VA Ann Arbor Healthcare System Policy Memorandum S-5

May 15, 2003

[EMERGENCY PREPAREDNESS PLAN]{.underline}

1\. [PURPOSE]{.underline}: Establish plans for coping with facility and
community emergencies and disasters, address procedures that deal with
facility and staff preparedness as well as patient management issues,
and delegation of authority to assure prompt and effective action under
emergency conditions. The procedures and responsibilities contained in
this policy and further explained in the Manual are for the guidance of
all patients, employees, volunteers, and visitors associated with the VA
Ann Arbor Healthcare System (VAAAHS) and should be followed to the
fullest extent possible.

2\. [POLICY]{.underline}:

a\. This policy outlines procedures to be followed in the event of
internal or external emergencies occurring at this facility, such as
fire, explosion, or major damage from some unforeseen causes such as
lightning, falling aircraft, etc., and seeks to:

\(1\) Prevent injuries to persons.

\(2\) Rescue casualties and entrapped persons.

\(3\) Provide emergency medical care of casualties.

\(4\) Prevent damage and loss of property, particularly those records
necessary for providing service to beneficiaries.

\(5\) Maintain and restore necessary services.

\(6\) Furnish casualty and damage information promptly.

\(7\) Investigate and analyze cause of emergency and recommend
corrective action.

\(8\) Expand to treat casualties from a community disaster, and to
provide back‑up medical support to the Department of Defense (DoD).

b\. Priority of assistance shall be:

\(1\) Patients

\(2\) VAAAHS volunteers and visitors

\(3\) Employees

\(4\) Irreplaceable records and valuable property

\(5\) Other property

c\. The attached manual is the master plan outlining procedures to be
followed in event of internal and external disasters. Specific plans
follow this master plan outlining procedures to be followed in the event
of specific disasters:

\(1\) Fire

\(2\) Community Disaster

\(3\) Tornado

\(4\) Snow Emergency

\(5\) Utilities Failure

(6) Chemical Spill

(7) 

\(7\) Chemical, Radiological and Biological Terrorism

\(8\) Bomb Threat

\(9\) Earthquake

\(10\) Civil Disturbance/Terrorist Act

\(11\) Hospital Evacuation and Relocation

\(12\) Communication Failure

(13 VA/DoD Contingency Plan

The Emergency Operations Center (EOC) will determine the plan to be
used. The nature of the disaster and the extent of the damage will
determine the course of action. The Veterans Affairs Ann Arbor
Healthcare System Emergency Preparedness Plan uses the following four
procedures to prepare for and respond to any and all disasters:

-   Mitigation - Reduce the risk through anticipatory actions;

-   Preparedness - Steps taken before an emergency and/or disaster
    occurs, with focus on the

> development of emergency operations plans and systems;

-   Response -- Focus on minimizing personal injury and property damage
    through emergency functions such as warning, evacuation, search and
    rescue, provision of shelter and medical service; and

-   Recovery -- Begins immediately following an emergency and/or
    disaster with efforts to restore minimum services and continues with
    longer-term efforts to return to normal or near normal operating
    conditions.

3\. [RESPONSIBILITIES]{.underline}:

a\. The regular day‑to‑day management organization and service
responsibilities/authorities will be applicable at all times. Under
certain emergency circumstances, some service functions will be deferred
or canceled pending termination of the emergency. Under these
conditions, employees in these services will be made available for other
assignments within the Ann Arbor Healthcare System.

b\. [Emergency]{.underline} Preparedness [Coordinator
(EPC).]{.underline} The Director has designated the Chief, Police
Service as Emergency Preparedness Coordinator. EPC prepares, coordinates
and maintains the Emergency Preparedness Plan, including initial
training of all new employees and annual retraining of all employees to
assure effective execution of all plans. The Industrial Hygienist will
serve as alternate EPC. The EPC will activate drills at least twice a
year. One drill will involve an external emergency; the other activation
will pertain to an internal emergency. Activation of the Fire Plan
should take place at least once per shift, per quarter in each patient
occupied building. A critique of each fire drill will take place within
48 hours by the Emergency Preparedness Coordinator.

c\. [Safety and Occupational Health Committee]{.underline} will critique
plan activation(s) within 30 calendar days. Each critique will review
issues pertaining to facility preparedness, staff preparedness, and
effective management of patients/casualties, during activation.
Documentation of plan activation(s) will include problems identified
during implementation, corrective actions taken, and staff involvement.

Follow-up on plan activation's, each identified problem will be
addressed by education, system changes, plan updates, reassignment of
duties, equipment acquisition, or other corrective action. Summary
reports and critique findings will be forwarded for review by the
facility\'s Safety Committee to the Administrative Executive Board, who
monitors and evaluates the overall Emergency Preparedness program
effectiveness on an ongoing basis.

d\. [Department Heads will]{.underline}

\(1\) Services that are called upon to assist in emergency preparedness
responses will prepare and maintain a Service specific policy (Service
Plan for Disaster) in support of this Master Plan and route it to the
Emergency Preparedness Coordinator annually. Each Service plan will
address their individual service-specific recovery phase of a disaster,
i.e.- reordering of supplies, processing claims, returning equipment
settings to normal and whatever other actions need to be taken to return
to a normal operating condition.

\(2\) Maintain a current \"Emergency Cascade Call Back Chart."

\(3\) Assign employees to assure adequate coverage of the unit
responsibilities during semi-annual drills and/or actual disaster
scenarios.

\(4\) Train personnel annually to perform the details of the Service
Plan and document training.

\(5\) In the event of a disaster, ensures that all employees in his/her
service are notified and make every effort to preserve all records,
concentrating on those with highest priority. Release unassigned
personnel and/or those not immediately needed to the Manpower Pool.

e\. [All Employees]{.underline} Responsibilities[.]{.underline}

\(1\) Remain familiar with the provisions of the Plan and execute them
in an emergency.

