Section 4 - Emergency Operations Planning

Table of Contents

4.1. Types of Planning in Emergency Management Programs 4 - 1

4.2. Types of Emergency Operations/Response Planning 4 - 1

4.3. Principles 4 - 1

4.4. Use of the Incident Command System (ICS) 4 - 2

> 4.4.1. National Incident Management System (NIMS) 4 - 2
>
> 4.4.2. Incident Command System (ICS) 4 - 2
>
> 4.4.2.1. Command (Management) Section 4 - 3
>
> 4.4.2.2. Operations Section 4 - 4
>
> 4.4.2.3. Planning Section 4 - 5
>
> 4.4.2.4. Logistics Section 4 - 7
>
> 4.4.2.5. Finance Section 4 - 8

4.5. What Is The Emergency Operations Plan (EOP)? 4 - 10

4.5.1. Developing an EOP 4 - 10

Figure 4.1: Essential Function Assignment Matrix 4 - 10

Figure 4.2: VHA EOP Format 4 - 11

4.5.2. Aligning ICS within the EOP 4 - 11

4.5.2.1. Management and Planning 4 - 11

4.5.2.2. Logistics and Finance 4 - 13

4.5.2.3. Operations Section 4 - 14

4.5.2.3.1. Business Continuity Operations 4 - 14

4.5.2.3.2. Equipment, Plant and Utilities Operations 4 - 15

4.5.2.3.3. Safety and Security Operations 4 - 16

4.5.2.3.4. Health and Medical Operations 4 - 17

4.6. Implementation 4 - 18

> 4.6.1. Initial Actions Upon Recognition of an Actual or Potential
> Event 4 - 18
>
> 4.6.1.1. Incidents Without Warning 4 - 18
>
> 4.6.1.2. Incidents With Warning 4 - 18
>
> 4.6.2. Continuing Actions 4 - 18
>
> 4.6.2.1. Incident Management Team 4 - 18
>
> Figure 4.3: Incident Management Team Designations 4 - 19
>
> 4.6.2.2. Incident Management Facilities 4 - 19
>
> 4.6.2.3. Emergency Operations Center 4 - 19
>
> 4.6.2.4. Operational Relationships 4 - 19
>
> Figure 4.4: VHA CO EOP 4 - 20
>
> 4.6.3. Incident Action Planning 4 - 21
>
> Figure 4.5: IAP Planning Process 4 - 21
>
> Figure 4.6: Checklist for Development of an IAP 4 - 22

4.6.4. Situation Status Reporting 4 - 22

*Enclosures*

1\. Sample VISN EOP 4 - 23

2\. Sample VAMC COOP Readiness Plan and VAMC EOP 4 - 27

3\. Sample VA Community Based Outpatient Clinic (CBOC) EOP with
Attachments 4 - 53

4\. Sample Key Activity Management Tool Template 4 - 71

5\. Key Activity Management Structure Template 4 - 73

6\. Employee Responsibility Pamphlet 4 - 75

*The following documents are on the CD-ROM that accompanies this
Guidebook*

*and at the CEOSH web site (vaww.ceosh.med.va.gov):*

7\. ICS Position Descriptions CD

Incident Manager

Incident Manager/Branch Director

Public Affairs Officer

Liaison Officer

Agency Representative

Safety Officer

Planning Section Chief

Situation Status Unit Leader

Resource Status Unit Leader

Documentation Unit Leader

Logistics Section Chief

Facilities Unit Leader

Communications Unit Leader

Transportation Unit Leader

Supply Unit Leader

Finance Section Chief

Time Unit Leader

Procurement Unit Leader

Compensation and Claims Unit Leader

Cost Unit Leader

Operations Section Chief

Business Continuity Group Leader

Equipment Plant and Utilities Group Leader

Safety-Security Group Leader

Health-Medical Group Leader

8\. ICS Reporting Forms CD

9\. EOC Guidance - Comprehensive Emergency Management (CEM) Program and

Emergency Operations Plan (EOP) CD

Section 4

Emergency Operations Planning

4.1. ***Types of Planning in Emergency Management Programs***. In 2004,
the National Fire Protection Association's (NFPA) Standard 1600,
Disaster/Emergency Management and Business Continuity Programs, was
designated as the nation's preparedness standard by the 9-11 Commission.
NFPA 1600 (<http://nasttpo.org/NFPA1600.htm>), while not mandatory for
healthcare organizations, is the basis for state, local and tribal
emergency management agency accreditation.

Emergency management involves the development of several kinds of plans:
strategic plans, which set the overall course and direction of the
program; emergency operations/response plans, which focus on the
mechanisms for activating the organization and its assets during an
actual operation; mitigation plans, which focus on prevention and
reduction of the impacts of hazards; continuity of operations plans and
a recovery plan or strategy, which guides the organization through
restoration of services, facilities and functions following a disaster
event.

4.2. ***Types of Emergency Operations/Response Planning***. For the
purposes of this guidance, three types of emergency operations/response
planning will be discussed:

-   *Emergency Operations Plan (EOP)* - Describes the organization-wide
    strategy for coordinating response and recovery actions. The EOP
    organizes the various Operating Units into Incident Command System
    (ICS) functional groups. The EOP serves as the basis for development
    of incident-specific guidance (see paragraph 4.5 below).

-   *Incident-Specific Guidance* - There are two types of
    incident-specific guidance: Readiness Plans and Standard Operating
    Procedures (SOPs). Sample Readiness Plans (see Section 5) were
    developed to provide guidance for special situations (Continuity of
    Operations; Chemical, Biological, Radiological, Nuclear and
    Explosive (CBRNE) events; and Decontamination). Sample Standard
    Operating Procedures (SOPs) (see Section 6) have been developed for
    many natural, technological and man-caused hazards, threats and
    events. SOPs contain basic information that can be used to guide the
    initial response to hazards, threats and events.

-   *Incident Action Plans (IAPs)* - Process used to guide on-going
    response and recovery activities. Incident-focused planning that
    consists of establishing objectives, priorities, staff assignments
    and resource requirements for each operational period. (See
    paragraph 4.6.3 below.)

4.3. ***Principles***.

