VETERANS AFFAIRS MEDICAL CENTER\
Houston, Texas

MEDICAL CENTER POLICY September 9, 2002

MEMORANDUM NO. 138EmP-001

COMPREHENSIVE EMERGENCY MANAGEMENT PROGRAM

I. [PURPOSE]{.underline}

The purpose of this policy is to identify actions to be taken at the
Houston VA Medical Center (HVAMC) to minimize any adverse impact on
patient care and to protect patients, visitors, and employees from the
effects of natural and manmade disasters. The program establishes a
universal structure for a systematic, coordinated, and effective
approach to emergency management, including:

> 1\. Fundamental policies and assumptions.
>
> 2\. A concept of operations that describes the process for
> organization-wide response to emergencies.
>
> 3\. An organizational structure that designates emergency assignments
> around day-to-day responsibilities and includes a process for
> decision-making on objectives and priorities.
>
> 4\. Assignment of specific, ongoing responsibilities for the
> prevention of emergencies or a reduction of adverse effects;
> development of capabilities needed to effectively manage and provide
> services in an emergency situation; response to problems caused by any
> emergency; recovery to resumption of services after an emergency, and
> a mechanism for corrective actions.

II\. [PROCEDURES]{.underline}

A. The HVAMC will assist local, state and federal agencies in the
procurement of medical resources in the event of a community disaster.
Based on our available resources, the Medical Center Director will
direct the admission of patients from other healthcare facilities that
are no longer able to provide care.

B. The HVAMC Comprehensive Emergency Management Program (CEMP) describes
a general strategy for managing contingency situations in an efficient
and effective manner using an all hazards approach. The program applies
to any internal or external emergency situation, including the Veterans
Affairs/Department of Defense (VA/DoD) Contingency Hospital System,
activation of the Federal Response Plan (FRP), or activation of the
National Disaster Medical System (NDMS).

C. The CEMP is a concept where hazard reduction, capability development,
and emergency operations are linked in an ongoing process of activities,
which occur in four phases:

> 1\. [Mitigation]{.underline}. Activities to eliminate risk to life and
> property from hazards.
>
> 2\. [Preparedness]{.underline}. Activities developed prior to a
> disaster or emergency to eliminate or reduce effects of hazards.
>
> 3\. [Response]{.underline}. Activities that address immediate and
> short-term effects of disaster or emergency.
>
> 4\. [Recovery]{.underline}. Activities and programs to return an
> entity to an acceptable condition.
>
> D. The CEMP incorporates the Hospital Emergency Incident Command
> System (HEICS) principles that apply to the HVAMC and local government
> response levels. The HEICS organizational structure closely mirrors
> the HVAMC day-to-day operation, but only uses a minimum number of
> administrative and clinical staff. Following is the HEICS organization
> chart:
>
> ![](media/image1.wmf)
>
> III\. [RESPONSIBILITIES]{.underline}

The CEMP applies to all staff of the HVAMC. It is the written record of
this on-going program, which includes the Environment of Care Standards,
Safety and Quality Management Programs. All service chiefs, service line
executives and care line executives have primary or support
responsibilities for one or more essential functions based upon their
normal day‑to‑day responsibilities and resources. All employees are
responsible for responding according to this program and for performing
their assigned duties in the event of a VA Medical Center or community
disaster or emergency.

A. [Command Responsibility:]{.underline} The Medical Center Director is
responsible for control and direction of all disaster responses and
civil defense activities at the HVAMC. In the absence of the Medical
Center Director, the following staff, in the order named, will assume
Incident Commander (IC) responsibility until relieved:

> 1\. Associate Director
>
> 2\. Facilities Management Service Line Executive
>
> 3\. Chief of Staff (COS)

4\. During other than regular duty hours the Administrative Officer of
the Day (AOD) will assume command responsibility until relieved by one
of the above listed staff.

B. [Designation of Officials]{.underline}

> 1\. With the assistance of the Area Emergency Manager (AEM), the
> Emergency Management Coordinator (EMC) shall prepare, coordinate and
> maintain the CEMP.
>
> 2\. [HEICS Public Information Officer (PIO)]{.underline}. The Public
> Affairs Officer shall initiate and coordinate procedures for
> collection and release of information concerning disaster casualties.
> S/he will coordinate with appropriate news media to ensure accuracy of
> broadcasted information. S/he shall furnish information to inquiring
> relatives and accredited news reporters.
>
> 3\. [HEICS Damage Assessment & Control Leader]{.underline}. Through
> the HEICS Logistics Chief, the Damage Assessment & Control Leader
> shall collect, record and preserve information and evidence relative
> to facility disasters including injury, damage and loss.
>
> 4\. [Evacuation Officer]{.underline}. The Safety Manager, Facilities
> Management Service Line (FMSL), shall train employees in the
> techniques of safe-lifting for evacuation and shall supervise such
> activities in the event of a disaster.
>
> 5\. [Evacuation of the Disabled.]{.underline} All service chiefs,
> service line executives and care line executives will be responsible
> for identifying individuals with physical, mental, or sensory
> impairments and their locations. Identify \"buddies\" to assist the
> disabled when a disaster occurs.

C. [All Employees]{.underline}

> 1\. All employees shall know their role during an emergency or other
> disruption of normal operation.

2.  Every employee shall provide an up-to-date work and home phone
    number where s/he can be reached.

3.  No employee will knowingly impede telephonic notification
    procedures.

D. [Hazards Analysis]{.underline}. Because of its geographical location,
topography, chemical and petroleum facilities, industrial and
transportation facilities, the HVAMC and its outpatient clinics at
Lufkin and Beaumont, may be subject to most of the following emergency
and disaster situations:

**Hazards Analysis Chart**

  --------------------------------- -------------------------------------
  **Hazard Type**                   **HVAMC**

  **Natural**                       **Risk Level**

  Avalanche                         None

  Drought                           Low to Moderate

  Earthquake                        Low

  Floods                            High

  Hurricane                         High

  Landslide                         None

  Subsidence                        Low

  Tornado/Water Spout               High

  Tsunami                           Low

  Volcano                           None

  Wildfire                          None

  Wind Storm                        Moderate

  **Technological**                 **Risk Level**

  HAZMAT/Fixed Facility             Low

  HAZMAT/Transportation             Low to Moderate

  HAZMAT/Production                 Low

  Fire                              Moderate (normal)

  Power Failure                     Moderate (normal)

  Utility/Telephone Failure         Moderate (normal)

  Radiological Incident/Fixed       Low
  Facility                          

  Radiological                      Low
  Incident/Transportation           

  **Other Threats**                 **Risk Level**

  Civil Disorder                    High (due to potential terrorism)

  Radiological                      High (due to potential terrorism)

  Chemical                          High (due to potential terrorism)

  Biological                        High (due to potential terrorism)
  --------------------------------- -------------------------------------

E. [Supplemental Emergency Response Plans (SERP)]{.underline}. Emergency
Supplemen­tal Plans are to be prepared by each service, service line and
care line detailing the manner in which each will meet their assigned
responsibilities. Each service chief, service line executive and care
line executive will submit one copy of their respective plans to the
Facilities Management Service Line Administrative Officer. In addition
to the emergency response plan a current cascade system of emergency
calls including home phone numbers will be submitted to the Facilities
Management Service Line Administrative Officer, Emergency Management
Coordinator, and the Area Emergency Manager. These cascade lists will be
reviewed and updated as necessary.

> 1\. [Testing]{.underline}. Exercises will be conducted at least twice
> a year to test this program and HVAMC readiness. These drills will be
> evaluated according to predetermined Environment of Care performance
> indicators.
>
> 2\. [Critiques]{.underline}. All members of the Emergency Management
> Program Committee (EMPC) will be prepared to present pertinent
> information at a general critique to be called by the Chairman,
> following each drill or other implementation of the program. Critiques
> will be held within a reasonable timeframe after implementation of the
> emergency plans.

V. [COMMITTEE]{.underline}

The following list of officials (or their designees) represents the
Emergency Management Program Committee (EMPC) membership tasked to
continually review, evaluate, revise and maintain the CEMP. The EMPC,
under the direction of the chair, shall coordinate EMPC meetings and
members shall meet at the call of the chair.

  --------------------------------------------------- ---------- ----------
  Associate Director                                  001        Chair

  Chief of Staff                                      11         Member

  Deputy Chief of Staff                               11A        Member

  Facilities Management Service Line Executive        138FMS     Member

  Operative Care Line Executive                       112OCL     Member

  Medical Care Line Executive                         111MCL     Member

  Information Management Service Line Executive       IRM        Member

  Business Office Service Line Executive              04BOSL     Member

  VA Police Chief                                     07B        Member

  Human Resources Manager                             05HRM      Member

  Environmental Management Section Manager            137EMS     Member

  Safety Manager                                      138S       Member

  Patient Access Center Manager                       04PAC      Member

  Acquisition & Materiel Management Section Manager   90         Member

  Quality Management Coordinator                      00Q        Member

  Pharmacy Section Manager                            119        Member

  Chief Nurse Executive                               118CPO     Member

  Mental Health Care Line Executive                   116MHCL    Member

  Education Service Line Executive                    141ESL     Member

  Public Affairs Officer                              00X        Member

  Staff Assistant to the Director                     002SK      Member

  Area Emergency Manager                              13C        Member

  Emergency Management Coordinator                    138EmP     Member

  AFGE Local 1633 Representative                      AFGE       Member

  Bed Control Representative                          04PACU     Member

  Facilities Management Service Line Representative   138FMS     Recorder
  --------------------------------------------------- ---------- ----------

V. [REFERENCES]{.underline}

> *Comprehensive Accreditation Manual for Hospitals*, Joint Commission
> on Accreditation of Healthcare Organizations.
>
> MP-l, Part II, Chapter 13, March 20, 1985, Emergency Preparedness
> Planning.
>
> Medical Center Policy Memorandum 130ENG-007, *Utility Management
> Program.*

VI\. [RESCISSION]{.underline}

> Medical Center Policy Memorandum No. 002N-002, *Emergency Medical
> Preparedness Plan*, dated December 7, 1999.

\\s\\

EDGAR L. TUCKER\
Medical Center Director

Attachment Comprehensive Emergency Management Program

**[Comprehensive Emergency Management Program]{.smallcaps}**

Table of Contents

[Chapter I Emergency Notification for Disaster Condition of Potential
Disaster
1](#chapter-i-emergency-notification-for-disaster-condition-of-potential-disaster)

[External Cascade Instructions 3](#external-cascade-instructions)

[Chapter II Community Casualty Plan
4](#chapter-ii-community-casualty-plan)

[Initial Plan 14](#initial-plan)

[List of Sources for Emergency Purchases
16](#list-of-sources-for-emergency-purchases)

[Mutual Aid Agreements with other Healthcare Facilities
18](#mutual-aid-agreements-with-other-healthcare-facilities)

[Chapter III Civil Disturbance Preparedness Program
19](#chapter-iii-civil-disturbance-preparedness-program)

[Chapter IV Bomb Threats 21](#chapter-iv-bomb-threats)

[Telephone Notification Bomb Threat Checklist
30](#telephone-notification-bomb-threat-checklist)

[Bomb Threat Telephone Report 31](#bomb-threat-telephone-report)

[Bomb Search Schedule 32](#bomb-search-schedule)

[Chapter V Adverse Weather Conditions
34](#chapter-v-adverse-weather-conditions)

[Chapter VI Patient Evacuation 36](#chapter-vi-patient-evacuation)

[Chapter VII Radiation Disaster 39](#chapter-vii-radiation-disaster)

[Chapter VIII Bio-terrorism Readiness Plan
42](#chapter-viii-bio-terrorism-readiness-plan)

[Chapter IX Chemical Disaster 44](#chapter-ix-chemical-disaster)

[Chapter X Environment Of Care Performance Indicators
45](#chapter-x-environment-of-care-performance-indicators)

[Chapter XI National Disaster Medical System
46](#chapter-xi-national-disaster-medical-system)

[National Disaster Medical System (NDMS) Operations Plan
47](#national-disaster-medical-system-ndms-operations-plan)

[Chapter XII VA/DoD Contingency Plan
55](#chapter-xii-vadod-contingency-plan)

# Chapter I Emergency Notification for Disaster Condition of Potential Disaster

A. [Personnel Alert]{.underline}

> 1\. See Cascade System for Emergency Calls at
> [\\\\vhahoufpch\\doclib\\Internal Cascade Call
> System.xls](../../../../../../../../doclib/Internal%20Cascade%20Call%20System.xls).
>
> 2\. The Medical Center Director will use available communications
> (tele­phone, messenger, two-way radio, public address system, etc.) to
> issue an "all clear".
>
> 3\. In the event of the failure of normal communications (telephone
> system, overhead paging system) all two-way portable radios, which are
> required to switch to Channel No. 5 during emergencies, will be used
> for status reports to the Emergency Operations Center by way of their
> service-, service line-, or care line-specific communication plan. In
> lieu of no radios, runners from either the service, service line, care
> line, or manpower pool will be used.

B. [Fire Signal]{.underline}

> 1\. Pull alarm device box or telephone 911.
>
> 2\. Give name and specific location.

C. [Medical Emergency]{.underline}. Dial 911 for life-threatening
emergencies. This includes outlying buildings, parking lots and grounds.
Give name and specific location.

D. [Adverse Weather]{.underline}

> 1\. Upon issuance of a National Weather Service adverse weather
> advisory, VA Police Service will establish a weather watch. The VA
> Police Chief or designated representative, will establish liaison with
> local police, fire and weather services as needed. Further, liaison
> with the Texas Medical Center (TMC) Inc., 406 Jones Library Building,
> will be established to receive information from the City of Houston
> Emergency Management Office. The Medical Center Director will be kept
> informed.
>
> 2\. Information received will be forwarded to the Medical Center
> Director for further action.
>
> 3\. By order of the Medical Center Director, when a tornado warning
> for the southern area of Houston is issued or there is a tornado
> touchdown within a 10-mile radius of the HVAMC, the *Community
> Casualty Plan* will be activated.
>
> 4\. See Adverse Weather Conditions, Chapter V.
>
> 5\. The AEM & EMC will use on-line weather monitors as an additional
> early warning/alert procedure.

E. [City Emergency Alert System]{.underline}. The City of Houston
conducts weekly tests of its emergency alert system, to ensure ability
of the HVAMC and other facilities to receive emergency broadcasts.
During an actual event, this system will announce an audio alert.

Appendix 1A

## External Cascade Instructions

Should an external cascade be executed, please follow these simple
steps:

A. As soon as you are contacted, you should call the *primary* manager
whose name is listed just below your alternate\'s name and is indicated
by three asterisks (**\*\*\***) to the left of their title. If you do
not reach that person, then call their alternate. If you do not reach
either person, go down one more \*\*\*PRIMARY and make the call for the
person you did not reach. Continue doing this until you contact someone
in person. This ensures a steady flow of contacting.

B. After you reach the other **\*\*\***PRIMARY, then you should activate
your own in-house external cascade (your service, service line, or care
line). It is important to keep those numbers updated often since one
wrong number can relate to numerous employees not being located. Once
you begin your in-house cascade, [you should immediately call the
Emergency Management Coordinator (EMC), Phillip Walker]{.underline},
whose numbers are listed on the External Cascade, or if he doesn't
answer (home or cellular), call the alternate, Luis Carreras, the Area
Emergency Mgr (AEM). Inform him that you have initiated your in-house
cascade, and that you successfully contacted the **\*\*\***PRIMARY that
you were responsible to call. If you were not successful, and you went
down to another service, service line, or care line, please inform the
EMC of that action so that he can ensure someone is contacted to begin
that in-house cascade. NOTE: Do not wait until your in-house cascade is
completed to call the EMC, call him as soon as you begin your in-house
cascade. This will ensure that the QA established procedures would be
effective in managing the timeliness of the cascade. Also, if the
cascade is only a *test or exercise*, you should communicate this to
everyone you call and tell them that no one is to report to duty outside
their normal shift.

C. Once your in-house cascade has been completed, on the next business
day, or as soon as possible, please provide the EMC and the AEM via
e-mail with a report as follows:

> Service, service line, or care
> line:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Total number of VA employees in your service, service line, or care
> line\_\_\_\_\_\_\_\_\_
>
> Total number contacted \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Total number of employees already on duty \_\_\_\_\_\_\_\_\_\_\_

# Chapter II Community Casualty Plan

*Note: This program is intended as a general guide and it is essential
that everyone involved be flexible to meet situations as they develop.*

A. [Major Objectives]{.underline}

> 1\. Provide essential medical care and treatment for community
> casualties, regardless of veteran status, whose illnesses or injuries
> are results of a disaster or whose care and treatment are complicated
> by a disaster.
>
> 2\. Accommodate casualties to the fullest extent of the medical
> center's capabilities and reasonable resources. In conjunction with
> our humanitarian admission criteria, beds will depend upon
> availability.
>
> 3\. This medical center can assume that no outside support will be
> available for a minimum of 24-hours and should be as self-sufficient
> as possible.
>
> 4\. Coordinate blood supply requirements with Gulf Coast Regional
> Blood Center.
>
> 5\. Adjust available staff to meet requirements for an indefinite
> period of time (i.e. 12-hour shifts).
>
> 6\. Suspend those functions that do not directly contribute to
> emergency operations. Redirect the efforts required for those
> functions to accomplish emergency tasks.
>
> 7\. Attempt to arrange on-site housing & accommodations for key staff.

