

TRAINING/EXERCISES: The Network staff will conduct at least one exercise every two years in the
designated Alternate EOC.




                                                 C-2
EMERGENCY OPERATIONS PLAN                                               August 2007
NETWORK                                                                    Annex D



                             NETWORK EOC Job Action Sheets (JAS)



Incident Management Team Commander                             D-2

Mobilization Checklist                                                D-4

Establishing the VISN Emergency Operations Center              D-6

Public Information Officer                                     D-8

Logistics Section Chief                                        D-10

Planning Section Chief                                         D-13

Finance Section Chief                                          D-16

Operations Section Chief                                       D-19

       Medical Care Branch Director                            D-22
       Business Continuity Branch Director                     D-25
       Infrastructure Branch Director                          D-28
       Security Branch Director                                D-31

Incident Action Planning Checklist                             D-34

Telecommunications Unit Officer                                D-35




                                              D-1
EMERGENCY OPERATIONS PLAN                                                            August 2007
NETWORK                                                                                 Annex D

                              Incident Management Team Commander

EOC Commander Job Action Sheet

Mission:       Organize and direct activities in the VISN Emergency Operations Center (EOC). This
individual represents, but may or may not be, the Agency Administrator (an ICS term for the person-in-
charge).

       The checklist of activities presented below should be considered as a minimum requirement for
the position. Users of this Job Action Sheet are encouraged to augment this list as necessary. Note that
some activities are one-time actions while others are ongoing or repetitive for the duration of the
incident.

Timeframe             Tasks

Immediate      ___    Receive a briefing from first responder personnel, assess
                      overall incident situation.

               ___    Activate elements of the Incident Command System (ICS) through the
                      notifications system, as required to meet the needs of the situation.

               ___    Put on position identification vest and ID badge.

               ___    Brief the EOC Director’s Staff (see below) and distribute Job Action Sheets.

               ___    Convene an Incident Action Planning meeting with the EOC Director’s staff
                      (Public Affairs, Liaison, Safety, Legal, Planning, Logistics, Finance and
                      Operations) plus the Transportation Unit Officer and Telecommunication Unit
                      Officer; provide incident policy, objectives and general strategy.

               ___    Approve and authorize implementation of written Incident Action Plan (IAP).

               ___    Determine information needs and inform EOC staff of these needs.

               ___    Ensure that Divisions have made the appropriate regulatory notifications (e.g., to
                      the Local Emergency Planning Committee (LEPC), State Emergency Response
                      Commission (SERC), State and Federal Environmental Protection Agency (EPA),
                      National Response Center if the incident involves a spill or release of oil or
                      hazardous materials or nuclear, biological or chemical warfare agents).

Ongoing        ___    Coordinate staff activity.

               ___    Manage incident operations.

               ___    Ensure safety and health of all personnel.

               ___    Approve requests for additional resources and requests for release of resources.
                                                    D-2
EMERGENCY OPERATIONS PLAN                                                       August 2007
NETWORK                                                                            Annex D



           ___   Authorize the release of information to the public.

           ___   Ensure Incident Status Summary is completed on a regular basis.

           ___   Ensure planning meetings are conducted on a regular basis, as needed.

           ___   Communicate status to VHA EOC, as appropriate.

           ___   Consult with Section Chiefs on needs for staff/responder food and relief.
                 Consider same for dependents. Authorize plan of action.

           ___   Determine appropriate level of service during immediate aftermath; confer with
                 Section Coordinators on the development of operational objectives and strategy
                 for the recovery period.

           ___   Observe and assist operations staff who exhibit signs of stress. Refer them to the
                 Safety Officer, as required.

           ___   Approve requests for the release of resources and supplies.

           ___   Keep a log of decisions.

           ___   Ensure records kept during the incident are compiled.

           ___   Convene an incident critique within a two-week period for the review of incident
                 activities.

           ___   Convene an Emergency Operations Plan (EOP) review meeting to discuss
                 possible revisions to the hospital's Emergency Management Program.

                 Notes:




                                             D-3
EMERGENCY OPERATIONS PLAN                                                           August 2007
NETWORK                                                                                Annex D

                                           Mobilization Checklist

The purpose of this checklist is to guide the decision to activate the VISN Emergency Operations Plan
(EOP); thus, mobilizing the organization, as well as to structure the deactivation or demobilization
process.

 Situation Assessment: Based upon the information received, the VISN Duty Officer/person in
  charge will perform an assessment of the situation taking into consideration the following factors:
   What? (Incident Characteristics).
     Type of Primary Event (Direct Impact) – Use appropriate SOP in the Emergency Management
      Guidebook, Section 7.2.
     Magnitude.
     Expected Duration.
     Likely Secondary Events (Indirect Impacts).
   When? (Incident Timing).
     Warning Period? Length?
     Time of Day: Morning - Afternoon - Evening.
     Day of Week: Weekday - Weekend.
     Season of the Year.
     Weather Conditions: Past, Present and Future.
   Where is it now, and where is it going?
     Location and scope.
     What could be impacted?
     Patient Census/Occupancy
     Activities Affected
     Essential Resources
     Facilities
   What resources might be needed?


 Initial Response Actions: The VISN Duty Officer (e.g., initial EOC Director) will conduct an initial
  action planning meeting and continue throughout the duration of the event:
       Identify and establish emergency policies.
       Set initial shift or operational period.
       Establish objectives for that shift, considering:
                                                     D-4
EMERGENCY OPERATIONS PLAN                                                          August 2007
NETWORK                                                                               Annex D

        Attainable in Period.
        Measurable.
      Define immediate priorities.
    Level of EOP implementation?
        Notify Key Operations Managers
        Provide an incident briefing
        Situation
        Policies
        Objectives for shift
        Priorities for shift
        Conduct incident action planning meetings to set objectives, staffing and resource needs for
         each upcoming shift/operational period. (see Incident Action Planning Checklist).
        Activate/mobilize essential functions/key activities as needed.
 The Emergency Operations Center (EOC) should be established if the incident will last more than
  one shift. The following information is intended as guidance only:




                                                 D-5
EMERGENCY OPERATIONS PLAN                                                          August 2007
NETWORK                                                                               Annex D

                    Establishing the VISN Emergency Operations Center (EOC)

EOC Functions:
 Communications.
 Information collection, display and documentation.
 Action planning.
 Coordinated resource management.
 Development of public information.

Configuration of an EOC:
 Check-in.
 Message center.
 Operations coordination with displays.
 Administrative support (copier, files, etc.).
 Planning meetings

   Note: Media briefings should not be conducted near the EOC.

Equipment and Supplies:
 Communications (separate in/out lines for phones and Fax’s)
 E-mail, web access
 Cable TV
 Radio (AM/FM/Weather Alert)
 Ham radio (if available)
 Satellite Phones
 Information processing and display (e.g., video projectors, easels/flipcharts/dry erase boards)
 Adequate workspace for the group that will assemble, arranged in a manner to facilitate coordination
   (e.g., tables and chairs arranged in a “U” or hollow square)
 Office supplies
 HEICS Vests

Important Information Sources:
 Emergency Operations Plan(s) for the VA Medical Center, VISN and the Community.
 Key Personnel Resource Matrix/Call-down rosters.
 Resource lists and agreements with vendors.
 Maps/Blueprints.
 Phone books.
 Name tags.
 Flashlights.
 CNN/other local, regional and national radio and TV media outlets

Managing Time: Within each operational period, the following sequence should occur:
 Shift change meetings.
 Situation briefing.
 Incident action planning meeting (Please see separate SOP attached to Plans

                                                  D-6
EMERGENCY OPERATIONS PLAN                                                          August 2007
NETWORK                                                                               Annex D

       Section Coordinator Job Action Sheet).
   Assign resources.
   Track/coordinate progress.
   Provide situation updates, as necessary.

Managing Information: There are four types of messages:
 Inquiries seeking information.
 Advisories providing information.
 Requests asking for resources.
 Orders directing activities.

The Message Center receives, records and routes information to the appropriate functions/operating
groups.

What Should be Tracked/Displayed:
 Situation status.
 Resource status (assigned, available, out-of-service).
 Reporting times.
 Key decisions.

Common Mistakes:
 Lack of a viable EOP and/or EOC.
 No knowledge of community resources.
 Lack of leadership.
 Not establishing a control on information flow.
 Untrained staff.
 Key people leaving the EOC.
 Non-essential personnel at the EOC.




                                                  D-7
EMERGENCY OPERATIONS PLAN                                                            August 2007
NETWORK                                                                                 Annex D

                                      Public Information Officer

Public Information Officer (PIO) Job Action Sheet

You Report To:         ________________________ (Incident Mgt Team Commander)

Mission:       VISN spokesperson to the news media.

       The checklist of activities presented below should be considered as a minimum requirement for
the position. Users of this Job Action Sheet are encouraged to augment this list as necessary. Note that
some activities are one-time actions while others are ongoing or repetitive for the duration of the
incident.

Timeframe      Tasks

Immediate      ___     Receive initial briefing from the Incident Management Team Commander
                       (IMTC), including any policies on the release of information.

               ___     Read this entire sheet and review EOC organizational chart.

               ___     Put on position identification vest and ID badge.

               ___     Establish a Public Information Area away from Emergency Operation Center
                       (EOC) and tactical incident areas. Arrange for the necessary workspace, materials,
                       telephones, personal computers and staffing. Appoint a staff coordinator, as
                       needed.

               ___     Contact other at-scene agencies to coordinate released information, with
                       respective PIOs. Keep Liaison Officer informed of any significant actions or
                       information.

               ___     Obtain copy of the current Incident Status Summary from the Planning Section
                       Coordinator.

               ___     Prepare initial information summary / news release.
                       Establish a Documentation Area in the EOC. Arrange for the necessary
                       workspace, materials, equipment, and staffing.

               ___     Establish and organize an incident file system.

               ___     Establish a duplication service and respond to requests.

Ongoing        ___     Confer with the IMTC to gain approval of news releases.

               ___     Confer with the IMTC, Safety Officer or Police Representative on which physical
                       areas of the VISN office are restricted access to the news media.

                                                   D-8
EMERGENCY OPERATIONS PLAN                                                          August 2007
NETWORK                                                                               Annex D

           ___   Issue ongoing information summaries and news releases.

           ___   Conduct tours of the non-restricted areas of the incident for
                 on-site media. Ensure their personal safety and health.

           ___   Retain and file duplicate copies of official forms and reports.

           ___   Accept and file reports and forms submitted by EOC staff.

           ___   Provide incident documentation for the EOC Director’s Staff.

           ___   Maintain, retain and store incident files for later use.

           ___   Ensure the personal safety and health of all staff.

           ___   Provide for staff rest and relief.

           ___   Keep a log of actions.

                 Notes:




                                               D-9
EMERGENCY OPERATIONS PLAN                                                              August 2007
NETWORK                                                                                   Annex D

                                          Logistics Section Chief

Logistics Section Chief Job Action Sheet

You Report To: ___________________ (Incident Mgt Team Commander)

Mission:      Organize and direct all aspects of Planning Section. Lead the collection and analysis of
information and the development of Incident Action Plans.

               The checklist of activities presented below should be considered as a minimum
requirement for the position. Users of this Job Action Sheet are encouraged to augment this list as
necessary. Note that some activities are one-time actions while others are ongoing or repetitive for the
duration of the incident.

Timeframe       Tasks

Immediate ___      Receive an initial briefing from the Incident Management Team Commander.

                ___     Read this entire sheet and review the EOC organizational chart.

                ___     Put on position identification vest and ID badge.

                ___     Activate elements of the Planning Section, as required to meet the needs of the
                        incident (Situation Status Officer, Resource Status Officer, Documentation
                        Officer); distribute the Sheets and Vests; provide an initial briefing.

                ___     Establish the Resources and Situation Area(s) in the EOC. Arrange for the
                        necessary workspace, materials, telephones, personal computers and staffing.

                ___     Establish information requirements and reporting schedules for all Incident
                        Command System (ICS) supervisory positions for use in preparing the written
                        Incident Action Plan (IAP).

                ___     Activate elements of the Logistics Section, as required to meet the needs of the
                        Incident, distribute Sheets and Vests; provide an initial briefing.

                ___     Establish Logistics Area in the EOC. Arrange for the necessary workspace,
                        materials, telephones, personal computers and staffing.

                ___     Participate in the Incident Action Planning meetings, prepare the resource order as
                        directed by the Incident Manager.

                ___     Coordinate staff activity in support of Operations.

                ___     Establish a Situation Status (SITSTAT) Board in the EOC. Arrange for the
                        necessary workspace, materials, telephones, personal computers and staffing.

                                                    D-10
EMERGENCY OPERATIONS PLAN                                                         August 2007
NETWORK                                                                              Annex D

           ___   Brief and assign duties to SITSTAT personnel staffing the EOC: Collect all
                 incident-related data; post data on displays at scheduled intervals; provide
                 photographic services and maps; maintain current SITSTAT report on the
                 incident; provide SITSTAT information to specific requests.

           ___   Meet with and brief support staff.

           ___   Determine present inventory levels

           ___   Assess transportation resources (vehicles, drivers, fuel, patient carrying devices,
                 etc.) available immediately at the incident site.

           ___   Determine unmet transportation resource needs. Coordinate resource requests
                 from external agencies through the Liaison Officer.

           ___   Ensure the personal safety and health of all staff.

           ___   Provide for staff rest and relief.

           ___   Assign personnel to assemble gurneys, litters, wheelchairs and stretchers based
                 upon requirements of Operations Section Group.

Ongoing    ___   Assign staff to manage and advise on the following:
                 ____ Access to Services.
                 ____ Vital Records/records preservation.
                 ____ Business relocation.
                 ____ Other:

           ___   Coordinate with the Labor Pool & Credentialing Unit for support staff, as
                 required.

           ___   Assist the Operations Section Coordinator and Group Leaders with the assignment
                 of staff.

           ___   Observe and assist operations staff who exhibit signs of stress. Refer them to the
                 Safety Officer, as required.

           ___   Coordinate staff activity.

           ___   Provide for temporary incident facilities including the possibility of evacuation
                 and/or relocation of medical services outside of existing structure, as required.

           ___   Receive regular updates on the status of the physical facility from the Key
                 Operations Managers. Coordinate this information with the Logistics Branch
                 Coordinator

           ___   Maintain inventory of supplies and equipment. Prepare resource orders for review
                                               D-11
EMERGENCY OPERATIONS PLAN                                                        August 2007
NETWORK                                                                             Annex D

                 by the Logistics Section Chief and approval by the IMTC.

           ___   Arrange for servicing of re-usable equipment.

           ___   Supervise preparation of the Incident Action
                 Plan(s). (See Incident Action Planning Checklist.)

           ___   Assemble information on alternative strategies.

           ___   Provide periodic predictions on incident potential.

           ___   Compile and display incident status summary information.

           ___   Coordinate staff activities of resource and situation status, documentation,
                 provision of technical assistance, and distribution of incident information.

           ___   Keep a log of actions.

                 Notes:




                                             D-12
EMERGENCY OPERATIONS PLAN                                                                                  August 2007
NETWORK                                                                                                       Annex D



                                           PLANNING SECTION CHIEF

Mission:     Oversee all incident-related data gathering and analysis regarding incident operations and assigned
             resources, develop alternatives for tactical operations, conduct planning meetings, and prepare the
             Incident Action Plan (IAP) for each operational period.


Date: _________ Start: ________ End: ________ Position Assigned to: __________________ Initial: _______

Position Reports to: Incident Commander                 Signature: _________________________________________

Hospital Command Center (HCC) Location: _________________________ Telephone: _____________________

Fax: _____________________ Other Contact Info: __________________ Radio Title: _____________________

Immediate (Operational Period 0-2 Hours)                                                                        Time     Initial
Receive appointment and briefing from the Incident Commander. Obtain packet containing Planning
Section Job Action Sheets.
Read this entire Job Action Sheet and review incident management team chart (HICS Form 207). Put on
position identification.
Notify your usual supervisor of your HICS assignment.
Determine need for and appropriately appoint Unit Leaders, distribute corresponding Job Action Sheets
and position identification. Complete the Branch Assignment List (HICS Form 204).
Brief Planning Section Unit Leaders and Managers on current situation and incident objectives; develop
response strategy and tactics; outline Section action plan and designate time for next briefing.
Distribute the Section Personnel Time Sheet (HICS Form 252) to Planning Section personnel and ensure
time is recorded appropriately. Submit the Section Personnel Time Sheet to the Finance/Administration
Section’s Time Unit Leader at the completion of a shift or at the end of each operational period.
In consultation with the Incident Commander, establish the incident objectives and operational period.
Initiate the Incident Objectives Form (HICS Form 202) and distribute to all activated HCC positions.
Document all key activities, actions, and decisions in an Operational Log (HICS Form 214) on a continual
basis.
Establish and maintain communications with Logistics Section Chief and Staging Manager to ensure the
accurate tracking of personnel and resources by the Personal Tracking and Materiel Tracking Managers.
Facilitate and conduct incident action planning meetings with Command Staff, Section Chiefs and other key
positions to plan for the next operational period. Coordinate preparation and documentation of the Incident
Action Plan and distribute copies to the Incident Commander and all Section Chiefs.
Ensure the Situation Unit Leader and staff regularly update and document status reports from all Section
Chiefs and Unit Leaders.
Ensure Planning Section personnel comply with safety policies and procedures.
Document all communications (internal and external) on an Incident Message Form (HICS Form 213).
Provide a copy of the Incident Message Form to the Documentation Unit.

Intermediate (Operational Period 2-12 Hours)                                                                    Time     Initial
Meet regularly with the Incident Commander to brief on the status of the Planning Section and the Incident

                                                              D-13
EMERGENCY OPERATIONS PLAN                                                                                  August 2007
NETWORK                                                                                                       Annex D

Immediate (Operational Period 0-2 Hours)                                                                        Time     Initial
Action Plan.
Initiate the Resource Accounting Record (HICS Form 257) to track equipment used during the response.
Attend command briefings and meetings.
Continue to conduct regular planning meetings with Planning Section Unit Leaders, Section Chiefs,
Command Staff, and the Incident Commander for continued update and development of the Incident Action
Plan.
Ensure that the Planning Section is adequately staffed and supplied.

Extended (Operational Period Beyond 12 Hours)                                                                   Time     Initial
Continue to monitor Planning Section personnel’s ability to meet workload demands, staff health and
safety, resource needs, and documentation practices.
Conduct regular situation briefings with Planning Section.
Continue to receive projected activity reports from Section Chiefs and Planning Section Unit Leaders at
designated intervals to prepare HCC status reports and update the Incident Action Plan.
Continue to maintain the Resource Accounting Record (HICS Form 257) to track equipment used during the
response.
Ensure the Demobilization Unit Leader assesses ability to deactivate positions, as appropriate, in
collaboration with Section Chiefs and develops and implements a demobilization plan.
Ensure the Documentation Unit Leader is receiving and organizing all HCC documentation, including
Operational Logs (HICS Form 214) and Incident Message Forms (HICS Form 213).
Ensure your physical readiness through proper nutrition, water intake, rest, and stress management
techniques.
Observe all staff and volunteers for signs of stress and inappropriate behavior. Report concerns to the
Employee Health & Well-Being Unit. Provide for staff rest periods and relief.
Upon shift change, brief your replacement on the status of all ongoing operations, issues, and other relevant
incident information.

Demobilization/System Recovery                                                                                  Time     Initial
As needs decrease, return Planning Section staff to their usual jobs and combine or deactivate positions in a
phased manner.
Continue to meet with Command Staff, Section Chiefs and Planning Section Unit Leaders to evaluate
facility and personnel, review the demobilization plan and update the Incident Action Plan.
Ensure collection of all HCC documentation and Operational logs from Command and Sections as positions
are deactivated and sections demobilized.
Assist Section Chiefs in restoring hospital to normal operations.
Coordinate final reporting of patient information with external agencies through Liaison Officer and Public
Information Officer.
Work with Planning and Finance/Administration Sections to complete cost data information.
Begin development of the Incident After-Action Report and Improvement Plan and assign staff to
complete portions/sections of the report.
Debrief staff on lessons learned and procedural/equipment changes needed.