4.3.1. Planning for disasters is not the same as disaster management.
Disaster planning is an ongoing educational process designed to reduce
the unknowns for those who will be responsible for carrying out certain
actions during emergencies and disasters. The Incident Command System
(ICS), a component of the National Incident Management System (NIMS),
provides a universal structure and process to manage the organization's
response and recovery activities.

4.3.2. The organization of the Emergency Operations Plan is based on the
functions of the Incident Command System. This enhances overall
coordination between services and departments and simplifies staff
education and training, since the structure applies to all hazards.

4.4. ***Use of the Incident Command System (ICS)***.

4.4.1. *National Incident Management System (NIMS)*
<http://www.fema.gov/nims>. Homeland Security Presidential Directive
(HSPD) #5, Management of Domestic Incidents, was signed by the President
in February 2003. (Beginning in fiscal year 2005, federal departments
and agencies shall make adoption of the NIMS a requirement.) The purpose
of this Directive is to enhance the ability of the United States to
manage domestic incidents by establishing a single comprehensive
National Incident Management System. In order to prevent, prepare for,
respond to and recover from terrorist attacks, major disasters and other
emergencies, the United States Government shall establish a single
comprehensive approach to domestic incident management. The objective is
to ensure that all levels of government across the Nation have the
capability to work efficiently and effectively together, using a
national approach to domestic incident management. Working within these
efforts and with regard to domestic incidents, the United States
Government treats crisis management and consequence management as a
single integrated function, rather than as two separate functions.

HSPD #5 directed the Secretary of Homeland Security to develop, submit
for review to the Homeland Security Council and administer a National
Incident Management System (NIMS). This system will provide a consistent
nation-wide approach for federal, state and local governments to work
effectively and efficiently together to prepare for, respond to and
recover from domestic incidents, regardless of cause, size or
complexity. To provide for inter-operability and compatibility among
federal, state and local capabilities, the NIMS will include a core set
of concepts, principles, terminology and technologies covering: the
incident command system; multi-agency coordination systems; unified
command; training; identification and management of resources (including
systems for classifying types of resources); qualifications and
certification; and, the collection, tracking and reporting of incident
information and incident resources.

4.4.2. *The Incident Command System*'s (ICS) organizational structure
described below is completely consistent with the NIMS requirement. An
ICS organization has five major functional areas:

-   Command

-   Operations

-   Planning

-   Logistics

-   Finance

4.4.2.1. **Command (Management) Section**. Command is responsible for
overall management of the incident. Command also includes certain staff
functions required to support the command function. The command function
may be conducted in two general ways:

A. Command Function.

-   Single Command - In a single command structure, a single incident
    commander is solely responsible (within the confines of authority)
    to establish objectives and overall management strategy associated
    with the incident. The incident commander is directly responsible
    for follow-through to insure that all functional area actions are
    directed toward accomplishment of the strategy. The implementation
    of the planning required to effect operational control will be the
    responsibility of a single individual (operations chief) who will
    report directly to the incident commander.

-   Unified Command - In a unified command structure, the individuals
    designated by their jurisdictions (or by departments within a single
    jurisdiction) must jointly determine objectives, strategy and
    priorities. As in a single command structure, the operations chief
    will have responsibility for implementation of the plan. The
    determination of which agency (or department) the operations chief
    represents must be made by mutual agreement of the unified command.
    It may be done on the basis of greatest jurisdictional involvement,
    number of resources involved, by existing statutory authority or by
    mutual knowledge of the individual's qualifications for a specific
    type of incident.

B. Command staff positions are established to assume responsibility for
key activities that are not a part of the line organization. Although
additional positions may be required depending upon the nature and
location of the incident or requirements established by the incident
commander, in IMS three specific staff positions are identified:

-   *Information Officer* (Public Affairs Officer) - The Information
    Officer's function is to develop accurate and complete information
    regarding incident cause, size, current situation, resources
    committed and other matters of general interest. The Information
    Officer will normally be the point of contact for the media and
    other governmental agencies that desire information directly about
    the incident. In either a single or unified command structure, only
    one Information Officer would be designated. Assistants may be
    assigned from other agencies or departments involved.

-   *Safety Officer* - The Safety Officer's function at the incident is
    to assess hazardous and unsafe situations and develop measures for
    assuring personnel safety. The Safety Officer should have emergency
    authority to stop and/or prevent unsafe acts. In a unified command
    structure, a single Safety Officer would be designated. Assistants
    may be required and assigned from other agencies or departments
    making up the unified command.

-   *Liaison Officer* - The Liaison Officer's function is to be a point
    of contact for representatives from other agencies. In a single
    command structure, the representatives from assisting agencies
    coordinate through the Liaison Officer. Under a unified command
    structure, representatives from agencies not involved in the unified
    command coordinate through the Liaison Officer. Agency
    representatives assigned to an incident should have authority to
    speak on all matters for their agency.

4.4.2.2. **Operations Section**. Tactical operations at the incident
include all activities that are directed toward reduction of the
immediate hazard, establishing situation control and restoration of
normal operations. The specific method selected will be dependent upon:

-   The type of incident.

-   The agencies involved.

-   The objectives and strategies selected.

A. Functions.

-   *Staging Areas*. Staging areas are locations designated by the
    Operations Chief within the incident area where resources available
    for assignment are temporarily located. The Operations Chief may
    establish, move or discontinue the use of staging areas. All
    resources within the designated staging areas are under the direct
    control of the Operations Chief and should be on a 3-minute
    availability. Staging area managers will request logistical support
    (for example, food, fuel and sanitation) from appropriate logistics
    section units.

-   *Resources*. Initially in any incident, the individual resources
    that are assigned will be reporting directly to the individual who
    has overall responsibility - the Incident Commander. As described
    earlier, as the incident grows in size or complexity the Incident
    Commander may designate an operations chief to assume tactical
    direction of resources. Resources may be used in several ways:

    1.  Single Resources - In general, single resources will be used for
        initial attack and first-response situations.

    2.  Task Forces - Task forces are any combination of resources put
        together for a specific assignment. Task forces call for a
        leader, usually in a separate vehicle, and command
        communications between all resource elements.