B. [Plan Outline]{.underline}. Appendix 2A of this chapter designates
the various activities and details which constitute our initial plan of
action in the event of a community disaster. It is intended to serve as
a convenient reference. Adjustments to meet developing and changing
needs may be necessary and may be implemented at any level. These
changes will be determined and directed by the IC.

C. [Activation of Plan]{.underline}. Upon notification of a community
disaster, the information will be communicated to the Medical Center
Director during regular duty hours or to the Administrative Officer of
the Day (AOD) during other than regular hours. As much information as
possible will be obtained concerning the type of disaster, estimated
number and approximate arrival time of casualties, name, telephone
number and organization represented by the person calling.

1.  Upon activation of the Community Casualty Plan during normal working
    hours, all Executives and Chiefs (or alternates) will report to the
    auditorium (Room 4A-300) for information concerning the disaster and
    other instructions. In the event of unavailability of the
    auditorium, the Medical Center Director will designate an alternate
    site.

> 2\. During other than regular duty hours, the Medical Center Director
> will initiate the External Cascade System by contacting the Associate
> Director and the COS in accordance with the written cascade
> procedures.

D. [Operations]{.underline}

> 1\. [Number of Casualties]{.underline}. Although the HVAMC has a fully
> staffed and equipped emergency room, the number of casualties that can
> adequately be cared for is limited. The COS or AOD should determine
> how many and the type of casualties we can accommodate, taking into
> account the hospital\'s staff, the extent of the disaster, the time of
> day, and any other resources needed. Generally we have limited
> facilities for Weapons of Mass Destruction (WMD) or HAZMAT disaster
> victims. (See Chapter VIII, Radiation, Biological or Chemical
> Disaster).
>
> 2\. [Ambulance Reception]{.underline}. The receiving and unloading of
> ambulances and other vehicles bearing casualties will occur at the ER
> entrance, unless an alternate location is specified due to the need
> for DECON procedures.
>
> 3\. [Triage - Building 100, Emergency Room Canopy Area]{.underline}
>
> a\. The process of receiving, sorting and classifying the injured will
> be controlled by the Patient Access Center and a medical chart will be
> prepared for each casualty including non-veterans.
>
> b\. In the event of extensive chemical or radiological casualties, the
> triage officer will request assistance via the Emergency Operations
> Center from Houston Fire Department (HFD) 911 dispatch. If this
> assistance is not available, the triage officer will notify the
> HVAMC's Emergency Operations Center (EOC) and the Safety Officer will
> initiate decontamination procedures to safeguard patients, visitors,
> employees and property. NOTE: Biological casualties will be addressed
> separately.

c.  There will be adequate supplies of instruments and appliances for
    dealing with immediate life-threatening situations conveniently
    stored. Emergency tags for entering diagnosis, emergency treatment
    rendered and routine instructions will be available. Upon request,
    narcotics will be brought to the area by Pharmacy staff who will be
    responsible for security.

d.  In the event of a WMD disaster that may include Nuclear, Biological,
    or Chemical contamination, all clothing and articles of incoming
    casualties will be properly identified and accounted for to assist
    in investigations.

e.  Biological casualties will be treated according to Public Health
    guidelines.

> 4\. [Ambulatory Casualty Treatment.]{.underline} This treatment area
> is for patients with minor lacerations, minor fractures, first- and
> second-degree burns, hysteria, sprains and contusions of a relatively
> minor nature.
>
> 5\. [Casualty Transport]{.underline}. The Emergency Room nurse manager
> will provide an organized flow of patients from one treatment area to
> another. Efficient use of nearby elevators will assist in moving the
> injured vertically. In the event of an electrical outage, at least one
> elevator in each bank will be available under emergency power.

E. [Responsibilities]{.underline}

> 1\. [Emergency Operations Center (EOC)]{.underline}
>
> a\. Establish and maintain essential lines of communication. Document
> and maintain a written audit trail of all patients from time of
> reception through completion of treatment.
>
> b\. Coordinate assignments of personnel to casualty care areas.
>
> c\. Release unneeded staff to normal duty.
>
> d\. In conjunction with the medical staff, determine need for transfer
> of hospital patients to community facilities.
>
> 2\. [Initial Triage Area Personnel]{.underline}
>
> a\. Report promptly to designated area and to responsible official for
> assignment.

b.  Prepare to provide essential urgent care. The designated nurse will
    bring the transport kit and the Chief, Pharmacy Section or designee,
    will bring the narcotics to the designated triage area. If needed,
    EOC staff will designate an alternate triage area.

c.  A responsible official will inform the EOC of additional personnel
    needs.

d.  The EOC staff will coordinate the changes of Incident commanders as
    necessary.

> 3\. [Chief of Staff]{.underline}

a.  Assumes responsibility as Operations Manager as outlined in Hospital
    Emergency Incident Command System (HEICS) Job Action Sheets (JAS).

b.  Responsible for staffing the Patient Reception Team as outlined in
    the VA/DOD Contingency Plan.

c.  Assign personnel to initial triage area and support teams.

> d\. Evaluate minimal staffing needs for normal hospital operations.
>
> e\. Adjust long-range staffing plans as necessary.

f.  The professional staff shall provide physicians and other staff to
    advise, assist and treat (as necessary) injured during removal from
    wreckage or disaster area. As evacuation progresses, the physicians
    should withdraw to treatment functions.

g.  Ensure emergency clinicians are adequately trained in all areas to
    include WMD casualties.

> 4\. [Operative Care Line]{.underline}. Upon notification of an
> emergency, the Operating Room supervisor will:
>
> a\. Notify staff normally assigned in that area.
>
> b\. Ready operating rooms to provide definitive operative care.
>
> c\. Notify EOC staff of number of available operating suites and
> number of available SICU beds.
>
> d\. Coordinate with the Environmental Management Section to ensure
> adequate staffing for increased workload.
>
> 5\. [Clinical Practice Office]{.underline}
>
> a\. The Chief Nurse Executive, or designee, will ensure that adequate
> staff is assigned to the triage area to assist with emergency
> treatment and care.
>
> b\. The Emergency Room Nurse Manager in triage will coordinate with
> physicians in treatment rooms and the HEICS Operations Chief regarding
> specific unit assignments of victims from the triage area.
>
> 6\. [Voluntary Section]{.underline}. Maintain roster of active
> volunteers and service organizations that may be utilized in an
> emergency.
>
> 7\. [Patient Access Center (PAC) Manager]{.underline}
>
> a\. Record information on casualties and furnish information to Public
> Affairs & Consumer Relations Officer at Emergency Operations Center.
>
> b\. Collect information on bed availability from each unit and supply
> it to triage and Emergency Operations Center.
>
> c\. Provide emergency messenger service on request of EOC.
>
> d\. Maintain listing and location of evacuated patients and
> casualties.
>
> e\. Provide patient information to the HEICS Planning Chief and PIO.

d.  Maintain a complete record of all deceased casualties and provide
    information to HEICS Planning Chief and PIO and the Chaplain's
    Office.

e.  Tag all belongings of each patient to ensure ownership.

> 8\. [Information Management Service Line]{.underline}
>
> a\. Maintain a log of switchboard activities during disaster.
>
> b\. Manage the setup of all command center communications, to include
> telephone and computer support.
>
> c\. Maintain list of all medical center employees including current
> addresses and phone numbers.
>
> d\. Assist with any data or voice communication needs between this
> medical center and the community partners in managing the emergency.
>
> 9\. [Facilities Management Service Line]{.underline}
>
> a\. Establish Damage Control Center in Building 103 under the
> Engineering Section Manager, Facilities Management Service Line.
> Implement procedures for alternate utility sources, if needed,
> according to the Utility Management Plan.
>
> b\. Assist in the rescue and evacuation of casualties.
>
> c\. Provide transportation for movement of casualties, patients,
> personnel, supplies, etc.
>
> 10\. [Human Resources Management Section]{.underline}
>
> a\. Direct personnel from disaster manpower pool, Library Conference
> Room 4A-400D, upon request and maintain record of assignments. Ensure
> that all service chiefs, service line executives and care line
> executives send all non-essential personnel to the manpower pool
> located in the Library Conference Room 4A-400D.
>
> b\. Coordinate use of available personnel from other agencies and
> community as necessary. Service chiefs, service line executives, and
> care line executives will assign non-essential personnel to the
> disaster manpower pool, Library Conference Room 4A-400D.
>
> c\. Initially assign two persons to the Emergency Operations Center to
> act as messengers.

d.  Maintain list of employees who speak languages other than English.

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11. [Acquisition & Materiel Management Section]{.underline}

> a\. SPD will furnish supplies and equipment to support emergency plan
> (Disaster Cart).
>
> b\. Coordinate the availability of supplies and equipment from
> emergency sources.
>
> c\. Plan for internal distribution or obtain essential supplies and
> equipment from outside sources.
>
> d\. Ensure an adequate operating inventory is on hand.
>
> 12\. [Environmental Management Section, Facilities Management Service
> Line]{.underline}
>
> a\. Man and operate elevators S6-S10 (keys to be picked up and
> returned to the Lock Shop). Man and operate emergency elevator to ICU
> (key to be picked up and returned to the Emergency Room).
>
> b\. Provide patient transfer teams to disaster triage area initially.
>
> c\. Coordinate patient transfer teams in waiting area next to Rooms
> C1A-802, 804 and 806.
>
> d\. Provide linen throughout the Medical Center, as required.
>
> 13\. [Pathology & Laboratory Medicine Section]{.underline}
>
> a\. Provide information on blood supply, by blood type, to Emergency
> Operations Center, Room 4A-220.
>
> b\. Be prepared to coordinate blood supplies and needs with the Gulf
> Coast Regional Blood Center.
>
> c\. Be responsible for drawing patient blood samples at triage site as
> directed by triage physician or other medical staff.
>
> d\. Provide blood and blood components for all medical center patients
> as needed.
>
> e\. Notify potential blood donors of possible need for additional
> blood.
>
> f\. Provide all emergency laboratory examinations.
>
> g\. Make a complete record of all deceased and safeguard personal
> effects.
>
> h\. Fingerprint unidentified deceased in coordination with the VA
> Police Chief or designee.
>
> i\. Provide morgue facilities.
>
> j\. Arrange for transfer of deceased through medical center
> authorities.
>
> 14\. [Radiation Safety Officer]{.underline}
>
> a\. The Radiation Safety Officer (RSO) will assume coordinating
> control in case of a nuclear radiation disaster. The RSO will
> automatically report to the triage area if the type of disaster is
> unknown. Responsibilities will be as specified in the Medical Center
> Policy Memorandum addressing the Radiation Safety Program.
>
> b\. Nuclear Medicine Section will include radiation emergencies in its
> SERP and act as a resource.
>
> 15\. [VA Police Service]{.underline}
>
> a\. VA police officers will provide traffic control, both vehicular
> and pedestrian, and limit access to facility and grounds as directed.
>
> b\. VA Police Service will provide a weather information center during
> warnings of severe weather and advise the Medical Center Director or
> representative.

c.  Fingerprint unidentified casualties.

d.  Assist outside law enforcements in any investigation of terrorist or
    other types of non-natural disasters.

> 16\. [Nutrition & Food Section]{.underline}
>
> a\. Provide food to casualties when directed.
>
> b\. Continue food service to all patients.

c.  Provide food to personnel assisting in the disaster cleanup and
    patient care when directed.

d.  Be prepared to assist other community partners during food shortages
    due to a catastrophic event when directed by the Medical Center
    Director.

> 17\. [Canteen Section]{.underline}
>
> a\. Provide staff to assist Nutrition & Food Section as needed.
>
> b\. Secure all Canteen facilities to public and staff.
>
> c\. Be prepared to use Canteen facilities in support of Nutrition &
> Food Section as needed.
>
> d\. Inventory all food and other useful items for use as needed.
>
> 18\. [Medical Care Line]{.underline}
>
> a\. Will be responsible for treatment of all casualties.

b.  Will furnish staff as directed to areas of minimal care, emergency
    and triage as necessary.

c.  Ensure key staff is trained for WMD casualties.

> 19\. [Mental Health Care Line]{.underline}
>
> a\. Send psychiatrists to triage area when requested.
>
> b\. Treat all psychiatric problems that arise.
>
> c\. Provide assistance with disturbed patients, visitors and staff.
>
> 20\. [Social Work Practice Manager]{.underline}
>
> a\. Assist in the determination of which patients can be discharged
> for maximum availability of beds.
>
> b\. Coordinate with Volunteer and Chaplain sections to provide
> emotional and psychological needs of patients\' families.
>
> c\. Provide counseling and disposition services to patients.
>
> d\. Coordinate contacts with local community emergency social
> resources.
>
> e\. Telephonically notify disaster patients\' families of patients\'
> arrival at the medical center or transfer to another facility.
>
> f\. Provide qualified individuals to perform duties with patient
> reception team.
>
> 21\. [Fiscal Section]{.underline}
>
> a\. Provide funds for emergency purchases.
>
> b\. Maintain fiscal records.
>
> c\. Evacuate essential medical records if threatened.
>
> 22\. [Dental Section]{.underline}. Send dentists to triage area when
> requested.
>
> 23\. [Radiology Section]{.underline}. Provide diagnostic services as
> directed.
>
> 24\. [Audiology and Speech Pathology Section]{.underline}
>
> a\. Send audiologist to triage area when requested.
>
> b\. Provide liaison between persons with hearing and speech
> disabilities and triage medical care team to assure equal access is
> provided.
>
> 25\. [Other Care Lines and Clinical Staff]{.underline}. Be available
> for disasters as directed.
>
> 26\. [Bed Services Available]{.underline}. The following bed services
> are available at the HVAMC: Medical Care Line, Neurology Care Line,
> Mental Health Care Line, Operative Care Line, Spinal Cord Injury Care
> Line, Rehabilitation Care Line, and Extended Care Line.