\(2\) Report for duty upon learning of a large-scale disaster if
communication cannot be

established.

\(3\) Review Roles and Responsibilities on an annual basis.

4\. [EMERGENCY OPERATION CENTER (EOC)]{.underline}:

a\. The principle will be followed that authority is never vacated. The
Associate Director will assume the responsibility of activating and
manning the EOC in the Director's Suite. The alternate site for the EOC
will the Administrative Officer of the Day's office on the first floor
of building 1 West.

If a key member of the EOC is not present, the person appointed to act
in that capacity will assume the responsibilities of the EOC. This same
principle applies to all roles and responsibilities associated with this
Manual.

a\. The regular management and service responsibilities and authorities
will be applicable at all times. Under some emergency circumstances,
some service functions will be deferred or canceled pending termination
of the emergency. Under these conditions, employees of these services
will be available for other assignments in the VA Ann Arbor Healthcare
System.

b\. The VAAAHS Emergency Preparedness Coordinator is a member of the
Washtenaw County and the City of Ann Arbor Emergency Management
Committees. As a member, the Emergency Preparedness Coordinator meets
and coordinates with these committees monthly. In the event of an
emergency of such proportions that assistance is needed from the local
community, the VAAAHS has an agreement with Washtenaw County to use
whatever resources are available through the Washtenaw Emergency
Management Plan. The VAAAHS is part of the Washtenaw County Emergency
Management Plan and can be called upon to assist in emergency
situations. Accordingly, we can also share whatever resources the
Washtenaw County Emergency Management system has for emergencies at our
facility.

5\. [PROCEDURES FOR USE OF]{.underline} CONTRACT [EQUIPMENT AT PATIENTS
RESIDENCE]{.underline}:

a\. Patients that are issued oxygen equipment for use at their residence
are given back-up cylinders in the event of cylinder failure and are
instructed to call the 24 hour vendor call number for immediate
assistance.

b\. Patients that are given pain control devices and nutrition devices
for use at their residences are instructed to contact the 24 hour vendor
call number for immediate assistance.

c\. All patients are instructed to call their local 911 for immediate
medical assistance.

6\. REFERENCES:

o Executive Order 11490, February 26, 1963

o NFPA 1600 - Disaster Management - 1998 edition

o JCAHO Environment of Care Standards

o Circular 10‑99‑116, October 4, 1988, DM&S VA. Subj: VA/DoD Contingency
Planning and National Disaster Medical Systems

o Public Law 97-174, Section 5011A, "Veterans Administration and
Department of Defense Health Resources Sharing and Emergency Operations
Act," dated April 1992

o Executive Order 12658, "Assignment of Emergency Preparedness
Responsibilities," dated November 18, 1988; National Security Decision
Directive 47 (1982)

o Public Law 93-288, "Robert T. Stafford Disaster Relief and Emergency
Assistance Act," as extended and amended by Public Law 100-707 (1988)

o Presidential Decision Directive #39

o Public Law 100-180, "Transportation of Certain Veterans on Department
of Defense Aero medical Evacuation Aircraft," dated December 5, 1987

o VA Directive 0320, Emergency Preparedness Planning

6\. [RESCISSIONS]{.underline}: Policy Memorandum S-5, dated 16 April
2002

7\. [EXPIRATION]{.underline}: May 2006

8\. [FOLLOW‑UP RESPONSIBILITY]{.underline}: Emergency Preparedness
Coordinator (07)

# James W. Roseborough

JAMES W. ROSEBOROUGH

Director

Attachments

Distribution: F

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[ACTIVATION PROCEDURES]{.underline}**

The **Emergency Operations Center** (EOC) will determine the plan to
use. The nature of the disaster and the extent of the damage will
determine the course of action. **[If a fire, activate the Fire Plan
first]{.underline}.**

**[ACTIVATION OF THE EMERGENCY PREPAREDNESS PLAN]{.smallcaps}:**

A. Upon notification of an ongoing disaster within the community, the
telephone operator will transfer the information or call to the
Emergency Operations Center (EOC). The EOC member will make the decision
to implement all or part of this plan:

**[During Administrative Hours]{.smallcaps}: 8:00 AM to 4:30 PM - Mon.
through Fri.**

\(1\) Medical Center Director (extension 5458)

\(2\) Associate Director (extension 5455)

\(3\) Chief of Staff (extension 7901, 7903)

\(4\) Chief of Police/Emergency Preparedness Coordinator (extension
7914)

\(5\) Associate Director for Patient Care (extension 7920)

\(6\) Chief Information Officer (extension 5733)

(7) Chief Resource Officer (extension 7972)

\(8\) VISN 11 EOC Office. (separate but mandatory call by EOC)

**[During Non‑Administrative Hours]{.smallcaps}:** The Administrative
Officer of the Day **(AOD)** - (extension 5271 or beeper 348) **will
assume RESPONSIBILITIES for the Emergency Operations Center until
relieved** by one of those listed above, in order of priority.

B. The telephone operator will stand by to receive instructions from the
EOC.

C. Emergency Operations Coordinator will determine the announcement to
be made over the PA.

D. If authorized, the telephone operator will announce:

**\"ATTENTION PLEASE. THIS IS AN EMERGENCY PREPAREDNESS SITUATION.
PLEASE ACTIVATE (Insert name of plan given by EOC).\" Repeat once.**

For drills add: \"THIS IS A DRILL. THIS IS ONLY A DRILL.\"

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

All portable radios will be switched to the Facilities Management
frequency and left there until the \"All Clear\" is given by the EOC
with proper identification. All messages will be given in plain English
language. The Facilities Management radio frequency (channel-3) is the
Emergency Preparedness frequency at all times.