                                                               D-14
EMERGENCY OPERATIONS PLAN                                                                                 August 2007
NETWORK                                                                                                      Annex D

Immediate (Operational Period 0-2 Hours)                                                                        Time    Initial
Upon deactivation of your position, ensure all documentation and Operational Logs (HICS Form 214)
are submitted to the Documentation Unit.
Upon deactivation, brief the Incident Commander on current problems, outstanding issues, and follow-up
requirements.
Submit comments to the Incident Commander for discussion and possible inclusion in an after-action report;
topics include:
      Review of pertinent position descriptions and operational checklists
      Recommendations for procedure changes
      Section accomplishments and issues
Participate in stress management and after-action debriefings. Participate in other briefings and meetings as
required.

Documents/Tools
   Hospital Emergency Operations Plan
   Incident Action Plan
   HICS Form 202 – Incident Objectives Form
   HICS Form 204 – Branch Assignment List
   HICS Form 207 – Incident Management Team Chart
   HICS Form 213 – Incident Message Form
   HICS Form 214 – Operational Log
   HICS Form 257 – Resource Accounting Record
   HICS Form 254 – Disaster Victim/Patient Tracking Form
   HICS Form 252 – Section Personnel Time Sheet
   HICS Form 257 – Resource Accounting Record
   Hospital organization chart
   Hospital telephone directory
   Radio/satellite phone




                                                              D-15
EMERGENCY OPERATIONS PLAN                                                                              August 2007
NETWORK                                                                                                   Annex D

                                 FINANCE/ADMINISTRATION SECTION CHIEF

Mission:      Monitor the utilization of financial assets and the accounting for financial expenditures. Supervise the
              documentation of expenditures and cost reimbursement activities.


Date: _________ Start: ________ End: ________ Position Assigned to: __________________ Initial: _______

Position Reports to: Incident Commander                 Signature:                                            ____

Hospital Command Center (HCC) Location: _________________________ Telephone: _____________________

Fax: _____________________ Other Contact Info: __________________ Radio Title: _____________________

Immediate (Operational Period 0-2 Hours)                                                                     Time    Initial
Receive appointment and briefing from the Incident Commander. Obtain packet containing
Finance/Administration Section Job Action Sheets.
Notify your usual supervisor of your HICS assignment.
Read this entire Job Action Sheet and review incident management team chart (HICS Form 207). Put on
position identification.
Determine need for and appropriately appoint Finance/Administration Unit Leaders, distribute
corresponding Job Action Sheets and position identification. Complete the Branch Assignment List
(HICS Form 204).
Brief Finance/Administration Section Unit Leaders on current situation, incident objectives, and strategy;
outline Section action plan; and designate time for next briefing.
Participate in Incident Action Plan preparation, briefings, and meetings as needed and,
      Provide cost implications of incident objectives
      Ensure that the Incident Action Plan is within financial limits established by the Incident
          Commander
      Determine if any special contractual arrangements/agreements are needed.
Obtain information and updates regularly from Finance/Administration Section Unit Leaders; maintain
knowledge of current status of all Units; inform Situation Unit Leader of status information.
Distribute the Section Personnel Time Sheet (HICS Form 252) to Finance/Administration Section staff and
ensure time is recorded appropriately. Submit the Section Personnel Time Sheet to the
Finance/Administration Section’s Time Unit Leader at the completion of a shift or at the end of each
operational period.
Ensure Finance/Administration Section personnel comply with safety policies and procedures.
Document all key activities, actions, and decisions on an Operational Log (HICS Form 214) on a continual
basis.
Document all communications (internal and external) on an Incident Message Form (HICS Form 213).
Provide a copy of the Incident Message Form to the Documentation Unit.

Intermediate (Operational Period 2-12 Hours)                                                                 Time    Initial
Communicate frequently with the Incident Commander; brief routinely on the status of the
Finance/Administration Section.
Initiate the Resource Accounting Record (HICS Form 257) to track equipment used during the response.
Designate times for briefings and updates with Finance/Administration Section Unit Leaders to develop or

                                                              D-16
EMERGENCY OPERATIONS PLAN                                                                                  August 2007
NETWORK                                                                                                       Annex D

Immediate (Operational Period 0-2 Hours)                                                                        Time     Initial
update the Section action plan.
Approve a "cost-to-date" incident financial status report submitted by the Cost Unit Leader every eight hours
summarizing financial data relative to personnel, supplies and other expenditures and expenses.
Work with the Incident Commander and other Section Chiefs to identify short and long term issues with
financial implications; establish needed policies and procedures
Ensure that the Finance/Administration Section is adequately staffed and supplied.

Extended (Operational Period Beyond 12 Hours)                                                                   Time     Initial
Continue to monitor Finance/Administration Section staff’s ability to meet workload demands, staff health
and safety, resource needs, and documentation practices.
Conduct regular situation update briefings with Finance/Administration Section.
Continue to maintain the Resource Accounting Record (HICS Form 257) to track equipment used during the
response.
Schedule planning meetings with Finance/Administration Section staff to update the Section action plan and
demobilization procedures.
Ensure that required financial and administrative documentation Is properly prepared. Collate and process
invoices received.
Present financial updates to the Incident Commander and Command Staff every 8 hours and as requested.
Ensure that routine, non-incident related administrative oversight of hospital financial operations is
maintained.
Continue to document actions and decisions on an Operational Log (HICS Form 214).
Coordinate emergency procurement requests with Supply Unit Leader.
Maintain cash reserves on hand.
Ensure automated teller machines (ATMs) located in the hospital (whether hospital- or other-owned are
maintained and available to staff.
Consult with local, state, and federal officials regarding reimbursement regulations and requirements; ensure
required documentation is prepared according to guidance received.
Ensure your physical readiness through proper nutrition, water intake, rest, and stress management
techniques.
Observe all staff and volunteers for signs of stress and inappropriate behavior. Report concerns to the
Employee Health & Well-Being Unit. Provide for staff rest periods and relief.
Upon shift change, brief your replacement on the status of all ongoing operations, issues, and other relevant
incident information.

Demobilization/System Recovery                                                                                  Time     Initial
As needs in the Finance/Administration Section decrease, return staff to their usual jobs and combine or
deactivate positions in a phased manner.
Collect and analyze all financial related data from Finance/Administration Section Units.
Ensure processing and payment of invoiced costs.
Submit required reimbursement paperwork and track payments.


                                                                D-17
EMERGENCY OPERATIONS PLAN                                                                                 August 2007
NETWORK                                                                                                      Annex D

Immediate (Operational Period 0-2 Hours)                                                                        Time    Initial
Debrief staff on lessons learned and procedural/equipment changes needed.
Upon deactivation of your position, ensure all documentation and Operational Logs (HICS Form 214)
are submitted to the Planning Section Chief.
Upon deactivation of your position, brief the Incident Commander on current problems, outstanding
issues, and follow-up requirements.
Submit comments to the Incident Commander for discussion and possible inclusion in an after-action report;
topics include:
      Review of pertinent position descriptions and operational checklists
      Recommendations for procedure changes
      Section accomplishments and issues
Participate in stress management and after-action debriefings. Participate in other briefings and meetings as
required.

Documents/Tools
   Incident Action Plan
   HICS Form 204 – Branch Assignment List
   HICS Form 207 – Incident Management Team Chart
   HICS Form 213 – Incident Message Form
   HICS Form 214 – Operational Log
   HICS Form 252 – Section Personnel Time Sheet
   HICS Form 257 – Resource Accounting Record
   Hospital emergency operations plan
   Hospital organization chart
   Hospital telephone directory
   Radio/satellite phone
   Hospital inventory
   Hospital financial data forms
   State and DHS/FEMA reimbursement forms




                                                              D-18
EMERGENCY OPERATIONS PLAN                                                                                   August 2007
NETWORK                                                                                                        Annex D

                                            OPERATIONS SECTION CHIEF

Mission:      Develop and implement strategy and tactics to carry out the objectives established by the Incident
              Commander. Organize, assign, and supervise Staging, Medical Care, Infrastructure, Security,
              Hazardous Materials, and Business Continuity Branch resources.


Date: _________ Start: ________ End: ________ Position Assigned to: __________________ Initial: _______

Position Reports to: Incident Commander                  Signature: _________________________________________

Hospital Command Center (HCC) Location: _________________________ Telephone: _____________________

Fax: _____________________ Other Contact Info: __________________ Radio Title: _____________________


Immediate (Operational Period 0-2 Hours)                                                                         Time     Initial
Receive appointment and briefing from the Incident Commander. Obtain packet containing Operations
Section Job Action Sheets.
Read this entire Job Action Sheet and review incident management team chart (HICS Form 207). Put on
position identification.
Notify your usual supervisor of your HICS assignment.
Determine need to appoint Staging Manager, Branch Directors, and Unit Leaders in Operations Section;
distribute corresponding Job Action Sheets and position identification. Complete the Branch Assignment
List (HICS Form 204).
Brief Operations Section Branch Directors and Staging Manager on current situation and incident
objectives; develop response strategy and tactics; outline Section action plan and designate time for next
briefing.
Participate in Incident Action Plan preparation, briefings, and meetings as needed; assist in identifying
strategies; determine tactics, work assignments, and resource requirements.
Obtain information and updates regularly from Operations Section Branch Directors and Staging Manager;
maintain current status of all areas; inform Situation Unit Leader of status information.
Maintain communications with Logistics Section Chief and Staging Manager to ensure the accurate
movement and tracking of personnel and resources to Staging Area.
Ensure Operations Section personnel comply with safety policies and procedures.
Document all key activities, actions, and decisions in an Operational Log (HICS Form 214) on a continual
basis.
Document all communications (internal and external) on an Incident Message Form (HICS Form 213).
Provide a copy of the Incident Message Form to the Documentation Unit.

Intermediate (Operational Period 2-12 Hours)                                                                     Time     Initial
Communicate regularly with the Incident Commander, Public Information Officer and Liaison Officer; brief
regularly on the status of the Operations Section.
Designate time(s) for briefings and updates with Operations Section leadership to develop or update the
Section action plan.
Ensure the following are being addressed:
     Section Staff health and safety

                                                               D-19
EMERGENCY OPERATIONS PLAN                                                                                   August 2007
NETWORK                                                                                                        Annex D

Immediate (Operational Period 0-2 Hours)                                                                         Time     Initial

        Patient tracking
        Patient care
        Patient family support
        Interfacility transfers (into and from facility)
        Fatality management
        Information sharing with local EOC, public health, and law enforcement in coordination with the
         Liaison Officer
        Personnel and resource movement through Staging Area
        Documentation
Initiate the Resource Accounting Record (HICS Form 257) to track equipment used during the response.
Schedule planning meetings with Branch Directors and Staging Manager to update the Section action plan
and demobilization procedures.
Coordinate patient care treatment standards and case definitions with public health officials, as appropriate.
Ensure that the Operations Section is adequately staffed and supplied.
Coordinate personnel needs with Labor Pool & Credentialing Unit Leader, supply and equipment needs with
the Supply Unit Leader, projections and needs with the Planning Section, and financial matters with the
Finance/Administration Section.
Ensure coordination with any assisting or cooperating agency.

Extended (Operational Period Beyond 12 Hours)                                                                    Time     Initial
Continue to monitor Operations Section personnel’s ability to meet workload demands, staff health and
safety, resource needs and documentation practices.
Continue to maintain the Resource Accounting Record (HICS Form 257) to track equipment used during the
response.
Conduct regular situation briefings with Operations Section Branch Directors and Staging Manager.
Address issues related to ongoing patient care:
    Ongoing patient arrival
    Bed availability
    Patient transfers
    Patient tracking
    Staff health and safety
    Mental health for patients, families, staff, incident management personnel
    Fatality management
    Staffing
    Staff prophylaxis
    Medications
    Medical equipment and supplies
    Personnel and resource movement through Staging Area
    Linkages with the medical community, area hospitals, and other healthcare facilities
    Documentation
Ensure your physical readiness through proper nutrition, water intake, rest, and stress management
techniques.
Observe all staff and volunteers for signs of stress and inappropriate behavior. Report concerns to the
Employee Health & Well-Being Unit. Provide for staff rest periods and relief.
Upon shift change, brief your replacement on the status of all ongoing operations, issues, and other relevant

                                                                D-20
EMERGENCY OPERATIONS PLAN                                                                                 August 2007
NETWORK                                                                                                      Annex D

Immediate (Operational Period 0-2 Hours)                                                                        Time    Initial
incident information.

Demobilization/System Recovery                                                                                  Time    Initial
As needs decrease, return Operations Section staff to their usual jobs and combine or deactivate positions in
a phased manner, in coordination with the Demobilization Unit Leader.
Coordinate patient care restoration to normal services.
Coordinate final reporting of patient information with external agencies through Liaison Officer and Public
Information Officer.
Work with Planning and Finance/Administration Sections to complete cost data information.
Debrief staff on lessons learned and procedural/equipment changes needed.
Upon deactivation of your position, brief the Incident Commander on current problems, outstanding issues,
and follow-up requirements.
Upon deactivation of your position, ensure all documentation and Operational Logs (HICS Form 214) are
submitted to the Documentation Unit.
Submit comments to the Incident Commander for discussion and possible inclusion in an after-action report;
topics include:
      Review of pertinent position descriptions and operational checklists
      Recommendations for procedure changes
      Section accomplishments and issues
Participate in stress management and after-action debriefings. Participate in other briefings and meetings as
required.

Documents/Tools
   Incident Action Plan
   HICS Form 204 – Branch Assignment Sheet
   HICS Form 207 – Incident Management Team Chart
   HICS Form 213 – Incident Message Form
   HICS Form 214 – Operational Log
   HICS Form 257 – Resource Accounting Record
   Hospital emergency operations plan
   Hospital organization chart
   Hospital telephone directory
   Radio/satellite phone




                                                              D-21
EMERGENCY OPERATIONS PLAN                                                                                 August 2007
NETWORK                                                                                                      Annex D

                                     MEDICAL CARE BRANCH DIRECTOR

Mission:      Organize and manage the delivery of emergency, inpatient, outpatient, and casualty care, and clinical
             support services.


Date: _________ Start: ________ End: ________ Position Assigned to: __________________ Initial: _______

Position Reports to: Operations Section Chief            Signature: _______________________________________

Hospital Command Center (HCC) Location: _________________________ Telephone: _____________________

Fax: _____________________ Other Contact Info: __________________ Radio Title: _____________________

Immediate (Operational Period 0-2 Hours)                                                                       Time     Initial
Receive appointment and briefing from the Operations Section Chief. Obtain packet containing Medical
Care Branch Job Action Sheets.
Read this entire Job Action Sheet and review incident management team chart (HICS Form 207). Put on
position identification.
Notify your usual supervisor of your HICS assignment.
Determine need for and appropriately appoint Medical Care Branch Unit Leaders, distribute
corresponding Job Action Sheets and position identification. Complete the Branch Assignment List
(HICS Form 204).
Document all key activities, actions, and decisions in an Operational Log (HICS Form 214).
Collaborate with Medical/Technical Specialist(s) concerning medical care guidance.
Brief the Medical Care Branch Unit Leaders on current situation, incident objectives and strategy; outline
Branch action plan and designate time for next briefing.
Evaluate Medical Care Branch capacity to perform:
     Inpatient
     Outpatient
     Casualty Care
     Mental Health
     Clinical Support Services (lab, diagnostic radiology, pharmacy)
     Patient Registration
Ensure new patients are being rapidly assessed and moved to definitive care locations (i.e., admission,
surgery, discharge, transfer.)
Ensure pre-existing patients receive needed care and reassurance.
Assess problems and needs in Branch areas; coordinate resource management.
Ensure Branch personnel comply with safety policies and procedures.
Instruct all Unit Leaders to evaluate on-hand equipment, supply, and medication inventories and staff
needs in collaboration with Logistics Section Branches; report status to the Operations Section Chief.
Determine need for surge capacity plan implementation and/or modification of existing plan.
Coordinate with Inpatient and Casualty Care Unit Leaders to prioritize patient transfer needs.
Determine if communicable disease risk exists; implement appropriate response procedure(s).
Collaborate with the appropriate Medical/Technical Specialist, if activated.

                                                             D-22
EMERGENCY OPERATIONS PLAN                                                                                  August 2007
NETWORK                                                                                                       Annex D

Immediate (Operational Period 0-2 Hours)                                                                        Time     Initial
Regularly meet with the Operations Section Chief to discuss plan of action and staffing in all service
areas.
Document all communications (internal and external) on an Incident Message Form (HICS Form 213).
Provide a copy of the Incident Message Form to the Documentation Unit.

Intermediate (Operational Period 2-12 Hours)                                                                    Time     Initial
Continue to meet regularly with Operations Section Chief for status reports, and relay important
information to Branch staff.
Continue coordinating patient care, disposition of patients, and clinical services support.
Ensure patient transfer coordination and tracking is being done according to the Emergency Operations
Plan and hospital procedures.
Ensure patient records are being done correctly and collected.
Ensure patient care needs are being met and policy decisions to institute austere care (altered level of
care) practices are determined and communicated effectively.
Advise the Operations Section Chief immediately of any operational issue you are not able to correct or
resolve.
Assess environmental services (housekeeping) needs in all clinical care and clinical support areas;
contact the Infrastructure Branch Leader or Environmental Services Unit Leader, as appropriate, with
identified needs.
Review personnel protection practices; revise as needed.
Ensure patient safety issues are identified and addressed.
Report equipment and supply needs to Operations and Logistics Section Chiefs.
Continue to provide updated clinical information and situation reports to Unit Leaders and staff.
Ensure patient data is collected and shared with appropriate internal and external officials, in
collaboration with the Liaison Officer.
Ensure staff health and safety issues are being addressed; resolve with the Safety Officer and Employee
Health & Well-Being Unit, as appropriate.
Develop and submit a Branch action plan to the Operations Section Chief when requested.
Communicate with Clinical Support Services Unit Leader to ensure accurate routing of test results.

Extended (Operational Period Beyond 12 Hours)                                                                   Time     Initial
Continue to monitor Medical Care Branch’s ability to meet workload demands, staff health and safety,
resource needs, and documentation practices.
Continue to ensure patient transfer coordination and tracking; mitigate identified issues.
Rotate staff on a regular basis.
Continue to document actions and decisions on an Operational Log (HICS Form 214) and submit to the
Operations Section Chief at assigned intervals and as needed.
Continue to provide the Operations Section Chief with regular situation updates.
Provide Branch Unit Leaders with situation update information and revised patient care practice
standards.


                                                              D-23
EMERGENCY OPERATIONS PLAN                                                                                 August 2007
NETWORK                                                                                                      Annex D

Immediate (Operational Period 0-2 Hours)                                                                       Time     Initial
Ensure your physical readiness through proper nutrition, water intake, rest, and stress management
techniques.
Observe all staff and volunteers for signs of stress and inappropriate behavior. Report concerns to the
Employee Health & Well-Being Unit Leader. Provide for staff rest periods and relief.
Upon shift change, brief your replacement on the status of all ongoing operations, issues, and other
relevant incident information.

Demobilization/System Recovery                                                                                 Time     Initial
As needs for Medical Care Branch staff decrease, return staff to their usual jobs, and combine or
deactivate positions in a phased manner.
Assist Operations Section Chief and Unit Leaders with restoring patient care and clinical support areas to
normal operations. Notify the Operations Section Chief when restoration is complete.
Ensure return/retrieval of equipment and supplies and return all assigned incident command equipment.
Debrief staff on lessons learned and procedural/equipment changes needed.
Upon deactivation of your position, brief the Operations Section Chief on current problems, outstanding
issues, and follow-up requirements.
Upon deactivation of your position, ensure all documentation and Operational Logs (HICS Form 214)
are submitted to the Operations Section Chief.
Submit comments to the Operations Section Chief for discussion and possible inclusion in the after-
action report; topics include:
      Review of pertinent position descriptions and operational checklists
      Recommendations for procedure changes
      Section accomplishments and issues
Participate in stress management and after-action debriefings. Participate in other briefings and meetings
as required.