Appendix 2A

## Initial Plan

+-------------+---+----------+-------------+--------------+----------+
| Activity    | E | Location | Responsible | Initial      | Radio    |
|             | x |          | Official    | Staff        | Call     |
|             | t |          |             |              | Sign     |
|             | . |          |             |              |          |
+-------------+---+----------+-------------+--------------+----------+
| Emergency   | 7 | Building | Medical     | HEICS        | O        |
| Operations  | 1 | 100      | Center      | Officers     | peration |
| Center      | 0 | B        | Director    |              | Center   |
|             | 0 | oardroom |             | Others as    |          |
|             |   | (Room    |             | deemed       |          |
|             |   | 4A-235)  |             | necessary    |          |
+-------------+---+----------+-------------+--------------+----------+
| Triage      | 3 | Building | Prime Care  | ER Medical   | Triage   |
|             | 7 | 100\     | Director    | Director     |          |
|             | 4 | E        |             |              |          |
|             | 8 | mergency |             | ER clinical  |          |
|             |   | Room     |             | staff        |          |
+-------------+---+----------+-------------+--------------+----------+
| Alternate   | 7 | Building | Prime Care  | ER Medical   | Triage   |
| Triage #1   | 1 | 100\     | Director    | Director     |          |
|             | 9 | Main     |             |              |          |
|             | 1 | Entrance |             | ER clinical  |          |
|             |   | Lobby    |             | staff        |          |
+-------------+---+----------+-------------+--------------+----------+
| Alternate   | 6 | Building | Operative   | Chief        | None     |
| Triage #2   | 1 | 100      | Line        | Surgical     |          |
|             | 8 | Clinic   | Executive   | Resident     |          |
|             | 4 | Area #1  |             |              |          |
|             |   |          |             | Ca           |          |
|             |   |          |             | rdiovascular |          |
|             |   |          |             | Surgeons     |          |
|             |   |          |             |              |          |
|             |   |          |             | Anest        |          |
|             |   |          |             | hesiologists |          |
|             |   |          |             |              |          |
|             |   |          |             | Nurses as    |          |
|             |   |          |             | required     |          |
|             |   |          |             |              |          |
|             |   |          |             | Pharmacist   |          |
+-------------+---+----------+-------------+--------------+----------+
| Delayed     | 6 | Building | Medical     | Chief        | None     |
| Care        | 6 | 100      | Care Line   | Neurology    |          |
|             | 2 | Clinic   | Executive   | Resident     |          |
|             | 6 | Area #2  |             |              |          |
|             |   |          |             | Four         |          |
|             |   |          |             | registered   |          |
|             |   |          |             | nurses       |          |
|             |   |          |             |              |          |
|             |   |          |             | One licensed |          |
|             |   |          |             | vocational   |          |
|             |   |          |             | nurse        |          |
+-------------+---+----------+-------------+--------------+----------+
| Minimal     | 2 | Building | Medical     | Prime Care   | None     |
| Care        | 0 | 100      | Care Line   | Clinic       |          |
|             | 5 | Clinic   | Executive   | physicians   |          |
|             | 3 | Area #3  |             |              |          |
|             |   |          |             | nursing      |          |
|             |   |          |             | staff as     |          |
|             |   |          |             | required     |          |
+-------------+---+----------+-------------+--------------+----------+
| DOA and     | 3 | Building | ER Nurse    | One nurse,   | None     |
| Expected to | 8 | 100\     | Manager     | as required  |          |
| Expire      | 0 | (Rooms\  |             |              |          |
|             | 3 | 1A-801,\ |             |              |          |
|             |   | 1A-803)  |             |              |          |
+-------------+---+----------+-------------+--------------+----------+
| Police      | 7 | Building | VA Police   | VA Police    | Security |
| Traffic     | 1 | 100\     | Chief       |              |          |
| Control and | 0 | (Room    |             |              |          |
| Security    | 6 | 1A-820)  |             |              |          |
+-------------+---+----------+-------------+--------------+----------+
| Disaster    | 4 | Building | HRM Section | Available    | Manpower |
| Manpower    | 5 | 100      | Manager     | staff        | Pool     |
| Pool        | 1 | (Room    |             |              |          |
|             | 7 | 4A-400D) |             |              |          |
+-------------+---+----------+-------------+--------------+----------+
| Patient     | 3 | Building | En          | E            | None     |
| Transport   | 8 | 100\     | vironmental | nvironmental |          |
| Pool        | 0 | ER       | Management  | Management   |          |
|             | 3 | waiting  | Section     | Section      |          |
|             |   | area     | Manager     | staff        |          |
|             |   | outside  |             |              |          |
|             |   | VA       |             |              |          |
|             |   | Police   |             |              |          |
|             |   | office   |             |              |          |
+-------------+---+----------+-------------+--------------+----------+
| Casualty    | 7 | Building | External    | Public       | None     |
| Information | 3 | 100\     | Affairs     | Affairs      |          |
|             | 4 | (Room    | Executive   | Officer      |          |
|             | 9 | 4A-231)  |             |              |          |
|             |   |          |             | Social       |          |
|             |   |          |             | Workers      |          |
|             |   |          |             |              |          |
|             |   |          |             | Chaplains    |          |
+-------------+---+----------+-------------+--------------+----------+
| Tra         | 7 | Building | Engineering | All          | Transp   |
| nsportation | 4 | 100\     | Section     | available    | ortation |
|             | 7 | (Room    | Dispatcher  | drivers      |          |
|             | 4 | 4B-358)  |             |              |          |
+-------------+---+----------+-------------+--------------+----------+
| Com         | 4 | Building | Telephone   | Two          | None     |
| munications | 9 | 100\     | Unit        | telephone    |          |
|             | 5 | (Room    | Supervisor  | operators    |          |
|             | 2 | 3A-324)  |             |              |          |
+-------------+---+----------+-------------+--------------+----------+
| Supplies    | 7 | Building | A&MM        | Available    | None     |
|             | 0 | 100\     | Section     | staff        |          |
|             | 9 | (Room    | Manager     |              |          |
|             | 0 | 4B-308)  |             |              |          |
+-------------+---+----------+-------------+--------------+----------+
| Damage      | 7 | Building | Engineering | HEICS        | L        |
| Control     | 4 | 100\     | Section     | Logistics    | ogistics |
|             | 7 | (Room    | Manager     | Chief        | Chief    |
|             | 4 | 4B-358)  |             |              |          |
+-------------+---+----------+-------------+--------------+----------+
| Linen       | 7 | Building | Textile     | Textile Care | None     |
|             | 4 | 100\     | Management  | staff        |          |
|             | 8 | (Room    | Section     |              |          |
|             | 8 | BC-350)  | Manager     |              |          |
|             | \ |          |             |              |          |
|             | 7 |          |             |              |          |
|             | 2 |          |             |              |          |
|             | 0 |          |             |              |          |
|             | 8 |          |             |              |          |
+-------------+---+----------+-------------+--------------+----------+

**All two-way radios (HT1000) should be on Channel 5 for all disaster
*or* disaster drill communications.**

Appendix 2B

## List of Sources for Emergency Purchases

Blood

+-----------------------------------+-----------------------------------+
| Gulf Coast Regional Blood Center  |                                   |
|                                   |                                   |
| 1400 LaConcha                     |                                   |
|                                   |                                   |
| Houston, TX 77054                 |                                   |
|                                   |                                   |
| \(713\) 790-1200                  |                                   |
+-----------------------------------+-----------------------------------+

[Pharmaceuticals]{.underline}

+-----------------------------------+----------------------------------+
| Bindley-Western Drug Co.          | Foxmeyer Drug                    |
|                                   |                                  |
| 3526 E. T.C. Jester               | 950 Grand Ave.                   |
|                                   |                                  |
| Houston, TX 77018                 | Beaumont, TX 77704               |
|                                   |                                  |
| \(713\) 683-0505 or (713)         | \(800\) 221-0558                 |
| 683-0453                          |                                  |
+-----------------------------------+----------------------------------+
| Tennessee Wholesale Drug Co.      |                                  |
|                                   |                                  |
| 200 Cumberland Blvd.              |                                  |
|                                   |                                  |
| Metro Center                      |                                  |
|                                   |                                  |
| Nashville, TN 37228               |                                  |
|                                   |                                  |
| \(800\) 251-3425                  |                                  |
+-----------------------------------+----------------------------------+

[Blankets]{.underline}

+----------------------------------+-----------------------------------+
| American Hospital Supply Corp.   | Sears Roebuck                     |
|                                  |                                   |
| 920l Grogans Mill                | 598 Garden Oaks Blvd.             |
|                                  |                                   |
| The Woodlands, TX 77380          | Houston, TX 770l8                 |
|                                  |                                   |
| \(281\) 367-9201                 | \(713\) 695-2111                  |
+----------------------------------+-----------------------------------+

Subsistence

+-----------------------------------+-----------------------------------+
| Glazier Food Co.                  | Sysco Foods                       |
|                                   |                                   |
| 1280 Oliver St.                   | 535 Portwall                      |
|                                   |                                   |
| Houston, TX 77007                 | Houston, TX 77029                 |
|                                   |                                   |
| \(713\) 869-6411                  | \(713\) 672-8080                  |
+-----------------------------------+-----------------------------------+
| Allen Foods, Inc.                 |                                   |
|                                   |                                   |
| 8543 Page Ave.                    |                                   |
|                                   |                                   |
| St. Louis, MO 63114               |                                   |
|                                   |                                   |
| \(314\) 426-4100                  |                                   |
+-----------------------------------+-----------------------------------+

Medical Transportation

+-----------------------------------+----------------------------------+
| Guinn Flying Service              | Life Flight                      |
|                                   |                                  |
| 6821 Piccadilly                   | 6410 Fannin                      |
|                                   |                                  |
| Houston, TX                       | Houston, TX 77039                |
|                                   |                                  |
| \(713\) 645-8628                  | \(713\) 797-4397                 |
+-----------------------------------+----------------------------------+

Funeral Directors

+-----------------------------------+----------------------------------+
| Citizens Funeral Home             | Niday Funeral Home               |
|                                   |                                  |
| 7512 Lockwood                     | 4136 Broadway                    |
|                                   |                                  |
| Houston, TX 77076                 | Houston, TX 7706l                |
|                                   |                                  |
| \(713\) 631-1393                  | \(713\) 644-3831                 |
+-----------------------------------+----------------------------------+
| Houston Memorial Funeral Home\    | Williams & Sons Funeral Home\    |
| 10817 W. Hardy\                   | 7811-1/2 Cullen\                 |
| Houston, TX 77076\                | Houston, TX 77051\               |
| (713) 692-4441                    | (713) 738-2234\                  |
|                                   | (713) 733-4361                   |
+-----------------------------------+----------------------------------+

> Appendix 2C

## Mutual Aid Agreements with other Healthcare Facilities

The HVAMC is committed to cooperating with the local area by assisting
with medical support during a disaster. Mutual aid agreements have been
signed with the following health care facilities: Texas Children\'s
Hospital, San Jacinto Methodist Hospital, Hermann Hospital, and Columbia
Woman\'s Hospital of Texas. Copies of the signed agreements may be
obtained from the Area Emergency Manager.

# Chapter III Civil Disturbance Preparedness Program

***Note**: As circumstances dictate, the provisions of Chapter II,
[Community Casualty]{.underline} [Plan]{.underline}, will be affected in
addition to the instructions contained in this chapter.*

A. [Objective.]{.underline} To provide countermeasures for facility
emergencies resulting from riots, civil disturbances or individuals
threatening violence.

B. [General Procedures]{.underline}

> 1\. The VA Police Chief will notify the Harris County Sheriff\'s
> Office, City of Houston Police Department, and any other assistance
> resource as directed by the Medical Center Director. Notify VA Central
> Office (Director, Security Staff, 13D).
>
> 2\. Service chiefs, service line executives and care line executives
> should be prepared for a high absentee rate during the first days of
> the emergency. Accordingly, their departmental staff plans should make
> provisions for this contingency.
>
> 3\. Admitting area staff should expect that the number of patients
> admitted is likely to increase as darkness approaches.
>
> 4\. Medical Center staff should draw all blinds, shades and drapes at
> dusk and use a minimum of light throughout the Medical Center.
>
> 5\. Off-duty employees will be contacted by phone, messenger or local
> radio stations.

C. [Responsibilities of Service Chiefs, Service Line Executives and Care
Line Executives]{.underline}

> 1\. Ensure that non-essential personnel are sent to the HEICS manpower
> pool located in the Library Conference Room 4A-400D.
>
> 2\. Ensure that adequate food and water is on-hand for staff, families
> of staff, patients, visitors and assisting personnel from other
> entities.
>
> 3\. Ensure that adequate resources are procured.
>
> 4\. Ensure that essential resources are safeguarded.
>
> 5\. Ensure that cascades and SERPs are updated regularly.
>
> 6\. Ensure that staff remain current on all essential training
> requirements.

# Chapter IV Bomb Threats

A. [Purpose]{.underline}. This chapter describe how individual employees
and the medical center will act when a Bomb Threat is received. The
appendices include a form to be used by an individual who receives the
threat.

> 1\. [Situation and Assumptions]{.underline}. Any bomb threat needs to
> be taken seriously. A bomb threat can be the result of an individual
> who wishes to disrupt the activities of the institution. Usually the
> threat is not real, but the individual making the threat achieves
> their goal by making the institution react. However, there are
> occasions where the threat is real. Therefore, it is important to have
> a program to comprehensively search and identify a possible device.
> Because a device is usually concealed in a container that appears out
> of place to people who know what is usually in the area, it is
> important that any search team include, if possible, individuals from
> the area.
>
> 2\. [Concept of Operation]{.underline}.
>
> a\. [Threatening messages/bomb threat information]{.underline}: A
> threatening tele­phone call may be received either by a patient,
> visitor, volunteer or an employee. Threatening telephone calls may be
> directed toward a staff member or may be the announcement of an
> explosive or other harmful threat directed toward a person or
> government property. The extent of search, evacuation and activation
> of other aspects of the program will be determined by the Medical
> Center Director or designated representative.
>
> \(1\) When call is received:
>
> \(a\) Employees receiving calls that convey a threat against medical
> center property, personnel, patients, etc., should remain calm and
> take the following steps:
>
> ([1]{.underline}) Attempt to keep the caller talking as long as
> possible without increasing the caller's antagonism.
>
> ([2]{.underline}) Continue to keep the caller talking to allow time
> for tracing the call.
>
> ([3]{.underline}) Other personnel in the immediate area should contact
> VA Police Service by dialing 911.
>
> ([4]{.underline}) Inform the police dispatcher that a threatening call
> has been received and identify the extension number.
>
> ([5]{.underline}) VA Police Service will attempt to trace the call by
> contacting Southwestern Bell Security.
>
> \(b\) Any employee who receives a threatening call that announces a
> bomb threat, will attempt to get the following information (see
> Appendix 4B) and write it down immediately.
>
> ([1]{.underline}) Location of the bomb or explosive device.
>
> ([2]{.underline}) Time it will explode.
>
> ([3]{.underline}) Identify how the caller got the information.
>
> ([4]{.underline}) Attempt to obtain identification from the caller.
>
> \(c\) Upon termination of the call, immediately write the exact
> wording of the threatening conversation, time it was received and the
> extension number on which the call was received. This information
> should be provided to VA Police Service at extension 7106.
>
> \(d\) During normal administrative hours, VA Police Service will
> immediately contact the Medical Center Director\'s office when
> notified of a threat and then notify Engineering Section, FMS at
> extension 7474 to make certain that bomb threat staff is activated to
> follow SERP search procedures.
>
> \(e\) During non-administrative hours, the police supervisor will
> contact the AOD and the Medical Center Director or alternate.
>
> \(f\) During non-administrative hours, the AOD is responsible for
> dissemination of information to the nursing units.
>
> \(2\) Reporting the threat:
>
> \(a\) Report all threats to VA Police by calling 911.
>
> \(b\) Take action as directed by Medical Center Director or designee,
> which may include both searches and evacuation. Police Service will
> assume bomb scene security. During non-administrative hours the AOD
> will be the Acting Medical Center Director until relieved by the
> Medical Center Director or designee.
>
> b\. [Leadership during bomb threat]{.underline}:
>
> \(1\) The Medical Center Director or designee will determine the
> extent of the search for the bomb. This decision will be based on
> available information. A search may be directed to a single section or
> the full facility.
>
> \(2\) Police Service will assume bomb scene security.
>
> \(3\) During normal administrative hours, the Facilities Management
> Service Line Executive will act as Search Coordinator (extension
> 7474). The COS or designee will act as Search Coordinator for the
> outpatient clinic areas (extension 7034). Any nurses assigned to the
> search area will assist those coordinating the search.
>
> \(4\) During non-administrative hours, the AOD will act as Search
> Coordinator until relieved by the Medical Center Director or designee.
>
> \(5\) After the determination of the scope of the search (full
> facility or partial), the senior employee in affected area will be
> asked to immediately search their own area and report the results of
> the search to the VA Police. Searches will always be made in teams of
> two. If an area is not occupied, service chiefs, service line
> executives and care line executives in charge of the unoccupied area
> will be called and asked to return or have designees more familiar
> with the areas return to search the unoccupied areas.
>
> c\. [Searching for a device]{.underline}: Search procedures and
> evacuation of patients, visitors, and employees depend upon the
> location, information about the bomb, time of day, validity of
> information, etc. If the threat can be localized to a section or
> sections of the HVAMC, then a complete search of the facility may not
> be necessary. The decision to limit the search will be made by the
> Medical Center Director or alternate based on available information.
>
> \(1\) Administrative and clinical areas will be divided into search
> sections. Each nursing unit will be considered an individual search
> area. All adjacent halls, stairwells, fire escapes, utility rooms,
> cupboards, closets, public or private bathrooms, storerooms, and
> waiting rooms will be considered part of the section. The charge
> person will be asked to immediately search their own area and report
> to the Search Coordinator. Laundry chutes will be the responsibility
> of Textile Management Section staff.
>
> \(2\) Strict security should be maintained on each section searched
> until the entire search is complete.
>
> d\. [Discovery of suspected bomb]{.underline}
>
> \(1\) Any employee finding a package suspected of being a bomb or
> similar device will immediately notify the VA Police by calling 911.
> DO NOT TOUCH OR DISTURB A SUSPECTED BOMB.
>
> \(2\) The immediate area will be promptly evacuated. Any areas above
> and below the suspected bomb will also be evacuated.
>
> \(3\) Large-scale evacuation procedures will be initiated only when
> ordered by the Medical Center Director or designee.
>
> \(4\) The Police Chief or designee will contact authorities deemed
> advisable by the Medical Center Director. Houston Police Bomb Squad
> will be called if a suspected device is found.
>
> 3\. [Administration and Logistics]{.underline}: The administration and
> implemen­tation of this program and training on its policies and
> procedures, shall be the responsibility of the Police Chief and the
> Emergency Management Program Committee, with the assistance of the
> service chiefs, service line executives and care line executives. The
> effectiveness of the administration of this program shall be evaluated
> through plan implementation during actual emergencies or exercises.
> Staff knowledge and responsibilities shall be critiqued by the service
> chiefs, service line executives and care line executives and reported
> to the VA Police Chief. VA Police Service will make periodic reports
> to the Emergency Management Program Committee.
>
> 4\. [Plan Development and Maintenance]{.underline}: The Police Chief
> and the Facilities Management Service Line Executive are responsible
> for coordinating the development and implementation of this program.
> They shall coordinate the development with the Emergency Management
> Program Committee. Periodic training on the concepts included in this
> program shall be given.