    3.  Strike Team - Strike teams are a set number of resources of the
        same kind and type with common communications, operating under
        the direct supervision of a leader.

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-   *Organization of Operations - Divisions, Groups and Branches*.
    Operational control can be organized in three ways when the number
    of resources (single increments, task forces or strike teams)
    exceeds the span-of-control of the operations chief or allows for
    clearer designation of activities:

1)  Geographical Divisions - The best use of geographical divisions is
    to divide an area into natural separations of terrain, geography
    and/or population density.

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1)  Functional Groups - Functional groups can best be used to describe
    areas of like activity. For example, off-loading, triage, treatment,
    holding, patient recording, transportation, etc., could be
    functional groups.

> Note: The organizational structure described in this Guidebook uses
> functional groups: business continuity; equipment, plant and
> utilities; safety and security; and, health and medical. This approach
> to organizing operations takes into account the range of operational
> requirements hospitals may face from the impacts that hazards, threats
> and events can have on a healthcare facility (most other ICS models
> proposed for hospitals focus solely on providing medical care to
> arriving victims).

-   *Branches* - Branches may be established when the incident is
    multi-jurisdictional and where resources are best managed under the
    agencies that have normal control over those resources.

B. Staff.

-   *Operations Section Chief and Deputies*. The Operations Section
    Chief is responsible for the direct management of all incident
    tactical activities. The Operations Chief assists in the formulation
    of the action plan. An Operations Chief should be designated for
    each operational period, and the chief should have direct
    involvement in the preparations of the action plan for the period of
    responsibility. The Operations Chief may have deputy positions.
    Deputies from other agencies are encouraged in multi-jurisdictional
    situations. Deputies should be equally as qualified as the
    Operations Chief.

4.4.2.3. **Planning Section**. The Planning Section is responsible for
the collection, evaluation and dissemination of tactical information
about the incident. The Section maintains information on the current and
forecasted situation and on the status of resources assigned to the
incident. The Section is also responsible for the preparation and
documentation of action plans. The Section has four primary units and
may have a number of technical specialists to assist in evaluating the
situation and forecasting requirements for additional personnel and
equipment.

-   *Planning Section Chief and Deputy* - The Planning Section Chief is
    responsible for the gathering and analysis of all data regarding
    incident operations and assigned resources, developing alternatives
    for tactical operations, conducting the planning meetings, and
    preparing the action plan for each operational period. Under a
    unified command structure, the Planning Section Chief may have a
    deputy from one or more of the other involved jurisdictions.

-   *Resources Unit* - The Resources Unit has the responsibility to make
    certain that all assigned personnel and resources have checked in at
    the incident. It is also responsible for maintaining current status
    on all resources. A status keeping system will be required that will
    show the current location of all assigned resources as well as the
    current status condition for all resources. The Resources Unit will
    maintain a master list of all resources. This should include key
    supervisory personnel, primary resources used in tactical
    operations, support resources, transportation equipment, and all
    others.

-   *Situation Unit* - The Situation Unit is responsible for collecting,
    processing and organizing situation information; preparing situation
    summaries; and, developing projections and forecasts of future
    events related to the incident. The Situation Unit will prepare maps
    and intelligence information for use in the action and recovery
    plan(s). The Situation Unit may also require expertise in the form
    of technical specialists.

-   *Documentation Unit* - The Documentation Unit is responsible for
    maintaining accurate and complete incident files; providing
    duplication services to incident personnel; and for filing,
    maintaining, and storing incident files for legal, analytical and
    historical purposes. The Documentation Unit is maintained within the
    Planning Section primarily because it has a major responsibility
    toward the preparation of the Incident Action Plans, as well as
    maintaining files on many records that are developed as part of the
    overall command post and planning function.

-   *Demobilization Unit* - The Demobilization Unit is responsible for
    developing an Incident Demobilization Plan. The Plan should include
    specific demobilization instructions for all overhead and resources
    that require demobilization (e.g. non-local personnel and
    resources). The Demobilization Unit must also ensure that the Plan,
    once approved, is distributed both at the incident and to necessary
    off-incident locations. It is appropriate for the Demobilization
    Unit to begin early in the incident, particularly in developing
    rosters of personnel and resources, and to obtain any missing
    information from the incident check-in process.

-   *Technical Specialists* - Technical specialists assigned to the
    planning section may report directly to the planning section chief;
    may function in an existing unit (for example, an epidemiologist
    could be made a part of the situation unit); or may form a separate
    unit within the planning section, depending upon the requirements of
    the incident and the needs of the planning section chief. It is also
    possible that technical specialists could be reassigned to other
    parts of the organization, such as to operations on tactical matters
    or finance on fiscal matters. Generally, if the expertise is needed
    for only a short time and will normally be only one person, that
    person should be assigned to the situation unit. If the expertise
    will be required on a long-range basis and may require several
    personnel, it is advisable to establish a separate unit in the
    planning section. The incident itself will primarily dictate the
    needs for technical specialists. Examples of specialists that may be
    required for health and medical operations are Epidemiologist,
    Sanitarian, Environmental Impact Specialist, Resource Use and Cost
    Specialist, Psychologist, Fatalities Specialist, Toxic Substance
    Specialist and Training Specialist.

4.4.2.4. **Logistics Section**. The Logistics Section is responsible for
providing all support needs to the incident, except air operations. The
Logistics Section would order all resources from off-incident locations.
It would also provide facilities, transportation, supplies, equipment
maintenance and fueling, feeding, communications and medical services
(the Medical Unit serves the needs of the responders).

-   *Logistics Section Chief and Deputy* - The Logistics Section will be
    managed by a Logistics Section Chief; the section may also have a
    deputy. A deputy position is encouraged when all designated units
    are established on an incident.

-   *Supply Unit* - The Supply Unit is responsible for ordering,
    receiving, storing and processing of all incident-related resources,
    personnel and supplies. The Supply Unit, when established, has the
    basic responsibility for all off-incident ordering. This will
    include all tactical and support resources and all expendable and
    nonexpendable supplies required for incident support. The Supply
    Unit also has the responsibility for providing the locations and the
    personnel to receive, process, store and distribute all supply
    orders. The Supply Unit will also have the responsibility for
    handling equipment operations that include storing, disbursing and
    servicing of all equipment and portable nonexpendable supplies when
    required by the situation.