Documents/Tools
   Incident Action Plan
   HICS Form 204 – Branch Assignment List
   HICS Form 207 – Incident Management Team Chart
   HICS Form 213 – Incident Message Form
   HICS Form 214 – Operational Log
   Hospital emergency operations plan
   Hospital organization chart
   Hospital telephone directory
   Radio/satellite phone




                                                             D-24
EMERGENCY OPERATIONS PLAN                                                                                 August 2007
NETWORK                                                                                                      Annex D

                                BUSINESS CONTINUITY BRANCH DIRECTOR

Mission:     Ensure business functions are maintained, restored or augmented to meet designated Recovery Time
             Objectives (RTO) and provide limited interruptions to continuity of essential business operations.


Date: _________ Start: ________ End: ________ Position Assigned to: __________________ Initial: _______

Position Reports to: Operations Section Chief          Signature: _________________________________________

Hospital Command Center (HCC) Location: _________________________ Telephone: _____________________

Fax: _____________________ Other Contact Info: __________________ Radio Title: _____________________

Immediate (Operational Period 0-2 Hours)                                                                       Time     Initial
Receive appointment and briefing from the Operations Section Chief. Obtain packet containing Business
Continuity Branch Job Action Sheets.
Read this entire Job Action Sheet and review incident management team chart (HICS Form 207). Put on
position identification.
Notify your usual supervisor of your HICS assignment.
Document all key activities, actions, and decisions in an Operational Log (HICS Form 214) on a continual
basis.
Appoint Unit Leaders, as appropriate; distribute corresponding Job Action Sheets and identification.
Brief the Business Continuity Branch on current situation, incident objectives and strategy; outline
Branch action plan and designate time for next briefing.
Evaluate Business Continuity Branch capacity to:
     Perform department and facility business continuity plan activation
     Determine ability to meet RTO for all impacted business functions
     Ascertain continuity of business functions including assessment of impacted areas
     Acquire access to essential business records (e.g., patient medical records, purchasing contracts,
        etc.)
     Support needed movement or relocation to alternate business operation sites
Assess problems and needs in Branch area; coordinate resource management with Support Branch
Director, as appropriate.
Instruct Unit Leaders to evaluate business capabilities, recovery plan actions, and progress in meeting
RTOs; report status to the Operations Section Chief.
Participate in briefings and meetings as requested.
Regularly meet with the Operations Section Chief to discuss plan of action and staffing.
Receive, coordinate, and forward requests for IT and communications support to the Communications
Unit Leader and IT/IS Unit Leader.
Document all communications (internal and external) on an Incident Message Form (HICS Form 213).
Provide a copy of the Incident Message Form to the Documentation Unit.

Intermediate (Operational Period 2-12 Hours)                                                                   Time     Initial
Meet regularly with Operations Section Chief for status reports, and relay important information to
Branch staff.


                                                             D-25
EMERGENCY OPERATIONS PLAN                                                                                 August 2007
NETWORK                                                                                                      Annex D

Immediate (Operational Period 0-2 Hours)                                                                       Time     Initial
Continue coordinating the Business Continuity Branch’s ability to maintain or recover impacted business
functions.
Evaluate all activated business continuity plans and modify as necessary any predicted unmet RTOs.
Identify specific activities or resources needed to ensure timely resumption of business functions.
Coordinate with the Infrastructure Branch Director for access to critical power needs or building
assessments.
Coordinate with the Security Branch Director for building access and staff safety
Coordinate with the Service Branch Director or Communications Unit Leader and the IT/IS Unit Leader
to ensure shared strategies for business resumption.
Advise the Operations Section Chief immediately of any recovery issue you are not able to correct or
resolve.
Develop and submit a Branch action plan to the Operations Section Chief when requested.

Extended (Operational Period Beyond 12 Hours)                                                                  Time     Initial
Continue to monitor Business Continuity Branch’s ability to maintain or recover impacted business
functions
Ensure your physical readiness through proper nutrition, water intake, rest, and stress management
techniques.
Observe all staff and volunteers for signs of stress and inappropriate behavior. Report concerns to the
Employee Health & Well-Being. Provide for staff rest periods and relief.
Upon shift change, brief your replacement on the status of all ongoing operations, issues, and other
relevant incident information.

Demobilization/System Recovery                                                                                 Time     Initial
As needs for Business Continuity Branch staff decrease, return staff to their usual jobs, and combine or
deactivate positions in a phased manner.
Assist Operations Section Chief and Branch Directors with restoring all business functions to normal
operating condition. Notify the Operations Section Chief when restoration is complete.
Ensure return/retrieval of equipment and supplies and return all assigned incident command equipment.
Debrief staff on lessons learned and procedural/equipment changes needed.
Upon deactivation of your position, ensure all documentation and Operational Logs (HICS Form 214)
are submitted to the Operations Section Chief.
Upon deactivation of your position, brief the Operations Section Chief on current problems, outstanding
issues, and follow-up requirements.
Submit comments to the Operations Section Chief for discussion and possible inclusion in the after-
action report; topics include:
      Review of pertinent position descriptions and operational checklists
      Recommendations for procedure changes
      Section accomplishments and issues
Participate in stress management and after-action debriefings. Participate in other briefings and meetings
as required.

Documents/Tools
                                                             D-26
EMERGENCY OPERATIONS PLAN                                       August 2007
NETWORK                                                            Annex D

Immediate (Operational Period 0-2 Hours)                             Time     Initial

   Incident Action Plan
   HICS Form 204 – Branch Assignment Sheet
   HICS Form 207 – Incident Management Team Chart
   HICS Form 213 – Incident Message Form
   HICS Form 214 – Operational Log
   Hospital emergency operations plan
   Hospital organization chart
   Hospital telephone directory
   Radio/satellite phone
   Facility blueprints and maps
   PC with internet access, as available
   Business continuity plans with contact information




                                                         D-27
EMERGENCY OPERATIONS PLAN                                                                                August 2007
NETWORK                                                                                                     Annex D

                                    INFRASTRUCTURE BRANCH DIRECTOR

Mission:     Organize and manage the services required to sustain and repair the hospital’s infrastructure operations,
             including: power/lighting, water/sewer, HVAC, buildings and grounds, medical gases, medical devices,
             structural integrity, environmental services, and food services.


Date: _________ Start: ________ End: ________ Position Assigned to: __________________ Initial: _______

Position Reports to: Operations Section Chief              Signature: _______________________________________

Hospital Command Center (HCC) Location: _________________________ Telephone: _____________________

Fax: _____________________ Other Contact Info: __________________ Radio Title: _____________________

Immediate (Operational Period 0-2 Hours)                                                                       Time    Initial
Receive appointment and briefing from the Operations Section Chief. Obtain packet containing
Infrastructure Branch Job Action Sheets.
Read this entire Job Action Sheet and review incident management team chart (HICS Form 207). Put on
position identification.
Notify your usual supervisor of your HICS assignment.
Appoint Infrastructure Branch Unit Leaders and complete the Branch Assignment List (HICS Form 204).
Brief the Infrastructure Branch on current situation, incident objectives and strategy; outline Branch
action plan and designate time for next briefing.
Document all key activities, actions, and decisions in an Operational Log (HICS Form 214) on a continual
basis.
Assess Infrastructure Branch capacity to deliver needed:
     Facility heating and air conditioning
     Power
     Telecommunications
     Potable and non-potable water
     Medical gas delivery
     Sanitation
     Road clearance
     Damage assessment and repair
     Facility cleanliness
     Vertical transport
     Facility access
Assess problems and needs in Branch area; coordinate resource management.
Ensure Branch personnel comply with safety policies and procedures.
Instruct all Unit Leaders to evaluate on-hand equipment, supply, and medication inventories and staff
needs, in collaboration with Logistics Section’s Service and Support Branches or Units, as appropriate;
report status to the Operations Section Chief and the Support Branch or Supply Unit Leader, as
appropriate.
Meet regularly with the Operations Section Chief to discuss plan of action and staffing.
Initiate facility damage assessment in collaboration with Logistics Section’s Facilities Unit, if warranted;
repair problems encountered, and update the Operations Section Chief of the situation. Assist in
completion of the Facility System Status Report (HICS Form 251)
                                                              D-28
EMERGENCY OPERATIONS PLAN                                                                                 August 2007
NETWORK                                                                                                      Annex D

Immediate (Operational Period 0-2 Hours)                                                                       Time     Initial
Document all communications (internal and external) on an Incident Message Form (HICS Form 213).
Provide a copy of the Incident Message Form to the Documentation Unit.

Intermediate (Operational Period 2-12 Hours)                                                                   Time     Initial
Continue coordinating facility support services.
Ensure prioritization of problems when multiple issues are presented.
Ensure documentation records are completed correctly and collected.
Coordinate use of external resources to assist with maintenance and repairs.
Report equipment needs to the Supply Unit Leader.
Supervise salvage operations with the Operations Section Chief, if indicated.
Ensure staff health and safety issues are being addressed; resolve with Infrastructure Branch Director,
Safety Officer and Employee Health and Well-Being Unit Leader.
Develop and submit a Branch action plan to the Operations Section Chief when requested.
Advise the Operations Section Chief immediately of any operational issue you are not able to correct or
resolve.
Meet regularly with Operations Section Chief for status reports, and relay important information to
Branch staff.
Continue coordinating facility support services.
Ensure documentation and records are being completed correctly and collected.

Extended (Operational Period Beyond 12 Hours)                                                                  Time     Initial
Continue to monitor the Infrastructure Branch’s ability to meet workload demands, staff health and
safety, resource needs, and documentation practices.
Rotate staff on a regular basis.
Continue to document actions and decisions on an Operational Log (HICS Form 214) and send to the
Operations Section Chief at assigned intervals and as needed.
Continue to provide the Operations Section Chief with regular situation updates.
Ensure your physical readiness through proper nutrition, water intake, rest, and stress management
techniques.
Observe all staff and volunteers for signs of stress and inappropriate behavior. Report concerns to the
Employee Health & Well-Being Unit Leader. Provide for staff rest periods and relief.
Upon shift change, brief your replacement on the status of all ongoing operations, issues, and other
relevant incident information.

Demobilization/System Recovery                                                                                 Time     Initial
As needs for Infrastructure Branch staff decrease, return staff to their usual jobs, and combine or
deactivate positions in a phased manner.
Assist the Operations Section Chief and Branch Directors with restoring hospital infrastructure services
to normal operating condition.
Ensure return/retrieval of equipment and supplies and return all assigned incident command equipment.


                                                              D-29
EMERGENCY OPERATIONS PLAN                                                                              August 2007
NETWORK                                                                                                   Annex D

Immediate (Operational Period 0-2 Hours)                                                                     Time    Initial
Upon deactivation of your position, brief the Operations Section Chief on current problems, outstanding
issues, and follow-up requirements.
Upon deactivation of your position, ensure all documentation and Operational Logs (HICS Form 214)
are submitted to the Operations Section Chief.
Debrief staff on lessons learned and procedural/equipment changes needed
Submit comments to the Operations Section Chief for discussion and possible inclusion in the after-
action report; topics include:
      Review of pertinent position descriptions and operational checklists
      Recommendations for procedure changes
      Section accomplishments and issues
Participate in stress management and after-action debriefings. Participate in other briefings and meetings
as required.

Documents/Tools
   Incident Action Plan
   HICS Form 204 – Branch Assignment List
   HICS Form 207 – Incident Management Team Chart
   HICS Form 213 – Incident Message Form
   HICS Form 214 – Operational Log
   Hospital emergency operations plan
   Hospital organization chart
   Hospital telephone directory
   Radio/satellite phone
   Facility maps and ancillary services schematics
   Vendor support and repair directory




                                                            D-30
EMERGENCY OPERATIONS PLAN                                                                                 August 2007
NETWORK                                                                                                      Annex D

                                           SECURITY BRANCH DIRECTOR

Mission:      Coordinate all of the activities related to personnel and facility security such as access control, crowd
              and traffic control, and law enforcement interface.


Date: _________ Start: ________ End: ________ Position Assigned to: __________________ Initial: _______

Position Reports to: Operations Section Chief            Signature: _________________________________________

Hospital Command Center (HCC) Location: _________________________ Telephone: _____________________

Fax: _____________________ Other Contact Info: __________________ Radio Title: _____________________

Immediate (Operational Period 0-2 Hours)                                                                       Time     Initial
Receive appointment and briefing from the Operations Section Chief. Obtain packet containing Security
Branch Job Action Sheets.
Read this entire Job Action Sheet and review incident management team chart (HICS Form 207). Put on
position identification.
Notify your usual supervisor of your HICS assignment.
Document all key activities, actions, and decisions in an Operational Log (HICS Form 214) on a continual
basis.
Determine need for and appropriately appoint Security Branch Unit Leaders, distribute corresponding
Job Action Sheets and position identification. Complete the Branch Assignment List (HICS Form 204).
Establish Security Command Post.
Identify and secure all facility pedestrian and traffic points of entry, as appropriate.
Consider need for the following, and report findings to the Operations Section Chief:
    Emergency lockdown
    Security/bomb sweep of designated areas
    Providing urgent security-related information to all personnel
    Need for security personnel to use personal protective equipment
    Removing unauthorized persons from restricted areas
    Security of the HCC, triage, patient care, morgue, and other sensitive or strategic areas from
        unauthorized access
    Rerouting of ambulance entry and exit
    Security posts in any operational decontamination area
    Patrol of parking and shipping areas for suspicious activity
    Traffic Control
Brief the Security Branch on current situation, incident objectives and strategy; outline Branch action
plan and designate time for next briefing.
Ensure Branch personnel comply with safety policies and procedures and proper use of personal
protective equipment, if applicable.
Coordinate immediate security personnel needs from current staff, surrounding resources (police, sheriff,
or other security forces), and communicate need for additional external resources through Operations
Section Chief to the Liaison Officer.
Assist in maximizing capability of the Branch to meet work demands. Assess problems and needs in
Branch area; coordinate resource management.


                                                                D-31
EMERGENCY OPERATIONS PLAN                                                                                 August 2007
NETWORK                                                                                                      Annex D

Immediate (Operational Period 0-2 Hours)                                                                       Time     Initial
Participate in briefings and meetings as requested.
Document all communications (internal and external) on an Incident Message Form (HICS Form 213).
Provide a copy of the Incident Message Form to the Documentation Unit.

Intermediate (Operational Period 2-12 Hours)                                                                   Time     Initial
Meet regularly with Operations Section Chief for status reports, and relay important information to
Branch staff.
Communicate the need and take actions to secure unsafe areas; post non-entry signs.
Ensure Security Branch staff identify and report all hazards and unsafe conditions.
Ensure patient valuables are secure; initiate chain of custody procedures as necessary.
Coordinate activities with local, state, and federal law enforcement, as appropriate; coordinate with the
Liaison Officer and the Law Enforcement Interface Unit Leader.
Confer with Public Information Officer to establish areas for the media.
Ensure vehicular and pedestrian traffic control measures are working effectively.
Consider security protection for the following, as indicated based on the nature/severity of the incident:
    Food
    Water
    Medical resources
    Blood resources
    Pharmaceutical resources
    Personnel and visitors
Ensure proper equipment needs are met and equipment is operational prior to each operational period.
Develop and submit a Branch action plan to the Operations Section Chief when requested.
Advise the Operations Section Chief immediately of any operational issue you are not able to correct or
resolve.

Extended (Operational Period Beyond 12 Hours)                                                                  Time     Initial
Continue to monitor Security Branch personnel’s ability to meet workload demands, staff health and
safety, resource needs, and documentation practices.
Continue coordination with law enforcement officials.
Prepare and maintain records and reports, as appropriate.
Ensure your physical readiness through proper nutrition, water intake, rest, and stress management
techniques.
Observe all staff and volunteers for signs of stress and inappropriate behavior. Report concerns to the
Employee Health & Well-Being. Provide for staff rest periods and relief.
Upon shift change, brief your replacement on the status of all ongoing operations, issues, and other
relevant incident information.

Demobilization/System Recovery                                                                                 Time     Initial
As needs for Security Branch staff decrease, return staff to their usual jobs and combine or deactivate
positions in a phased manner.
Determine when to resume normal security procedures; ensure removal of special signage after “all

                                                              D-32
EMERGENCY OPERATIONS PLAN                                                                              August 2007
NETWORK                                                                                                   Annex D

Immediate (Operational Period 0-2 Hours)                                                                     Time    Initial
clear” is announced.
Determine with the Hazardous Materials Branch Director and other appropriate authorities the final
disposition of patient valuables.
Coordinate completion of work with law enforcement and Liaison Officer.
Ensure return/retrieval of equipment and supplies and return all assigned incident command equipment.
Ensure personal protective equipment used by Security is cleaned, repaired, and/or replaced.
Debrief staff on lessons learned and procedural/equipment changes needed.
Upon deactivation of your position, ensure all documentation and Operational Logs (HICS Form 214)
are submitted to the Operations Section Chief.
Upon deactivation of your position, brief the Operations Section Chief on current problems, outstanding
issues, and follow-up requirements.
Submit comments to the Operations Section Chief for discussion and possible inclusion in the after-
action report; topics include:
      Review of pertinent position descriptions and operational checklists
      Recommendations for procedure changes
      Section accomplishments and issues
Participate in stress management and after-action debriefings. Participate in other briefings and meetings
as required.

Documents/Tools
   Incident Action Plan
   HICS Form 204 – Branch Assignment Sheet
   HICS Form 207 – Incident Management Team Chart
   HICS Form 213 – Incident Message Form
   HICS Form 214 – Operational Log
   Hospital emergency operations plan
   Hospital organization chart
   Hospital telephone directory
   Radio/satellite phone
   Facility blueprints and maps




                                                            D-33
EMERGENCY OPERATIONS PLAN                                                             August 2007
NETWORK                                                                                  Annex D

                                   Incident Action Planning Checklist

In the Incident Command System (ICS), considerable emphasis is placed on developing effective written
Incident Action Plans (IAPs). The steps outlined in this checklist will allow for the development of a
written IAP in a minimum amount of time. Not all incidents require detailed written plans. Recognizing
this, the following planning process provides a series of basic planning steps, which are generally
appropriate for use in any incident situation. The determination of the need for written IAPs and
attachments is based on the requirements of the incident, and the judgment of the EOC Director. The
Planning Section Coordinator normally conducts the planning meeting.

Checklist Item                                              Primary Responsibility

Briefing on situation and resource status                   Plans Coordinator (PC)
Set overall objectives and priorities for period/shift      EOC Director
Identify activity areas and control objectives              Operations Coordinator (OC)
Specify tactics for each Group                              OC
Specify resources needed by each Group                      OC, Logistics Coordinator (LC),
                                                            Finance Coordinator (FC).
Specify facilities and reporting locations                  OC, LC.
Place resource and personnel order                          LC, FC.
Consider communications, medical and traffic plan           OC, PC, LC
requirements
Finalize, approve and implement incident action plan        PC, OC, EOC Director




                                                     D-34
EMERGENCY OPERATIONS PLAN                                                              August 2007
NETWORK                                                                                   Annex D



                                     Telecommunications Unit Officer

Telecommunications Unit Officer Job Action Sheet

You Report To: ___________________________ (Logistics Section Chief)

Mission:       Plan and coordinate the use of communications systems and equipment to support
incident-related needs.

               The checklist of activities presented below should be considered as a minimum
requirement for the position. Users of this Job Action Sheet are encouraged to augment this list as
necessary. Note that some activities are one-time actions while others are ongoing or repetitive for the
duration of the incident.