**(2) The Public Address (PA) System:**

The PA system will be used to transmit actual fire, disaster, or
disaster drill information. EOC will give information regarding a fire,
drill, or disaster over the PA system.

E. EOC will initiate the Facility Cascade Notification Plan. After
hours, the Top Management Team can be in communication via 3‑way
conference call to inform them of the disaster and initiate cascade
notification.

F. EOC may contact department heads by conference call to inform them of
the disaster and the type of plan activated.

[G. [COMMUNICATIONS]{.underline}:]{.smallcaps}

**1. Radios:**

All portable radios will be switched to the Facilities Management
frequency and left there until the "All Clear" is given by the EOC with
proper identification. All messages will be given in plain English
language. The Facilities Management radio frequency (channel 3) is the
Emergency Preparedness frequency at all times.

**2. The Public Address (PA) System:**

The PA system will be used to transmit actual fire, disaster, or
disaster drill information. EOC will give information regarding a fire,
drill, or disaster over the PA system.

The \"All Clear\" will be given by the EOC, or by the Operator under
authorization of the EOC.

Three PA announcements will be given for any drill, or actual emergency
at all times. One for alarm location; one for emergency plan activation;
and one for the "All Clear" notification.

H. **QUICK ACTIVATION PROCEDURES:**

Tornado and fire emergencies can occur at any time. For this reason,
Tornado or Fire Plans can be activated immediately, **[WITHOUT THE PRIOR
ACTIVATION OF THE EOC]{.underline}.**

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[ACTIVATION of FIRE PLAN]{.underline}:**

\(1\) [Employee Responsibilities]{.underline}:

\(a\) Upon discovery of fire, all employees will take immediate action
at the site of the fire emergency while contacting the telephone
operator at extension 3333; telephone operator will then activate the
fire plan. The acronym **RACE** is used to implement the following
procedures:

**[R]{.smallcaps}** - [Rescue]{.smallcaps} Rescue any people

**[A]{.smallcaps}** - [Activate Alarm]{.smallcaps} Pull fire alarm, call
operator at extension 3333

**[C]{.smallcaps}** - [Close]{.smallcaps} Close all windows and doors

**[E]{.smallcaps}** - [Extinguish]{.smallcaps} Extinguish fire to the
best ability using nearest fire

extinguisher

\(b\) Upon hearing fire alarm, identify location of fire by locator
charts adjacent to all fire alarm pull stations. If the fire is not in
your area, be alert for additional instructions. Refrain from calling
the telephone operator and using the elevators.

\(2\) **Operator receives notification of fire alarm through one of the
following sources:**

**[SOURCE OPERATOR PROCEDURE]{.smallcaps}**

VA Police Obtain information and repeat back to source:

Call‑in, or Location of fire

personal contact Name of reporter and callback extension

Alarm activation Verify alarm location on printer or CRT screen. Call or

radio VA police to inform them of the alarm location.

**Upon notification of FIRE, the telephone operator will:**

**Make a Public Address Announcement stating \"WE HAVE A FIRE - ALARM
ACTIVATION ON [[(Location)]{.underline}]{.smallcaps}.\"**

**Repeat once.**

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[ACTIVATION of the TORNADO PLAN]{.underline}:**

\(1\) Telephone operator will announce over the PA System: "**ATTENTION
PLEASE - This is an Emergency Preparedness Situation. Please activate
Tornado Warning Plan immediately. There is currently a tornado warning
for our area."** Repeat once.

\(2\) **Activate telephone cascade notification IMMEDIATELY**.

\(3\) **All Departments will notify staff IMMEDIATELY upon
notification.**

\(4\) **TAKE ALL PATIENTS BACK TO THEIR ASSIGNED ROOMS**.

\(a\) Move beds and patients away from windows.

\(b\) Close window shades and/or drapes, and ALL DOORS: i.e., office,
patient rooms, stairway and fire doors.

\(c\) Secure patients away from glass sources immediately.

\(d\) Ambulatory patients (including wheelchair patients) will be
evacuated to inside corridors.

\(e\) **Patients must remain on the unit until an \"All Clear\" is
issued.**

\(5\) All other outpatients, employees, and visitors must take cover
away from any glass source or doorway. Seating in center corridors is
required. EOC will instruct the telephone operator to notify the
following:

**[REGULAR HOURS NON‑ADMINISTRATIVE HOURS]{.smallcaps}**

**Chief, Police Service Patient Care Coordinator**

**Associate Director for Patient Care Medical Center Police**

**Facilities Management AOD**

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**PLAN SELECTION & E.S.F. ACTIVATION(S)**

Any plan activation will involve public address and telephone cascade
notification. EOC will select plan before activation. ***[E.S.F. #1 IS
ALWAYS ACTIVATED FIRST, AFTER ANY PLAN IS SELECTED!!]{.underline}***

**[Emergency Support Function]{.underline} -
[Definitions]{.underline}:**

**E.S.F. #1 - Management**

**E.S.F. #2 - Resources**

**E.S.F. #3 - Facility Response Plan Activation**

**E.S.F. #4 - Safety and Security**

**E.S.F. #5 - Health, Medical, & Mass Casualty** **Care**

**E.S.F. #6 - Community Support Services**

**E.S.F. \# 7 - Recovery Procedures**

**[PLAN]{.underline} [E.S.F. ACTIVATIONS]{.underline}**

**FIRE 2, 4, 5 , 6 & 7**

**COMMUNITY DISASTER 2, 4, 5, 6 & 7**

**TORNADO 2, 4, 5, 6 & 7**

**SNOW 2 & 7**

**UTILITIES FAILURE 2, 4, 6 & 7**

**CHEMICAL SPILL 2, 4, 6 & 7**

**CHEMICAL, RADIOLOGICAL AND**

**BIOLOGICAL TERRORISM 2, 4, 5, 6 & 7**

**BOMB THREAT 2, 4, 6 & 7**

**EARTHQUAKE 2, 4, 5, 6 & 7**

**CIVIL DISORDER/ 2, 4, 6 & 7**

**TERRORIST ACT**

**HOSPITAL EVACUATION 2, 4, 5, 6 & 7**

**COMMUNICATION FAILURE 2 & 6 & 7**

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**VA/DoD CONTINGENCY 2, 4, 5 & 6 & 7**