B. [Standard Operating Procedures]{.underline}

> 1\. [Search Area Definitions]{.underline}:
>
> a\. Administrative and clinical areas will be divided into search
> sections. Each nursing unit will be considered an individual search
> area. All adjacent halls, stairwells, fire escapes, utility rooms,
> cupboards, closets, public and private bathrooms, storerooms,
> telephone booths and waiting rooms will be considered part of the
> section. The charge person will be asked to immediately search their
> own area and report to the Search Coordinator. Laundry chutes will be
> the responsibility of Textile Management Section staff.
>
> b\. Strict security should be maintained on each section searched
> until the entire search is complete.
>
> 2\. [Search Protocol]{.underline}:
>
> a\. Call received by employee.
>
> b\. VA Police notified by calling 911. The police supervisor contacts
> the AOD, Associate Director, Medical Center Director, Chief, Police
> Service, etc., as outlined in the VA Police SOP.
>
> c\. Decision made regarding search.
>
> d\. Initial search made.
>
> e\. All involved, search sections and report results back to VA
> Police.
>
> f\. Decision to continue by conducting follow-up search.
>
> g\. Follow-up search made.
>
> h\. Results reported to Medical Center Director by Police Chief or
> highest-ranking police officer.
>
> If suspected bomb found, DO NOT TOUCH. Evacuate the surrounding area.
> Notify VA Police (extension 7106). The Police Service will notify the
> Houston Police Bomb Squad. Houston Police Bomb Squad will deal with
> suspected bomb.
>
> 3\. [Initial Search]{.underline}:
>
> a\. All radio communication systems (two-way radio systems, beepers or
> cellular phones) will be turned off during the bomb threat. Search
> teams will turn off two-way radios, beepers or other cellular phones.
> Code teams will be placed on special alert during a bomb threat.
> Notifications will be accomplished by overhead announcements instead
> of the beeper system. Other communication will be over hard-wired
> telephone systems only.
>
> b\. Teams should consist of two people, both preferably from the area
> being searched.
>
> c\. Teams should NOT disturb any suspicious item found. Evacuate the
> surrounding area. Police Service will notify Houston Police Bomb
> Squad. Houston Police Bomb Squad will deal with suspected bomb.
>
> REMEMBER! If an area is not accessible, make note of these areas on
> the Unsearched/Locked Rooms Report.
>
> d\. Room Searches:
>
> \(1\) Upon entering rooms, team will stop, look and listen for
> something unusual.
>
> \(2\) Divide the room in half for a more thorough search.
>
> \(3\) The room search will be divided into height level searches. They
> should be done in order.
>
> \(a\) Floor to hip height.
>
> \(b\) Hip height to chin.
>
> \(c\) Chin to ceiling.
>
> \(4\) Do not attempt to search false ceiling spaces at this time.
>
> \(5\) Do not attempt to look in every drawer. Look in obvious places
> (i.e., trash containers, under covered areas, drawers near doors).
>
> \(6\) Go through every room in this manner until the entire building
> search is complete. This will end the initial search.
>
> \(7\) Upon completion of the initial search, return to the Emergency
> Operations Center to report and to submit the Unsearched/Locked Rooms
> Report to the Medical Center Director or VA Police.
>
> 4\. [Follow Up Search]{.underline}:
>
> a\. All radio communication systems (two-way radio systems, beepers or
> cellular phones) will be turned off during the bomb threat. Search
> teams will not carry or use two-way radios, beepers or other cellular
> phones. Overhead paging will be used instead of the beeper system.
> Other communication will be over hard-wired telephone systems only.
>
> b\. Teams should consist of two people: one from the area being
> searched and the other from Facilities Management Service Line.
>
> c\. Teams should NOT disturb any suspicious item found.
>
> d\. Room Searches:
>
> \(1\) Upon entering rooms, team will stop, look and listen for
> something unusual.
>
> \(2\) Divide the room in half for a more thorough search.
>
> \(3\) Be more thorough the second time through.
>
> \(4\) Look in closets, drawers, suitcases, cupboards, enclosed
> washbasins, toilet tanks, windowsills, etc.
>
> \(5\) The room search will be divided into patterns. They should be
> done in order.
>
> \(a\) Floor to hip height.
>
> \(b\) Hip height to chin.
>
> \(c\) Chin height to ceiling.
>
> \(d\) Above the false ceiling. Facilities Management Service Line
> staff conduct this.
>
> \(6\) Go through every room in this manner until the entire building
> search is complete. This will end the second search.
>
> \(7\) Upon completion of the search, return to the Emergency
> Operations Center to report and to submit report to the Medical Center
> Director or Police Service.

C. [Bomb Threat and Threatening Phone Call Plan]{.underline}

> 1\. [Purpose]{.underline}. These procedures shall be applied for the
> protection of life, primarily, and for the protection of property,
> secondarily, in the safest, most expeditious manner and with minimal
> disruption to medical center business and operations.
>
> 2\. [Records]{.underline}. It is imperative that records be maintained
> of patients, employees and anyone else who has made a clear and
> positive voice threat of harm or destruction. This type of file will
> help for referral and comparison with the characteristics of threat
> callers and can minimize disruption of facility operations and lead to
> prevention of crimes of violence. All threat records should be
> forwarded to the VA Police for retention.
>
> 3\. [Control]{.underline}. The Medical Center Director or designee
> will retain complete decision authority over actions to be taken in
> response to bomb threats or bomb discoveries. The decision point in
> bomb threat reaction, i.e., whether to evacuate, to initiate search
> procedures, or to ignore the threat, is of far more consequence in a
> healthcare facility than in any other type facility *and must be made
> by the Medical Center Director* or designee.
>
> 4\. [Notification]{.underline}. When a bomb threat is received or
> otherwise initiated, the employee who received the threat shall notify
> the medical center police supervisor on duty by calling 911. The
> employee will then complete Appendix 4B, \"Bomb Threat Phone Report,\"
> and take it to the on-duty police supervisor in Building 100, Room
> 1A-820. Upon receipt of such notification, the on-duty police
> supervisor will notify the telephone operator. The telephone operator
> will notify the individuals specified in Appendix 4A.
>
> 5\. [Operation]{.underline}
>
> a\. All employees will immediately search their assigned areas and
> report to the HEICS Safety & Security Officer at extension 7106 and
> the EOC at extension 7100, that their area has been cleared. After
> close of business, Police Service, Environmental Management and
> Engineering Sections staff on duty will conduct a search of all closed
> areas normally open to the public. Areas normally locked and
> unavailable to the public or patients will not be searched unless
> there is reason to be suspicious.
>
> b\. The police supervisor shall remain near the police dispatch area
> until relieved by higher authority. The supervisor will check off all
> cleared areas. Floor plan lists will be provided by Facilities
> Management Service Line and maintained by the Police Service.
>
> c\. The police supervisor will meet with the City of Houston police
> officers that respond to the HVAMC's call and advise them of details
> of the bomb threat message and of what is being done by HVAMC staff.
> After all areas have been searched and cleared, the police supervisor
> will so advise employees throughout the hospital.
>
> d\. Bomb threat files will be maintained by Police Service.

**IF A SUSPICIOUS PACKAGE IS LOCATED - DO NOT TOUCH IT! NOTIFY MEDICAL
CENTER POLICE IMMEDIATELY.**

Appendix 4A

## Telephone Notification Bomb Threat Checklist

The telephone operator will call the following staff at their offices
during normal working hours. Telephone operators will ensure home
telephone numbers are kept current for after-hours notification.

> Medical Center Director 7100
>
> Associate Director 7531
>
> Chief of Staff 7011
>
> Facilities Management Service Line Executive 7474
>
> Police Chief 7106
>
> Police Service Administrative Division Manager 3310
>
> Police Service Uniformed Section Supervisor 6208
>
> Emergency Management Office 7973
>
> Chief Nurse Executive 7475
>
> Information Management Service Line Executive 7148
>
> Environmental Management Section Manager 7488
>
> AOD (irregular tour) Pager 1821

Appendix 4B

## Bomb Threat Telephone Report

**Complete this questionnaire after receiving a bomb threat.**

Caller ID: (\_\_\_) \_\_\_\_\_-\_\_\_\_\_ Date: Time Received: Ended:

**Exact words of Caller:**[\
]{.underline}

**Questions to ask:**

When will it explode?

Where is it located? Building Floor Area Room

What kind of bomb is it?

What will make it explode?

How do you detonate it?

What does it look like?

Why kill or injure innocent people?[\
]{.underline}

Why was it put there?

What is your name?

Address?

**Description of Voice:**

Male Female Calm Nervous

Young Middle Age Old

Speech: Rough Refined Accent

Speech Impediment (describe)

Unusual phrases

Recognize voice? If so, who do you think it was?

**Background Noise:**

Music Running Motor (type) Traffic Whistles

Bells Horns Aircraft Tape Recorder

Machinery Other

Did the caller indicate knowledge of the facility?

If so, how?

**Remarks:**

**DELIVER BOMB THREAT REPORT TO MEDICAL CENTER POLICE IMMEDIATELY\
**(Building 100, Room 1A-820)

Appendix 4C

## Bomb Search Schedule

  ------------------ -------------------- -------------------------------
  **Function**       **Responsible        **Area**
                     Staff**              

  Active Units       Nursing Unit Staff   Corridors, patient rooms,
                                          toilet areas and other unit
                                          space open to the public

  Public Areas       Police Service       Elevator lobbies of all floors
                                          and the main lobby

  Public Areas       Environmental        Public toilets, corridors,
                     Management Section   areas with general employee
                                          locker rooms (does not include
                                          surgery or other special locker
                                          rooms which are the
                                          responsibility of the
                                          respective services, service
                                          lines and care lines), ATS
                                          holding rooms and conference
                                          rooms, other spaces as assigned
                                          by the police supervisor

  All Administrative Service line and     Offices, conference rooms and
  service lines and  section staff        toilets with respective areas
  sections                                open to the public.

  Nutrition & Food   Section staff        All Nutrition & Food areas open
  Section                                 to the public

  Rehabilitation     OT, PT, VRT staff,   Therapeutic areas open to the
  Care Line          as appropriate       public

  Veterans Canteen   Section staff        Retail store, food service
  Section                                 area, canteen offices, canteen
                                          areas open to the public

  Engineering        Section staff        All section areas, grounds,
  Section                                 stairwells, elevators,
                                          interstitial spaces and
                                          mechanical bays, other spaces
                                          as assigned by police
                                          supervisor
  ------------------ -------------------- -------------------------------

  ------------------ -------------------- -------------------------------
  **Function**       **Responsible        **Area**
                     Staff**              

  Operative Care     Care line staff      Care line offices, locker
  Line                                    rooms, lounges, room, and other
                                          care line areas open to the
                                          public

  Chaplain Section   On-duty chaplains    Chapel and all areas by
                                          Chaplain Section open to the
                                          public

  Medical Care Line  Care line staff      ER, Prime Care, PAC area
                                          conference rooms, examination
                                          rooms and other spaces occupied
                                          by MCL staff that are open to
                                          the public

  Mental Health Care Care line staff      All Mental Health Care Line
  Line                                    conference rooms, waiting rooms
                                          and other spaces open to the
                                          public and patients

  Library Section    Section staff        All Library spaces open to the
                                          public and patients

  Pathology &        Section staff        All P&LM Section spaces open to
  Laboratory                              the public or patients
  Medicine Section                        

  Human Resources    Section staff        All HRM Section spaces open to
  Management Section                      the public

  Pharmacy Section   Section staff        All Pharmacy waiting areas
  ------------------ -------------------- -------------------------------

#  Chapter V Adverse Weather Conditions

A. [Purpose]{.underline}. This section shall be applied for the
protection of life, primarily, and for the protection of property,
secondarily, and with minimal disruption to medical center business and
operation.

B. [Control]{.underline}. At the Medical Center Director\'s discretion
and when conditions warrant, an emergency meeting of all service chiefs,
service line executives and care line executives will be held in order
to coordinate the preparation and operation of all services, service
lines, and care lines. At this time an EOC post will be established to
disperse information to the services, service lines, and care lines
throughout the period of the emergency. Should telephone service be
disrupted, each service, service line and care line will designate a
courier exclusively assigned to transmit and receive messages to and
from the EOC.

C. [Notification]{.underline}. Upon notification of adverse weather
conditions, the Medical Center Director will order the appropriate
services to prepare for the conditions anticipated.

D. [Responsibilities]{.underline}

> 1\. [Facilities Management Service Line]{.underline}. Be prepared to
> prevent flooding and window damage. Ensure continuation of all utility
> services and any appropriate action.
>
> 2\. [Clinical Practice Office]{.underline}. Be prepared to move
> patients as necessary from areas of danger and to continue nursing
> duties with minimum interruptions. Be prepared to discharge as many
> patients as necessary.
>
> 3\. [Patient Access Center (PAC)]{.underline} Arrange to move as many
> patients to other VA medical centers as necessary.
>
> 4\. [Nutrition & Food Section, CSSL]{.underline}. Be prepared to
> furnish meals to employees, visitors, volunteers or family members of
> employees who may be at this medical center.
>
> 5\. [Human Resources Management Section, BOSL]{.underline}. Be
> prepared to call as many employees to return to duty as deemed
> necessary by the Medical Center Director. In situations such as
> flooding or hurricane, the Human Resources Manager, or designee, is
> authorized to inform returning employees that they may bring members
> of their immediate family with them if they are in danger from the
> weather.
>
> 6\. [Police Service]{.underline}. Will secure all entrances and allow
> only authorized employees to enter. Further, set up roving patrols in
> order to maintain security and notify the Medical Center Director of
> any damage to the HVAMC so appropriate action can be taken to prevent
> further damage.

E. [Submission of Weather Plan]{.underline}. All services, service lines
and care lines must include, in detail, their individual adverse weather
plan in their Emergency Response Plan. Copies must be forwarded to the
Facilities Management Service Line Executive. Each plan will be written
to support functions outlined above and in accordance with the other
sections of the facility\'s emergency response plan.

# Chapter VI Patient Evacuation

A. [Policy]{.underline}. It is the policy of the HVAMC to evacuate
patients, as a last resort when remaining in the area would pose an
unacceptable risk. This risk may come from a fire, utility failure,
hazardous material spill, structural damage, or terrorist act. The
facility will use other assets, the authorized components of the
National Disaster Medical System (NDMS) and Mutual Aid Agreements, as
needed.

B. [Procedures --- Phase I]{.underline}

> 1\. The Medical Center Director will advise key staff (using the
> Cascade System) of our need to evacuate and relocate patients within
> the HVAMC complex.
>
> 2\. The Patient Access Center Manager will poll the units for
> available beds and report it to the Medical Center Director and COS.
>
> 3\. The COS will direct the relocation of patients to units most
> capable of providing a level of care.
>
> 4\. The Health Information Management Section (HIMS) will maintain
> communications with unit staff to assure that patient records are kept
> current and that reallocations occur as directed.
>
> 5\. The Police Service will control access to the buildings and area
> being evacuated.
>
> 6\. Nursing unit staff, as well as all other available employees, will
> assist in the evacuation and transport of patients as directed by the
> nurse manager, charge nurse or safety staff. Generally, patients will
> be moved by one of the following methods:
>
> a\. Ambulatory patients shall be assisted off the unit by evacuation
> personnel, following assigned evacuation routes. Evacuation personnel
> shall stay with assigned patients until they are transferred to the
> next \"link\" in the evacuation chain. *Patients will never be left
> unattended.*
>
> b\. Wheelchairs will be utilized for wheelchair-bound patients.
> Wheelchairs should be reused as much as possible for continuing
> evacuation.
>
> c\. Bed-ridden or otherwise incapacitated patients should be moved in
> their beds as much as practical; otherwise, move patients to the
> floor, wrap in blankets or sheets and drag along the floors to
> evacuation routes. In the event of smoke or fire, excessive heat, or
> chemical irritant, cover the patient's face with a wet towel as much
> as is practical. In a smoke-filled environment, move patients along as
> close to the floor as possible.
>
> 7\. After all patients are evacuated from the area; Engineering
> Section and Police Service staff will make a final inspection and
> secure the area.
>
> 8\. The Facilities Management Service Line Executive, or designee,
> will attend to the facility deficiencies causing the evacuation and
> direct facility vehicles as may be needed to relocate patients or
> equipment.

C. [Procedures --- Phase II]{.underline}

> 1\. The Medical Center Director will advise key staff (using the
> Cascade System) and the South Central VA Health Care Network Director
> of our need for total evacuation and request support as needed.
>
> 2\. The Area Emergency Manager will poll other VAMCs or local NDMS
> participating medical centers to determine bed availability and so
> advise the Medical Center Director and Patient Access Center Manager.
>
> 3\. The Police Service will direct incoming patient transportation
> vehicles to appropriate locations for patient pickup.
>
> 4\. The Health Information Management Section Manager will direct
> staff to each loading point to maintain patient information.
>
> 5\. The Facilities Management Service Line Executive or designee will
> attend to the facility deficiencies causing the evacuation and direct
> facility vehicles to the proper loading points.
>
> 6\. Evacuation will be by priorities as established by the COS.
> Procedures will be as stated in paragraphs B.6., a.-c., above.
>
> 7\. Patient pickup points will be as follows:
>
> a\. West: Transitional Care Center entrance
>
> b\. Center: Main entrance
>
> c\. East: Spinal Cord Injury entrance
>
> 8\. The Patient Access Center Manager will provide the Medical Center
> Director with the roster showing where each patient has been
> transferred.