Timeframe       Tasks

Immediate ___      Receive an initial briefing from the Logistics Section Chief
                      including any policies on the use of volunteers
                      (i.e. amateur or “ham” radio operators).

                ___     Read this entire sheet and review Emergency Operations Center (EOC)
                        organizational chart.

                ___     Put on position identification vest and ID badge.

                ___     Establish the communications capabilities necessary to operate the EOC as well as
                        other critical incident facilities (i.e., Labor Pool, Reception Area, etc.). Arrange
                        for the necessary workspace, materials telephones, personal computers and
                        staffing.

                ___     Assess current status of the internal and external telephone system and inform the
                        Logistics Section Chief.

Ongoing         ___     Participate in Incident Action Planning meetings to determine the
                        communications requirements of tactical and support elements activated. Prepare
                        the communications portion of the written Incident Action Plan (IAP).

                ___     Establish an appropriate communications distribution, maintenance and
                        accountability system.

                ___     Ensure the personal safety and health of all staff.

                ___     Provide for staff rest and relief.

                ___     Ensure that communications operators in the EOC use message forms to
                        document all communications/actions.
                                                      D-35
EMERGENCY OPERATIONS PLAN                                                     August 2007
NETWORK                                                                          Annex D



           ___   Recover equipment from de-activated or released resources.

           ___   Keep a log of actions.

                 Notes:




                                           D-36
EMERGENCY OPERATIONS PLAN                                                              August 2007
NETWORK                                                                                   Annex D

                                          Medical Branch Director

Medical Branch Director Job Action Sheet

You Report To: _______________ (Operations Section Chief)

Mission:       Assist the Operations Section Chief in short- and medium-term planning for the provision
of health, medical and mass care services. Manage staff assigned to Group.

               The checklist of activities presented below should be considered as a minimum
requirement for the position. Users of this Job Action Sheet are encouraged to augment this list as
necessary. Note that some activities are one-time actions while others are ongoing or repetitive for the
duration of the incident.

Timeframe       Tasks

Immediate ___      Receive an initial briefing from the Operations Section Chief.

                ___     Read this entire sheet and review the Emergency Operations Center (EOC)
                        organizational chart.

                ___     Put on position identification vest and ID badge.

Ongoing         ___     Assign staff to manage and advise on the following:
                        ___    Capability Assessment
                        ___    Patient Distribution
                        ___    Employee Health
                        ___    Other

                ___     Coordinate with the Labor Pool & Credentialing Unit on the classification and
                        credentialing of medical staff.

                ___     Assist the Operations Section Coordinator and Group
                        Leaders with the assignment of appropriate medical staff.

                ___     Participate in Incident Action Planning meetings: Assist in resource requirements
                        planning for desired service levels.

                ___     Ensure the personal safety and health of all staff.

                ___     Provide for staff rest and relief.

                ___     Observe and assist operations staff who exhibit signs of stress. Refer them to the
                        Safety Officer, as required.

                ___     Keep a log of actions.

                                                      D-37
EMERGENCY OPERATIONS PLAN                                                             August 2007
NETWORK                                                                                  Annex E

                                            Annex E

                               Situation and Incident Reporting

Overview: A critical aspect of the overall response and recovery activities relating to a hurricane
impacting Veterans Affairs (VA) medical facilities, patients, and personnel, is accurate and
timely situation reporting. Timing of these reports must be consistent and scheduled as part of
the overall operational cycle established by the VHA Incident Manager.

Types of Reports:

       a. Medical Facility Operating Status Capability Assessment Report (OSCAR): The
          OSCAR (Attachment F-1) is an internal VA medical facility report to be used as a
          checklist to prepare the Incident and Situation Reports as described below.

       b. Incident Report: This report (see Attachment E-2) is a “one time” VA medical
          facility report initiated to report an incident to the VISN and VHACO. The purpose of
          the report is to provide the VISN Director and, subsequently, the Deputy Under
          Secretary for Operations and Management of an event or occurrence that has, or
          potentially will have, a negative impact upon a VA medical facility, patients or
          staff—including one of adverse publicity..

       c. Subsequent Reporting: For emergency situations that are not resolved within the
          initial 4 hour period, subsequent reporting involves the use of two forms: a VAMC
          Situation Report (SITREP) and a VA Facility Incident Action Plan (IAP). These
          reports (see Attachments F, G) are provided by a VA medical facility to the Network
          according to the schedule below, unless otherwise directed.

           VA Facility Issue Brief/SITREP            by 0730 hrs., local time
           VA Facility Incident Action Plan          by 1100 hrs., local time
           VA Facility Issue Brief/SITREP            by 1930 hrs., local time.


       d. Network Office: The Network Office will forward the Incident Report to the Outlook
          mail group VHA JOC, with the subject line: “ATTN: VHA JOC Duty Officer.” If
          Outlook is down, the report should be submitted by telephone using 304-264-4800,
          and then faxed to 304-264-4499.

           Subsequent Reporting: For emergency situations involving only one VA Facility,
           the Network Office will forward by 0730 hours local time the VA Facility SITREP
           and/or VA Facility IAP to the Outlook mail group VHA JOC with the subject line:
           “ATTN: VHA JOC Duty Officer”, unless otherwise directed.

           For significant emergency situations that involve multiple VA Facilities, the Network
           Office may elect to combine VA Facility reports and submit a VISN Issue Brief and


                                               E-2
EMERGENCY OPERATIONS PLAN                                                      August 2007
NETWORK                                                                           Annex E

        VISN IAP to the VHA JOC according to the schedule below, unless otherwise
        directed.

        VISN Issue Brief/SITREP         by 0900 hrs., local time
        VISN IAP                        by 1300 hrs., local time
        VISN Issue Brief/SITREP         by 2100 hrs., local time.

        Incident Termination: The Network Office will send an email indicating termination
        of an incident at a VA Facility to the VHA JOC.

        After Action Reporting: The VHA JOC may request After Action Reports (Annex
        H) from the Network Office and/or VA Facilities based on the nature, magnitude and
        duration of the incident.




                                          E-3
EMERGENCY OPERATIONS PLAN                                               August 2007
NETWORK                                                                    Annex E



                           INCIDENT REPORT
DATE: __________

TYPE OF EMERGENCY: __________________________________________

CAUSE: _______________________________________________________

DEATHS:     NO ___ YES ____ IF YES, PATIENTS: _____ STAFF: ______

INJURIES:   NO ___ YES ____ IF YES, PATIENTS: _____ STAFF: ______

OPERATIONAL STATUS OF FACILITY:

     _____ GREEN (Fully Operational)
     _____ YELLOW (Operational but with emergency systems (e.g., power functioning)
     _____ RED (Partial Operation)
     _____ BLACK (Non-Operational)

LOCATION OF EMERGENCY: ______________________________________

EMERGENCY/DISASTER PLAN ACTIVATED? Y _____ N _____

ICS IMPLEMENTED? Y _____ N _____

SYSTEM FIXED/PROBLEM CORRECTED?              Y _____ N _____ IF NO, ANSWER
THE FOLLOWING:

CURRENT STATUS (Describe):
_____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
__________________________________________


ESTIMATED DATE AND TIME THAT SYSTEM WILL BE OPERATIONAL OR
PROBLEM WILL BE CORRECTED: ______________________________________

NARRATIVE COMMENTS;
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________


                                       E-4
EMERGENCY OPERATIONS PLAN                                           August 2007
NETWORK                                                                Annex E

______________________________________________________________________________
______________________________________________________________________________
_______________

SUBMITTED BY: NAME ________________________________________________

PHONE _______________________ CELL PHONE ________________________

FAX __________________________ PAGER ____________________________




                                     E-5
EMERGENCY OPERATIONS PLAN                                                                         August 2007
NETWORK                                                                                              Annex F

                                          Emergency Management Program
                Operating Status Capability Assessment Report (OSCAR)

Event: _________________________                     Date: _____________ Time: ________

                              Questions               Y     N     Comments

1. Can you continue to treat incoming                            If NO, why not?
     patients?
2.   Any patient evacuated to outside the                        If YES, where
     hospital                                                    ______ Total evacuated
                                                                 ______ # of unstable/critical

3.   Any fatalities?                                             If YES,
                                                                 ______ Patients
                                                                 ______ Staff

4. Any patients/staff injured?                                   If YES,
                                                                 ______ Patients
                                                                 ______ Staff

5.   Any structural damage:                                      Partial Collapse?

                                                                 Total Collapse?

6.   Any major non-structural problems?                          If YES, what are the problems?

7.   Power from any source?

8. Can you communicate with the outside world?                   If YES, how?

9. Access to all essential areas of the hospital?                If NO, is anyone trapped?

10. Sufficient number of elevators working?

11. Water lines intact to essential areas?

12. Natural gas lines intact to essential areas?

13. Medical gas lines intact to essential areas?

14. Adequate staff at the hospital?

15. Adequate supplies and equipment

16. Outside assistance needed?                                   If YES, what?

17. Need structural engineer sent to hospital?




                                                      F-1
EMERGENCY OPERATIONS PLAN                                                                 August 2007
NETWORK                                                                                      Annex F


18. Number of Critical Care Beds?

19. Number of Medical/Surgical Beds?

20. Number of Psychiatric Beds?

21. Other specialty beds available (state number and type)?

22. Number of OR suites open and ready for surgery?

23. Number of Patients Admitted Since Last Report (Date/Time)?     Total: ___________

                                       Med/Surgical: __________
                                       Critical Care: __________
                                       Psychiatric: __________
                                       Other (Type): __________


24. Number of Patients Seen in ER Since Last Report (Date/Time)?    Total: ____________

    Number of ER Patients Admitted:                ____________
    Number of ER Patients Transferred:             ____________
    Number of ER Patients Treated & Released: ____________

25. Do you have at least a 3-day operational
    capacity in each of the following areas?

    a.   Communications?

    b.   Electrical Power?

    c.   Natural Gas?

    d.   Diesel Fuel (Generator)?

    e.   Water?

    f.   Sewage/Refuse Disposal?

    g.   Supplies? (Specify)

                             Oxygen?

                             Pharmaceuticals?

                               Other Medical Supplies?

                               Non-Medical Supplies?

                               Equipment?

                             Food?

                             Other ? (Specify)




                                                          F-2
EMERGENCY OPERATIONS PLAN                                                                    August 2007
NETWORK                                                                                         Annex G


                                    (Name of Medical Center)
                       Situation Report (SITREP)
                                                  (Numbered Sequentially)Report   No.___________
                                                                   Date of Report ___________

                    (Event – Brief Description; e.g., “Facility Fire”)

      I.       Background and Current Situation: (Give brief background of the event and
      situation update from the last SITREP.)
   Example: “On November 12, 2001, a structural fire resulted in damage to the nursing home
      facility (Building 4301) causing the evacuation and relocation of 52 patients. Patients
      were evacuated without incident and are temporarily being provided care and housed in
      the main hospital building. Most of the damage was resulted from smoke and water.
      Investigation completed yesterday has determined that the cause of the fire was careless
      use and disposal of smoking materials by a painting contractor working in the nursing
      home facility.

      II.     Operations Status/Update: (Provide overall status by color code: Green,
      Yellow, Red or Black; followed by narrative providing specifics relating to the response
      to the event; and if applicable, information relating to efforts to attain full operational
      status with an estimated date.)
   Example: Facility Status: “Red”
   1. Nursing home admissions curtailed pending clean up and repair of building 4301.
      Estimated completion date is November 19, 2001. In the interim new admissions are
      being referred to our contract facility.
   2. VA Police have cited contractor employee for smoking in a restricted area. Regional
      General Counsel’s Office reviewing whether further actions are warranted against the
      individual and/or contractor.
   3. Estimated damages are $155,000.

      III.    Point(s) of Contact: (List name, phone, cell phone, fax and pager numbers of
      individual(s) who should be contacted if additional information is desired.)

______________________________________________                           ____________________
    (Signature of Medical Center Director or Designee)                                Date




                                                    G-1
EMERGENCY OPERATIONS PLAN                                                            August 2007
NETWORK                                                                                 Annex G

                                           (Sample)

                                        NETWORK
              VISN Situation Report (SITREP)
                                            (Numbered Sequentially)Report No :     ___
                                                               Date of Report: _______

                 (Event – Brief Description; e.g., “Hurricane Amy”)

     Background and Current Situation:
          (Give brief background of the event and situation update from the last SITREP.)
  Example: “On August 12, 2006, a Category II hurricane made landfall in the Miami,
     Florida area causing coastal flooding, shore erosion, and damage to structures and
     infrastructure within the Miami/Dade County Area. Initial reports are that there are2
     deaths and 80-100 injured. A number of Miami area hospitals are closed or operating at
     reduced capacity due to staffing shortages and lack of electrical power and diesel fuel for
     emergency generators. ..

     I.       Operations Status/Update: (Provide overall status for each VISN medical
     facility (to include CBOCs) by color code: Green, Yellow, Red or Black; followed by
     narrative providing specifics relating to the response to the event; and if applicable,
     information relating to efforts to attain full operational status with an estimated date.
     Also provide any related operations information regarding the overall VISN response)
  Example:
  Miami VA HCS:
     Facility Status: “Yellow”
              Patient Census: 120
                     ICU:                      5
                     Med/Surg:                70
                     Nursing Home:            30
                     Dom:                     15
         Comments: Hospital is operating on Emergency Power and has restricted admissions
     to only emergencies. Outpatient clinics are closed due to operating status of the medical
     facility and debris and flooding making travel to from the facility hazardous or impossible
     for both patients and staff. Diesel fuel adequate for 48 hours but re-supply questionable.
     VISN is working to provide re-supply for fuel and other necessary medical/non-medical
     supplies. Staff relief is being planned by VISN 8 through the West Palm Beach VAMC
     as soon as roads become passable. Damage to the facility at this time is limited to
     grounds, broken windows, and some room damage. Estimated damages at this point are
     $450,000.



                                              G-2
EMERGENCY OPERATIONS PLAN                                                         August 2007
NETWORK                                                                              Annex G

              Satellite OPCs:
                      Oakland Park:
                              Clinic Status: (As above; provide color of operation status)
                              Comments: (As necessary)
                      Key West
                              Clinic Status: (As above; provide color of operation status)
                              Comments: (As necessary)
              CBOCs
                      Key Lorgo
                              Clinic Status: (As above; provide color of operation status)
                              Comments: (As necessary)
                      Homestead
                              Clinic Status: (As above; provide color of operation status)
                              Comments: (As necessary)
                      Pembroke Pines
                              Clinic Status: (As above; provide color of operation status)
                              Comments: (As necessary)
                      Hollywood
                              Clinic Status: (As above; provide color of operation status)
                              Comments: (As necessary)
                      Deerfield Beach
                              Clinic Status: (As above; provide color of operation status)
                              Comments: (As necessary)
                      Coral Springs
                              Clinic Status: (As above; provide color of operation status)
                              Comments: (As necessary)
James A Haley Veterans Hospital
              Facility Status: Green
              Comments: None
Bay Pines VAMC
              Facility Status: Green
              Comments: None
West Palm Beach VAMC
              Facility Status: Green
              Comments: Medical facility is preparing to send additional support staff to the
VAMC Miami consisting of 20 Med/Surg RNs, 6 ICU RNs, and 15 LPNs. Support staff will be
deployed once safe transport to the VAMC Miami can be assured as roads re-open.




                                             G-3
EMERGENCY OPERATIONS PLAN                                                                                             August 2007
NETWORK                                                                                                                  Annex G



                                 INCIDENT ACTION PLAN SUMMARY FORM
                                                       1. VHA Entity                                           2. Station/VISN
       Incident Action Plan Summary
3. Incident Name                                       4. Operational Period Date:


                                                                                                    Time:
                                         Staff Assigned to the Incident
Agency Executive                                                Public Information Officer


Policy Coordination Entity POC                                  Operations Chief


IMT Commander                                                   Logistics Chief


Deputy IMT Commander                                            Finance Chief


Safety Officer                                                  Planning Chief


Liaison Officer                                                 Technical Specialist


                                                     Current Situation




                                           Resources Assigned this Period
                                                               Contact Info #                                              Reporting
                                                                                     # of Persons
Team/Task Force                       Leader / POC                                                  Location               Info/Notes
                                                                                     / units
                                                                                                                           /Remarks




                                     Objectives for the Next Operational Period




                                                               G-4
EMERGENCY OPERATIONS PLAN                                                             August 2007
NETWORK                                                                                  Annex G




                  Response Strategies for the Next Operational Period
 Objective        Strategy                                        Responsible Party




                             Next Planning Cycle Activities




Prepared by               Approved by Incident Manager                  Date          Time




                                                G-5
EMERGENCY OPERATIONS PLAN                                                         August 2007
NETWORK                                                                              Annex G




II   Plans Status and Update


III Logistics Status and Update


IV Finance Status and Update


Point(s) of Contact: (List name, phone, cell phone, fax and pager numbers of individual(s) who
should be contacted if additional information is desired.)




______________________________________________                   ____________________
     (Signature of VISN Director or Designee)                        Date


                                      ISSUE BRIEF FORMAT


Issue Title:

Date of Report:

Brief Statement of Issue and Status:

Actions, Progress, and Resolution Date:

Contact for Further Information:




                                                G-6
EMERGENCY OPERATIONS PLAN                                                                     August 2007
NETWORK                                                                                          Annex H

                                   Emergency Management Program
                                 After Action Report (AAR)
                                                         For

I.       Functional/Key Activity Area: List one of the following:
         ·      Management (MG)
         ·      Public Information (PA)
         ·      Liaison (LN)
         ·      Planning/Intel (PI)
         ·      Logistics (LG)
         ·      Finance/Admin (FA)
         ·      Operations (OP)
         ·      Business Continuity (BC)
         ·      Plant & Utilities (PU)
               Safety & Security (SS)
         ·     Health & Medical (HM)
     II.    Issue (Designator and Description):




     III.      Discussion:




     IV.       Action:




     V.        Office of Primary Responsibility:



     VI.       Suspense Date:




_______________________________________                          __________________________
            (Signature of Medical Center Director or Designee)                          Date




                                                         H-1
EMERGENCY OPERATIONS PLAN                                                           August 2007
NETWORK                                                                                 Annex I

                EMERGENCY CONTACTS AND COMMUNICATIONS PLAN

PURPOSE: The purpose of the Emergency Communications Plan is to provide emergency contact
phone numbers and outline the emergency communications resources available to Network facilities
and the order they will be used.