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[[ACTIVATION ROLES & RESPONSIBILITIES]{.underline}]{.smallcaps}**

**[ESF #1 - MANAGEMENT]{.smallcaps}**

[**EMERGENCY OPERATIONS CENTER** **(EOC)-** **ESF #1**]{.smallcaps}

Primary Location: Director\'s office

Alternate Location: AOD office/as determined by Director

Off hours: AOD office

**EMERGENCY OPERATIONS COORDINATOR:**

**[During regular work hours (8:00 a.m. ‑ 4:30 p.m.,
M‑F)]{.underline}:**

\(a\) Medical Center Director 5458

\(b\) Associate Director of Operations 5455

(c) Chief of Staff 7901, 7903

(d) Chief, Police Service/EPC/Incident Commander 7529, 7914 (page
    734-670-1751)

(e) Associate Director for Patient Care 7920

\(e\) Chief Information Officer 5733 (page 734 797-9877)

\(g\) Chief Resource Officer 7972

**[During other than normal working hours]{.underline}:**

The AOD (beeper 348) will assume responsibility for the EOC until
relieved by one of the above designees.

**[RESPONSIBILITIES]{.smallcaps}:**

A. Select and activate a plan, notifies operator of plan to announce.
Initiate notification of the Emergency Operations Coordinator list.
Coordinates information with the Incident Commander.

B. Initiate the Facility Cascade Notification Plan, alerting all
departments as to the type and location of the disaster and which
disaster plan is in effect, via coordination with the telephone
operator.

C. Assure the safety of patients, visitors, and employees.

D. Notify the VISN Director and the Area Emergency Manager (A.E.M.) when
any activation occurs. After emergency or disaster has ended, the
Director will forward to the VISN Director a report of the emergency and
its effects on the facility, including casualties, damages, etc.

E. Establish and maintain liaison with Federal, State, County, and/or
Local authorities, American Red Cross, police departments, and other
health care institutions, as needed.

F. Determine when to discontinue other health care activities.

G. Coordinate all information from all participants during drill or
disaster scenario. Coordinate all distribution of resources.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[INCIDENT COMMANDER - ESF #1]{.smallcaps}**

Coordinator: Chief, Police Service (07)

1st Alternate: Industrial Hygienist (50IH)

Primary Location: Internal Emergency: Disaster Area

External Emergency: Disaster Site

**[RESPONSIBILITIES:]{.smallcaps}**

A. Communicates with VHA, other Federal, State, County, and City of Ann
Arbor Emergency Preparedness agencies, and the EOC. Manage all aspects
of the disaster site as the Incident Commander, unless relieved by
higher authority.

B. Operates as liaison with EOC, Triage Physician and Triage Nurse.
Report needs to the EOC.

C. Facility-specific Emergency Preparedness Coordinator (E.P.C.)

D. Conducts a comprehensive investigation of the disaster and assesses
property damage after all casualties are removed from disaster site.

E. Interviews witnesses promptly, arrange for photographs of pertinent
scenes (with Medical Media Department), analyzes conditions and utilizes
experts of any specialization to establish facts or information, and
preserve evidence in its original condition.

F. Coordinates critique of disaster procedures and disaster drills.

G. Conducts critique of event within two working days, and evaluates
issues pertaining to facility and staff preparedness as well as patient
management. Document, identify, and recommend or implement corrective
actions to address identified issues, and initiate revisions to this
manual to coincide with identified changes.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[MEDIA or PUBLIC INFORMATION]{.smallcaps}: - ESF #1**

Primary Location: Emergency Operation Center (EOC)

Alternate Location: Determined by the EOC

**Coordinator: Public Affairs Officer (PAO)**

**RESPONSIBILITIES:**

A. Coordinates factual information pertaining to number of casualties,
fatalities, and receive all visitors to the hospital. Establish contact
with appropriate public media. Release of information: exercise a strict
censorship on releasing information with concurrence and approval of the
EOC.

B. During actual internal or external disaster, news releases or
prepared statements on damage will be released by the PAO only.

C. Facilities Maintenance Department will provide and erect signs
directing visitors to the PAO.

D. Representatives of the media are escorted to media room. VA Police
will enforce this restriction.

E. A messenger will be assigned to the PAO in order to provide
information from the EOC about the emergency situation. Written brief
detail is given to the messenger to provide the PAO with accurate
information.

F. Assigns support to the PAO by recording and photographing damage to
property and injuries. This will include photographic support to the
Incident Commander, when requested.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[COMMUNICATIONS INFORMATION OFFICER - ESF #1 & #3]{.smallcaps}**

**Coordinator: Communication Information Officer (CIO)**

Alternate: CIO designee

Primary Location: EOC

Alternate Location: Determined by the EOC

**[RESPONSIBILITIES:]{.smallcaps}**

A. Communications during the disaster period will be maintained between
the hospital and the community when appropriate by the most expedient
means available, utilizing any or all of the following:

1\. Telephone when possible, but only for emergencies.

2\. Portable radios and short wave radios.