-   *Facilities Unit* - The Facilities Unit is responsible for
    establishing, setting up, maintaining and demobilizing all
    facilities used in support of incident operations. The Unit is also
    responsible for providing any facility maintenance required. The
    Facilities Unit will set up the incident communications center, as
    well as trailers and/or other forms of shelters for use in and
    around the incident area. Oftentimes, the incident base and camps
    may be established in areas where there are existing structures that
    may be used totally or in part. The Facilities Unit will also
    provide and set up necessary personnel support facilities that
    include areas for feeding, sleeping and sanitation/shower. The
    Facilities Unit will order through supply any additional support
    items required, like portable toilets, shower facilities, lighting
    units and other items needed.

-   *Ground Support/Transportation Unit* - The Ground Support Unit is
    responsible for:

1)  Maintenance and repair of primary tactical equipment, vehicles and
    mobile ground support equipment.

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1)  Time reporting on all incident-assigned ground equipment including
    contract equipment.

2)  Fueling of all mobile equipment.

3)  Providing transportation services in support of incident operations
    except air.

4)  Implementing the Incident Traffic Plan.

> In addition to its primary function of maintenance and services of all
> mobile vehicles and equipment, the Ground Support Unit will, on major
> incidents, maintain a Transportation Pool. The Transportation Pool
> will consist of staff cars, buses, pickups and other vehicles that can
> be used for purposes of transporting personnel from one location to
> another. The Ground Support Unit must also provide the Resources Unit
> with up-to-date information on the status of transportation vehicles,
> their locations and capability.

-   *Communications Unit* - The Communications Unit is responsible for
    the development of plans to make the most effective use of
    incident-assigned communications equipment and facilities; the
    installation and testing of all communications equipment;
    supervision and operation of the incident communication center;
    distribution and recovery of equipment assigned to incident
    personnel; and, the maintenance and on-site repair of communications
    equipment. The Communications Unit has a major responsibility for
    effective communications planning due to the potential multi-agency
    uses. This is especially important in determining required radio
    nets, establishing inter-agency frequency assignments and ensuring
    that maximum use is made of all assigned communications capability.
    The Communications Unit leader should attend all incident-planning
    meetings to ensure that tactical operations planning can be
    supported by available incident communications systems.

-   *Food Unit* - The Food Unit is responsible for determining food and
    water requirements, menu planning, food ordering, determining
    cooking facilities, cooking, serving and general maintenance of the
    food service areas.

-   *Medical (Employee Health) Unit* - The Medical Unit is primarily
    responsible for:

1)  Developing the Incident Medical Plan (for responders).

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1)  Developing procedures for handling any major medical emergency
    involving incident personnel.

2)  Providing rehabilitation, medical aid and transportation for injured
    and ill personnel.

3)  Assisting in the processing of all paperwork related to injuries or
    deaths of personnel.

> It is important to establish a Medical Unit on major incidents. The
> Medical Unit will have responsibility for all medical services for
> responders. The Unit leader or designee will develop a medical plan
> that will form a part of the incident action plan. The medical plan
> should provide specific information on medical aid capabilities at
> incident locations, provide information on potential hazardous areas
> or conditions, and provide for off-incident locations and procedures
> for handling serious situations. The Medical Unit will also assist the
> finance section in handling procedures related to
> compensation-for-injury claims and paperwork including written
> authorizations, billing forms, witness statements and administrative
> documents on medical situations as required.

4.4.2.5. **Finance Section**. The Finance Section is established on
incidents when the agencies involved have a specific need for finance
services. In some cases where only one specific function is required
(i.e., cost analysis), a position could be established as a technical
specialist in the Plans Section. When a Finance Section is established
due to an incident, the Time, Procurement, Compensation/Claims and Cost
Units may be established, as the need requires.

-   *Finance Section Chief* - The Finance Section Chief will determine,
    based on present and future requirements, the need for establishing
    specific units. In certain functional areas such as procurement, a
    functional Unit need not be established if only one person would
    work in the Unit. In that case, a Procurement Officer would be
    assigned rather than designating a unit. The Finance Section Chief
    should be designated from the jurisdiction/agency that has the
    requirement due to the specialized nature of the finance functions.
    The Section Chief may have a deputy.

-   *Time Unit* - The Time Unit is primarily responsible for ensuring
    that daily personnel time recording documents are prepared and
    compliance to the agency's time policy is being met. If necessary,
    because of the agencies involved, personnel time records will be
    collected and processed for each operational period. The Time Unit
    leader may desire to have one or more assistants who are familiar
    with respective agencies' time recording policies. Records must be
    verified, checked for accuracy and posted according to existing
    policy. Excess hours worked must also be determined and separate
    logs maintained.

-   *Procurement Unit* - The Procurement Unit is responsible for
    administering all financial matters pertaining to vendor contracts.
    The Procurement Unit will coordinate with local jurisdictions on
    sources for equipment, prepare and sign equipment rental agreements
    and process all administrative paperwork associated with equipment
    rental and supply contracts.

> Note: In some agencies, certain procurement activities will be
> accomplished as a function of the supply unit in the logistics
> section. The procurement unit will also work closely with local cost
> authorities.

-   *Compensation/Claims Unit* - Compensation-for-injury and claims are
    included together within one unit. It is recognized that specific
    activities are different, and may not always be accomplished by the
    same person. Compensation-for-injury is responsible to see all forms
    required by worker's compensation programs and local agencies are
    completed. The person performing this activity is also responsible
    for maintaining a file of injuries and illnesses associated with the
    incident and insuring that all witness statements are obtained in
    writing. Many of this Unit's responsibilities are done or partially
    done in the Medical Unit, and close coordination with that Unit is
    essential. The Claims function will be responsible for handling the
    investigation into all civil tort claims involving property
    associated with or involved in the incident. The Unit will maintain
    logs on claims, obtain witness statements, document investigations,
    and agency follow-up requirements.