PROCEDURES:

     1. Communications initiated by either the Network office or a Network facility will use the
        following resources in the order listed or as directed by the Network:

        a.   Telephone and/or fax
        b.   Cell Phone
        c.   E-mail (Outlook/Global Address: VHA V18 Emergency Team)
        d.   Satellite phone
        e.   Ham Radio

    2. Emergency contact phone numbers are:

             a. VHA CONTACTS:
                   (1) Deputy Under Secretary for Health for Operations & Management:
                            (202) 273-5826
                   (2) VHA EMSGH Emergency Operations Center
                            (304) 264-4800
             b. NETWORK CONTACTS:
                   (1) NETWORK EOC:
                         (a) Phone: (602) 212-2125 and (602) 212-2126
                         (b) Fax: (602) 212-2129
                   (2) NETWORK Alternate EOC @ Phoenix VAMC:
                         (a) Phone: (602) 277-5551, x6451 (telephone jack #132-59)
                         (b) Alternate Phone: (602) 277-5551, x5322
                         (c) Fax: (602) 277-5551, x6559 (telephone jack #132-59)
                   (3) Albuquerque EOC
                         (a) Phone: (505) 256-2886 or (505) 265-1711 x5659
                         (b) Fax: (505) 256-2855
                   (4) Amarillo EOC
                         (a) Phone: (806) 354-7852 or (806) 355-9703, x7221
                         (b) Fax: (806) 354-7860
                   (5) Big Spring EOC
                         (a) Phone: (915) 264-4810
                         (b) Fax: (915) 264-4878
                   (6) El Paso EOC
                         (a) Phone: (915) 778-8423
                         (b) Fax: (915) 564-7920
                   (7) Phoenix EOC
                         (a) Phone: (602) 277-5551 x6454

                                                I-1
EMERGENCY OPERATIONS PLAN                                                   August 2007
NETWORK                                                                         Annex I

                       (b) Fax: (602) 277-5551 x6489 (Not located in EOC)
                 (8) Prescott EOC
                       (a) Phone: (928) 717-7429
                       (b) Fax: (928) 776-6098
                 (9) Tucson EOC
                       (a) Phone: (520) 792-1450, x5021
                       (b) Fax: (520) 629-1818/1820 or 4948

         c. STATE EMERGENCY CONTACTS:
               (1) Arizona Division of Emergency Management Emergency Operations
                   Center:
                    (a) Phone: (602) 231-6242
                    (b) Switchboard: (602) 244-0504
                    (c) Fax: (602) 231-6271
               (2) New Mexico:
                    (a) Phone: (505) 476-9635
                    (b) Fax: (505) 471-5922
               (3) Texas Department of Public Safety
                   Division of Emergency Management
                    (a) 24 Hour phone #: (512) 424-2277
                    (b) Fax: (512) 424-2444

         d. VA REGIONAL COUNSEL EMERGENCY CONTACT:

            Office of General Counsel Region 13 (Not aligned with VHA Regions)
            Nancy J. Canonico, Regional Counsel
            Office: (254) 297-5303
            Blackberry: (254) 640-2176
            Fax: (254) 297-5310
            Home: Deleted for privacy
            E-mail: nancy.canonico@va.gov

            Alternate Contact: Nancy Moran, Assistant Regional Counsel
            Office: (254) 297-5313
            Home: Deleted for privacy
            Cell: (254) 534-0516
            Fax: (254) 297-3966
            E-mail: nancy.moran@va.gov

            Office of General Counsel Region 19 (Not aligned with VHA Regions)
            Mark Romaneski, Regional Counsel
            Office: (602) 212-2091
            BlackBerry: (602) 206-0825
            Fax: (602) 212-2144
            E-mail: mark.romaneski@va.gov


                                           I-2
EMERGENCY OPERATIONS PLAN                                                            August 2007
NETWORK                                                                                  Annex I



                Alternate Contact: Jeanne Morris, Assistant Regional Counsel
                Office: (602) 212-2091
                Home: Deleted for Privacy
                E-mail: Jeanne.morris@va.gov

IMPLEMENTATION: Verbal instructions followed by e-mail messages will be given by telephone
or cell phone if those systems are functioning. The instructions will include reminding the Network
facilities to monitor their e-mail for future message.

If the phone and cell phone systems are not functioning, the facility experiencing an
emergency/disaster will attempt to send an e-mail message to the other Network facilities to inform
them of situation. Any facility receiving an emergency message will contact the Network office to
ensure they are aware of the problem.

Should the telephone, cell phone and e-mail systems fail due to an emergency, amateur radio is often
the best means of communicating with the affected area. The Network has a significant "ham" radio
capability both at the Network Office and at most field facilities. The purpose of this annex is to
outline procedures for activating this system should an emergency strike a facility within the
Network. This annex includes:

     A.    Use of the Government Emergency Telecommunications Service (GETS)
     B.    Ham radio capability within the VISN
     C.    Checklist for the Network Emergency Operations Center for system activation
     D.    Roster of hams in Mesa who support the Network Office
     E.    Initial frequencies on which hams would meet in the event of an emergency
     F.    Net control protocol

GOVERNMENT EMERGENCY TELECOMMUNICATIONS SERVICE (GETS)

The Government Emergency Telecommunications Service (GETS) provides Federal, State and
local government National Security and Emergency Preparedness (NS/EP) users with a unique
switched voice and voice-band data communications service. GETS is used during periods of
natural or man-made disasters or emergencies that cause congestion or network outages. GETS is
an emergency telecommunications service and is designed to be used when NS/EP personnel are
unable to complete emergency calls through their regular telecommunications means.

Additional information may be obtained by contacting the VHA GETS Program
Coordinator Emergency Management Strategic Healthcare Group (EMSHG), Carol Beard
at:
     Telephone: 304-264-4804
     Fax: 304-264-4499
     E-mail: carol.beard@med.va.gov
     For more information on the GETS program go to Website: http://gets.ncs.gov




                                                 I-3
EMERGENCY OPERATIONS PLAN                                                          August 2007
NETWORK                                                                                Annex I

NETWORK GETS PROCEDURES:

    Each Network facility is responsible for appointing a GETS Program Coordinator
    Each Network facility management team will determine who should have GETS cards
    Individuals requesting GETS cards should contact the facility GETS Program Coordinator
     who will assist in the application and forward the request to the VHA GETS Program
     Coordinator Carol Beard at the EMSHG.
    The facility GETS Program Coordinator will maintain a listing of GETS Card holders
    Each Network facility program coordinator will ensure that the GETS cards are accounted for
     when a card holder leaves the facility:
         o If an individual transfers to another VA and requests to keep the card the information
             will be provided to the VHA GETS Program Coordinator.
         o If the individual leaves the VA the card will be destroyed and the VHA GETS Card
             Program Coordinator will be advised of the action.
    All personnel in possession of a GETS card will test their card each quarter. The test results
     will be reported to the facility GETS Coordinator.
    The facility GETS Coordinator will consolidate all test results and report the results to the
     EMSHG Area Emergency Managers and/or Management Assistant,
     denison.waterman@med.va.gov, at the Albuquerque VAMC.
         o Name and location of callers
         o Certify that the GETS Cards were tested that quarter

HAM RADIO CAPABILITY WITHIN NETWORK

     Network Office                 Radio station in building (WG7VA); support by local hams
     Albuquerque                    Radio station on-campus (N5VA); support by local hams Daily
                                    Net call at 11 a.m. MST on frequency14.287.
     Amarillo                       Station on-campus; support by employee hams and local ham
                                    club members
     Big Spring                     No support
     El Paso                        No station on-campus; support by employee hams and local
                                    ham club members
     Lubbock                        No support
     Phoenix                        No support
     Prescott                       Radio station on-campus; support by local hams
     Tucson                         Radio station on-campus; support by local hams

HAMS SUPPORTING NETWORK OFFICE

The following hams from the Mesa area have agreed to support the Network Office in an emergency
by operating the radio station. These are the only non-VA individuals authorized to enter the
Network Office and to operate the radio equipment. Each has been issued an ID badge by the
Network Office.

     Name                           Phone Number                                Call Sign
Rick Aldom                          Deleted for Privacy                         W7STS

                                                I-4
EMERGENCY OPERATIONS PLAN                                                               August 2007
NETWORK                                                                                     Annex I

Bill Hosking                           Deleted for Privacy                            W7JSW

Bill Houston                           Deleted for Privacy                                   AB7YU

PROCEDURE FOR ACTIVATION OF HAM RADIO SYSTEM

Once Network Office staff has made the determination that the amateur radio station needs to be
activated to assist with an emergency response, they should take the following actions:

1.    Contact one of the ham operators listed above and apprise him of the situation, and request
      activation of the radio station.
2.    As radio operators arrive, have office staff verify their identity and assure they are on the above
      list of approved operators; assure they are wearing a valid ID badge.
3.    Brief the operators on the situation.
4.    Have them meet with NEOC staff to coordinate internal communications processes and
      procedures.

INITIAL "MEET ME" FREQUENCIES FOR HAM RADIO ACTIVATION

Should an emergency occur at a facility within the Network that results in activation of the ham radio
system, the following radio frequencies will be used for initial contact. Recent experience has shown
that the 40-meter band is preferred during daylight hours and the 80-meter bands during nighttime
hours. Initial and backup frequencies are indicated in the following tables:

DAYLIGHT HOURS

       PRIMARY BAND                       PRIMARY FREQ.                   BACKUP FREQ(S)
          40 Meters                           7.230                       7.285 7.050 (CW)
     SECONDARY BAND(S)
          20 Meters                              14.225                   14.185 14.050 (C)
          80 Meters                               3.860                   3.8685 3.500 (CW)

NIGHTTIME HOURS

       PRIMARY BAND                       PRIMARY FREQ.                   BACKUP FREQ(S)
          40 Meters                           7.230                       7.285 7.050 (CW)
     SECONDARY BAND(S)
          80 Meters                               3.860                   3.8685 3.500 (CW)
          20 Meters                              14.225                  14.185 14.050 (CW)

NET CONTROL DESIGNATION

WG7VA at the VISN office in Mesa will be Net Control in all instances when the VISN emergency
amateur radio network is activated.



                                                   I-5
EMERGENCY OPERATIONS PLAN                                                              August 2007
NETWORK                                                                                    Annex I

COMMUNICATION PROTOCOL

Upon activation of the Network emergency amateur radio network, radio station operators at the
Network Office (WG7VA) will go to the primary band for the appropriate time of day and begin
broadcasting on the primary frequency. They will assume the role of Net Control. They will
broadcast on this frequency for 10 minutes and, if no contacts are made, then go to the alternate
frequency on the same band and broadcast for another 10 minutes. If no contacts are made there, Net
Control will switch to the primary frequency on the first secondary band, and follow the same
procedure.

As field facilities begin to activate their radio stations, they will follow the same procedure as above
for WG7VA. As they make contact with WG7VA, they will direct all radio traffic to Net Control in
order to provide accurate information to the Network Emergency Operations Center (NEOC). Direct
conversations among field stations will be limited.

Net Control operators will log all incoming message traffic and see that it is provided to the NEOC.
They will also strive to maintain effective radio discipline among all stations.
The operators will continue to serve as Net Control for the duration of the emergency and will be
relieved only by the NEOC.

EMERGENCY TELEPHONE NUMBERS FOR AMATEUR RADIO STATIONS

The following is a list of telephone numbers at the amateur radio station locations at each field
facility:

     Albuquerque                      505-265-1711 ext 2321
     Amarillo                         806-355-9703 ext 7005 or 7006
     Prescott                         520-445-4860 ext 6248
     Tucson                           520-629-4947
     Network Office                   602-200-6293

IRIDIUM SATELLITE TELEPHONE USAGE INSTRUCTIONS AND NUMBERS

If the satellite phone shows the word “Iridium”, it is ready to use.

If the satellite phone shows “Fast Charge Complete” it has been turned off. You must do the
following:
        Press and hold the  key to turn the phone on.
        Enter PIN 1111, Press (OK).
        When the word “Iridium” shows on the screen the phone is ready to use.

To make an FTS or a local call with the satellite phone:
     Dial: 00-697-(area code) (Telephone number), press (OK).
             Example: 00-697-602-222-2797

To make an 800 call with the satellite phone:

                                                   I-6
EMERGENCY OPERATIONS PLAN                                                            August 2007
NETWORK                                                                                  Annex I

       Dial 00-699-1-800-(7 digits), press (OK).
              Example: 00-699-1-800-322-0469

To receive a call:
       Press the (OK) button or any digit number when you hear the phone ring. You will be
connected and on the speakerphone. If you choose to use the handset, just pick it up at anytime.

To end a call:
      Press (OK).

To turn the power off:
       Press and hold the  key. The phone will show “Fast Charge Complete”. Do NOT leave the
phone in this state. The power should remain on to allow incoming calls.

To Use the Phone Book:
       Hit the (MENU) key
       At the prompt “Phone Book View Options?” Press (OK).
       At the “Personal Numbers View Options?” Press (OK).
       At the “Find Entry By Name Select?” Press (OK).
       Enter 1st letter of name you want to call, Press (OK).
       The name and number of a match will appear. If this is the correct number, Press (OK).
               At the “Call Number Select?” Press (OK).
       OR You may continue to hit the (MENU) key and it will cycle through the rest of the numbers that
are programmed onto the system. The numbers to the left of the satellite numbers listed below indicate
which memory function they have been programmed into.

Calling the satellite phone from another satellite phone:
       Location                                    Number Program #
       Albuquerque………………………………. 00-8816-763-27071
       Amarillo…………………………………… 00-8816-763-27072……….
       Big Spring…………………………………. 00-8816-763-27073……….
       El Paso…………………………………….. 00-8816-763-27074……….
       Phoenix……………………………………. 00-8816-763-27076……….
       Prescott……………………………………. 00-8816-763-27075……….
       Tucson…………………………………….. 00-8816-763-27077……….
       Network …………………………………… 00-8816-763-27070……….


To Remove Telephone from Docking Station and Use as Handheld Set

1. Turn the Power off before removing telephone from station.
      Press and hold the  key. The phone will show “Fast Charge Complete”.

2. Unlock the telephone – SAVAHCS phones are not locked onto the docking station.

3. Remove the phone from the Docking Station

                                                  I-7
EMERGENCY OPERATIONS PLAN                                                             August 2007
NETWORK                                                                                   Annex I

       While pushing the top of the phone against the docking station, rotate the antenna connector
       up. The antenna connector is located directly above the lock and has a cord attached to it.
       Once this is in the up position, you can remove the telephone.

4. Attach the portable antenna on the phone.
       The Antenna is stored in the carrying case.
       Attach it in the down position. Press and hold the lock release button at the top of the phone.
       Push the antenna until it clicks into place and release the button.

5. Turn the power on to the telephone.
      Press and hold the  key to turn the phone on.
      The phone will prompt you to rotate and extend the antenna, do so at this time.
      To receive reception, the antenna must be pointed towards the South Eastern sky.
      The icon at the upper left of the screen will show what strength of signal the phone is getting.
      Enter PIN 1111, Press (OK).
      When the word “Iridium” shows on the screen the phone is ready to use.

6. Phone Usage
      See previous page for detailed instructions

                      To return the telephone to the docking station

1.Turn the Power off
      Press and hold the  key. The screen will be empty.

2. Remove the antenna from the telephone.
      Place the antenna in the down position.
      Press the button at the top of the phone.
      Pull the antenna straight out.

3. Insert the phone into the docking station
       Using the key, rotate the antenna connector to the up position.
       Rotate the antenna coupler on the docking station to the up position.
       Couple the antenna hole at the back of the phone to the connector in the station.
       Push the top of the phone firmly against the connector and rotate the antenna coupler down to
       latch the phone in place.
       Check the bottom end of the phone to make sure it is securely coupled to the connector.
       Lock the phone into the cradle by turning the key clockwise.

                                        Telephone Numbers
Calling the satellite phone from another satellite phone:
       Location                                    Number Program #
       Albuquerque………………………………. 00-8816-763-27071
       Amarillo…………………………………… 00-8816-763-27072……….
       Big Spring…………………………………. 00-8816-763-27073……….
                                                  I-8
EMERGENCY OPERATIONS PLAN                                                     August 2007
NETWORK                                                                           Annex I

      El Paso…………………………………….. 00-8816-763-27074……….
      Phoenix……………………………………. 00-8816-763-27076……….
      Prescott……………………………………. 00-8816-763-27075……….
      Tucson…………………………………….. 00-8816-763-27077……….
      Network …………………………………… 00-8816-763-27070……….

Calling the satellite phone from a standard land based and/or cellular phone:
       Location                                   Number               Program #
       Albuquerque………………………………. 808-434-7071
       Amarillo…………………………………… 808-434-7072
       Big Spring………………………………… 808-434-7073
       El Paso……………………………………. 808-434-7074
       Phoenix…………………………………… 808-434-7076
       Prescott…………………………………… 808-434-7075
       Tucson……………………………………. 808-434-7077
       Network ………………………………….. 808-434-7070

Calling VISN Numbers:
       Location                          Number
       VISN Network Director……………….…. 00-697-602-222-2692……
       Patricia McKlem cell phone……………… 00-697-602-421-6202……

Calling Emergency Number:
       Location                       Number
       Local emergency number………………… 00-697-911………………




                                              I-9
EMERGENCY OPERATIONS PLAN                                                               August 2007
NETWORK                                                                                     Annex I

                 QUARTERLY TESTING OF IRIDIUM SATELLITE PHONES

POLICY: Iridium Satellite phones have been provided to all Network facilities for use in the
Emergency Operations Center (EOC) as an alternate means of communication. These phones will be
tested (at a minimum) on a quarterly basis.

RESPONSIBILITY:
       a. Facility Directors are responsible for the overall satellite phone program at their facility to
include the designation of a facility satellite phone coordinator and alternate.
       b. The Satellite Phone Coordinator (or Alternate) is responsible for
               (1) safeguarding the satellite phone
               (2) ensuring that appropriate staff are trained on the use of the phone
               (3) ensuring the phone is maintained in a fully charged status at all times
               (4) conducting quarterly testing
               (5) ensuring phone is available for use when the EOC is activated
       c. The Area Emergency Managers located at the Southern Arizona VAHCS and the New
Mexico VAHCS are responsible for operational and procedural issues, i.e., satellite phone policy and
confirming that each facility has conducted the quarterly satellite phone test.

PROCEDURE: The satellite phone coordinator, or alternate, will conduct quarterly testing of the
Iridium Satellite phone not later than the 25th day on the last month of each quarter. The coordinator
should contact a facility, prior to making the call, if the test is to be from satellite to satellite, to
ensure the receiving facility has activated their phone for the testing. The following information will
be provided to the Management Assistant/EMSHG, Denison Waterman
(Denison.Waterman@med.va.gov) by outlook message:

       a. Name of Caller:
       b. Name of party called:
       c. Type of call: (Satellite to Satellite)
                        (Satellite to Landline)
                         (Landline to Satellite)
       d. Number of personnel at your facility trained on use of the satellite phone:
       e. Problem/Concerns with the use of the phone:

CONTACTS:
    a. Dan L. Johnston, AEM/EMSHG, SAVAHCS: 520-629-4947
    b. Randy Waterman, MA/EMSHG, NMVAHCS: 505-265-1711, ext 2094

ATTACHMENT: Listing of Satellite Phone Coordinators and Alternates




                                                   I-10
EMERGENCY OPERATIONS PLAN                                                                                August 2007
NETWORK                                                                                                      Annex I



                                                                           NETWORK Satellite Phone Contacts
        Facility Name                  Address            Satellite Ph #                  Name                  Phone Nr.     User Type                E-mail Address
  New Mexico VA health Care 1501 San Pedro Dr, SE;       8816-763-27071      Mr. George Marnell              505-265-1711,   Primary      George.Marnell@va.gov
  System                    Albuquerque, NM 87108                            Director                        Ext 2220
                                                                             Mr. Ben Rogers                  505-265-1711    Alternate    Benjamin.Rogers@va.gov
                                                                             Liaison                         Ext 6427
  Amarillo VA Health Care    5010 Amarillo Blvd. West;   8816-763-27072      Mr. Byron K. Jaqua              806-354-7801    Primary      Bryon.Jaqua@med.va.gov
  System                     Amarillo, TX 79106                              Director
                                                                             Mr. David Bessler               806-355-9703,   Alternate    david.bressler@va.gov
                                                                                                             Ext. 7155
  West Texas VA Health Care 300 Veterans Blvd; Big       8816-763-27073      Mr. Michael Bell                915-264-4810    Primary      Michael.Bell4@med.va.gov
  System                    Spring, TX 79720                                 Director
                                                                             Mr. Bruce Brown                 915-264-4818    Alternate    bruce.brown4@med.va.gov
                                                                             Telecommunications
  El Paso VA Health Care     5001 N. Piedras St.; El     8816-763-27074      Mr. Bruce Stewart               915-564-7904    Primary      Bruce.Stewart@va.gov
  System                     Paso, TX 79930                                  Director
                                                                             Mr. Ray Perdue                  915-564-7902    Alternate    Everett.Perdue@va.gov
                                                                             Executive Assistant
  Carl T. Hayden VA Medical 650 E. Indian School Rd.,    8816-763-27076      Mr. Donald F. Moore             602-222-6444    Primary      Donald.Moore@med.va.gov
  Center                    Phoenix, AZ 85012                                Director
                                                                             Mr. Paul H. West, FACHE,        602-222-6445    Alternate    Paul.West@med.va.gov
                                                                             Associate Director
  Northern Arizona VA Health 500 Highway 89 North;       8816-763-27075      Ms. Laurel L. Tayon             928-925-6941    Primary      laurel.tayon@med.va.gov
  Care System                Prescott AZ 86313                               Safety/Emergency Manager
                                                                             Ms. Lorene LaRue                928-776-6003    Alternate
                                                                             Program Support Assistant                                    lorene.larue@med.va.gov
  Southern Arizona VA        3601 S. 6th Ave.; Tucson,   8816-763-27077      Mr. Jonathan H. Gardner,        520-629-1821    Primary      Jonathan.Gardner@va.gov
  Health Care System         AZ 85723                                        FACHE, Director
                                                                             Mr. Dan L. Johnston, Area       520-629-4947    Alternate    Dan.Johnston@va.gov
                                                                             Emergency Manager
  Southwest Health Care      6950 East Williams Field    8816-763-27070      Ms. Patricia A. McKlem          602-222-2692    Primary      Patricia.mcklem@va.gov
  Network; VISN-18           Road; Mesa AZ 85212                             Network Director
                                                                             Ms. Joan Funckes                602-222-2681    Alternate    Joan.Funckes@va.gov
                                                                             Executive Assistant