D. [Responsibilities]{.underline}

> 1\. The Medical Center Director, or alternate, is responsible for
> ordering area evacuation (Phase I) or total building evacuation (Phase
> II).
>
> 2\. The Nursing staff on the affected units will be responsible for
> supervising the method and order of patient evacuation in conjunction
> with the Safety Manager who will supervise staff from the disaster
> manpower pool in the proper lifting and carrying of patients. The
> Facilities Management Service Line Executive, or designee, will be
> responsible for selecting and coordinating the evacuation route with
> the Nursing and Safety staff.
>
> 3\. The Patient Access Center (PAC) Manager is responsible for
> coordinating the recording of patient transfers and the safeguarding
> of the patient records.
>
> 4\. The Police Service is responsible for controlling access to the
> building, securing areas evacuated and posting personnel if necessary
> and maintaining vehicle traffic flow around the medical center.

# Chapter VII Radiation Disaster

A. [Policy]{.underline}. This facility is not equipped to deal with a
large-scale radiation disaster. The following information is provided
for small-scale radiation accidents. In the event of a radiation
disaster it is the policy of this medical center to:

> 1\. Isolate patients and limit contamination to ensure safety of
> hospital staff and facilities.
>
> 2\. Request assistance via the Emergency Operations Center from the
> Houston Fire Department 911 dispatcher.

B. [Objectives]{.underline}

> 1\. To provide emergency care to patients that have been accidentally
> contaminated or exposed.
>
> 2\. To ensure the safety of Medical Center staff and facilities.
>
> 3\. Determination of actual exposure shall be done by description of
> accident before patient arrives at the Medical Center or from the use
> of a radiation survey meter after arrival.
>
> 4\. Upon notification that individuals involved in a radiation
> accident are being sent to the Medical Center, the Radiation Safety
> Officer (extension 7396) shall be notified by the Emergency Room nurse
> manager (Triage) immediately so that proper guidance can be provided.
> The switchboard operator will also contact the Radiation Safety
> Officer, Nuclear Medicine physician and the Texas Department of
> Health, when advised.
>
> a\. The Nuclear Medicine physician may be contacted via the Medical
> Center's operator, or by calling extension 7115.
>
> b\. The Texas Department of Health may be contacted at (512) 834-6688
> or after-hours at (512) 481-1000.
>
> 5\. Upon arrival of the radiation accident victim, the first concern
> should be for the correction of life threatening situations and
> implementation of proper medical care.
>
> 6\. The specific procedures regarding treatment and protection of
> patients and employees will be found in the Medical Center Policy
> addressing the HVAMC's Radiation Safety Program.
>
> 7\. There are four basic types of radiation exposure:
>
> a\. Externally emitted radiation that penetrates body tissues
>
> *Example*: X-rays, Gamma rays, beta particles, and neutrons.
>
> *Guidelines and precautions to observe in caring for the patient:*
>
> \(1\) With the possible exception of neutron exposure, the patient is
> not radioactive and poses no hazard to attending persons. Depending on
> the degree of exposure, the patient may become quite sick and show
> various symptoms, including nausea and vomiting.
>
> \(2\) From the standpoint of radiation, the patient does not require
> isolation or special handing procedures.
>
> \(3\) All of the patient\'s personal items (e.g., clothes, money,
> watch, rings, belt, tie clasp, etc.) should be collected and retained.
> Each object should be labeled with the patient\'s name and location.
>
> b\. Radioactive material deposited on the skin or clothing
>
> *Example*: Radiation may evolve from a solid liquid, gas, or powder.
>
> *Guidelines and precautions to observe in caring for the patient:*
>
> \(1\) Anyone touching the patient or handling clothing may become
> contaminated.
>
> \(2\) Rubber gloves, shoe covers, and a lab coat should be worn by all
> attending persons. Respiratory equipment may also be desirable,
> depending on the chemical properties of the contaminating substance.
>
> c\. Radioactive material inhaled, ingested or internally deposited
> through a wound:
>
> \(1\) Radiation may be emitted from substances in a solid, liquid, or
> gaseous form.
>
> \(2\) Normally inhaled, ingested, or wound deposited radioactive
> materials, in the absence of external contamination, do not constitute
> a serious hazard to attending persons. The quantities deposited are
> normally low.
>
> \(3\) Contamination problems may arise when vomiting or bleeding
> occurs. The patient should be handled as if s/he were externally
> contaminated with a radioactive liquid.
>
> \(4\) Medical staff by direction of the HEICS Operations Chief will
> label and save all of the patient's personal objects and all urine,
> feces and vomitus.
>
> d\. Radioactive material in a solid form that is imbedded with body
> tissues:
>
> Flying pieces of radioactive metal, glass, or wood can cause this
> condition. This type of contamination usually follows an explosion and
> may involve particles that emit large amounts of radiation.
>
> \(1\) Of the four listed, this type of accident is rare, but could be
> the most hazardous to attending persons.
>
> \(2\) The imbedded objects may be highly contaminated or radioactive
> and should be removed from the patient as soon as possible. Depending
> on survey meter readings, remote handling tools and limited personnel
> exposure periods may be advised.
>
> \(3\) Obviously, many problems and questions arise with this type of
> contamination. The most important point to stress is that a person
> trained in the use of simple radiation survey instrumentation should
> be present with instruments to assess the radiation levels emanating
> from the patient.
>
> \(4\) Label and save all of the patient\'s objects and all urine,
> feces, and vomitus.
>
> e\. Being forewarned of the types of accidents gives Medical Center
> staff better means of communicating the problem to the Radiation
> Safety Officer. When s/he arrives s/he will work closely with the
> nurses and physicians to implement the best plan for managing the
> problem.

# Chapter VIII Bio-terrorism Readiness Plan

A. [Reporting Requirements and Contact Information]{.underline}. The
HVAMC and other healthcare facilities may be the initial sites of
recognition and response to bio-terrorism events. If a bio-terrorism
event is suspected, local emergency response systems should be
activated. Notification should immediately include the HEICS IC,
Officers, Chiefs and Administrative Services Director and prompt
communication with the local and state health departments, FBI field
office, local police, CDC, and medical emergency services. The following
telephone notification numbers are available for HEICS staff use:

> INTERNAL CONTACTS:
>
> Medical Center Director, extension 7100
>
> INFECTION CONTROL, extension 7808
>
> EPIDEMIOLOGIST (Infectious disease physician), extension 7589
>
> ADMINISTRATION/PUBLIC AFFAIRS, extension 7349
>
> HEICS PIO ext 7349
>
> EXTERNAL CONTACTS:
>
> LOCAL HEALTH DEPARTMENT (713) 794-9181/Pager (713) 549-5047
>
> STATE HEALTH DEPARTMENT (713) 767-3000
>
> FBI FIELD OFFICE (713) 693-5000
>
> BIO-TERRORISM EMERGENCY NUMBER, CDC Emergency Response Office (770)
> 488-7100
>
> CDC HOSPITAL INFECTIONS PROGRAM (404) 639-6413

B. [Potential Agents]{.underline}. Four diseases with recognized
bio-terrorism potential (anthrax, botulism, plague, and smallpox) and
the agents responsible for them are described in Section II of this
document. The CDC does not prioritize these agents in any order of
importance or likelihood of use. Subsequent installments of this
document will address additional agents with bio-terrorism potential,
including those that cause tularemia, brucellosis, Q fever, viral
hemorrhagic fevers, and viral encephalitis, and disease associated with
staphylococcal enterotoxin B.

C. [Detection of Outbreaks Caused by Agents of
Bio-terrorism]{.underline}. Bio-terrorism may occur as covert events, in
which persons are unknowingly exposed and an outbreak is suspected only
upon recognition of unusual disease clusters or symptoms. Bio-terrorism
may also occur as announced events, in which persons are warned that an
exposure has occurred. Patients may need to be treated based upon the
syndrome-based criteria, which refers to:

Rapid response to a bio-terrorism-related outbreak requires prompt
identification of its onset. Because of the rapid progression to illness
and potential for dissemination of some of these agents, it may not be
practical to await diagnostic laboratory confirmation. Instead, it will
be necessary to initiate a response based on the recognition of
high-risk syndromes.

D. [Epidemiological features]{.underline}. Epidemiological principles
must be used to assess whether a patient's presentation is typical of an
endemic disease or is an unusual event that should raise concern.
Features that should alert healthcare providers to the possibility of a
bio-terrorism-related outbreak include:

> 1\. A rapidly increasing disease incidence (e.g., within hours or
> days) in a normally healthy population.
>
> 2\. An epidemic curve that rises and falls during a short period of
> time.
>
> 3\. An unusual increase in the number of people seeking care,
> especially with fever, respiratory, or gastrointestinal complaints.
>
> 4\. An endemic disease rapidly emerging at an uncharacteristic time or
> in an unusual pattern.
>
> 5\. Lower attack rates among people who had been indoors, especially
> in areas with filtered air or closed ventilation systems, compared
> with people who had been outdoors.
>
> 6\. Clusters of patients arriving from a single locale.
>
> 7\. Large numbers of rapidly fatal cases.
>
> 8\. Any patient presenting with a disease that is relatively uncommon
> and has bio-terrorism potential (e.g., pulmonary anthrax, tularemia,
> or plague).

# Chapter IX Chemical Disaster

This facility is not equipped to deal with a large-scale chemical
disaster. In the event of a notification of hazardous material spill or
other chemical disaster it is the policy of this medical center to:

> 1\. Initiate lockdown procedures to ensure that contamination does not
> occur within any of the facility buildings.
>
> 2\. Isolate patients in area outside Building 100 to limit
> contamination and to ensure the safety of Medical Center patients,
> visitors, staff, volunteers and facilities.
>
> 3\. Request assistance via the Emergency Operations Center from the
> Houston Fire Department 911 dispatcher.
>
> 4\. Start basic decontamination procedures by removal of all clothing
> from suspected contaminated individuals in an area that ensures
> privacy.
>
> 5\. While maintaining privacy, rinse patient with water, soap & other
> necessary decontamination solutions to dilute chemical agents.
>
> 6\. Issue patient hospital clothing and triage to an uncontaminated
> area.
>
> 7\. Brief all staff on situation and begin medical treatment of
> casualties.
>
> 8\. Maintain a minimal stockpile of medical supplies to treat chemical
> casualties (to be maintained in Pharmacy).
>
> 9\. In the event of facility, area and staff, contamination, all
> efforts to contain the contamination will be implemented (see Medical,
> FMS and Police individual emergency plans).
>
> 10\. Medical Care Line and Business Office Service Line plans will
> include handling of deceased and personal effects, whether
> contaminated or not.
>
> 11\. Infection Control will initiate communications with the city's
> Public Health Department to report issues.

After lockdown, VA Police will ensure that anyone leaving the compound
during this security procedure will be decontaminated to protect
community.

# Chapter X Environment Of Care Performance Indicators

[Indicator]{.underline}: The HVAMC will conduct a minimum of two
emergency practice drills annually. Each service, service line and care
line is required to send all available personnel to an assigned area to
become part of a manpower pool.

[Threshold]{.underline}: At least 60-employees must be available to
assist in an exercise or a real emergency.

[Indicator]{.underline}: The HVAMC will conduct a minimum of two
emergency practice drills annually. As part of the Hospital Emergency
Incident Command system (HEICS), key managers will assemble in the
assigned EOC to initiate the flow of actions required to address the
emergency. It is important that these leaders meet quickly.

[Threshold]{.underline}: 100% of the HEICS staff, or a designated
alternate, must report to the EOC after meeting any other requirements,
such as signing in as a service chief, service line executive or care
line executive within 15 minutes from time of initial contact.

# Chapter XI National Disaster Medical System

A. [Policy]{.underline}. This medical center is designated as a Federal
Coordinating Center (FCC) for the National Disaster Medical System
(NDMS) and will support the Department of Veterans Affairs' role in
national emergency management. This includes the VA\'s role as primary
backup to the Department of Defense healthcare (VA/DoD Contingency Plan)
in the event of a national security emergency and in support of the
participation in the event of a natural or technological disaster
occurring within the United States.

B. [Procedures]{.underline}

> 1\. During a military contingency, this medical center will
> reconfigure to accommodate battlefield casualties (VA/DoD Contingency
> Plan). The utilization of available DoD and VA resources is presumed
> prior to implementation of NDMS. The NDMS is solely composed of
> non-Federal staffed beds. VA beds are not counted as NDMS beds.
>
> 2\. In a civil disaster, the order is reversed and non-Federal beds
> are the first to be utilized. The HVAMC, at the discretion of the
> Medical Center Director, will sanction the admission of veteran
> patients from a disaster area or the admission of non-veteran patients
> for humanitarian reasons.
>
> 3\. This medical center will participate in periodic NDMS exercises to
> test the system and to comply with JCAHO accreditation requirements
> for external exercises.

C. [Responsibilities]{.underline}

> 1\. When properly notified, the Medical Center Director will activate
> the NDMS for the greater Houston area.
>
> 2\. The NDMS Area Emergency Manager (AEM) and Emergency Management
> Coordinator will poll participating civilian hospitals for bed
> availability. Data collected will be reported to the Patient Access
> Center Manager to plan the distribution of casualties as they arrive
> in the Houston area.
>
> 3\. The Patient Access Center Manager will ensure that a reception and
> sorting team is assembled so decisions regarding hospital assignments
> can be made and reported.

Appendix 11A

## National Disaster Medical System (NDMS) Operations Plan

The National Disaster Medical System (NDMS) is a Federal initiative
designed to improve the nation\'s emergency response capability. This
plan ensures that preparations are made for appropriate response to the
arrival of mass casualties resulting from a catastrophic disaster within
the United States or an overseas conflict involving conventional
weapons. Casualties resulting from a catastrophic disaster may be
transported from any region of the United States to the greater Houston
area.

This plan describes special responsibilities required *upon
implementation of the NDMS*. Private health care facilities which have
designated beds for care of incoming casualties have been contacted, and
have signed a Memorandum of Understanding. Each facility will have
designated an individual as the NDMS liaison to be the point of contact
when the plan is activated or tested.

The National Disaster Medical System within the greater Houston area
functions as a partnership of federal, state and local, and public and
private agencies and organizations. This plan is prepared under
delegated authority of the Department of Defense, Department of Veterans
Affairs, Federal Emergency Management Agency, and the Department of
Health and Human Services, and is consistent with Public Law 93-288 and
Public Law 97-147 and policies developed within this area.

Record of changes, distribution, etc., will be accomplished by the
Federal Coordinating Center. All recommendations for changes or other
corrections should be brought to the attention of the NDMS Area Manager
(138/13C), VA Medical Center, 2002 Holcombe Blvd., Houston, Texas 77030.

I. [Purpose]{.underline}. The Greater Houston Area NDMS Operations Plan
establishes and provides necessary direction in implementing the NDMS.
The goal is to establish a system of responses in the continental United
States which will make use of existing federal and civilian hospitals
and their health care delivery capabilities to quickly provide a large
number of hospital beds and services, with built-in flexibility for
growth as the need arises, to respond to a national emergency or
disaster. This plan prescribes procedures for providing a medical
response which could:

A. Provide back-up medical support to the Federal Medical Care Systems,
(DoD or VA) during a national security emergency.

B. Supplement state and local medical resources in response to major
multiple casualty peacetime disasters.

II\. [ASSUMPTION AND GENERAL POLICY GUIDANCE]{.underline}. Assumptions
and policy guidance are based on actual or anticipated circumstances.

A. [Assumptions]{.underline}: Incoming casualties will have received
sufficient medical treatment to stabilize their conditions to allow
transport, but still require acute care. Some patient\'s conditions may
have deteriorated to a more critical state during transport. If so, this
information will be relayed to the Federal Coordinating Center at the
HVAMC in order to assure appropriate medical arrangements upon arrival.

1\. Patients will be moved by the U. S. Air Force's Air Mobility Command
or the Civil Reserve Air Fleet (CRAF), from airlift hubs, such as San
Antonio, Texas to NDMS Areas, to Houston. Their movement will be under
the auspices of the Global Patient Movement Requirements Center (GPMRC),
located at Scott AFB, Illinois.

> 2\. Physicians, nurses and ancillary support personnel will be
> available in NDMS participating hospitals to provide treatment to
> patients in the numbers and categories committed by those hospitals.
>
> 3\. At least 12 to 48 hours notice will normally be provided prior to
> arrival of patients in the greater Houston area.
>
> 4\. Medical supplies, pharmaceutical, and equipment will be readily
> available in the local area to support anticipated hospital
> requirements.
>
> 5\. Transportation will be available to provide prompt movement of
> patients to designated hospitals from the existing transportation
> system within Houston, i.e., Emergency Medical Services (EMS),
> Metropolitan Transit Authority (METRO), and volunteer ambulance
> services.
>
> 6\. In time of a national security emergency, guidance from DoD will
> be available regarding military personnel administration.
>
> 7\. In time of a national security emergency, Federal medical
> personnel will be available to support incoming casualties.
>
> 8\. Participating hospitals will take all necessary actions to accept
> incoming NDMS casualties, based upon bed availability at the time of
> NDMS activation.
>
> 9\. Hospitals may, upon activation of the system and on actual request
> for beds, offer more or less than the number of beds in the NDMS
> Memorandum of Understanding.
>
> 10\. The City of Houston, Harris County, Ft. Bend County, Galveston
> County, and Montgomery County Regulation agencies will support this
> plan.