-   *Cost Unit* - The Cost Unit is responsible for providing cost
    analysis data for the incident. The Unit must insure that all pieces
    of equipment and personnel that require payment are properly
    identified, obtain and record all cost data, analyze and prepare
    estimates of incident costs, and maintain accurate records of
    incident costs. The Cost Unit will be increasingly called upon to
    provide input to the planning function in terms of cost estimates of
    resource use. The Unit must maintain accurate information on the
    actual cost for the use of all assigned resources.

4.5. ***What Is The Emergency Operations Plan (EOP)?*** An EOP is
designed to explain the organization-wide strategy for responding to and
recovering from hazards, threats and events of any kind. It does this
through establishing:

-   Fundamental policies and assumptions.

-   A concept of operations that guides direction, control and
    coordination.

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-   An organizational structure that is aligned by functions and
    designates assignments to departments and services that are
    consistent with day-to-day responsibilities.

4.5.1. *Developing an EOP*. To achieve integration with the Incident
Command System, the EOP format organizes departments' and services'
day-to-day activities into their respective ICS function (see Figure
4.1). This is the same approach used by local, county, state and
national emergency management plans. One department or service is then
chosen to be the lead agent for each functional area, based upon that
department's core mission or resources.

Figure 4.1: Essential Function Assignment Matrix

+------------+----------+----------+---------+---------+------+------+
|            | **Ma     | *        | **B     | **Equ   | **Sa | **He |
|            | nagement | *Finance | usiness | ipment, | fety | alth |
|            | &        | &        | Conti   | Plant & | &    | &    |
|            | Pl       | Log      | nuity** | Util    | Se   | M    |
|            | anning** | istics** |         | ities** | curi | edic |
|            |          |          |         |         | ty** | al** |
+------------+----------+----------+---------+---------+------+------+
| Director's | LS-M     |          |         |         |      |      |
| Office     |          |          |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| Canteen    |          | -        |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| A&MM       |          | LS-L     | -       |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| Ambulatory |          |          |         |         |      | -    |
| Care       |          |          |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| Chaplain   |          |          |         |         |      | -    |
+------------+----------+----------+---------+---------+------+------+
| Chief of   |          |          |         |         |      | LS   |
| Staff      |          |          |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| Dental     |          |          |         |         |      | -    |
+------------+----------+----------+---------+---------+------+------+
| Nutrition  |          | -        |         |         |      |      |
| & Food     |          |          |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| Emer.      |          |          |         |         |      |      |
| Manager    |          |          |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| E          |          | -        | -       | LS      | -    |      |
| ngineering |          |          |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| Env.       |          |          |         | -       |      |      |
| Management |          |          |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| Fiscal     |          | LS-F     |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| Human      |          | -        |         |         |      |      |
| Resources  |          |          |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| IT         | -        | -        | -       | -       |      |      |
+------------+----------+----------+---------+---------+------+------+
| Pathology- |          |          |         |         |      | -    |
| Laboratory |          |          |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| MAS        |          |          | -       |         |      | -    |
+------------+----------+----------+---------+---------+------+------+
| Medicine   |          |          |         |         |      | -    |
+------------+----------+----------+---------+---------+------+------+
| Nursing    |          |          |         |         |      | -    |
+------------+----------+----------+---------+---------+------+------+
| Pharmacy   |          | -        |         |         |      | -    |
+------------+----------+----------+---------+---------+------+------+
| Policy &   |          |          |         |         | LS   |      |
| Security   |          |          |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| Psychiatry |          |          |         |         |      | -    |
+------------+----------+----------+---------+---------+------+------+
| Public     | -        |          |         |         |      |      |
| Affairs    |          |          |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| Radiology  |          |          |         |         |      | -    |
+------------+----------+----------+---------+---------+------+------+
| Safety     |          |          |         |         | -    |      |
+------------+----------+----------+---------+---------+------+------+
| Social     |          |          |         |         |      | -    |
| Work       |          |          |         |         |      |      |
+------------+----------+----------+---------+---------+------+------+
| Voluntary  |          | -        |         |         |      | -    |
+------------+----------+----------+---------+---------+------+------+

Each Lead Service is responsible for coordinating with the supporting
departments and services to carry out detailed planning activities and
for participation in training and exercises. Detailed planning
activities include reviewing and revising Standard Operating Procedures
and/or Readiness Plans; refining ICS Position Descriptions and creating
other checklists and guidance as necessary.

The EOP can be formatted in several ways. The format used in local,
state and national EOPs consists of a basic plan, functional annexes and
hazard-specific appendices. The basic plan provides an overview of
general information, such as situation, assumptions, concept of
operations and so on. Each functional annex addresses a particular
functional area (called Emergency Support Functions in the National
Response Plan). The appendices include incident-specific guidance, such
as Standard Operating Procedures, checklists and resource lists. This
format is illustrated in Figure 4.2, below. The EOP can also be
formatted in Memorandum format (see sample VISN, VAMC and Outpatient
Clinic EOPs, Enclosures 1 through 3).

Figure 4.2: VHA EOP Format

![](media/image1.wmf)

4.5.2. *Aligning ICS within the EOP*. The following information
illustrates how the various VAMC services and departments relate to the
EOP's functional annexes/structure of Incident Command System (ICS):

4.5.2.1. **Management and Planning** - The purpose of the Management and
Planning function is to plan, organize, staff, direct, control and
evaluate the VAMC\'s response and recovery to emergencies.

> A. Operating Units:
>
> 1\) Lead

-   VAMC Director (Management)

-   Emergency Program Coordinator (Planning)

> 2\) Support

-   IRM Service

-   Medical Administration Service

-   Public Affairs Officer

-   Other Services, as applicable

> B. Key Activities.
>
> 1\) Management

-   Mobilization/Demobilization - Activation and deactivation of the EOP
    is at the discretion of the VAMC Director or designee.

-   Emergency Policies - The need for emergency policy changes prior to,
    during or after the emergency is at the discretion of the VAMC
    Director. Examples of these would include curtailment of elective
    procedures, out-placing patients, and employees' emergency leave).

-   Liaison - The liaison function includes serving as a point of
    contact for representatives from other agencies/organizations.