3\. Hospital Emergency Administrative Radio (H.E.A.R.) located in the
telephone operators' room.

4\. Messenger Department by employees in the office of the VA Police.

B. Communications between key staff within the hospital will be
maintained by telephone when possible. Messenger service from the
Manpower Pool will be utilized if necessary. **Distribution of portable
radios to patient care wards will be done via coordination between the
CIO, EOC, and the Manpower Pool.** The telephone operators will instruct
portable Radio users on portable radio operation.

C. CIO will survey the radio communications available for contact with
their counterparts in the community, other owners or operators. Maintain
inventory of emergency portable radios for emergency preparedness usage,
within CIO.

D. Communication lines between the Disaster Site and EOC will be
maintained by the CIO via telephone or portable radio.

E. CIO will also organize messenger service from the EOC, if required.
At least one messenger will be on hand at all times to receive or
dispatch TWX messages.

F. If station communications become inoperable or partially inoperable,
the CIO will acquire backup systems from the community or seek messenger
service from the Manpower Pool.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[BUSINESS OFFICE - ESF #1]{.smallcaps}**

Coordinator: Inpatient Supervisor/Business Office Manager

Alternate: Business Office Designee

Primary Location: EOC/TRIAGE

Alternate Location: Admissions Office

**[RESPONSIBILITIES:]{.smallcaps}**

A. Reports bed availability to EOC and AC&P; information is used for
emergency bed assignments.

B.  Establishes and maintains a record for each casualty treated and/or
    hospitalized. Supply of Emergency Medical Tags will be maintained in
    the Utilization Management office or other appropriate areas.

C. Reports casualty condition(s) changes of victims to EOC on concurrent
basis.

D. Maintains safekeeping and tracking of all personal valuables,
clothing of patients and casualties.

E. Removes and protects all clinical records from the disaster site or
threatened areas.

F. Provides administrative support, to the clinical staff in the
casualty receiving area (Triage), the non-critical casualty receiving
area, and the AOD, on off hours.

G. Organizes and trains supervisors and teams for the following:

1\. Registration

2\. Patient effects

3\. Clinical records

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[EMERGENCY SUPPORT FUNCTIONS]{.smallcaps}**

**E.S.F. #2 - RESOURCES**

**[FACILITIES MANAGEMENT OFFICER - ESF #2]{.smallcaps}**

Coordinator: Facilities Management Officer

1st Alternate: Chief Resource Officer

2nd Alternate: Human Resources Manager

Primary Location: EOC

Alternate Location: Determined by the EOC

[**RESPONSIBILITIES:**]{.smallcaps}

A. Provides necessary resources for emergency repairs or restoration of
all utilities, buildings, structures, and all other hospital facilities
on the station.

B. Notifies Emergency Transportation Pool and other teams about the
emergency needs.

C. Provides support for fire protection, stretchers for casualties, and
immediately transport Chief, Police Service to the disaster site.

D. Organizes immediate dispatch of transportation resources as ordered
by EOC for any disaster site

E. Secures and mans freight elevators for movement of casualties and
supplies with the Manpower Pool.

**[EMERGENCY TRANSPORTATION POOL: TRANSPORTATION (51GT)]{.smallcaps}**

A. The Service Foreman, Transportation Section, is designated
\"Emergency Transportation Officer.\"

B. Emergency Transportation Officer has responsibility to distribute,
dispatch, rent, or acquire vehicles to meet this emergency requirement.
The following procedures will be used:

\(1\) Facility vehicles equipped with a radio connection to the medical
center telephone operator and the garage will be utilized first.

\(2\) When larger vehicles be required for evacuation of patients from
the medical center, commercially owned buses are the most appropriate
vehicles and should be contacted.

University of Michigan Transportation Department (734)‑764‑3427

Ann Arbor Public Schools Transportation Department (734)‑994‑2330

Ann Arbor Transportation Authority (734)‑973‑6500

GSA Motor Pool (313)‑226‑3193

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

\(3\) Procedures for acquiring non‑VA trucks or other emergency
equipment:

\(a\) Ann Arbor Police Department and Washtenaw County Sheriff\'s
Department maintain a current list of companies providing emergency
truck service. After receiving a telephone call from the EOC, they will
call the company.

\(b\) Procedure to follow is detailed below:

\(1\) In the event emergency vehicles are required to move equipment,
supplies, linen, etc., the EOC will request that the Emergency
Transportation Officer call the Ann Arbor Police Department (761‑2425)
and/or Washtenaw County Sheriffs Department (971‑3911).

\(2\) Emergency Transportation Officer will be prepared to provide the
following information:

[[1]{.underline}]{.smallcaps} Name, title, and location

[[2]{.underline}]{.smallcaps} Reason for emergency

[[3]{.underline}]{.smallcaps} Number and size of truck(s) required

[[4]{.underline}]{.smallcaps} Enclosed or open type

[[5]{.underline}]{.smallcaps} Staging area for vehicles (coordinate with
VA Police)

C. Should Battle Creek or Detroit VAMC drivers or vehicles be needed to
support the emergency transportation pool, call the Engineering/Facility
Management Departments at those facilities.

Medical Center [Telephone]{.smallcaps} [Number]{.smallcaps}

[Battle]{.smallcaps} [Creek]{.smallcaps}

Engineering Service 616-974‑3784

[Detroit]{.smallcaps}

Facility Engineering Section 313 576-1000, ext. 4175

Designee, Facility Engineering Section 313 576-1000, ext. 4175

D. Helicopter Support:

\(1\) Contact Cleveland, Ohio, U.S. Coast Guard Rescue Center (District
Headquarters) (1‑800‑321‑4400) and ask for helicopter support for quick
transportation of Ann Arbor patients to Detroit VAMC or other health
care facilities.