B. [Policy Guidance]{.underline}:

> 1\. All incoming flights carrying patients will arrive at one of four
> airports: Primarily at Ellington Field, with Hobby, Intercontinen­tal,
> or Sugarland airports as back ups.
>
> 2\. The Global Patient Movement Requirements Center (GPMRC) will only
> regulate, to the greater Houston area, patients in the categories and
> numbers for which treatment capacity has been reported as available.
>
> 3\. All beds committed to NDMS are acute care beds within the five
> GPMRC categories (ie., Critical care (CC), Medical-Surgical (MM-SS),
> Psychiatric (MP), Burn (SBN), and Pediatric (MC).
>
> 4\. Hospitals will use their own procedure and record keeping system
> when treating NDMS patients.
>
> 5\. Funds will be provided by the US government to allow for timely
> reimbursement to hospitals, physicians, and other providers of service
> involved in NDMS. Support agencies can bill the Federal government for
> reasonable and customary charges.
>
> 6\. Minors and patients who are ready to be released from area
> hospitals become the responsibility of the Federal Coordinating
> Center. The NDMS Area Manager should be contacted at (713) 794-7973
> for instructions.
>
> 7\. Unresolved policy and guidance problems should be brought to the
> attention of the NDMS Area Manager.

C. [Concept of Operations]{.underline}:

> 1\. Should a disaster occur that cannot be handled by state or local
> resources, the governor of a state may request the President of the
> United States, or designee, to activate the NDMS. If approved, notice
> of the implementation will be given to activated areas. In Houston,
> the HVAMC would relay activation to all participating organizations.
>
> 2\. A manifest of patients being sent to the greater Houston area will
> be made available by the Global Patient Movement Requirements Center
> (GPMRC). Preliminary assignment of patients to hospitals will be made
> based on expected bed availability of participating hospitals as
> provided by the hospital to the Federal Coordinating Center.
> Assignment of patients will be based upon patient information provided
> by GPMRC. Normally, the receiving hospital will know in advance the
> number and types of patients it will receive, and an estimated time of
> arrival.

D. [Coordination and Control]{.underline}

> 1\. [Alert]{.underline}: Upon receipt of an alert from the Under
> Secretary for Health of the Department of Veterans Affairs, or other
> individuals authorized to implement the NDMS, the HVAMC will take the
> following steps:
>
> a\. Activate the NDMS operations center at the HVAMC.
>
> b\. Request that the City of Houston Emergency Management office alert
> other participating agencies, Houston Fire Department Dispatcher,
> Metropolitan Transit Authority (METRO), Salvation Army, Red Cross,
> etc.
>
> c\. Contact participating hospitals to determine the number of
> available beds. Beds and services will not be required to be made
> available on the basis of an alert. Committed beds and services will
> be required only when it can be determined, with some degree of
> certainty, that they will be needed within 12 to 72 hours.
>
> d\. Develop and update a daily roster of beds available for use, and
> report them through Global Patient Movement Requirements Center
> (GPMRC), as required.
>
> 2\. [NDMS Operations Center Activation]{.underline}: Upon receipt of
> alert notification, the HVAMC will assume responsibility for
> coordination of all tasks associated with the management of patients
> received under this program. The NDMS Operations Center (OC) will be
> located at the HVAMC, telephone (713) 794-7973. As soon as the NDMS
> Alert has been announced, space within the NDMS operation center will
> be provided for the Metropolitan Transit Authority (METRO), Houston
> Fire Depart­ment, etc. Office space and clerical support will be
> provided to these organizations by HVAMC as it becomes available.
>
> 3\. [Coordination]{.underline}: Each of the participating
> organizations will designate a staff member to serve as the
> organization\'s NDMS contact person and will provide the name and
> telephone number to the NDMS Area Manager.
>
> a\. When an organization assigns a new NDMS contact person,
> notification of change should be made immediately. The
> responsibilities of the NDMS contacts include, but are not limited to
> the following:
>
> \(1\) Serve as the point of contact for the organization and identify
> key staff members, i.e., contact for bed statistics;
>
> \(2\) Review plans at least annually and report suggested changes to
> include maximum and minimum bed available to NDMS.
>
> \(3\) Attend coordinating and planning meetings for exercises and
> actual implementation; and
>
> \(4\) Act as a focal point in the organization to educate the staff as
> to the current operation of NDMS.
>
> b\. Each NDMS participating organization will participate in NDMS
> exercises, as required.
>
> 4\. [Control]{.underline}. The HVAMC Director is responsible for
> directing the NDMS operation in the greater Houston area.
>
> a\. Overall NDMS operations will be planned and orchestrated by the
> NDMS Area Manager, under the guidance of the HVAMC Director.
>
> b\. The NDMS Operations Center will be established at HVAMC, Building
> 100, Room 5B-210. All participating organizations will channel reports
> and information through the Operations Center.
>
> c\. Primary communication between hospitals and the NDMS Operation
> Center will be by telephone (713-794-7973), and FAX (713-794-7970)
> equipment.
>
> d\. Primary communications between the reception area(s) and receiving
> facilities hospitals will be telephone and FAX equipment.
>
> e\. Communication between transporting vehicles and receiving
> facilities will be via the City of Houston communications system,
> depending on the type of vehicle or situation.
>
> 5\. [Organization and Efficiency]{.underline}
>
> a\. [General]{.underline}. Organizations having activities in support
> of the NDMS operation are encouraged to develop and maintain their own
> supporting plans. Planning for NDMS can be specifically incorporated
> into most disaster or contingency plans as annexes or appendices.
>
> b\. [Organization]{.underline}:
>
> \(1\) The NDMS operation is organized around health care facilities
> for the care of incoming casualties, and supporting systems of
> transportation to ensure the casualties arrive at participating
> hospitals.
>
> \(2\) Each participating organization will maintain control of policy
> guidance for their respective jurisdiction and areas of
> responsibility.
>
> \(3\) The NDMS Area Manager is designated the planner and coordinator
> for NDMS in the greater Houston area. This person will orchestrate the
> efforts of the HVAMC as well as external hospital and service agencies
> during activation of NDMS.
>
> c\. [Responsibilities]{.underline}:
>
> \(1\) The HVAMC is responsible for:
>
> \(a\) The NDMS Operations Center maintaining communications with all
> agencies in support of the NDMS operations.
>
> \(b\) Advising all Houston area agencies and participating hospitals
> as to the status of the operation.
>
> \(c\) Maintaining a viable public information program, through the
> HVAMC Public Affairs Officer.
>
> \(d\) Providing administrative support for patient locator and
> monitoring system.
>
> \(e\) Maintaining the NDMS Area Plan on a current basis, and
> distributing updates.
>
> \(f\) Conducting periodic exercises of the NDMS in Houston.
>
> \(g\) Receiving casualties as a primary receiving hospital of the
> DoD/VA Contingency Hospital System. (In case of military casualties,
> the HVAMC will first be saturated and then patients will be admitted
> to private sector hospitals. In the case of civilian disaster
> casualties, private sector hospitals will first be saturated and the
> HVAMC will then receive casualties on a space-available basis only.)
>
> \(2\) [Supporting Agencies]{.underline}:
>
> \(a\) The Houston Fire Department will utilize available EMS personnel
> to establish reception, triage, and communications, and coordinate
> movement of patients from the arrival site.
>
> \(b\) Ft. Bend County Emergency Management Office and Ft. Bend County
> EMS will assist the sorting, communication, and movement of casualties
> to Ft. Bend County and Southwest Houston hospitals. (They will work
> with the City of Houston Emergency Management Office and Fire
> Department during activation.)
>
> \(c\) Coordinators at NDMS participating hospitals and agencies will
> act as liaison for their hospital or agency during NDMS operations.
>
> \(d\) All agencies, activities, and resources involved in NDMS
> operations will retain their identity throughout all phases of the
> execution of this plan.
>
> \(e\) The Department of Defense (DoD) will provide support as
> requested in accordance with current DoD directives for disaster
> support, and provide administrative support for military casualties.
>
> \(f\) Coordination of traffic control, crowd control, security and
> escort of public transportation resources, and moving patients to
> hospitals, should be made with the police liaison in the City of
> Houston Emergency Management Office and other jurisdictions in the
> greater Houston area, as required, i.e., Pasadena, Galveston, Texas
> City, etc.

# Chapter XII VA/DoD Contingency Plan

I. [EXECUTIVE SUMMARY]{.underline}. The HVAMC VA/DoD Contingency Plan
has been prepared to comply with Department of Veterans Affairs and
Veterans Health Administration mission tasking under Public Law 97-174.
The Medical Center\'s mission assignment is to serve as a Primary
Receiving Center (PRC) and a Federal Coordinating Center (FCC) under the
National Disaster Medical System (NDMS).

A. [Purpose]{.underline}.

> 1\. This plan defines the role of the Medical Center with policies and
> procedures relative to Department of Veterans Affairs and Department
> of Defense (VA/DoD), joint contingency planning, implementation, and
> support.
>
> 2\. Public Law 97-174 (38 USC 5011.A), the (then) Veterans
> Administration and Department of Defense, Health Resources Sharing and
> Emergency Operations Act, mandates that the VA support the military
> health care system during and immediately following a period of war or
> national emergency declared by the President or Congress. This
> emergency medical Management program requires VA Medical Centers to
> develop contingency plans to care for the large number of casualties
> expected in such situations.

B. [Scope]{.underline}. This plan is applicable to all persons employed
by the HVAMC. This contingency plan is a component of Medical Center
Policy Memorandum No. 138EmP-001, *Comprehensive Emergency Management
Plan*.

> 1\. [Implementation]{.underline}. Upon notification by the Secretary
> of Veterans Affairs, the Under Secretary for Health of the Veterans
> Health Administration (VHA) will activate the VA component of the
> Contingency Hospital System (CHS). The South Central VA Health Care
> Network Network Director will notify the Medical Center Director who
> will initiate the Medical Center\'s emergency notification or
> \"Cascade\" system, as necessary. Cascade recalls ensure appropriate
> personnel are available at the Medical Center to provide services
> consistent with our general mission statement.
>
> 2\. [Priority for Care]{.underline}. DoD patients will receive
> priority care over all VA beneficiaries except those service-connected
> (SC) veterans, or non-service-connected veterans (NSC) with a
> life-threatening emergency. NSC inpatients who may be discharged
> without a significant compromise of their health will be released from
> the Medical Center. Others may be referred to community hospitals, as
> the HVAMC does not have secondary support centers.
>
> 3\. [Out-placement of NSC Patients]{.underline}. Under Public Law
> 97-174, service-connected veterans retain the highest priority for
> care. In a VA/DoD contingency, active duty military personnel receive
> a higher priority than non-service-connected veterans. Thus, in order
> to free up beds to meet our mission goal, non-service-connected
> veterans may be discharged or transferred to other VA or community
> health care facilities. The attending physician will make the
> determination as to whether a non-service-connected veteran can be
> discharged without a significant compromise to the patient\'s health.
> If it is medically compromising to discharge, but movement is
> feasible, the patient may be transferred to a community hospital. This
> transfer will be made in accordance with the procedure outlined in
> Medical Center Policy Memorandum No. 04-001, Transfer of Patients.
> *Note: VA will maintain responsibility for continuity of care for
> out-placed patients.*
>
> 4\. [Mission]{.underline}.
>
> a\. The HVAMC is a tertiary referral Medical Center with 355 operating
> beds, excluding 120 nursing home beds. The Medical Center will make
> 25% or approximately 89 of its beds available to DoD within 72 hours
> of mobilization. A detailed summary of beds by category is available
> from the Patient Access Center Manager.
>
> b\. Personnel lost to military mobilization will have some impact on
> the facility\'s operations and will affect the planned bed commitment
> under the VA/DoD Contingency Plan.
>
> c\. All aspects of facility logistical support requirements and
> tasking have been addressed in this plan and adequate emergency
> requirements solidified.

II\. [POLICIES]{.underline}

A. The Medical Center will refer information requests or inquiries
pertaining to Network or national issues or matters to the Network
Emergency Operations Center (NEOC).

B. VA will meet its legislatively mandated mission to support the
military health care system during and immediately following a period of
war or national emergency as declared by the President or Congress.

C. Medical care reimbursement from DoD will be made available to VA
Networks and Medical Centers to accomplish the VA/DoD contingency
mission.

D. During a time of military conflict or national emergency, the major
goal of the VA is to provide the maximum number of staffed beds to
active duty military casualties in as short a time as possible. At the
same time, the VA will continue to perform its mission of providing care
to service-connected (SC) veterans, who retain the highest priority for
VA admission and care.

E. The primary focus of VA Medical Centers will shift to the care of
patients in accordance with the following admissions priority (See
REFERENCES, to determine location of additional guidance):

> 1\. Medical emergencies
>
> 2\. Service-connected veterans
>
> 3\. Active duty military casualties/active duty patients
>
> 4\. All other veterans in accordance with existing priorities.

F. VA shall provide the full range of services required by DoD
casualties as it would for any veteran patient treated by VA.

G. Immediately upon activation of the VA/DoD Contingency Hospital
System, the Deputy CMD for Administration and Operations (DCMD/A&O) is
charged by the Under Secretary for Health to activate and staff the VACO
Command Center and to implement and manage the VA/DoD Contingency
Hospital System.

H. VA Medical Centers will refer policy matters requiring national
attention to VISNs which will direct them to the Assistant Deputy Under
Secretary for Health (ADUSH).

I. When individuals are discharged from active duty to service-connected
veteran status, VA will continue to provide the full range of services
required by this new veteran cohort. These will include convalescence
and rehabilitation services, acute care, outpatient care, and nursing
home care.

J. Each Network Director will have a Network VA/DoD Contingency Plan
providing for alert notifications, Network Emergency Operations Center,
and review/reporting requirements for each VA Medical Center. The South
Central VA Health Care Network Plan is locally available in the Medical
Center Director\'s office.

K. Each Medical Center will have a VA/DoD Contingency Plan as part of
its Medical Center Emergency Management Program. This plan will
delineate responsibilities and duties to accomplish the VA/DoD
contingency mission. It will be based on the guidance in the VHA Medical
Center Annex, the South Central VA Health Care Network VA/DoD
Contingency Plan, and applicable regulations, policies and federal
statutes including NDMS. The plan will be updated annually and submitted
to the Emergency Management Strategic Health Group (EMSHG) (13C) and
Assistant Deputy Under Secretary for Health (ADUSH) (10N) through the
VISN Office (10N16).

L. Continuity of care will be assured for all veteran patients.

M. The Medical Center Director will designate an individual and backup
who will have responsibility for VA/DoD contingency planning at the
Medical Center. This individual is the liaison to the local military
treatment facility for joint contingency planning. Where possible, the
expertise of the Area Emergency Manager should be used to assist in the
development and execution of this program.

N. The VA Medical Center staff that should have non-critical/sensitive
clearances include the Medical Center Director, Associate Director,
Chief of Staff, the staff contact person for contingency planning, and
the Medical Center Director\'s secretary. Requests for
non-critical/sensitive clearance for other key staff may be made in
accordance with MP-l. Part I, Chapter 5, *Security*.

O. The Medical Center Director will establish a 24-hour a day point of
contact for the Global Patient Movement Requirements Center (GPMRC). The
Business Office Service Line Executive will be the point of contact
during normal duty hours and the AOD will be the point of contact after
normal duty hours.

P. Female casualties have the same eligibility as male casualties and
will be accorded the full range of services required.

Q. The Casualty Assistance Coordinator is the Patient Access Center
Manager.

III\. [SITUATIONS]{.underline}

A. [Conditions]{.underline}. The Medical Center will operate as a
Primary Receiving Center. In this role, our mission is to receive and
coordinate placement of casualties directed to the facility by the
Global Patient Movement Requirements Center (GPMRC). The Medical
Center\'s capability is specified as tertiary/referral category
facility.