-   Safety - The safety activity includes having authority over the
    safety of all personnel, and monitoring and advising on hazardous
    conditions.

-   Public Affairs - The public affairs function may include the
    development of accurate and complete information regarding the
    incident cause, magnitude, situation updates, status of resources,
    and other matters of general interest. The public affairs function
    will normally be the point of contact for the media and other
    governmental agencies that request or need information concerning
    the incident and its impact upon the patients, staff and facility.
    Inquiries by family members about the status of patients will also
    be handled by the Public Affairs Officer.

-   Reporting - The reporting activity would include internal reporting,
    such as situation status, resource status, etc.; and external
    reporting, such as bed availability, situation status, etc.

> 2\) Planning

-   Situation Status - The situation status activity includes
    maintaining current status information on the incident.

-   Resource Status - The resource status activity includes maintaining
    current status information on all resources (human and physical)
    assigned, available or out-of-service at the incident.

-   Incident Action Planning - The incident action planning activity is
    the setting of objectives for each shift or operational period of
    the incident to guide response and recovery efforts.

-   Documentation - The documentation activity includes the maintenance
    of a file system and records on all incident activities. Provide
    duplication services to the Emergency Operations Center staff.

> C. ICS Position Descriptions and Forms (see Enclosure 7).
>
> 1\) Incident Commander/Manager

-   Liaison Officer

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-   Safety Officer

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-   Public Affairs Officer

> 2\) Plans Section Chief

-   Situation Status Unit

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-   Resource Status Unit

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-   Documentation Unit

D. Standard Operating Procedures (see Section 6).

> 1\) Line of Succession
>
> 2\) Delegation of Authority

4.5.2.2. **Logistics and Finance** - The purpose of the Logistics and
Finance function is to provide the services and support necessary to
accomplish the response and recovery objectives.

A. Operating Units.

1\) Lead

-   A&MM (Logistics)

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-   Fiscal (Finance)

> 2\) Support

-   Human Resource Management Service

-   Facilities/Engineering Service

-   Pharmacy Service

-   IRM Service

-   Nutrition and Food Service

-   Voluntary Service

-   Others as applicable

B. Key Activities.

> 1\) Logistics - The logistics function will obtain/procure all
> resources required to manage the situation and to bring the facility
> back to pre-incident status. Logistics includes: facilities,
> transportation, supplies, equipment maintenance and fueling, feeding,
> communications and other services, as appropriate.

-   Supply - The supply activity includes ordering, receiving and
    issuing equipment and supplies, etc., to support incident-related
    needs.

-   Facilities - The facilities activity includes the provision of
    buildings and space needed to support incident-related needs.

-   Transportation - The transportation activity includes the provision
    of resources required to support the facility's response and
    recovery efforts, e.g., vehicles, drivers, fuel and maintenance.

-   Communications - The communications activity includes the provision
    of communications equipment and services in support of the
    incident-related needs.

-   Food - The food activity includes the feeding of all persons working
    the incident.

-   Medical/Rehabilitation - The medical/rehabilitation activity
    includes the provision of medical, rest and support services to all
    persons working the incident, including their representatives, as
    required.

> 2\) Finance/Administration - The finance/administration function
> includes tracking and settling all incident related expenses; such as:

-   Time - The time activity includes timekeeping on all personnel
    assigned to the incident.

-   Procurement - The procurement activity includes the contracting,
    purchasing and disbursing activities related to the incident.

-   Compensation and Claims - The compensation and claims activity
    includes the reporting, investigation and processing of all claims
    related to injuries and property damages related to the incident.

-   Cost - The cost activity includes tracking all expenditures related
    to the incident.

> C. ICS Position Descriptions and Forms (see Enclosure 7).
>
> 1\) Logistics Section Chief

-   Supply Unit

-   Facilities Unit

-   Transportation Unit

-   Communications Unit

2\) Finance Section Chief

-   Time Unit

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-   Procurement Unit

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-   Comp/Claims Unit

-   Cost Unit

D. Standard Operating Procedures (see Section 6).

> 1\) Critical Supplies
>
> 2\) Staff Shortage
>
> 3\) Emergency Leave and Pay Policy
>
> 4\) Alternate Operating Facilities
>
> 5\) Interoperable Communications

4.5.2.3. **Operations Section**.

4.5.2.3.1. **Business Continuity Operations** - The purpose of the
Business Continuity function is to focus on certain aspects of health
care facility operations and service delivery that must not be
interrupted.

> A. Operating Units.
>
> 1\) Lead

-   Associate Director

> 2\) Support

-   IRM Service

-   Medical Administration Service

-   Others as applicable

> B. Key Activities.
>
> 1\) Telecommunications/Information Management Systems - The
> Telecommunications Systems activity includes the protection,
> inspection, evaluation, repair and maintenance of all facility
> information, communications, and detection systems.
>
> 2\) Patient Access to Services - The Patient Access activity includes
> the identification of alternative sources of medical care and
> ancillary services.
>
> 3\) Records Preservation - The Records Preservation activity includes
> the process of preserving critical administrative and clinical
> records.
>
> 4\) Business Relocation - The Business Relocation activity includes
> identification of business functions that must be relocated to ensure
> continuity of service delivery during recovery and restoration.
>
> C. ICS Position Description and Forms.
>
> Business Continuity Group Leader (see Enclosure 7).
>
> D. Standard Operating Procedures (see Section 6).
>
> 1\) Business Relocation
>
> 2\) Communications Disruption
>
> 3\) Critical Supplies
>
> 4\) Patient Access to Services
>
> 5\) Vital Records and Database Preservation
>
> 6\) Staffing Shortage
>
> 7\) VISTA and Other Computer System Disruptions

4.5.2.3.2. **Equipment, Plant and Utilities' Operations** - The purpose
of the Equipment, Plant and Utilities' function is to protect, evaluate,
control, repair and maintain plant and utility systems necessary for
patient care, and to perform those services essential to facility
operations and response and recovery objectives.