                                                                                         I-12
EMERGENCY OPERATIONS PLAN                                                              August 2007
NETWORK                                                                                   Annex J




           Hazard Vulnerability Analysis (HVA)
                      Instructions

The Hazard Vulnerability Analysis (HVA) is a way to focus attention on those hazards that are
   most likely to have an impact on the VA Medical Center (VAMC) and the surrounding
   community. The list of hazards includes possible events or threats that may occur within the
   community or VA property. Events that impact the community many times are brought into
   the facility. It is intended that a HVA be seen as an evolving document and be reviewed at
   least annually within the JCAHO Environment of Care Emergency Management annual
   report.
Doing the Analysis
There are four (4) categories that are used to help place each hazard into perspective. These
   categories are Probability, Human, Property, and Operational Impact on the facility. Each of
   these categories is based on a point system, ranging from 0 to 3. For each hazard, a point
   estimate of 0 (NA) to 3 (high) is given for each of the four (4) categories.
        Probability that any event may occur in the future. VAMC staff can gain insight on this
       by setting up a meeting with the local emergency management agency.
        Human Impact estimates the severity of impact on patients, visitors, and staff during an
       adverse event. For example, total electrical failure may result in a total evacuation of the
       VAMC. Potential injuries or death of patients, staff and visitors is estimated here. All
       events whether internal or external to our VAMCs, will most likely impact patients in
       some manner, whether it be an inconvenience, or result in injury or worse.
        Property Impact estimates the potential physical damage and losses to the
       infrastructure of the VAMC. Such damages and losses can result in costly repairs and
       delay in services, thereby impacting patient care and operations. Mitigation activities that
       target utilities, communications, and other building service systems will lessen impact of
       emergency events.
        Operational Impact estimates the impact of services that are required and expected by
       our patients, employees, and visitors. Understanding how services inter-relate before an
       emergency event occurs is needed to conduct a meaningful analysis. Examples of services
       include: in-patient care, availability of medicines, treatment schedules, fiscal accounting,
       etc. Operational activities can be preserved by well-planned mitigation strategies.
Event Scoring Guidelines. Event scores 2 or greater in any category will require that a
SOP be developed.




                                                J-1
EMERGENCY OPERATIONS PLAN                                                                                     August 2007
NETWORK                                                                                                          Annex J




                Facility: Network 18                                                         Date:      May 7, 2007


                                   HAZARD VULNERABILITY ANALYSIS
                                    NATURALLY OCCURRING EVENTS

                              SEVERITY CLASSIFICATION - LOW, MODERATE, HIGH
                       PROBABILITY           HUMAN                                   OPERATIONAL              RANK
                                                              PROPERTY IMPACT
 TYPE OF EVENT                               IMPACT                                    IMPACT
                        Likelihood this                                                                 SCORE 2 OR HIGHER
                                            Possibility of     Physical losses and    Interruption of
                       will occur within 1                                                               IN ANY CATEGORY
                                           death or injury          damages              services
                              year                                                                         REQUIRES SOP

                           0 = N/A            0 = N/A           0 = N/A                 0 = N/A         SOP Required Yes or
                         1 = Low            1 = Low           1 = Low                 1 = Low                    No?
        SCORE            2 = Moderate       2 = Moderate      2 = Moderate            2 = Moderate       (If yes, for sample
                         3 = High           3 = High          3 = High                3 = High                  SOP)

Drought/Dust Storm             3                 4                       1                  1                    9

Earthquake                     1                 1                      2                    1                   4

Fire Response                  1                 1                      2                    2                  6

Flood                          0                 0                      0                   0                   0

Hurricane                      1                  1                     1                    1                  4

Thunderstorm/
                               3                 1                       1                  3                   8
Lightening

Tornado/Micro burst            2                 2                       2                  2                    8

Tsunami                        0                 0                      0                   0                    0

                               0                 0                      0                   0                    0
Volcanic Eruption

                               0                  0                      0                  0                    0
Winter Storm




Name and title of person completing HVA                      Dan Johnston, AEM

Chairman: Emergency Planning Coordinator

                                                             Approved:




                                                               J-2
EMERGENCY OPERATIONS PLAN                                                                                   August 2007
NETWORK                                                                                                        Annex J




Comments:




               Facility:Network 18                                                         Date:      May 7, 2007


                                  HAZARD VULNERABILITY ANALYSIS
                                     HUMAN RELATED EVENTS

                             SEVERITY CLASSIFICATION – LOW, MODERATE, HIGH
                      PROBABILITY           HUMAN                                   Operational             RANK
                                                            PROPERTY IMPACT
 TYPE OF EVENT                              IMPACT                                    Impact
                       Likelihood this                                                                SCORE 2 OR HIGHER
                                           Possibility of     Physical losses and   Interruption of
                      will occur within 1                                                              IN ANY CATEGORY
                                          death or injury          damages             services
                             year                                                                        REQUIRES SOP

                          0 = N/A            0 = N/A           0 = N/A                0 = N/A         SOP Required Yes or
                        1 = Low            1 = Low           1 = Low                1 = Low                    No?
        SCORE           2 = Moderate       2 = Moderate      2 = Moderate           2 = Moderate       (If yes, for sample
                        3 = High           3 = High          3 = High               3 = High                  SOP)

Bomb Threat                   1                 3                      3                  3                   11

Civil Disturbance             1                 1                      1                   2                   5

Cyber Attack                  2                  0                     2                   3                   7

Hostage/Barricade
                              1                  1                     1                   2                   5
Situation

Terrorist Event               1                 2                       2                 3                    8

Violence in the
                              1                  2                     1                  2                    6
Workplace




Name and title of person completing HVA                     Dan Johnston, AEM

Chairman: Emergency Planning Coordinator
                                                             Approved:




                                                              J-3
EMERGENCY OPERATIONS PLAN                                                                                     August 2007
NETWORK                                                                                                          Annex J

Comments:




 * For hazardous material events, go to HVA "Hazardous Material Event"

                 Facility: Network 18                                                        Date:      May 7, 2007


                                    HAZARD VULNERABILITY ANALYSIS
                                     HAZARDOUS MATERIALS EVENTS

                               SEVERITY CLASSIFICATION - LOW, MODERATE, HIGH
                        PROBABILITY           HUMAN                                   Operational             RANK
                                                               PROPERTY IMPACT
 TYPE OF EVENT                                IMPACT                                    Impact
                         Likelihood this                                                                SCORE 2 OR HIGHER
                                             Possibility of     Physical losses and   Interruption of
                        will occur within 1                                                              IN ANY CATEGORY
                                            death or injury          damages             services
                               year                                                                        REQUIRES SOP

                            0 = N/A            0 = N/A           0 = N/A                0 = N/A         SOP Required Yes or
                          1 = Low            1 = Low           1 = Low                1 = Low                    No?
       SCORE              2 = Moderate       2 = Moderate      2 = Moderate           2 = Moderate       (If yes, for sample
                          3 = High           3 = High          3 = High               3 = High                  SOP)

Biologic Event                  1                 2                      1                  2                    6
(External)
Biologic Event                  0                 0                       0                 0                    0
(Internal)
Chemical Event                  1                  2                      1                  2                   6
(External)
Chemical Event                  0                 0                       0                 0                    0
(Internal)
                                1                 2                      2                  2                    7
Explosion
                                 1                2                       1                  2                   6
Radiation Event




Name and title of person completing HVA                       Dan Johnston, AEM

Chairman: Emergency Planning Coordinator

                                                              Approved:




Comments:

                                                                J-4
EMERGENCY OPERATIONS PLAN                                                          August 2007
NETWORK                                                                               Annex J




For more information, such as sample SOPs, please visit the National Engineering Service
Center website at http://vaww.nesc.med.va.gov.




                                              J-5
EMERGENCY OPERATIONS PLAN                                                     August 2007
NETWORK                                                                          Annex K

FACILITY EMERGENCY

1. Definition - An emergency occurring at a Network facility to which the facility can respond
without assistance from the Network.

2. Policy - Facility emergencies will be handled by that facility with the Network Office
involved only from the standpoint of receiving status reports on the situation and assisting, if
requested. The Network Office must be notified by the facility if the emergency has resulted
in injury to one or more individuals and/or if there has been disruption of services, which
hinder care delivery to patients.

3.   Facility Actions:

     _____     Contact the Network Office as soon as feasible to inform them of the situation.

     _____     Appoint a liaison person to coordinate with the Network Office.

     _____     Provide progress reports to the Network Office, as the situation permits.

     _____     Submit a brief after-action report to the Network Office within 14 days.

4.   Network Actions:

     _____     Monitor the situation with the local facility Director.

     _____     Assess the need to notify the Deputy Under Secretary for Health for Operations &
               Management and the Emergency Management Strategic Healthcare Group
               (EMSHG).

     _____     Provide assistance, if requested.




                                                   K-1
EMERGENCY OPERATIONS PLAN                                                        August 2007
NETWORK                                                                             Annex L

                          VA/DOD CONTINGENCY OPERATIONS

1. Definition: Activation of the VA healthcare system as the primary backup for the
Department of Defense (DoD) in wartime to provide medical care to military personnel should
the DoD system be overwhelmed.

2. Policy: Network facilities will maintain VA/DoD contingency plans in accordance with
Headquarters directives and in the event of an activation of the VA/DoD contingency system, the
Network Office with the support of the Area Emergency Managers (AEM’s) will coordinate the
Network response with national VA officials.

3.   Facility Actions (Routine)

     _____     Maintain a facility-level VA/DoD Contingency Plan; review/update annually.

     _____     Participate in national bed reporting exercises, if applicable.

4.   Facility Actions (Wartime)

     _____     Activate local VA/DoD plan as directed by Network Office.

     _____     Coordinate all activities with the Network Office during activation.

5.   Network Actions (Routine)

     _____     Oversee and certify annual review of facility plans based on national guidance.

     _____     Sponsor VA/DoD exercises, as appropriate.

6.   Network Actions (Wartime)

     _____     Coordinate activation of all Network facility contingency plans as directed by
               Headquarters.

     _____      Serve as focal point for all contingency-related activities affecting the Network
       facilities for the duration of the emergency.




                                                L-1
EMERGENCY OPERATIONS PLAN                                                      August 2007
NETWORK                                                                           Annex M




                   NATIONAL RESPONSE PLAN (NRP) ACTIVATION

1. Definition: An activation of the National Response Plan, which may result in federal
officials tasking the VA to provide resources during the recovery process.

2. Policy: The Network Office will receive all requests from the Emergency Management
Strategic Healthcare Group (EMSHG) for resources from the Network in support of an NRP
activation and will coordinate those requests with VISN facilities.

3.   Facility Actions:

     _____     Receive resource requests from the Network Office and determine if resource
               available. (Use DEMPS as a potential database)

     _____     Coordinate with the Network Office to provide resources.

4.   Network Actions:

     _____     Receive resource requests from EMSHG.

     _____     Alert VISN facilities of the resource needs.

     _____     If resources are available, coordinate logistics with EMSHG.

     _____     Assure that facilities providing resources effectively document the costs involved.

     _____     If multiple facilities are providing resources, consolidate documentation for
               Network.

     _____     Maintain accurate records of all actions taken during activation.




                                               M-1
EMERGENCY OPERATIONS PLAN                                                      August 2007
NETWORK                                                                           Annex N

          NATIONAL DISASTER MEDICAL SYSTEM (NDMS) ACTIVATION

1. Definition - NDMS is part of the national catastrophic disaster response program and provides
for the evacuation of casualties from a stricken area to pre-designated cities for hospitalization.

2. Policy - An NDMS activation would primarily involve Albuquerque and Tucson VA
facilities as they are the designated NDMS Federal Coordinating Centers (FCC’s) in Network.
NDMS is coordinated in the Phoenix area by Luke AFB, however, the Phoenix medical center
could be involved in an NDMS activation. Other facilities should not be affected.

3.   Facility Actions:

     _____     FCC’s will be notified directly of an activation of the NDMS system.

     _____     FCC’s will activate their local NDMS Operations Plan as directed by national
               authorities.

     _____     FCC’s will maintain communication with the Network Office during an NDMS
               activation and provide relevant information.

4.   Network Actions:

     _____     Monitor the situation with the FCC’s.

     _____     Provide assistance as appropriate.




                                               N-1
EMERGENCY OPERATIONS PLAN                                                      August 2007
NETWORK                                                                           Annex O



                                                               EMERGENCY MANAGEMENT PROGRAM ASSESSMENT

FACILITY: __________________________________________________________________________________
Emergency Management Coordinator: ______________________________________________________________________
PHONE NUMBER: ___________________________________________________________________________



REGULATORY REQUIREMENTS                                          FULL COMPLIANCE PARTIAL COMPLIANCE NO COMPLIANCE NOT APPLICABLE   COMMENTS
Requirement for defining "all Hazards" command structure
(EC.4.10.2)
Written strategic emergency management plan with goals and
objectives (EC.4.10.3)
Emergency Operations Plan addresses 4 phases of emergency
management: mitigation, preparedness, response & recovery.
(EC 4.10.5)
Procedures for initiating plan for response & recovery -
(EC.4.10.6)
Define facility's role in communitywide emergency responses
(EC 4.10.2)
Notifying external authorities (EC.4.10.8)
Notify personnel when emergency response measures are
initiated (EC.4.10.7)

Requirement for cooperative planning between healthcare
organizations (EC.4.10.15)
Two exercises per year (EC.4.20)
Annual community exercise
Annual exercise per CBOC
HVA for CBOCs
Managing patients' activities during an emergency i.e.,
scheduling, modifying or discontinuing services, control of
patient information and patient transportation. (EC.4.10.10)




                                                                             O-1
EMERGENCY OPERATIONS PLAN                                                         August 2007
NETWORK                                                                              Annex O


REGULATORY REQUIREMENTS                                             FULL COMPLIANCE PARTIAL COMPLIANCE NO COMPLIANCE NOT APPLICABLE   COMMENTS
Horizontal & vertical evacuations (EC.4.10.12)
Alternative Care Facility: patient necessities, tracking and
transportation (EC.4.10.13)

Plan establishes an orientation & education program for
personnel who participate in implementing the emergency
operations plan to include: (EC.4.10.20)


    a. Alternate roles & responsibilities during emergencies,
including who they report to in a command structure that is
consistent with the community (EC4.10.9 & EC.4.10.19)
   b. The information & skills required to perform duties during
an emergency
   c. The backup communication system used during an
disasters & emergencies EC.4.10.18)
   d. How supplies & equipment are obtained during disasters
or emergencies
   f. Requirement for establishing alternate care sites
(EC.4.10.13)
Personnel trained on incident management system (JCAHO &
NFPA)
Records document training conducted
Hazards Vulnerability Assessment (EC 4.10.1 & See NFPA
below)
Incident Command System (See NFPA below)
NFPA 99 - Chapter 12 Compliance
Emergency Management command structure links with the
community's command structure (EC.4.10.2)
   HEICS
   Other ICS
   Documented in EM Ops Plan
Identifying personnel during emergencies, i.e. picture ID, vests,
(EC4.10.14)


                                                                                O-2
EMERGENCY OPERATIONS PLAN                                                          August 2007
NETWORK                                                                               Annex O



REGULATORY REQUIREMENTS                                              FULL COMPLIANCE PARTIAL COMPLIANCE NO COMPLIANCE NOT APPLICABLE   COMMENTS

Managing logistics of critical supplies, i.e. pharmaceuticals,
medical supplies, food supplies, linen supplies, water supplies
(EC.4.10.10)
Contingency plans for electricity, water, ventilation, fire
protection systems, fuel sources, medical gas & vacuum
systems, communications systems (EC.4.10.20)
Contingency plans for staff: Housing, transportation of staff &
family, critical incident stress management (EC.4.10.10)
Security plans (See security section below) (EC.4.10.)
Communication with media (EC.4.10)
General emergency management and ICS staff education will
occur at time of hire.
Operational Recovery: Plans shall reflect measures needed to
restore operational capability to pre-disaster levels. (EC.4.10.6)
Decontamination Capabilities:
Facilities for radioactive, biological and chemical isolation and
decontamination (EC.4.10.21)
   Decon Team established
   Decon training conducted
   Decon equipment (Shelter/Shower etc.)
   Decon PPE:
         Level A
         Level B
         Level C

       Level D
Critical Incident Stress Management:
Emergency Communications - Internal & External: (EC.4.10.18)
   Direct Dial (DID) Phones
   Cell Phones
   Pager System



                                                                                 O-3
EMERGENCY OPERATIONS PLAN                                                 August 2007
NETWORK                                                                      Annex O

                                                                FULL             PARTIAL       NO           NOT
REGULATORY REQUIREMENTS                                      COMPLIANCE        COMPLIANCE   COMPLIANCE   APPLICABLE   COMMENTS
  Overhead paging system
  Enough hand-held two-way radios
  Ham radio equip on station
     HF
     UHF/VHF
     Licensed Ham Volunteers
     Licensed Ham Employees
     Narrow Band conversion completed
  Satellite Phone
Management Supervision/Oversight:
  Established Committee
  Meetings held as scheduled
  Minutes approved by Management
   Requirement for an annual evaluation of the program and
hazard vulnerability analysis (EC.9.10.4)
  Emergency Operations Center is established, equipped &
maintained
Security Plan:
  Bomb threat checklist available
  Traffic Control Plan written
  Lock down procedures written
  Suspicious Package/letter training
  Threatening letter training
Pharmacy Cache:
  Security systems in place
  Annual Pharmaceutical Cache Exercise conducted
VA/DOD Contingency Plan:
  Current written plan
  Exercised in last three years
  Training documented
  Bed reporting exercises
  Reception plan/team


                                                                      O-4
EMERGENCY OPERATIONS PLAN                                      August 2007
NETWORK                                                           Annex O

                                                   FULL                PARTIAL        NO            NOT
REGULATORY REQUIREMENTS                         COMPLIANCE           COMPLIANCE    COMPLIANCE    APPLICABLE   COMMENTS
National Disaster Medical System (NDMS)
  Current written operations plan
  Exercised in last three years
  Committee meetings
  Bed reporting exercises

Metropolitan Medical Response System (MMRS)
  Documentation of participation



REVIEWER SIGNATURE                            Date: ______________                DIRECTOR SIGNATURE          DATE: __________



REVIEWER PRINTED NAME                                                             DIRECTOR PRINTED NAME




                                                            O-5
EMERGENCY OPERATIONS PLAN                                                      August 2007
NETWORK                                                                           Annex P

                                   CASCADE ALERT PLAN
                               VETERANS INTEGRATED SERVICE
                                 Southwest Health Care Network

                                         INSTRUCTIONS

The Cascade Alert Plan is used to quickly contact key medical center staff in an emergency. The
VISN Director or Incident Commander at the VISN Emergency Operations Center (EOC) will
initiate the plan. In order for the Cascade Alert Plan to function effectively, all individuals
involved in an activation of the plan must follow the following instructions:

   a. The initiator must give a clear/concise message that he/she wants passed over the system.

   b. When calling the facilities/personnel below you on the cascade alert tree, try contacting
   the personnel in the order listed. If you are unable to contact the primary, contact one of the
   alternates and ensure the message you received is transmitted to that party.

   c. If you are unable to contact either the primary or alternate for a particular facility, move
   down to the facility next on the chain and go through the same process. If you are calling a
   home phone and reach an answering machine, please leave a short message (‘Cascade Alert
   Plan has been activated’. Relay the message you were give and then state “I will call the next
   facility in the chain”.)

   d. Each caller must make notes of each facility that was not contacted and pass that
   information on to the next person to whom they contact.

   e. The last person contacted must call the VISN EOC (602-212-2125), or alternate EOC
   (602-222-6451 or fax 602-222-6559) to complete the notification alert. That person should
   inform the EOC on which facilities, if any, were not contacted. Although the Network
   Alternate EOC is located at the Carl T. Hayden VA Medical Center, it is NOT located in the
   same location as the Carl T. Hayden VA Medical Center’s EOC.