> 1\. [Primary Receiving Centers (PRCs)]{.underline}. The HVAMC is both
> a primary receiving hospital for DoD casualties as well as a NDMS
> Federal Coordinating Center. The greater Houston area does not have a
> major military medical facility within 200 miles. Wilford Hall, USAF
> Medical Center, and Brooke Army Medical Center in San Antonio, Texas
> are the closest military medical treatment facilities. The Joint
> Military Medical Command (JMMC), Randolph AFB, San Antonio, is
> involved in the peacetime planning for medical support in time of war.
> However, in time of war their mission for planning is suspended. JMMC
> does not have a wartime role. Planning related to the placement of DoD
> casualties in our area should be coordinated through this agency prior
> to full mobilization of military assets. The size of the Houston area
> lends itself to the delivery of patients at four airports in the
> greater Houston area.
>
> a\. For patients going directly to the HVAMC, the most appropriate
> areas for patient delivery are Ellington (Primary) and Hobby Airports
> (Secondary).
>
> b\. For patients going to the 61 NDMS participating hospitals,
> consideration should be given to the locations of various hospitals to
> Ellington (primary), Hobby, Sugarland and Intercontinental Airports.
> All of these airports can accommodate large aircraft, including the
> C-141.
>
> The magnitude, severity and type of military causalities to be treated
> in the greater Houston area will dictate whether treatment can be
> provided solely through the HVAMC VA/DoD program, or whether such
> treatment must be provided through activation of NDMS. Again, both
> systems could be activated concurrently.
>
> Unlike the VA/DoD contingency planning, the NDMS is a voluntary
> effort; however, these plans must be integrated to ensure that quality
> care is provided in a timely manner. Therefore, Veterans Affairs
> support must be incorporated into the planning and exercises of NDMS.
> NDMS must be a part of VA/DoD contingency planning.
>
> 2\. [Secondary Support Centers (SSCs)]{.underline}. Those VA Medical
> Centers designated as SSC perform essentially the same contingency
> activities as a PRC, however, they receive patients relocated from
> PRCs instead of directly from the evacuation pipeline.
>
> HVAMC does not have SSCs. An installation support mission is not
> assigned to this facility.
>
> 3\. [Independent Outpatient Clinics (IOCs)]{.underline}. IOCs should
> be prepared to assist both primary and secondary Medical Centers in
> assuring continuity of care for patients discharged to their auspices
> and serve as an additional source of resources to supplement PRC(s).
> The Lufkin and Beaumont OPCs will support the HVAMC during a
> contingency operation.
>
> 4\. [Federal Coordinating Centers (FCCs)]{.underline}. The HVAMC is
> designated a FCC for the National Disaster Medical System (NDMS). As
> such, it has the coordinated support of (and coordinates federal
> support for) the greater Houston-Galveston Hospital Community in a
> declared disaster situation. This FCC has 61 participating hospitals
> with a maximum of 2,841 and a minimum of 1,624 staffed beds.

B. [Planning Assumptions]{.underline}.

> 1\. DoD patients will arrive in the primary receiving area (PRA) in
> generally stable condition, barring complications during travel. The
> general planning scenario envisions casualties moving through several
> echelons of care. Therefore, our role will be to continue care and
> supervise recovery.
>
> 2\. All veterans who present themselves for admission will be
> examined, evaluated, and a disposition made. The service-connected
> priority system is applicable in all cases, as above.
>
> 3\. Should the VA/DoD CHS reach its capacity, the National Disaster
> Medical System (NDMS) may be activated. NDMS PRAs may be coordinated
> by VAMCs or DoD medical facilities. The HVAMC, a Federal Coordinating
> Center (FCC), will coordinate these activities.

IV\. [CONCEPT OF OPERATIONS]{.underline}

A. [General]{.underline}. This plan outlines a measured response by
HVAMC which will be functionally organized for emergency operations.
This plan further envisions support for the VA/DoD Contingency Hospital
System (CHS), unfolding in four phases; planning, alert, activation, and
execution.

Upon activation of the Medical Center in the CHS, execution will be
controlled by an Emergency Operations Center (EOC), organized with
single points of contact and responsible for an integrated team response
for each functional area.

B. [National Disaster Medical System (NDMS)]{.underline}. The greater
Houston area NDMS Operations Plan establishes and provides necessary
direction in implementing the NDMS. The goal is to establish a system of
responses in the continental United States which will make use of
existing federal and civilian hospitals and their health care delivery
capabilities to quickly provide a large number of hospital beds and
services, with built-in flexibility for growth as the need arises, to
respond to a national emergency or disaster. This plan prescribes
procedures for providing a medical response which could:

1.  Provide back-up medical support to the Federal Medical Care Systems,
    (DoD or VA) during a national security emergency.

> 2\. Supplement state and local medical resources in response to major
> multiple casualty peacetime disasters.

C. [Notification]{.underline}. The VA Medical Center Director or
representative will receive system activation notification from the
South Central VA Health Care Network Director (ND). The ND will brief
the HVAMC Director on the situation and the anticipated sequence of
activities schedule, if known.

> 1\. Normal Duty Hours. (8-4:30, M-F) As warranted by the nature of the
> alert received, the Medical Center Director or designee will have the
> Police Service, coordinated with the telephone operator, make an
> announcement over the public address system. Key personnel will
> respond as instructed and be prepared to immediately report to their
> assigned areas of responsibility. This announcement will be followed
> with an internal \"cascade\" procedure to verify and clarify the
> announcement. Key personnel will ensure that specific employees are
> designated and rostered to respond in their functional areas.
>
> 2\. After Duty Hours. If the contingency plan is activated during
> other than normal duty hours, the Cascade Call System will be
> initiated by the Administrative Officer of the Day (AOD). Each service
> chief, service line executive and care line executive will then, as
> required, be responsible for initiating the Cascade Call Program for
> their respective service, service line or care line. If required,
> local radio stations will be asked to announce that a war or national
> emergency has been declared and request off-station employees to
> report to duty.

D. [Response Actions]{.underline}

> 1\. [Phases]{.underline}.
>
> a\. [Phase I - Planning]{.underline}. During this phase, there is no
> pending threat. The Medical Center\'s mission is readiness. We will
> ensure our readiness by thorough planning, training and establishing
> accountability for the requirements of all phases described therein.
>
> b\. [Phase II - Early Warning]{.underline}. No formal announcement is
> expected during this phase. The period immediately preceding armed
> conflict is characterized by heightened international tension, acts or
> threats of violence, and posturing of armed forces or incursion. Early
> warning may be limited or subtle as with the US Operations in Grenada
> and Panama. It is incumbent upon key Medical Center staff to
> anticipate worst-case scenarios without over-reacting. During this
> phase, preparation must be verified and by-name accountability
> established. Service, service line and care line internal training and
> rehearsals are encouraged. VHA Central Office could be expected to
> initiate the bed reporting and asset inventory requirements. The EOC
> may be set-up and exercised.
>
> c\. [Phase III - Activation]{.underline}. The South Central VA Health
> Care Network Director will notify the Medical Center Director or
> designee when the VA/DoD Contingency Plan has been activated. The plan
> may be activated in part regionally or functionally. The Medical
> Center Director will, when appropriate, initiate the Medical Center
> \"Cascade\" notification system. Cascade recalls ensure appropriate
> personnel are available to enable implementation of plan requirements.
> Whenever possible cascade plans should be developed to recall staff in
> relationship to the number of expected casualties (e.g., 1-25, 26-49,
> 50 or greater). See paragraph V.B., Alerting Procedure. This phase is
> characterized by making the EOC fully operational and completion of
> internal asset inventories.
>
> d\. [Phase IV - Execution]{.underline}. This phase is initiated with
> an announcement that casualties or transfer patients are inbound to
> the HVAMC. The phase is characterized by actual reception and care of
> DoD or VA patients. See RECEPTION, below.
>
> 2\. [Reception]{.underline}. A Patient Reception Team (PRT) or
> Facility Triage Team will be formed by all VA Medical Centers to
> receive casualties.
>
> a\. Primary Receiving Centers are responsible for the establishment of
> patient reception teams.
>
> \(1\) General team composition:
>
> \(a\) Team Coordinator (ER Physician or other qualified provider,
> additional physicians as required)

b.  Additional physicians as required

c.  Nursing (personnel, RNs, LVNs, and NAs)

> \(d\) Chaplain
>
> \(e\) Public Affairs Officer
>
> \(f\) IMS Patient Tracking and Administration Personnel as required
>
> \(g\) Driver (with litter van or bus as required)
>
> \(h\) Staff to assist as litter bearers
>
> \(i\) Mental Health Personnel
>
> \(j\) Others are determined by the COS

(2) Whenever very small numbers of patients are arriving, ground
    transportation to and from the airport will be arranged through
    Facilities Management Service Line.

(3) The City of Houston Emergency Operations Center will be contacted by
    Facilities Management Service Line for larger numbers of casualties.
    The Houston Fire Department EMS Service will be contacted by The
    City of Houston and will coordinate reception, triage, sorting and
    transportation according to the situation. The Houston Fire
    Department will contact private ambulance services to augment
    transportation requirements.

> b\. Depending on the number of casualties and their time of arrival,
> the PRT will be dispatched to the Ellington Field (Primary), Hobby,
> Intercontinental or Sugar Land Municipal airport(s), depending on the
> situation, to triage patients and make appropriate service and unit
> assignments. If required, referral to appropriate community facilities
> may be made.
>
> c\. Casualties arriving by ground transportation and those which have
> not triaged at the airport arrival site, will be received at the
> Ambulance (emergency) Entrance of the Medical Center. Sorting and
> classification will proceed in the triage area of Prime Care.
>
> d\. Triage areas will be equipped with tags and appropriate marking
> devices to designate the location of care areas. Nursing staff will
> provide wheeled litters or wheelchairs to the ambulance entrance, as
> required, to transport patients.
>
> 3\. [Sustaining]{.underline}. During activation of the VA/DoD CHS, the
> HVAMC will, to the extent possible, maintain routine operations while
> maximizing the number of staffed beds for DoD patients. The Medical
> Center will continue to perform its mission of providing care to
> service-connected veterans who retain the highest priority for VA
> admission and care.

V. [RESPONSIBILITIES.]{.underline}

A. [Department of Defense]{.underline}

> 1\. [GPMRC]{.underline}. The Global Patient Movement Requirements
> Center (GPMRC), Scott AFB, Illinois, will gather information on the
> number and types of patients and the availability of transportation
> and appropriate beds in the Continental United States (CONUS). GPMRC,
> in coordination with the [US Air Force\'s Air Mobility Command
> (AMC),]{.underline} then directs aircraft and other transportation
> modes to military evacuation points overseas or in the US for transfer
> of casualties to selected areas in CONUS.
>
> On initial arrival at staging sites in CONUS, sorting teams, in
> conjunction with GPMRC, will determine the closest facility most
> appropriate for care of casualties. The VHA Emergency Medical
> Strategic Health Group (EMSHG) Liaison Officer at GPMRC, (618)
> 229-7169, facilitates in this process and feeds advance information
> back through VHA Central Office and field facilities.
>
> 2\. [Military Coordinating Center (MCC)]{.underline}. Designated
> military coordinating centers will work closely with VA Medical
> Centers to ensure adequate DoD support is provided to VAMCs. The USAF
> MCC at Wilford Hall Medical Center, Mobilization/Readiness Office,
> (210) 292-2992/2552, will coordinate DoD support requirements for the
> HVAMC.

B. [Department of Veterans Affairs]{.underline}

> 1\. [VHA Central Office]{.underline}
>
> a\. Will monitor implementation of Network plans to ensure smooth
> operation, and will initiate improvements or corrective actions that
> are beyond the scope of the VISNs.
>
> b\. Develop plans for integration of contingency activities within the
> organizational units.
>
> c\. Identify continuing education and staff development activities
> associated with activation of the contingency system.
>
> d\. Identify additional resource requirements necessary to accomplish
> the contingency mission.
>
> e\. Staff and operate the VHA Central Office Command Center.
>
> f\. Establish a Central Information Center to serve as a national
> patient locator system for military casualties.
>
> 2\. [South Central VA Health Care Network (SCVAHCN)]{.underline}
>
> a\. The South Central VA Health Care Network (SCVAHCN) will provide
> policy and operational direction and technical assistance to ensure
> the successful implementation of the VA/DoD CHS. The South Central VA
> Health Care Network will monitor implementation of Medical Center
> plans to ensure smooth operation, and to initiate improvements or
> corrective actions that are beyond the scope and authority of the
> Medical Center.
>
> b\. Upon activation of the VA/DoD Contingency Plan (CONPLAN), the
> Network Director will establish a functionally organized Network
> Emergency Operations Center (NEOC).
>
> One of the key responsibilities of the NEOC includes the coordination
> and resolution of the Medical Center\'s problems and needs as
> requested by the Medical Center Director. The NEOC will serve as a
> clearinghouse between South Central VA Health Care Network VAMCs,
> VACO, and other federal agencies.
>
> 3\. [Houston VA Medical Center (HVAMC uses HEICS to manage
> events)]{.underline}

![](media/image2.wmf)

> a\. [Medical Center Director]{.underline}. The Medical Center Director
> is responsible for all facets of planning and execution of the VA/DoD
> contingency plan through designated Medical Center staff. The Medical
> Center Director provides guidance and \"Executive Intent\" through
> this plan. Serves as the initial HEICS Incident Commander (IC) in all
> emergencies.
>
> \(1\) Activate the Medical Center plan by initiating the Medical
> Center Cascade Call System.
>
> \(2\) Direct cancellation of annual leave and training details as
> necessary to meet the requirements of this plan.
>
> \(3\) Establish the Medical Center\'s Emergency Operations Center
> (EOC) in the Executive Board Room (4A-235). Establish a work schedule
> for 24-hour coverage of the EOC.

(4) Notify veteran's service organizations of the local situation.

(5) Approve expanded duty days and hours scheduled recommended by
    appropriate service chiefs, service line executives and care line
    executives.

(6) IC's mission**:** Organize and direct the Emergency Operations
    Center (EOC). Give overall direction for Medical Center operations
    and if needed, authorize evacuation. Following are the IC's HEICS
    responsibilities:

> \(a\) [Immediate]{.underline}
>
> \_\_\_\_ Initiate the Comprehensive Emergency Management Program
> (CEMP) by assuming role of Emergency Incident Commander (IC).
>
> \_\_\_\_ Review Job Action Sheet.
>
> \_\_\_\_ Put on IC identification vest.
>
> \_\_\_\_ Appoint Officers and Chiefs (Public Information, Safety &
> Security, Liaison, Logistics, Planning, Finance and Operations) and
> the Administrative Services Director.
>
> \_\_\_\_ Announce a status/action plan meeting of all Chiefs, Officers
> and the Medical Care Manager to be held within 5 to 10 minutes.
>
> \_\_\_\_ Receive status report and discuss an initial action plan with
> Chiefs, Officers and Medical Care Manager. Determine appropriate level
> of service during immediate aftermath.
>
> \_\_\_\_ Receive initial facility damage survey report from Logistics
> Chief, if applicable, evaluate the need for evacuation.
>
> \_\_\_\_ Obtain patient census and status from Planning Chief.
> Emphasize proactive actions within the Planning Section. Call for a
> hospital-wide projection report for 4, 8, 24 & 48 hours from time of
> incident onset from the Planning Chief. Adjust projections as
> necessary.
>
> \_\_\_\_ Authorize a patient prioritization assessment for the
> purposes of designating appropriate early discharge, if additional
> beds needed.
>
> \_\_\_\_ Assure that contact and resource information has been
> established with outside agencies through the Liaison Officer.
>
> \(b\) Intermediate
>
> \_\_\_\_ Coordinate with the Emergency Management Coordinator (EMC).
>
> \_\_\_\_ Authorize resources as needed or requested by Officers.
>
> \_\_\_\_ Designate routine briefings with Chiefs and Officers to
> receive status reports and update the action plan regarding the
> continuance and termination of the action plan.
>
> \_\_\_\_ Consult with Officers & Chiefs on needs for staff, physician,
> and volunteer responder food and shelter. Consider needs for
> dependents. Authorize plan of action.
>
> \(c\) Extended
>
> \_\_\_\_ Approve media releases submitted by P.I.O.
>
> b\. [Chief of Staff]{.underline}
>
> \(1\) The Chief of Staff has overall responsibility for medical staff
> sufficiency, planning, training, preparation, and execution of medical
> functions associated with this plan through designated staff members.
> Items of primary focus are: organization of the patient reception
> team; and during a contingency, quality assurance and
> evaluation/adjustment of clinical responsibility and continuity of
> care.

(2) Establishes tasking and responsibilities assigned herein to staff
    elements normally under the Chief of Staff\'s purview. Coordinates
    with and recommends tasking to the Associate Director for other
    staff.

(3) Serves as the HEICS Operations Chief with the following
    responsibilities:

> \(a\) [Immediate]{.underline}
>
> \_\_\_\_ Receive appointment from IC. Obtain packet containing
> Section\'s Job Action Sheets.
>
> \_\_\_\_ Read Job Action Sheet and review organizational chart.
>
> \_\_\_\_ Put on position identification vest.
>
> \_\_\_\_ Obtain briefing from IC.
>
> \_\_\_\_ Appoint the Medical Care, Medical Staff, Ancillary Services,
> Psychological Support, DECON Team, and Patient Reception Team
> Managers. Provide each with corresponding Job Action Sheets.
>
> \_\_\_\_ Brief all Operations Section managers on current situation
> and develop the section\'s initial action plan. Designate time for
> next briefing.
>
> \_\_\_\_ Establish Operations Command Center in the Education
> Conference Room 4A-322.
>
> \_\_\_\_ Meet with the Medical Care Manager, Medical Staff Manager and
> Nursing Manager to plan and project patient care needs.
>
> \_\_\_\_ Assist in action plan for total evacuation of facilities
> should it be ordered by the IC.
>
> \_\_\_\_ Be in constant contact with DECON Manager should a
> decontamination process be ongoing.
>
> \_\_\_\_ Be prepared to assist staff in replacements for detailed
> clinical staff in the event of a military mobilization of reservists
> or a VISN call under the DEMPS program.
>
> \(b\) Intermediate
>
> \_\_\_\_ Designate times for briefings and updates with all Operations
> Section managers to develop and update section action plans.
>
> \_\_\_\_ Brief the IC routinely on the status of the Operations
> Section.
>
> \(c\) Extended
>
> \_\_\_\_ Assure that all communications are copied to the
> Communications Manager; document all actions and decisions.
>
> \_\_\_\_ Observe all staff, volunteers and patients for signs of
> stress and inappropriate behavior. Report concerns to Psychological
> Support Manager. Provide for staff rest periods and relief.
>
> c\. [Associate Director]{.underline}
>
> \(1\) Assumes responsibility as the HEICS IC in the absence of the
> MCD.