> A. Operating Units.
>
> 1\) Lead

-   Facilities/Engineering Service

> 2\) Support

-   Environmental Management Service

-   A&MM Service

-   IRM Service

-   Medical Administration Service

-   Others as applicable

> B. Key Activities.
>
> 1\) Medical Devices/Systems - The Medical Devices/Systems activity
> includes the protection, inspection, evaluation, repair and
> maintenance of all patient care equipment and related systems.
>
> 2\) Medical Gas Systems - The Medical Gas Systems activity includes
> the protection, inspection, evaluation, repair and maintenance of all
> medical gas storage and delivery systems.
>
> 3\) Power/Light Systems - The Power/Lighting Systems activity includes
> the protection, inspection, evaluation, repair and maintenance of all
> electrical supply and distribution systems and lighting.
>
> 4\) Heat/Ventilation/Cool Systems - The Heating/Ventilating/Cooling
> Systems activity includes the protection, inspection, evaluation,
> repair and maintenance of all heating, ventilation and
> air-conditioning systems.
>
> 5\) Water/Sewer Systems - The Water/Sewer Systems activity includes
> the protection, inspection, evaluation, repair and maintenance of all
> potable water, wastewater and solid waste distribution and disposal
> systems.
>
> 6\) Buildings/Grounds/Roads - The Buildings, Grounds and Roads
> activity includes the protection, inspection, evaluation, repair and
> maintenance of all buildings, grounds and roadways.
>
> 7\) Debris and Waste Removal - The Debris and Waste Removal activity
> includes the proper disposal of disaster-generated debris and wastes
> including hazardous wastes.
>
> C. ICS Position Description and Forms
>
> Equipment, Plant and Utilities Group Leader (Please see Enclosure 7).
>
> D. Standard Operating Procedures (Please see Section 6).

1)  Alarm System Failure

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1)  Electrical Power Failure

2)  Elevators/Vertical Transport Failure

3)  Heating/Ventilation and Air Conditioning

4)  Internal Transport System Failure

5)  Medical Gases System Failure

6)  Roads and Grounds Blocked

7)  Waste and Debris Removal

8)  Water Delivery/Potability

4.5.2.3.3. **Safety and Security Operations** - The purpose of the
Safety and Security function is to protect the safety and security of
patients, visitors and staff.

> A. Operating Units.
>
> 1\) Lead

-   Police Service

-   Safety Service

> 2\) Support

-   Industrial Hygienist

-   Radiation Safety Officer

-   Facilities/Engineering Service

-   Fire Department/Service

-   Others as applicable

> B. Key Activities.
>
> 1\) Alerting and Warning - The Alerting and Warning activity includes
> the monitoring, receipt, verification and dissemination of information
> related to any threat to continuity of patient care.
>
> 2\) Hazmat Control/Decontamination - The Hazardous Materials Control
> activity includes the protection of hazardous materials stored on the
> property, and the evaluation, control and decontamination of any
> releases associated with actual or potential internal damage caused by
> the incident.
>
> 3\) Fire Suppression - The Fire Suppression activity includes the
> suppression of any fires associated with the incident.
>
> 4\) Search - The Search activity includes any search activities
> required as a result of the incident.
>
> 5\) Security - The Security activity includes the control of real or
> personal property, persons, vehicles and information necessary to the
> effective management of the incident.
>
> C. ICS Position Description and Forms.
>
> Safety and Security Group Leader (see Enclosure 7).
>
> D. Standard Operating Procedures (see Section 6).
>
> 1\) Alerting and Warning
>
> 2\) Facility Access Control
>
> 3\) Fire Suppression Systems

4.5.2.3.4. **Health and Medical Operations** - The purpose of the Health
and Medical Services function is to provide medical, health and mass
care services to patients, visitors and staff.

> A. Operating Units.
>
> 1\) Lead

-   Chief of Staff

> 2\) Support

-   Ambulatory Care

-   Medical Service

-   Surgical Service

-   Psychiatry Service

-   Psychology Service

-   Dental Service

-   Nursing Service

-   Social Work Service

-   Pharmacy Service

-   Radiology Service

-   Chaplain Service

-   Pathology and Laboratory Service

-   Medical Administration Service

-   Prosthetics Service

-   Director's Office

-   Other Services, as appropriate

> B. Key Activities.
>
> 1\) Patient Management - The Patient Management activity includes the
> continued care of the resident patient population.
>
> 2\) Triage - The Triage activity includes the sorting of patients
> whose conditions will allow them to be released from the VAMC, as well
> as the sorting of disaster victims and the worried well.
>
> 3\) Treatment - The Treatment activity includes the diagnosis and
> treatment of all patients and victims associated with the incident.
>
> 4\) Evacuation - The Evacuation activity includes all patient
> management activities related to the relocation of patients required
> by the incident.
>
> 5\) Outreach - The Outreach activity includes the monitoring of all
> patients receiving home-based care.
>
> 6\) Fatalities Management - The Fatalities Management activity
> includes the management of all fatalities associated with the
> incident.
>
> C. ICS Position Description and Forms.
>
> Health and Medical Group Leader (see Enclosure 7).
>
> D. Standard Operating Procedures (see Section 6).

1)  Alternative Care Site

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1)  Evacuation

2)  Fatality Management

3)  Mass Casualty Incident

4)  Outreach

4.6. ***Implementation.*** The Incident Command System (ICS) will be
used to plan, organize, staff, direct and control emergency situations.
An ICS organization unfolds in a modular fashion based 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). The specific organizational 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 of
the areas requires independent management, an individual is named to be
responsible for that area.

4.6.1 *Initial Actions upon Recognition of an Actual or Potential
Incident*.

4.6.1.1. Incidents Without Warning. For incidents that occur with little
or no warning, such as a fire on a ward, initial leadership and
direction will initially be provided by any employee who first
recognizes the danger.

4.6.1.2. Incidents With Warning. In an incident that provides warning
such as severe weather or reports of a cloud of hazardous materials
approaching the facility, the Director or designee would provide initial
leadership and direction.

4.6.2 *Continuing Actions*.

4.6.2.1. Incident Management Team. Facilities can adopt an approach used
in emergency service organizations where the IC heads a cadre referred
to as the Incident Management Team (IMT). The purpose of the IMT is to
support situation assessment, mobilization and response decisions. The
IMT is composed of the lead representative for each functional area (see
Figure 4.3).