                                                P-1
EMERGENCY OPERATIONS PLAN                                  August 2007
NETWORK                                                       Annex P




                       This page was deleted for privacy




                                      P-2
EMERGENCY OPERATIONS PLAN                                                             August 2007
NETWORK                                                                                  Annex Q



                      NATIONAL DISASTER MEDICAL SYSTEM (NDMS)
                                        And
                            VA/DoD CONTINGENCY (VA/DoD)
                                    BED REPORT

1. Definition - An NDMS bed reporting request would only involve the Albuquerque and Tucson VA
facilities as they are the designated NDMS Federal Coordinating Centers (FCC’s) in the Network.
The NDMS bed report consists of the available community hospital beds in Albuquerque and Tucson.

A VA/DoD Contingency bed report would involve Albuquerque, Phoenix and Tucson since they have
been designated as Primary Receiving Centers (PRC). Amarillo, Big Spring and Prescott VA medical
centers report their available beds to the appropriate Primary Receiving Center. A VA/DoD bed
report consists of the available beds in a VA medical center.

2. Policy – Requests for either an NDMS or VA/DoD bed report should come from VA Central
Office to the Network office. Bed report requests made during the routine business hours will be
forwarded to the Director at the appropriate VA medical center. The Network will also notify Dan
Johnston, Area Emergency Manager at the Southern Arizona VA Health Care System (SAVAHCS)
and the Area Emergency Manager at the New Mexico VA Health Care System (NMVAHCS). If the
Area Emergency Managers are not available during routine business hours, the Network will contact
Denison ‘Randy’ Waterman, Management Assistant at the NMVAHCS.

3. The following staff will be notified of bed report requests made during non-routine business hours,
i.e., weekends, holidays, and the evening and night shifts:

            a. Albuquerque (NDMS and VA/DoD bed report):

                NDMS FCC & VA/DOD Contingency:
                Primary:  (1) NMVAHCS AOD:                          Phone: 505-256-2352
                                                                    FAX     505-256-5799

                AODs at NMVAHCS will then contact (2) or (3), in that order:

                               (2) Denison "Randy" Waterman-        Home: 505-298-6857
                                                                    FAX: 505-256-5491

                               (3) Area Emergency Manager-- Home:
                                                              Pager: 800-393-6809
                                                              FAX: 505-256-5491
                                                              Cell: 505-975-7422



            b. Phoenix (VA/DoD bed report only):


                                                  Q-1
EMERGENCY OPERATIONS PLAN                                                             August 2007
NETWORK                                                                                  Annex Q




                          Administrator On Duty (AOD) –      Phone: (602) 222-2621
                                                             FAX:          (602) 212-2067

              c. Tucson (NDMS and VA/DoD bed report):

                          Administrator On Duty (AOD)        Phone: (520) 792-1450 x 6305
                                                             FAX:          (520) 629-4730
3. Network Actions:

     _____ Contact the Albuquerque, Phoenix and Tucson AODs if the management official cannot be
            reached.

     _____ Contact the Albuquerque and Tucson Area Emergency Managers.


4.    Facility Actions:

      _____     Albuquerque, Phoenix and Tucson VA medical centers will designate a primary and an
                 alternate person to enter the required bed report information in the TRAC2ES system.
                 Phoenix reports VA/DoD beds available in the Phoenix VA medical center. The
                 Albuquerque and Tucson VA medical centers report NDMS and VA/DoD beds as
                 required by VACO.

      _____      The facility primary and alternate contacts will be provided the name and phone
                 number of the individual(s) responsible for entering the bed report data through
                 TRAC2ES. The primary or alternate bed reporting coordinator will be contacted and
                 provide the information requiring a bed report.

      _____      The primary or alternate bed reporting coordinator will enter the bed report in
                 TRAC2ES for his or her respective VA facility within the guidelines accompanying
                 VACO’s bed report directive.

      _____      After the FCC and PRC bed reports are entered into the TRAC2ES system, each
                 facility will send an e-mail message to GPMRC at ustcgpmrc-
                 bedmodule@hq.transcom.mil to provide the Throughput report. Throughput is
                 defined as: The maximum number of patients that can be received at the airport,
                 staged, transported and admitted to the hospital (or hospitals of the NDMS) within any
                 24-hour period.




                                                   Q-2
EMERGENCY OPERATIONS PLAN                                                            August 2007
NETWORK                                                                                 Annex R



             DISASTER EMEREGNCY MEDICAL PERSONNEL SYSTEM (DEMPS)

   Each Network facility will appoint a primary and an alternate DEMPS coordinator. The
   facility’s primary and alternate coordinators are responsible for registering VA staff that
   volunteers for this program into the DEMPS database once his or her supervisor and the medical
   center Director have approved the application. The DEMPS Coordinators are also responsible
   for conducting an annual review of all personnel enrolled in the DEMPS Data Base. This review
   requires that each employee enrolled in the program be contacted to (1) confirm personnel want
   to stay enrolled in the program (2) update any information regarding the enrollee (3) delete
   personnel that no longer wish to remain on the DEMPS database. The Albuquerque and Tucson
   Area Emergency Managers will assist each Network facility in recruiting staff by offering to
   conduct DEMPS training. They will also assist facility coordinators with any questions or
   concerns regarding the program.

   The DEMPS database may be used by the VHA Emergency Management Strategic Health Care
   Group (13C), Network staff and/or the individual facility to identify staff that may be needed for
   deployment in response to an emergency situation.

   Any time clinical staff, i.e., physicians, nurses, etc., are deployed to another facility (this may
   include civilian facilities) they should take a copy of their professional credentials and current
   privileges with them. Within the VHA all provider credentials are entered into a computerized
   program called "Vetpro". The information (licensure, verification on education, and many other
   documents) on all credentialed providers is available to all VA's nationwide. (This also includes
   contract physicians who work in VA medical centers and providers credentialed through
   affiliation agreements with Medical Schools). This program requires special computer codes for
   access.

   In the absence of the credentials during a deployment of VA staff, the receiving VA can contact
   the originating facility to obtain permission to access the credentials through the Vetpro program.
   The Chief of Staff (COS) from the originating facility could also send a letter stating the provider
   is currently credentialed and has privileges at that facility and is in good standing. They could
   also provide the information on the privileges that the provider has with the originating facility.
   (Credentialing and privileging are two different issues.) This would allow the COS at the
   receiving VA to immediately grant privileges to a provider in a disaster/emergency situation.




                                                 R-1
EMERGENCY OPERATIONS PLAN                                                              August 2007
NETWORK                                                                                   Annex S



                              Continuity of Operations Plan (COOP)

1. Executive Summary. Presidential Decision Directive (PDD) 67 requires each federal department
   and agency to develop and maintain a Continuity of Operations Plan (COOP). The focus is to
   ensure that the respective department or agency can continue emergency essential functions, and
   resume normal operations as quickly as possible, in the event of a natural or man-made disaster or
   other event that would impact operational capability and capacity.
   Using an all-hazards approach, the Southwest Health Care Network Headquarters has developed
   an Emergency Operations Plan (EOP) that is consistent with planning guidance furnished by PDD
   67, Federal Preparedness Circular (FPC) 65, and Veterans Health Administration (VHA) Central
   Office (CO). This Plan also complies with the Joint Commission on Accreditation of Healthcare
   Organizations (JCAHO) Emergency Management Standard under the Environment of Care and
   the National Incident Management System.
   As with all emergency plans, it is hoped that this plan will never be used. As a result, this Plan is
   included in the Network Southwest Health Care Network Emergency Operations Plan (Annex S)
   and can be used to train employees, conduct exercises and provide a basis for continual update
   and improvement.
2. Introduction. The Emergency Operations Plan (EOP) is a component the Network’s Emergency
   Management Plan (EMP). The EOP is to be used for any hazard or threat to this Headquarters,
   external emergencies, and other. The EOP is structured to use the National Incident Management
   System (NIMS) and implement annexes.
3. Purpose. The purpose of the Network’s EOP is to describe how this headquarters will respond to
   emergency threats or events using the EOP. It provides an all-hazards approach to emergency
   management with the goal of protecting the life and safety of all employees and visitors to the
   headquarters office and to provide viable and executable contingency plans for the Continuity of
   Operations (COOP). COOP planning facilitates the performance of essential functions during and
   following any emergency or situation that may disrupt normal operations. The EOP will address
   policy requirements, assumptions and processes for a Network-wide response using the Hospital
   Incident Command System (HICS) and annexes.
4. Applicability and Scope. The COOP applies to all employees; it complies with FPC 65 and
   JCAHO requirements, as well as Veterans Health Administration (VHA) policies and federal
   regulations; and implements the VHA strategy for responding to all emergency events. It is
   designed to initiate a response to protect the well-being of employees and all occupants within the
   headquarters offices, protect the physical infrastructure and allow for business continuity to the
   fullest extent possible.
   a. In the event of an emergency or disaster, the headquarters will implement the EOP to make
      certain the necessary services are provided to ensure a safe environment for all employees and
      visitors. As required, the headquarters will work closely with the community to ensure
      effective interaction during response and recovery. The EOP and all annexes developed as a
      result of the Hazard Vulnerability Analysis (HVA), define the mitigation, preparedness,



                                                  S-1
EMERGENCY OPERATIONS PLAN                                                            August 2007
NETWORK                                                                                 Annex S



       response and recovery efforts necessary to minimize the potential adverse impact from all
       threats and events. The objectives of the EOP are:
       (1) Preventing and/or reducing loss of life and serious injury.
       (2) Protecting essential facilities, equipment, records and other assets.
       (3) Ensuring the continuous performance of essential functions/operations during an
           emergency.
       (4) Executing, as required, succession to office with accompanying authorities in the event a
          disruption renders agency leadership unable, unavailable or incapable of assuming and
          performing their authorities and responsibilities of offices.
       (5) Reducing or mitigating disruption to the headquarters operations; and, achieving a timely
           and orderly recovery from an emergency and resumption of full services.
       (6) Ensuring and validating COOP readiness through a dynamic, integrated test, training and
           exercise (TTE) program to support the implementation of COOP plans.
   b. The EOP ensures that the Southwest Health Care Network is capable of:
       (1) Being maintained at a high level of readiness and being implemented both with and
           without warning within twelve (12) hours and sustained up to thirty (30) days.
       (2) Scheduling regular testing, training and exercising of personnel, equipment, systems and
           procedures used to support the Network’s headquarters during a COOP event.
       (3) Including the development, maintenance and annual review of facility COOP capabilities
           using a multi-year strategy and program management plan.
   c. When activated, the EOP will provide for continued performance of essential functions under
      all circumstances. It also:
       (1) Defines a decision process for determining appropriate actions in implementing COOP
           plans and procedures.
       (2) Establishes a roster of fully equipped and trained personnel with the authority to perform
           essential functions and activities.
       (3) Provides a system for employee advisories, alerts and COOP activations plans with
           instructions for response with and without warning, during regular duty and non-duty
           hours.
       (4) Provides for personnel accountability throughout the duration of the emergency.
       (5) Establishes reliable policies, processes and procedures to acquire resources necessary to
           continue essential functions and sustain operations.
5. Essential Functions. The Network headquarters, located at the Williams-Gateway campus in
   Mesa, Arizona is responsible for providing oversight of seven VHA Health Care Systems in
   Arizona, New Mexico and West Texas and to assist in ensuring services are provided to all


                                                  S-2
EMERGENCY OPERATIONS PLAN                                                            August 2007
NETWORK                                                                                 Annex S



   eligible veterans    This COOP identifies essential functions as the basis for COOP planning. In
   order to identify these essential functions, each Section will complete a needs assessment that
   included:
          Determining all functions that must be uninterrupted.
          Prioritizing essential functions.
          Identifying mission critical data and systems necessary to conduct essential functions.
          Deferring functions not deemed essential to immediate needs until additional personnel
           and resources become available.

   The Network’s Emergency Operations Plan (which encompasses this COOP) is a supporting plan
   to the VA COOP. Agency interdependencies would be identified in the departmental level
   COOP, not in a subordinate level-supporting plan.


            Priority                         Essential Function
            1          Communications Reporting
            2          Computer Support
            3          Funding
            4          Coordinating Support with Network Facilities
            5          Logistical Support

6. Authorities and References. See paragraphs Annex S, 7.c.Leadership and c(2) Delegation of
   Authority.
7. Concept of Operations. If a warning or notification is received that a situation threatens to
   disrupt continuity of operations and/or poses a risk to staff and visitors safety, the Network
   Director/designee with primary responsibility and key managers will take appropriate action(s) to
   protect employees, visitors, resources and property based upon the threat.
   Hospital Incident Command System (HICS) will be used to plan, organize, staff, direct and
   control emergency situations. An ICS organization unfolds in a modular fashion upon the kind
   and size of an incident. The organization’s staff builds from the top down with responsibility and
   performance placed initially with the Incident Commander (IC). As the need exists, four separate
   sections (Operations, Plans, Logistics and Finance/Administration) can be developed, each with
   several units that can be established, as required. The specific organization structure established
   for any given incident will be based upon the management needs of the incident. If one individual
   can simultaneously manage all major functional areas, no further organization is required. If one
   or more areas require independent management, an individual is named to be responsible for that
   area.




                                                 S-3
EMERGENCY OPERATIONS PLAN                                                          August 2007
NETWORK                                                                               Annex S



  a. Decision Process. The EOP clearly describes the process of plan activation and the decision
     making process. It also needs to be recognized that the Network’s COOP is not a “stand-
     alone” plan, but is a supporting plan to the overall VHA COOP.
  b. Alert, Notification and Implementation Process. Whenever an emergency event or threat
     occurs that may require response, the IC or designee will acquire information as to the type
     event and potential impact to the headquarters. If the IC decides the emergency event will or
     may have an adverse impact to the headquarters, he or she will activate the EOP, which will
     require the following:
     (1) Implement the Mobilization Checklist (see Attachment D-4): This checklist provides a
         framework to initiate assessment, planning and emergency response based on current
         information available.
     (2) Activate EOC: The Hospital Incident Command System (HICS) will be
         activated.

     (3) Assess Incident Information and Evaluate: Depending upon the emergency, e.g., warning
         or real time event, the IC will determine the level of response based on the event and
         direct impact to headquarters based on information received from affected operational
         units and/or agencies from outside the facility:
                Naturally Occurring Events examples include:
                Drought
                Dust Storm
                E
                Flood
                Thunder Storm/Lightning
                /Microburst

                Human Related Events:
                Bomb Threat
                Civil Disturbance
                Cyber Attack
                Hostage/Barricade Situation
                Terrorist Event
                Violence in the Workplace

                Hazardous Materials Events:
                Biological Events
                   Anthrax Release in the Community or headquarters
                   Smallpox Release in the Community
                   Respiratory Virus Event (SARS or Pandemic Flu)
                  Chemical Events        Internal - None
                  External – Trucking on the 202 and Agricultural pesticides
                Radiation Exposure or Radioactive Contamination


                                               S-4
EMERGENCY OPERATIONS PLAN                                                        August 2007
NETWORK                                                                             Annex S



               Explosion-Internal headquarters Event (Evacuation Considerations)

               Business Continuity:
               Business Relocation
               Communications Disruption
               VISTA and other Computer System Disruptions

                Equipment, Plant and Utilities examples include:
               Alarm System Failure
               Electrical Power Failure
               Heating, Ventilation, Air Conditioning (HVAC) Failure (the Network is
               purchasing a generator for the Computer Room. There is an existing backup
               generator for the facility.
               Roads and Grounds Blocked (There is at least one other route in and out of the
               campus in addition to the main entrance.)
               Water Delivery/Potability (The Network has water delivered since it is believed
               that the campus water is not safe to drink.)

               Safety and Security:
               Alerting and Warning Facility Access Control
               Lockdown/Security - Heightened Security Procedures (Each Network staff
               member has a key to lockdown the Network offices.)
               Fire Suppression Systems Failure

     (4) EOC/Incident Commander Key Activities:
     (5) Situation Status. Maintain current information of the emergency event. Coordination
         with operating units and outside agencies that may include:
     (6) City/County Office of Emergency Services (OES), State Health Department, City/County
         Emergency Medical System (EMS), Federal/State Environmental Protection Agencies,
         Local Emergency Planning Committees (LEPC), Federal and Local Law Enforcement
         Agencies, e.g., FBI, ATF, etc., Local Utility and Waste Water Agencies, VISN and/or
         other VHA Contacts and Other Response Agencies such as the Red Cross.
     (7) Additional EOC/EOP functions and considerations:

               Initiating hazard reduction strategies and resource issues.
               Using SOP key activities spreadsheet for guidance.
               Conducting pre-event planning.

               Evaluating response actions and act accordingly.
               Initiating recovery actions when warranted.

               Conducting After Action Meeting and critique response actions and     make
               changes as necessary.


                                               S-5
EMERGENCY OPERATIONS PLAN                                                          August 2007
NETWORK                                                                               Annex S




     (8) Reporting
        (a) During any emergency event, communication is a major activity. Emergency
            communications will be by (telephone/cell phone/e-mail or satellite phone). If the
            telephone system is inoperable, the staff will contact Security by any means possible
            and request assistance.
        (b) The employee discovering the emergency will usually make first notification of an
            internal emergency. Fire notification can be through pulling the fire alarm box. Any
            emergency can be reported by dialing the emergency number 9-911. Know the
            location and number for the building being reported.
        (c) During the early stages of an emergency, information about the event may be limited.
            If the emergency is internal, it is important to communicate with the other staff as soon
            as possible.
        (d) If the internal emergency is other than a fire, the person in charge will determine if
            assistance from outside agencies is necessary. If outside assistance is needed, the
            person discovering the emergency will notify the VA policetelephone operator via the
            emergency number. If outside assistance is required, the staff will call 9-911.

     (9) Damage Assessment. The Carl T. Hayden Health Care System Engineering
         Service will perform damage assessment, and notify the Network Director if the
         buildings are suitable to maintain normal operations.

    (10) Evacuation. The purpose of this section is to describe how evacuation from the facility
        should take place. It outlines priorities for evacuation, and sets out in concept how the
        evacuation should take place. Each situation is different, and the individuals responsible
        for the evacuation need to consider the actual event and act accordingly.
        (a) The decision to evacuate is not an easy one. All available staff members and other
            able-bodied persons should do everything possible at the location of the emergency to
            assist emergency personnel and the removal of employees and visitors to a point of
            safety.
        (b) Exact evacuation procedures to be followed will be dictated by the nature of disaster
            and the extent of damage to the building.
        (c) Orders for evacuation will be given by the Director/designee.
        (d) Close all doors and windows.
        (e) Turn off all unnecessary electrical equipment, but leave the lights on.
        (f) Evacuate the area/building. Evacuation plans are posted on corridor walls.