(2) Serves as the HEICS Administrative Services Director with the
    following responsibilities:

> \(a\) Immediate
>
> \_\_\_\_ Receive appointment from IC.
>
> \_\_\_\_ Read this entire Job Action sheet and review organizational
> chart on back.
>
> \_\_\_\_ Put on position identification vest.
>
> \_\_\_\_ Obtain a briefing from IC.
>
> \_\_\_\_ Ensure that a radio is in the EOC and set to Channel-5.
>
> \_\_\_\_ Inform all emergency staff to go to Channel-5 on radios.
>
> \_\_\_\_ Initiate a communications check.
>
> \_\_\_\_ Ensure that the EOC constantly monitors radio communications.
>
> \_\_\_\_ Coordinate with the Logistics, Finance, & Planning Chiefs.
>
> \_\_\_\_ Ensure that adequate runners are available for the EOC from
> the manpower pool.
>
> \_\_\_\_ Coordinate with the Emergency Management Coordinator (EMC)
> and the Area Emergency Manager (AEM).
>
> \_\_\_\_ Keep the IC abreast of any significant incidents or successes
> during the emergency.
>
> \(b\) Intermediate
>
> \_\_\_\_ Ensure that the Damage Assessment and Control Leader secured
> and posted non-entry signs around unsafe areas.
>
> \_\_\_\_ Ensure that each Officer and Chief has adequate staff and
> volunteers to meet goals and objectives.
>
> \_\_\_\_ Through the Planning Chief, ensure that the Recorder is
> documenting all facts, information, & data.
>
> \_\_\_\_ Confer with PIO often to ensure information, data,
> statistics, etc provided are accurate.
>
> \_\_\_\_ Establish routine briefings with IC.
>
> \_\_\_\_ Observe all staff, volunteers and patients for signs of
> stress and inappropriate behavior. Report concerns to Psychological
> Support Manager. Provide for staff rest periods and relief.
>
> \(c\) Extended
>
> \_\_\_\_ Assist all Officers and Managers in meeting their missions.
>
> d\. Key staff and all service chiefs, service line executives and care
> line executives will adhere to HEICS JAS.

VI\. [RESOURCE REQUIREMENTS]{.underline}

A. Assets critical for initial 72 hours have been identified in the
appropriate service, service line or care line ESP.

> 1\. [Personnel]{.underline}.
>
> a\. [Staffing]{.underline}. The Medical Center\'s normal operating
> hours may be adjusted to accommodate the number and types of
> casualties received for the duration of the contingency. Clinical and
> support employee working hours may be adjusted and leave canceled or
> changed, etc., as necessary to accomplish reception and care of
> military patients. Address plans to replace staff unavailable due to
> military mobilization, including replacement sources.
>
> b\. [Security Clearances]{.underline}. The Medical Center Director is
> required to have a \"top secret\" clearance. The Chief of Staff, Area
> Emergency Manager (AEM), and medical center director\'s secretary
> require non-critical/sensitive clearance \"secret\" clearance. \"Top
> secret\" clearance is documented at HVAMC for the Medical Center
> Director and Associate Director. \"Secret\" clearance is documented
> for the AEM, the Chief of Staff, and the medical center director\'s
> secretary. Requests for non-critical/sensitive clearance for other key
> staff are made in accordance with MP-1, Part I, Chapter 5. A listing
> of security clearances for key HVAMC staff will be maintained by the
> Human Resources Management Section Manager, and be readily available
> to the HVAMC Director and EOC.
>
> 2\. [Supplies and Equipment]{.underline}.
>
> a\. Based on the type of patients we expect to receive, supplies and
> equipment must be pre-planned to assure access and availability. At a
> minimum, supplies will include those necessary for patient transfer
> from airplane to holding facility or ambulance, supportive care, and
> administrative supplies. The Global Patient Movement Requirements
> Center (GPMRC) will inform us of any special requirements, e.g.,
> ventilators, special beds, etc. NOTE: Litters and linen that arrive
> with the patients may have to be returned to the aircraft or replaced
> from existing supplies.
>
> b\. Warehouse stocks are maintained at a 3 day level by \"Primary
> Vendors\". Be prepared to increase stock levels and to accelerate the
> reorder cycle as and if permitted by a pre-contingency buildup phase.
>
> c\. See A&MMS SERP or unique VA/DoD Annex, and Casualty Reception
> Plan.
>
> 3\. [Communications]{.underline}.
>
> a\. Effective communication systems will be maintained for all phases
> and facets of the operation. This includes:
>
> \(1\) The role of switchboard operators in the cascade system and
> their interaction with the EOC.
>
> \(2\) Submission of daily bed availability report, patient transfer
> report (Primary Receiving Center), and Mobilization Impact Report, via
> computer linkage to FORUM.
>
> \(3\) Contact with local DoD facilities.
>
> \(4\) Communications with GPMRC when patients are regulated to the
> facility (PRCs).
>
> \(5\) Coordination with Military Patient Assistance Teams (MPAT).
>
> \(6\) Effectively utilizing cellular phone and station UHF/FM
> communications (net control) during casualty reception.
>
> \(7\) Control of incoming telephone communications to critical areas.
>
> \(8\) Establishment of primary and secondary computer system and
> outside linkage to backup existing system.
>
> b\. See IMS SERP or unique VA/DoD Annex, and Casualty Reception Plan.
>
> 4\. [Facilities]{.underline}.
>
> a\. [Pre-identified emergency care areas]{.underline} within the
> Medical Center will be equipped and stocked to meet emergency tasking
> requirements. List your designated emergency care area locations,
> location of supplies and equipment to support enhanced operations and
> the individual responsible for establishing the area.
>
> b\. [Admissions Curtailment]{.underline}. Curtailment of regular
> admissions and concurrent notification of patients and service
> organizations will take place only when the Medical Center Director
> determines it necessary to meet bed availability requirements and the
> action has been coordinated with the South Central VA Health Care
> Network. If earlier or preemptive action is warranted, the Network
> Director or representative will notify the HVAMC Director.
>
> c\. Discharge or Out-placement. Clinical services will assess the
> status of inpatients to plan for discharge or out placement of
> medically stable patients, if necessary, to meet bed availability
> requirements. Provisions must be made for continuity of care for all
> patients discharged or out placed. Approval of the Network Director
> will be requested prior to the transfer of non-emergency VA patients
> into community hospital facilities.
>
> d\. [Transfers]{.underline}. PRCs must appropriately coordinate the
> transfer of patients to SSCs to ensure maximum availability of beds.
> SSCs, when authorized, may also transfer patients to civilian
> hospitals to open up additional beds. The HVAMC no longer has SSCs.
>
> e\. [Patient Data]{.underline}. Patient tracking and reporting will be
> accomplished via VACO designated IMS DHCP models. Special data
> required by DoD may be provided through close coordination with
> assigned MPAT or the nearest military hospital.
>
> f\. [Treatment]{.underline}. The VA Medical Center will provide the
> full range of services required for DoD patients as it would for any
> veteran patient.
>
> g\. [Placement]{.underline}. Where feasible, military casualties
> should be housed together for security, control, and morale.
>
> h\. [Bed Reporting]{.underline}. Reporting of available beds to VACO
> and GPMRC will be through Transcom Regulating and Command & Control
> Evacuation System (TRAC^2^ES). Primary receiving centers must
> carefully coordinate bed reports to ensure accurate data is submitted.
>
> i\. [Administration Teams]{.underline}. DoD will assign MPATs to
> Primary Receiving Centers. A PRC will provide an operating location
> for the MPAT, including telephones, computer support, and supplies.
>
> j\. See individual service, service line or care line SERP or unique
> VA/DoD Annex.
>
> 5\. [Transportation]{.underline}.
>
> a\. The Medical Center will arrange for transportation of patients
> between Primary Receiving Centers and from HVAMC to civilian
> facilities as necessary. All sources presently used to transport
> veteran patients (ambulance, bus, etc.) will be used to transport
> casualties. The HVAMC has a letter of understanding with the Kerrville
> Bus Company at (713) 236-1887 to furnish transportation assets, when
> needed.
>
> b\. Primary Receiving Centers must also assure that adequate and
> appropriate transportation vehicles are available to move patients
> from airport reception area to HVAMC if DoD support is not available.
> The HVAMC Facilities Management Service Line will contact the City of
> Houston Emergency Operations Center at (713) 881-3045 and, after
> stating the nature of the emergency, request the needed transportation
> assets. The Houston Fire Department Emergency Medical Service (EMS) or
> the Metropolitan Transit Authority (METRO) will be contacted for the
> required transportation within the greater Houston area.
>
> c\. Local contract ambulance company may be able to provide additional
> support and should be contacted to assist and coordinate procurement
> of supplemental service from other transportation companies to support
> required needs. The procedure is to call the City of Houston at (713)
> 881-3045 and the Houston Fire Department EMS will contact contract
> ambulance companies to furnish additional transportation, as needed.
> The Medical Center will be billed through Financial Resources Manager
> at contract cost. Available resources and points of contact are listed
> in the transportation annex.
>
> d\. The Local Emergency Medical Services and military installation (if
> appropriate) commit their transportation resources including
> helicopters, ambulances, and buses. These resources and points of
> contact are listed in the transportation Annex of this Plan.
>
> e\. See ESPs prepared by Facilities Management and Information
> Management Service Lines.

B. [Controls and Responsibilities]{.underline}.

> 1\. The Medical Center Director will monitor all critical activity
> during the arrival and reception phase of operations. S/he will
> control/direct activities, as required, by cellular phone and be
> available on pager. During other phases, the Medical Center Director
> will exercise control through normal staff channels with the EOC
> executing contingency instructions. S/he may also be contacted through
> the EOC.
>
> 2\. Identify individuals responsible for requesting specific resource
> support for functional areas and the service and individual designated
> to coordinate the support.
>
> 3\. See Emergency Operations Center, SERP or unique VA/DoD Annex, and
> Casualty Reception Plan.

C. [Assets Critical for Continuing Operations]{.underline}.

> 1\. [Personnel]{.underline}.
>
> a\. Coordinate for supplemental VA staffing from IOCs and SOPCs/CBCs
> with facility management and the South Central VA Health Care Network.
>
> b\. Expand local recruitment efforts to support expanded and sustained
> medical operations through OPM, professional societies, community
> hospitals, and medical and nursing schools.
>
> c\. Contracts for clinical and administrative staff with local and
> national employment services.
>
> 2\. [Supplies and Equipment]{.underline}.
>
> a\. Develop additional equipment requirement lists and identify
> potential lease and loan sources.
>
> b\. Coordinate with local medical supply firms to ensure availability
> of high usage items.
>
> 3\. [Communications]{.underline}.
>
> a\. Assess needs or additional telephone lines to meet increased
> voice, facsimile, and data line requirements.
>
> b\. Procure or lease additional hand held radios, cellular phones, and
> pagers to expand the capability of alerting and recalling key staff
> and specialty team members.
>
> c\. Modify service cascade plans to meet mission tasking activity.
>
> d\. Conduct regular staff briefings to keep personnel informed of
> contingency activities.
>
> 4\. [Facilities]{.underline}.
>
> a\. Review and reassign facility space to support contingency workload
> requirements.
>
> b\. Consider development of expanded operating room hours to maximize
> potential usage schedules.
>
> c\. Assess security requirements to determine if facility entrances
> and exits need to be restricted.
>
> d\. Identify sites to house additional VA staff detailed to provide
> manpower assistance.
>
> 5\. [Transportation]{.underline}.
>
> a\. Negotiate additional ambulance contracts to meet patient movement
> demands.
>
> b\. Request additional vehicles (cars, vans, trucks) from GSA or
> rental agency to support facility operational needs.

VII\. [REFERENCES.]{.underline}

> Public Law 97-174, Sec. 5011A: \"Veterans Administration and
> Department of Defense, Health Resources Sharing and Emergency
> Operations Act\", May 4, 1982.
>
> Forces Command (DoD FORSCOM) CINCFOR CONPLAN 7300-90: \"Integrated
> CONUS Medical Mobilization Plan\", July 1, 1990.
>
> VACO, VHS&RA (re-designated VHA) VA/DoD Contingency Plan: VA/DoD
> Contingency Hospital System, VHS&RA Operations Plan, March 1991, with
> all Annexes, Attachments and Enclosures.
>
> Sec. Def. & Sec. VA, MOU regarding responsibilities under PL 97-174.
>
> VHS&RA (re-designated VHA) Circular 10-88-116, as supplemented by
> 10-91-(TBP).
>
> NDMS Operations Support Center Manual.
>
> NDMS Federal Coordinating Center Guide (USPHS).

VIII\. [TERMS AND DEFINITIONS]{.underline}

AECC Aeromedical Evacuation Control Center

AEM Area Emergency Manager

AMC Air Mobility Command

A&MMS Acquisition and Materiel Management Service

ASD Associate Director

ASMRO (Replaced-See GPMRC)

BDOC Bed Days of Care

CHS Contingency Hospital System

CONPLAN Contingency Plan

CONUS Continental United States

COS Chief of Staff

DHCP Decentralized Hospital Computer Program

DMRIS Defense Medical Regulating Information System

DoD Department of Defense

EMSHG Emergency Management Strategic Health Group

EMS Environmental Management Section

EOC Emergency Operations Center

FCC Federal Coordinating Center

FM Frequency Modulation

FORSCOM Forces Command

FRP Federal Response Plan

GPMRC Global Patient Movement Requirements Center

HEICS Hospital Emergency Incident Command System

HIMS Health Information Management Section

HRMS Human Resources Management Section

IOC Independent Outpatient Clinic

IMS Information Management Section

ISC Installation Support Center

JAS Job Action Sheets

JCAHO Joint Commission on Accreditation of Healthcare Organizations

MCC Military Coordinating Center

MEMO Memorandum

MOU Memorandum of Understanding

MPAT Military Patient Administration Team

NDMS National Disaster Medical System

NSC Non-Service Connected

PRA Primary Receiving Area

PRC Primary Receiving Center

PRT Patient Reception Team

NEOC Network Emergency Operations Center

SC Service Connected

SERP Supplemental Emergency Response Plan

SSC Secondary Support Center

SPD Supply Processing and Distributions Section

TBA To Be Announced

TBD To Be Determined

TRAC^2^ES Transcom Regulating and Command & Control Evacuation System

UHF/FM Ultra High Frequency/Frequency Modulation

US United States

USPHS United States Public Health Service

VA Veterans Affairs

VAMC Veterans Affairs Medical Center

VA/DoD Veterans Affairs/Department of Defense

VHA Veterans Health Administration

WOC Without Compensation

IX\. [PLAN REVIEW AND REVISION]{.underline}

A. Medical, Administrative, and Executive Staff reviews of proponent
SERPs and the CEMP with annexes, attachments, etc., will be completed
and forwarded to the EMC (138EmP) not later than November 15, annually.

B. The AEM and the Facilities Management Service Line Executive will
announce and suspense the annual review by MEMO and in appropriate staff
meetings, not later than October 1, annually. Extracts from the plan and
available supporting documents may be available, with advance notice, on
3.5\" computer disk.

C. The Facilities Management Service Line Executive and the AEM will
review and consolidate Medical Center comments to update the plan as
required, and report to the Medical Center Director and Network Director
not later than December 31, annually. Three copies of the HVAMC\'s
VA/DoD Contingency Plans must arrive at the South Central VA Health Care
Network Field Office no later than December 31.

D. [Follow-up Responsibility]{.underline}. The Area Emergency Manager
(AEM) in coordination with Facilities Management Service Line Executive.

X. [TRAINING, TESTS AND EXERCISES.]{.underline}

A. [Training]{.underline}. The primary responsibility for training of
Medical Center personnel on matters related to emergencies and disasters
will rest with the Facilities Management Service Line Executive.

1.  The Education Service Line Executive will coordinate VA/DoD training
    programs directed from Central Office via satellite teleconferences
    and assist in deployment of HVAMC overall training plans as
    necessary.

> 2\. It is the responsibility of each service chief to see that
> individuals within their respective service are aware of and
> understand their role related to VA/DoD contingency planning and
> operations. The services are responsible for individual employee
> training needs.

B. [Tests]{.underline}. This plan may be tested in its entirety or by
function at anytime by the responsible functional area leader. Tests may
be scheduled or unannounced.

C. [Exercises]{.underline}. This plan will be tested by annual exercise.
Exercises will be planned to coincide with South Central VA Health Care
Network and National VA/DoD contingency exercises. The Area Emergency
Manager (AEM), in coordination with the Facility Emergency Management
Program Committee and appropriate service chiefs, service line
executives and care line executives, have primary responsibility for
VA/DoD exercise planning.