Figure 4.3: Incident Management Team Designations

######  IMT Position VAMC Position/Service

Incident Commander Director's Office

Planning Section Chief Emergency Preparedness Coordinator

Logistics Section Chief AM&M Service

Finance Section Chief Fiscal Service

Operations Section Chief (Staffed based on the incident)

Business Continuity Group Leader Associate Director

Equipment/Plant/Utilities Group Leader Facilities/Engineering service

Safety and Security Group Leader Police and/or Safety Service

Health and Medical Group Leader Chief of Staff

4.6.2.2. Incident Management Facilities. An incident that involves a
distinct incident scene within the facility or on its grounds may
require establishing a Command Post (CP). A Command Post is an ad-hoc
location where decisions are made concerning control of the incident.
Not all incidents require a Command Post. The following steps are
required to manage this type of event:

-   Control the scene.

-   Establish a Command Post.

-   Conduct internal notifications.

-   Develop an initial strategy for protecting life and property.

-   Determine what resources are needed to control the problem.

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-   Continue to organize and manage the situation until relieved.

4.6.2.3. Emergency Operations Center. An Emergency Operations Center
(EOC) is the location where activities related to information
collection, inter-service coordination, strategic decision-making and
resource allocation are managed. Not all incidents require the use of
the EOC (more information on EOCs is located in Enclosure 9 to this
Section on the CD-ROM). The following steps can be used:

-   Gather information through ongoing assessments.

-   Brief EOC staff.

-   Establish shifts.

-   Set overall objectives for each shift.

-   Determine resource requirements.

-   Develop communications and traffic plans.

-   Keep complete documentation.

4.6.2.4. Operational Relationships. Operational relationships between
VHA CO, VISNs and VAMCs are illustrated in Figure 4.4.

Figure 4.4: VHA CO EOP

![](media/image2.wmf)

4.6.2.4.1 VHA Emergency Operations Center. The purpose of the VHA EOC
(EMSHG Operations Center) includes:

-   Serve as the overall VHA coordination point for events requiring
    VISN and VHACO activation.

-   Compile, authenticate and make available summary situation status
    and resource status information.

-   Coordinate with the VA Readiness Operations Center (ROC), which
    provides primary coordination with other Federal agencies at the
    national agency level.

4.6.2.4.2. VISN Emergency Operations Centers (EOCs) are responsible for
coordinating status, information and resource requirements from the
following entities:

-   VA Medical Center Emergency Operations Centers (EOCs). VAMC EOCs are
    responsible for coordinating status, information and resource
    requirements with and between Outpatient Clinics (OPC/CBOCs). VAMC
    EOCs should also coordinate with county or local government EOCs. A
    county EOC manages requests for resources to the emergency needs of
    local governments; manages and coordinates mutual aid from other
    counties and is the communications and coordination link to the
    state EOC.

-   State EOCs (SEOCs). A state EOC manages requests for resources to
    the emergency needs of counties and local governments; manages and
    coordinates mutual aid from other states; and, is the communications
    and coordination link to the Federal Emergency Management Agency
    (FEMA) during Presidentially-declared disasters. When the National
    Response Plan (NRP) is activated for events within the state, FEMA
    will co-locate its Disaster Field Office (DFO) with the SEOC.

-   Other VISNs. Due to the location of some facilities and
    characteristics of the incident, mutual-aid from neighboring VISNs
    may be an efficient means of providing support. Requests for support
    from the affected facility should go through the affected VISN EOC,
    and the provision of that assistance coordinated with the
    neighboring VISN EOC.

4.6.3. *Incident Action Planning*. Incident Action Planning (IAP) is a
process used to guide on-going response and recovery activities.
Operational periods are established (e.g., 4-, 8-, 12- or 24-hours)
within which the various activities in Figure 4.5 are accomplished.
(Note: Incident Action Plans are written for the [next]{.underline}
operational period.)

**Figure 4.5: IAP Planning Process**

![](media/image3.wmf)

The steps outlined below are used during the Planning Meeting to develop
an Incident Action Plan (IAP) in a minimum amount of time. Not all
incidents require detailed written plans. Recognizing this, the
following process provides a series of basic planning steps that are
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 Incident Commander. The Planning
Meeting is normally conducted by the planning section chief. The
checklist for development of an IAP (Figure 4.6) provides basic steps to
aid the planning section chief in developing the incident action plan.
(Incident Action Plan forms are included in this Section as Enclosure 8
on the CD-ROM.)

Figure 4.6 - Checklist for Development of an IAP

  ------------------------------------------- ---------------------------
  **Checklist Item**                          **Primary Responsibility**

  Briefing on situation and resource status.  Plans Chief (PC)

  Set overall objectives and priorities for   Incident Commander (IC)
  period/shift.                               

  Identify activity areas and control         Operations Chief (OC)
  objectives.                                 

  Specify tactics for each group.             OC

  Specify resources needed by each group.     OC

  Specify facilities and reporting locations. OC, Logistics Chief (LC)

  Place resource and personnel order.         LC

  Consider communications, medical and        OC, PC, LC
  traffic plan requirements.                  

  Finalize, approve and implement incident    PC, OC, IC
  action plan.                                
  ------------------------------------------- ---------------------------

4.6.4. *Situation Status Reporting*. For major events involving VAMCs,
VISNs and/or VHA CO, a daily schedule for conference calls and facility
operational/overall situation status reporting needs to be established
for the next operational period.

Enclosures

1\. Sample VISN EOP

2\. Sample VAMC Continuity of Operations (COOP) Readiness Plan and VAMC
Emergency Operations Plan (EOP)

3\. Sample Community Based Outpatient Clinic (CBOC) EOP with Attachments

4\. Sample Key Activity Management Tool Template

5\. Key Activity Management Structure Template

6\. Employee Responsibility Pamphlet

7\. ICS Position Descriptions

8\. ICS Reporting Forms

9\. EOC Guidance - Comprehensive Emergency Management (CEM) and
Emergency Operations Plan (EOP)