    (11) Status of Personnel. In the event of total evacuation and determination that the
         facility is damaged to the extent that personnel are not able to work at the primary
         location, the Network Director will make a decision on the status of employees.
         Designated personnel (GS-13 and above) will report to the alternate Network Emergency


                                               S-6
EMERGENCY OPERATIONS PLAN                                                         August 2007
NETWORK                                                                              Annex S



        Operations Center which will also serve as the COOP located at the Carl T. Hayden
        VAMC Nursing Home Room K112. Other personnel will be notified by his or her
        supervisor regarding his or her work status. The employees below the GS-13 pay grade
        will be assigned to work at the Carl T. Hayden VA Medical Center, at home or placed on
        Authorized Absence (AA). Each employee will be required to inform his or her
        supervisor of his or her location during the assigned tour of duty. These employees may
        be assigned to report to the alternate COOP site or other designated sites as deemed
        appropriate by their supervisor.

    (12) Public Information. During an emergency event, the need to disseminate accurate
        information to the public is essential. Good public information is necessary to keep
        people informed on what has happened and may/will happen. The information should
        address misinformation, and provide information to assist the public in their planning.
    (13) Critical Incident Stress Management. The purpose of this section is to describe a
        temporary stress management program that may be activated to assist victims and staff
        during the response phase of an emergency. This section will describe the mission,
        leadership, when the activity is activated, location, initial staffing and supplies and
        equipment needed to activate the area.
        (a) Stress is a normal response to an abnormal situation. During the response phase of an
        emergency staff may require psychological support.
        (b) Long-term support may be provided by internal staff or through the employee
        assistance contract provider.

                Levels of stress response/management to be part of this program include: acute
                disorders, stress intervention, stress debriefing and slowly evolving disorders.
                Critical incident stress management is designed to provide short-term intervention
                and support during the response phase of an emergency and for employees during
                the recovery phase of the emergency. This will be accomplished through
                intervention and individual and group debriefing sessions.
                Critical incident stress management resources will be provided to assist staff as
                deemed appropriate, or if the staff member requests assistance.

    (14) Administration and Implementation. The effectiveness of the administration of this plan
         shall be evaluated through plan implementation during actual emergencies or exercises.
         All employees at the headquarters receive training on the EOP and their roles
         commensurate with their responsibilities.
    (15) Information Collection and Evaluation System. Drills are conducted annually. Critiques
         of drills and actual emergencies are reviewed, and the information gained from them is
         used to develop and improve the EOP. Documentation of drills is forwarded to the VISN
         Emergency Planning Coordinator. If you have any questions or need additional assistance
         with the information contained in the EOP, please contact the Emergency Planning
         Coordinator, Tommy W. Ragan 602-200-2356 or the Deputy Network Director at 602-
         200-2134.


                                              S-7
EMERGENCY OPERATIONS PLAN                                                             August 2007
NETWORK                                                                                  Annex S



   c. Leadership.
       (1) Order of Succession. The order of succession for the Network is: The Network Director
           will assume full responsibility for operation of the Network Headquarters. Further
           successors are identified in the order in which they will assume command when the
           previous person on the list of successors is unavailable during an emergency. Each
           successor will be relieved of their temporary responsibilities when either the emergency
           ends or the next higher successor is available to assume command. The successors are
           listed in the chart below.


                                   Order of Succession
Network Director
Deputy Network Director
Chief Medical Officer (CMO)
Chief Fiscal Officer (CFO)
Chief Logistics Officer (CLO)


       (2) Delegation of Authority:
              Identifies the programs and administrative authorities needed for effective Network
              operations during an emergency.
              Documents the necessary authorities at all points where emergency actions may be
              required.
              Ensures that officials who may be expected to assume authorities in an emergency are
              trained to carry out their emergency duties.

                                 Delegations of Authority
Network Director authorities are assigned to the Network Chief Medical Officer until
VACO appoints an acting Network Director
CFO authorities are delegated to the Cindy Schoenwetter, Health Systems Specialist
CLO authorities are delegated to Gloria Garcia, V18 Contract Manager
Human Resource authorities are delegated to Melody Mikutowski, Recruitment Coord.
ISO authorities will be delegated to an individual by VACO


       (3) In addition to the authorities not already delegated to the members of the Team by virtue
       of their regular positions within the headquarters, all of the authorities of the Director are
       hereby delegated to the following members of the Team: (See order of succession.) These
       authorities may not be re-delegated.



                                                 S-8
EMERGENCY OPERATIONS PLAN                                                             August 2007
NETWORK                                                                                  Annex S



       (4) The authorities delegated by this Plan are to be exercised only in the case of emergencies
       and only in cases where the Network Director is unavailable or unable to perform his/her
       duties. These authorities may be exercised by members of the Team named above, as they are
       available and able and in the order in which they are listed, until such time as the Director is
       available to exercise such authorities.
       (5) Mission Critical Systems. Each headquarters’ key operating official has evaluated and
       documented the mission critical systems for their function. These are documented on the Key
       Operating Unit templates and are available in each Section Chief’s office.
       (6) Vital Files, Records and Databases. Each Section Chief maintains their vital records and
       provides for the security. Commonly shared information is maintained by the VISN
       Telecommunications Manager, with appropriate checks and security.
8. COOP Planning Responsibilities. Listed below are the key personnel and their responsibilities in
   the Network EOP:
       Network Director or Designee is responsible for carrying out the duties of the Incident
       Commander (IC) or Agency Executive. He/she is responsible for all headquarters
       response/recovery actions and for coordination with VA and external public officials.
       E): The Capital Asset Manager is the Network Emergency Program Coordinator. The EPC
       is responsible for carrying out the duties of Plans Section Chief and/or Liaison Officer.
       He/she ensures that the EOP is current, assists the IC with internal (Key Operations Managers)
       and external (community or agency) coordination. The Network EPC coordinates the
       Network’s emergency management program with the Albuquerque and Tucson Area
                                    Deputy Network Director: The Deputy Network Director is
       responsible for carrying out the duties of Deputy Incident Commander or Operations Chief for
       incidents that do not include significant medical/health issues.
       Chief Medical Officer: The Chief Medical Officer is responsible for carrying out the duties of
       a medical operations officer.
       Safety Officer: Any Network staff member can be assigned the Safety Officer duties and
       would be responsible for carrying out the duties of the incident Safety Officer and/or
       Safety/Security Group Leader. He/she monitors and initiates actions to ensure safe actions are
       taken during the emergency event.
       Public Affairs Officer: The Executive Assistant to the Network Director will act as the point
       of contact for the media that may request information concerning the incident and its impact
       upon patients, staff, and facility.
       Chief Fiscal Officer: The Chief Fiscal Officer is responsible for carrying out the duties of the
       Finance Chief. He/she coordinates funding and tracks expenses that relate to Network’s
       response to the emergency event.
       Chief Logistics Officer: The Chief Logistics Officered is responsible for carrying out the
       duties of the Logistics Officer. He or she coordinates emergency contracts and the
       procurement of supplies and equipment that are required in response to an emergency.


                                                 S-9
EMERGENCY OPERATIONS PLAN                                                              August 2007
NETWORK                                                                                   Annex S



     Chief Information Officer: Chief Information Officer is responsible for carrying out the duties
     of the Information Officer. He/she coordinates all activities related to information
     technology, including telephones, satellite phones, GETS cards, ham radio equipment, DHCP
     VISTA and the Network’s e-mail exchange server.
     ALL Network Headquarters Staff:
     (1) Maintain normal operating procedures to the best of their ability.
     (2) Notify Security or facility operator of any disturbance or emergency (i.e. fire, bomb threat,
         external community disaster, etc.) that may affect the headquarters.
     (3) Immediately check for injuries among staff and offer assistance, as practical. Seriously
         injured persons should not be moved unless they are in danger of further injury.
     (4) In the event of fatalities, area staff should cover the bodies and report to Incident
         Commander or supervisor as soon as possible.
     (5) Secure/protect records and other official files.
     (6) Ensure forwarded communications.
     (7) Shall:



                                                                        T) and other emergency
           responses. Where possible, staff should act to protect the life and safety of visitors and
           fellow employees.
                                                These exercises are intended to practice
           emergency response activities and improve readiness.

           how to improve the planning response activities.

                                   ion and education, as required.


                  Responsibility                                      Position
  Review and update, if necessary, COOP        Capital Asset Manager and VISN Area Emergency
  plan annually                                Managers (AEMs)
  Update telephone rosters biannually          Executive Assistant to the Network Director
  Review status of vital files, records and    Chief Information Officer
  databases
  Conduct alert and notification tests         Deputy Network Director
  Participate in the development of COOP       Deputy Network Director



                                                S-10
EMERGENCY OPERATIONS PLAN                                                              August 2007
NETWORK                                                                                   Annex S



   training
   Participate in COOP exercises                 Key Network personnel identified in paragraph 8
                                                on the preceding page.


9. Logistics.
   a. Alternate Location. In the event the headquarters operations are interrupted to the extent that
      staff are unable to provide essential functions in the existing facility the staff will relocate to
      the Alternate Emergency Operations Center located at the Carl T. Hayden VA Health Care
      System, Phoenix, AZ.
   b. Interoperable Communications. The headquarters maintains communications within the
      facility by telephone, cell phone, pagers and hand-held walkie-talkies. Interoperable
      communications are available through e-mail, GETS cards and satellite telephones.
   c. Alternate Site Communications: The VISN Telecommunications Manager will ensure
      computer capability at the alternate site. This commuter capability should be established to
      mirror access to all programs and functions routinely conducted at the primary location.
10. Test, Training and Exercises. Exercises are conducted at least annually. Records and critiques
     of the exercises are maintained by the Area Emergency Managers and the VISN Emergency
     Planning Coordinator.
11. COOP Plan Maintenance. This Network COOP will be evaluated at least annually and updated
    as needed. There shall be training opportunities provided to all staff regarding emergency
    management, including elements of the plan.


12. Review Date: Annually by the Emergency Management Subcommittee.




                                                 S-11
EMERGENCY OPERATIONS PLAN                                                             August 2007
NETWORK                                                                                  Annex T



                            Standard Operating Procedure (SOP)
            Large Scale Evacuation of VA Medical Centers by Commercial Contract

1. References:

a. VA Blanket Purchase Agreement (BPA) Number VA 101(049A3)-BP-0044

b. VA Directive 6504, "Restrictions on Transmission, Transportation and Use Of, and Access To,
VA Data Outside, VA Facilities", dated June 7, 2006

2. Purpose. The purpose of this SOP is to provide VA Planners with a concept of operations for the
activation and employment of a commercial BPA to assist in the large scale evacuation of VA
Medical Centers when required.

3. Objective. Within 24 hours of notification, evacuate up to a minimum of 30 intensive care litter
patients, a minimum of 150 litter patients and a minimum of 200 ambulatory patients from VA
facilities experiencing an emergency, or about to experience an emergency, to safer VA facilities up
to 500 miles distance.

4. Scope. This SOP supports all VA medical facilities in the United States and Puerto Rico during
the specified term of the BPA with Marbrisa Air Ambulance Company (affiliated with Strong Arm
Air Cargo, Inc. of Clearwater, Florida).

5. Assumptions:

a. Natural and/or manmade disasters and emergencies may be foreseen by a few days or may occur
without warning that compel the evacuation of one VA Medical Center (VAMC).

b. In the event of weather related emergencies, the main commercial airport(s) closest to the affected
VA facility will close 12 to 18 hours prior the weather event (e.g., hurricane).

c. Other VA patient evacuation operations (e.g., using VA owned or contracted ground ambulances,
and/or military assets) may occur simultaneous to the employment of commercial aeromedical assets
under the BPA with Marbrisa Air Ambulance Company.

d. In addition to a VA medical facility in an affected area, other governmental and non-governmental
medical facilities in the affected area may conduct patient evacuation operations simultaneous to VA
operations.

6. Concept of Operations:

a. VAMC Director determines the need to evacuate their facility and, in consultation with the
Veterans Integrated Service Network (VISN) Director, determines that the effort should be supported
by commercial aeromedical means. The VAMC Director identifies a 24/7 Point Of Contact who will


                                                 T-1
EMERGENCY OPERATIONS PLAN                                                            August 2007
NETWORK                                                                                 Annex T



be responsible for coordinating patient preparation and local ground transport operations with
Marbrisa Air Ambulance Company.

b. VISN Directors coordinate with the Deputy Under Secretary for Health for Operations and
Management (10N) to determine destination VAMC(s) for evacuated patients. Directors of
destination VAMC(s) identify a 24/7 point of contact who will be responsible for coordinating local
patient reception operations.

c. VHA (10N) selects the services required from Marbrisa Air Ambulance Company and coordinates
with the VHA Joint Operations Center (JOC).

d. The VHA JOC coordinates with authorized VA employees (listed below) to activate the BPA.

e. Marbrisa Air Ambulance Company coordinates evacuation operations directly with the identified
points of contact at the affected VAMC and at the destination VAMC(s).

7. BPA Activation Procedures:

a. In addition to the VA Contracting Officer, the following Department of Veterans Affairs
employees are authorized to place orders under the BPA with Marbrisa Air Ambulance Company:

Name                  Organization                  Dollar limit per purchase

Michael Vojtasko       Chief Consultant             $300,000.00 Max Per Call
                       EMSHG (13C)
                      (304) 264-4805/4835

Paul D. Kim, MD       Director of Operations        $300,000.00 Max Per Call
                      EMSHG
                      (304) 264-4815

Richard Callis        Deputy Chief Consultant       $300,000.00 Max Per Call
                      Operations and Planning
                      EMSHG
                      (304) 264-4800

Michael Feeser        Director of Plans             $300,000.00 Max Per Call
                      EMSHG
                      (304) 264-4805

b. Authorized VA employees will place orders telephonically or in person, will identify themselves
and provide the following information:

- BPA number
- Task Order number

                                                 T-2
EMERGENCY OPERATIONS PLAN                                                             August 2007
NETWORK                                                                                  Annex T



- Specific description of the supplies or services being purchased
- The unit price(s) and total price established by agreement with the Supplier; and
- The time and place of delivery.

c. The Marbrisa Air Ambulance Company contact information is:

Strong Arm Air Cargo, Inc.
4525 Airport Parkway
Clearwater, FL 33762-1451
Phone: (727) 532-9000
Fax: (727) 376-8737
24 Hour Phone: (813) 478-1586
8. Menu of Services Available. Orders placed under the BPA with Marbrisa Air Ambulance
Company may be for any or all of the following services from Marbrisa Air Ambulance Company, as
the situation warrants:

a. Operations Command and Control (OCC). Within two hours of notification from VA, the OCC
will be staffed 24/7 by 5 Marbrisa personnel with aviation, air ambulance and logistics expertise to
coordinate all aspects of the evacuation. The OCC will liaise with the VHA JOC to ensure situational
awareness as operations proceed. The VHA JOC 24 hour phone is: (304) 264-4800.

b. Field Coordination "Tiger" Team. The Marbrisa "Tiger" Team will consist of three physicians and
two administrative aides who will deploy to coordinate the evacuations between the affected VAMC,
the Marbrisa air ambulance aircraft, the Marbrisa OCC and the receiving VAMC(s). The "Tiger"
Team will be moved into place on the first air ambulance aircraft to respond from Marbrisa’s home
base. It is capable of assessing the situation, patient’s needs, insuring the correct air ambulance
medical crew is in place to perform the lift, ground ambulance crews are available and security issues
are mitigated. "Tiger" Team members may elect to ride with a patient on the aircraft if in their
opinion their skills may be required. The "Tiger" Team requires the following, to be provided by or
reimbursed therefore by VA: laptops, cell phones, black berries and portable satellite phones.

c. Air Ambulance Aircraft. Marbrisa will contract for up to 30 aircraft to work the project. Each air
ambulance will be capable of handling a litter patient and two to three ambulatory patients. Each air
ambulance will be equipped with an advanced life support stretcher system, patient oxygen, suction
and inventory. The medical crew will consist of a flight nurse and a respiratory therapist. This
amount of lift will move up to a minimum of 30 intensive care litter patients, up to a minimum of 150
litter patients and up to a minimum of 200 ambulatory patients within 24 hours.

d. Ground Ambulances. If the VA does not have a contract in place for these services, Marbrisa will
enter into agreements with appropriate certified vendors to provide the service.

e. Reports Manager. A member of the Marbrisa staff will be assigned as a Reports Manager to
professionally chronicle and maintain an hour-by-hour history of the evacuation in order to present
the VA with a detailed report within 21 days of conclusion of the case.


                                                  T-3
EMERGENCY OPERATIONS PLAN                                                               August 2007
NETWORK                                                                                    Annex T



f. Security Element. A ten person security detail will fly via commercial carrier to the closest airport
to the affected VAMC. At the airport the team will rent two vans for transportation. Upon arrival the
Security Element leader will liaise with the affected VAMC and the local police department to
coordinate routing and security from the facility to the airport. Upon arrival at the airport the security
detail would also assist in loading and patients.

9. Marbrisa Air Ambulance Company Responsibilities:

a. Provide emergency medical evacuation services for VA patients in the United States and/or Puerto
Rico if and when ordered by the Contracting Officer or an authorized representative during the
specified term of this agreement.
b. Along with all sub-contractors, be responsible for providing all aviation medical staff, equipment,
drugs, medicines and supplies needed for contract performance and be ready to begin performance
immediately after notification with the first evacuee airborne within six hours of notification and the
last evacuee airborne within 24 hours of notification.

c. Employ an organization, staffing, and management structure that will ensure completion of all
tasks on time, within budget, with a goal of exceeding expectations.

d. Enter into agreements and coordinate with ground ambulance providers in the area of the affected
VAMC to provide ground ambulance services on a priority basis to Marbrisa Air Ambulance. If the
VA has contracts in place with the facility ground ambulance operators, these operators will be
utilized first.

e. Enter into agreements, coordinate and credential air ambulance operators to insure that the number
of aircraft required for the lift to be performed are available when requested. Insure the operators
provide two complete flight and medical crews consisting of a registered nurse and respiratory
therapist to allow for 24 hour evacuation, as crew duty times are limited to 14 hours.

f. Coordinate with local police with jurisdiction where evacuated facilities are located as well as
coordination with the Transportation Security Administration and security officials at airports to used
for the evacuation.

g. Enter into agreements and coordinate with operators at both primary lift and secondary lift airports
where evacuations will be launched from. This coordination will be for fueling, and handling to
insure Marbrisa aircraft will have fuel and access to start carts, ground power units, and hangar
facilities to load during inclement weather.

h. Along with all sub-contractors, be responsible to have the necessary use rights and landing rights
at all airports to be served.

i. Execute all planning using proven operations security measures for maximum feasible security of
operations and personnel.




                                                   T-4
EMERGENCY OPERATIONS PLAN                                                                August 2007
NETWORK                                                                                     Annex T



j. Prepare quality assurance reports, as required, in order to identify and correct any issues in the
conduct of operations before escalation. They will be available on request.

k. Provide service in accordance with the safeguards of VA Directive 6504. This directive identifies
compliance with the technology and processes necessary to ensure that all VA sensitive data (personal
identifying data such as name, address, SSN and date of birth; and, personal information such as
medical condition, diagnostic codes, treatments, medications or billing information) is secure. This
includes data that is stored, generated or exchanged by VA, a contractor, subcontractor or a third
party, or of any of these entities, regardless of format (i.e., paper, microfiche, electronic or magnetic
portable media), or whether it resides on a VA or contractor or subcontractor’s electronic information
system.


___________________________      ____
Joseph A. Williams, Jr. BSN, MPM Date
Assistant Deputy Under Secretary
For Operations and Management




                                                   T-5

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:5
posted:8/28/2012
language:English
pages:111