\(2\) Landing Site, VA Medical Center, Ann Arbor ‑ Large field west of
medical center adjacent to Fuller Road (Mitchell Field).

\(3\) Landing Site, University of Michigan ‑ Helicopter pad north of
main hospital complex.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[RESOURCES - ESF #2]{.smallcaps}**

Coordinator: Chief Resource Officer

Alternate: Human Resources Manager

Primary Location: Resources Office, Bldg. #4

**[RESPONSIBILITIES:]{.smallcaps}**

This department will perform its normal duties and RESPONSIBILITIES
unless otherwise notified by the EOC.

**[CENTRAL STERILE SUPPLY - ESF #2]{.smallcaps}**

Coordinator: Central Sterile Supply Supervisor

Alternate: Designee, Central Sterile Supply

Primary Location: Central Sterile Supply Office

Secondary Location: Central Sterile Supply Section

**[RESPONSIBILITIES:]{.smallcaps}**

A. Provision of supply activities to meet the needs of the using
departments during the emergency with priority attention given to
Emergency Room, Operating Room and Triage.

B. Institutes and maintains adequate records of all supplies and
equipment issued.

C. Coordinates with Emergency Medical Team and EOC on the procurement,
maintenance and updating periodically of emergency dressing kit(s) and
other supply carts during any plan activation.

D. Assigns an employee to triage for the provision of supplies. Will
bring the triage cart, universal precautions cart, a crash cart, and
three needle disposal boxes.

E. Coordinates with Nutrition and Food Department for additional food
supplies if necessary.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[FACILITIES MAINTENANCE - ESF #2, #3, #4]{.smallcaps}**

Coordinator: Facilities Maintenance Supervisor

Alternate: Designee, Facilities Maintenance

Primary Location: Facilities Maintenance Office

Alternate Location: Determined by the EOC

**[RESPONSIBILITIES:]{.smallcaps}**

A. Provides linen support in emergencies. This includes the issuance of
pillows, blankets, sheets, etc.

B. At the announcement of any emergency plan, assigned Facilities
Maintenance personnel will retrieve and erect emergency directional
signs, including those that direct media and casualties to the correct
locations.

C. Perform fire‑fighting duties as described in the Fire Plan.

D. Facilities Maintenance personnel not assigned to specific
RESPONSIBILITIES will report to the Manpower Pool until the \"All
Clear\" is given.

E. Facilities Maintenance employees will take a linen cart with sheets,
towels, gowns and blankets to the triage area. Also two (2) large
trashcans with red garbage bags will be taken to the triage area.

F. **Facilities Maintenance supervisor during Non‑Administrative hours
will coordinate the Manpower Pool. Location will be at the supervisors'
discretion.**

**[NUTRITION & FOOD DEPARTMENT - ESF #2]{.smallcaps}**

Coordinator: Nutrition & Food Department Head

Alternate: Designated Lead Supervisor

Primary Location: Main Kitchen

**[RESPONSIBILITIES:]{.smallcaps}**

A. Provide for the expansion of services to patients, personnel, and
volunteer workers.

B. Nutrition & Food Department employees who report for emergency
support duty and are not specifically assigned to food preparation will
be sent to the Manpower Pool for duty assignments.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**HUMAN RESOURCES: (MANPOWER POOL) - ESF #2 & #5**

Coordinator: HR Department Head

Alternate: Designee, HRM Department

Primary Location: BSMT Floor West - Building #1W

Alternate Location: Determined by the EOC

**[RESPONSIBILITIES:]{.smallcaps}**

A. Operates the Manpower Pool via communication with EOC.

B. Manpower Pool Officer will take a portable radio to manpower pool. A
backup portable radio will be available through the CIO. Coordinate
disbursement of orange vests and other proper identification to all
Manpower Pool and other employees participating in the emergency
scenario.

C. Upon announcement of plan, all supervisors from Facilities
Maintenance and Voluntary Department will immediately dispatch to the
Manpower Pool, employees not otherwise assigned specific duties under
this plan.

D. HR Officer (or alternate) will immediately set up the Manpower Pool
for employee registration and assignments.

E. Any assistance from the Manpower Pool is coordinated through the EOC,
this will include coordination of resources from the clinical pool
and/or clinical resources.

F. One Freight elevator (Clinical Addition) will be used for
transportation of patients and supplies between the basement and the
7^th^ floor. One Freight Elevator will be used for access to floors 3
through 7.

G. All equipment will be brought to the Manpower Pool and be distributed
via coordination with the EOC.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[PHARMACY DEPARTMENT - ESF #2 & #5]{.smallcaps}**

Coordinator: Pharmacy Department Head

Alternate: Designee, Pharmacy Department

Primary location: Pharmacy Office

**[RESPONSIBILITIES:]{.smallcaps}**

A. Coordinates with the Emergency Medical Team and Casualty Treatment
Area(s) with the procurement, maintenance, and periodical updating of
medicine kits for trauma and cardiac emergency.

B. Dispatches a Pharmacist and a Pharmacy Technician with appropriate
supplies to the Emergency Medical Team in the ambulance garage (triage
site) or area where an emergency triage area has been set up.

C. A second Pharmacist and Pharmacy Technician are needed when the
Triage Team responds off-site to receive casualties. Blue Cart will
accompany to off-site triage site.

**[VOLUNTARY DEPARTMENT - ESF #2]{.smallcaps}**

Coordinator: Volunteer Coordinator

Alternate: Designee

Primary Location: Volunteer Office

**[RESPONSIBILITIES:]{.smallcaps}**

A. This Department will organize volunteers on duty and direct them to
the Manpower Pool Area for assistance as needed.

B. Volunteers will be assigned to assist outpatients as needed

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**E.S.F. #4 - SAFETY & POLICE**

[**VA POLICE - ESF #4**]{.smallcaps}

Coordinator: VA Police

1st Alternate: Industrial Hygienist

2nd Alternate: Infection Control Practitioner

Primary Location: Emergency Operations Center (EOC)

Alternate Location: Determined by EOC

**[RESPONSIBILITIES:]{.smallcaps}**

A. When disaster signal is sounded, will secure the scene and will not
allow any unauthorized traffic to approach near the building or pass on
roads where fire equipment and pumps are located. VA Police will be
utilized to its fullest extent to provide adequate security.

B. VA Police will:

1\. Control egress and ingress to hospital

2\. Control internal disaster site

3\. Seal off disaster casualty treatment areas (i.e., Radiology, Surgery
and Laboratory.)

4\. Meet and direct incoming emergency vehicles to the triage area

5\. Notify AOD off‑hours if local city sirens are heard

C. Assist in distribution of emergency communication equipment as
needed.

D. Direct all media and news reporters to a site designated by the EOC.

E. Provide traffic information as outlined in specific plans.

F. Provides transportation security of Emergency Medical Triage Team and
Chaplain from the EOC and Triage Staging Area to the disaster site.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[CHEMICAL]{.smallcaps} [SAFETY]{.smallcaps} [OFFICER - ESF
#4]{.smallcaps}**

Coordinator: Industrial Hygienist

1st Alternate: Radiation Safety Officer

Primary Location: Internal Emergency: Disaster Site

External Emergency: EOC

Alternate Location: Determined by the EOC

**[RESPONSIBILITIES:]{.smallcaps}**

A. Develops a comprehensive plan for specific protective, monitoring and
decontamination measures related to the chemical affects of **[on-site
fire or explosion]{.underline}.**

B. Organizes and supervises specialized teams that will be capable of
conducting chemical monitoring.

C. Maintains liaison with the Ann Arbor Fire Department, keeping abreast
of technical developments and current training needs.

D. Advises the EOC of the chemical hazards at **the on-site disaster.**
Provides the most appropriate manner in which to handle them.

E. Maintains communication with Incident Commander at all times. **Serve
as the Incident Commander during the Chemical Spill Plan activation.**

**INFECTION CONTROL PRACTITIONER - ESF #4,& 5**

Coordinator: Infection Control Practitioner

1st Alternate: Infection Control Designee

Primary Location: Emergency Operations Center

**RESPONSIBILITIES:**

A. Maintains communication with clinical staff during treatment and/or
decontamination of casualties.

B. Coordinates biohazard identification procedures with Industrial
Hygienist during casualty treatment and preplanning of care.

C. Assists in technical expertise during identification of biohazard,
chemical, pathological, or any unknown illness sustained by casualties.

D. Monitors usage of personal protective equipment during triage.
Notifies SPD when re-supply of PPE is needed in the PPE cart.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**E.S.F. #5 - MEDICAL CARE** **& MASS CASUALTIES**

**[PROFESSIONAL DEPARTMENTS OFFICE]{.smallcaps}: - ESF #5**

Coordinator: Chief of Staff

1st Alternate: ACOS/Ambulatory Care or Medicine Department Designee

2nd Alternate: Chief, Medicine Service

Primary Location: Chief of Staff's Office

Alternate Location: Determined by the EOC

**RESPONSIBILITIES:**

A. Exercises overall Information and supervision of the professional
care provided for casualties.

B. Assures medical and/or surgical staff notified immediately upon the
decision to utilize their specialty.

C. Maintains liaison with clinical department chiefs to assure adequate
Information and supervision of all aspects of professional care
required.

D. Informs EOC on the progress of casualty treatment associated with his
staff.

**[TRIAGE COORDINATION]{.smallcaps}:**

Triage requires clinical and administrative coordination of available
resources to safely and efficiently sort casualties and dispatch them to
the clinically indicated treatment area.

**PRIMARY TRIAGE LOCATION: AMBULANCE GARAGE**

**ALTERNATE LOCATION: AT EOC'S DISCRETION**

**Designated Triage Coordinators:**

\(1\) **Physician Triage Coordinator:**

Surgery Department or Chief Surgical Resident, or

Surgeon of the Day (during non‑administrative hours)

**RESPONSIBILITIES:**

\(a\) Supervises triage teams.

\(b\) Examines and sorts casualties for further definitive treatment.

\(c\) Obtains appropriate clinical supplies and personnel.

\(d\) Maintains radio contact with EOC for additional assistance and
availability of beds for patient transfer.

\(e\) Arranges transfer of the dead to the morgue.

\(f\) Directs stretcher-bearers.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

\(2\) **Patient Care Triage Coordinator:**

Head Nurse, Ambulatory Care or Triage Staff RN,

or SICU RN (designated by the Patient Care Coordinator during
non-administrative hours).

**RESPONSIBILITIES:**

\(a\) Assists in triage of patients and ordering appropriate clinical
supplies and personnel.

\(b\) During absence of Administrative Coordinator during
Non‑Administrative hours, directs manpower pool at the triage site.

\(3\) **Administrative Coordinator: Associate Director for Operations**

**RESPONSIBILITIES:** Responsible for efficient flow of patients at
triage site.

\(a\) Takes portable radio to triage site.

\(b\) Assists Triage Coordinator in performing indicated administrative
tasks and takes initiative in identifying and curtailing potential
management problems in the delivery of health care.

\(c\) Facilitates communication between Triage personnel, EOC, Incident
Commander, and other appropriate personnel.

(d) Communicates need for additional resources to the EOC.

(e) Ensures smooth traffic flow through the triage area.

    **Other Department RESPONSIBILITIES to the Triage Area:**

\(1\) **Patient Care:**

\(a\) All Patient Care units will send stretcher, wheelchair, and
rolling IV pole to triage area.

\(b\) Patient Care personnel may be requested to assist at the triage
area.

\(2\) **SPD:**

Brings the triage supply box to the ambulance garage, along with a
universal precaution cart, a crash cart, three (3) needle disposal
boxes, and a Personal Protective Gear (PPE) cart.

\(3\) **Pharmacy:**

Brings the triage pharmacy cart to the ambulance garage. A staff
pharmacist and

technician will assist with medication dispensing until cleared by the
triage physician.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

\(4\) **AOD/Utilization Management Department:**

\(a\) Maintains a medical records documentation kit, utilize during
drills or actual disaster Scenarios.

\(b\) A minimum of two (2) MIS persons will respond to the triage site
during Administrative Hours to place ID tags on casualties, keeps a
disaster patient log, and to initiate patient records.

\(c\) During non‑administrative hours, someone is assigned by the AOD or
Patient Care Coordinator to do the above.

\(5\) **Respiratory Therapy:** Bring one (1) \"H\" tank, three (3) \"E\"
tanks, and three (3) ambu bags to the triage site. A Respiratory
Therapist will remain at the triage site to assist as designated.

\(6\) **VA Police:** Direct traffic of ambulances and victims to the
triage area.

\(7\) **Facilities Maintenance:** Bring a linen cart with sheets,
towels, gowns and blankets, and two (2) large trash cans with red
garbage bags for disposal of contaminated waste.

\(8\) **Facilities Management Department:** Operate at least two (2)
freight elevators for transport of supplies and equipment initially, and
then transport of patients to designated treatment areas, when notified.

\(9\) **Medicine/Surgery Department:** Additional physicians may be
needed to assist in the triage area. Coordination of all clinical
support needs will be through the manpower pool.

**Triage Operation:**

\(1\) Casualties from an internal disaster will be transported from the
disaster site to the triage area unless the EOC designates an alternate
triage site. Coordination with the Incident Commander on any specific
transportation route will be completed between the EOC and IC, prior to
casualty or patient movement.

\(2\) For an external community disaster, the Medical Resource
Communication Center (MRCC) will contact the Telephone Operator or
Chief, Police Service at the medical center to indicate the number and
status of victims. VA Police will direct ambulances and victims to the
ambulance garage.

\(3\) Upon activation of the Plan and the triage of casualties is known
the Triage Team will assemble in the ambulance garage.

\(4\) Departments responsible for support supplies and/or equipment for
triage will go to the ambulance garage.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

\(5\) The **Manpower Pool** will assemble in the auditorium - Building
#1(or at a location designated by the EOC). Employees are assigned to
patient transport and assistance. An orange vest with a yellow
horizontal stripe & personal VA name tag will identify employees.

\(6\) **Utilization Management employees** will initiate a casualty log,
utilizing each name and social security number (if known), time of
arrival, treatment received, and temporary assignment of medical care
and care provider, of each casualty. An ID tag and card is secured on
each casualty. If the name and/or social security number is unknown,
identification numbers beginning with \"1,\" is used.

\(7\) **Physician and Patient Care personnel** will examine patients and
determine the clinically indicated treatment area:

**Medical Emergencies: MICU, or the ER, if MICU beds are not available,
then the**

**endoscopy unit on 7W in Building 1E.**

**Surgical Emergencies: OR, SICU or ER if the OR cannot receive the
patient immediately, PACU, endoscopy unit or cardiac observation unit.**

**Walking Wounded: Subspecialty Clinics**

**Hysterical or Behavioral Emergencies: Psychiatry Outpatient Clinic**

**Possible Fractures: Radiology, 3rd floor**

**Burns (severe): U of M Burn Unit**

**Pre-Op Unit: Ambulatory surgery unit: 5 North**

**Cardiac Observation Unit: 6 North**

**Fractures/Post-Op: 5 North**

\(8\) Documentation in the patient record will include name, social
security number, vital signs, allergies, chief problem, assigned
treatment area, and intervention performed in the triage area.

\(9\) Casualties sent to Radiology can be returned to the triage area
after x-rays, or a physician can review the x‑ray in Radiology. Status
of each x-rayed casualty will be relayed to EOC for further movement or
care consideration.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[PATIENT CARE CLINICAL POOL]{.smallcaps}: - ESF #5**

**Coordinator: Designee, Patient Care Department**

Primary Location: Manpower Pool

Alternate Location: Determined by the EOC

**RESPONSIBILITIES:**

A. All expanded role Patient Care personnel and Patient Care personnel
in orientation will report to the Patient Care Clinical Pool, located in
the Man Power Pool for reassignment if necessary.

B. Assign Patient Care personnel to triage, walking wounded area, or
other Patient Care units as needs dictate.

C. The Associate Director for Patient Care will obtain a radio via
communication with the EOC.

**[PATIENT CARE DEPARTMENT - ESF #5]{.smallcaps}**

Coordinator: Associate Director for Patient Care

Alternate: Designee, Patient Care Department

Primary Location: EOC

Secondary Location: Office of Associate Director for Patient Care

**[RESPONSIBILITIES:]{.smallcaps}**

A. Communicate Plan Activation to Patient Care employees.

B. Coordinate Patient Care activities and Patient Care Clinical Pool.

C. Direct each Patient Care unit to send a stretcher, wheelchair, and
rolling IV pole to the triage area.

D. Each Patient Care Coordinator on inpatient units will determine bed
availability and potential discharges in collaboration with MIS.

E. Each Patient Care Coordinator will coordinate evacuation of ward if
directed by the EOC

F. Radio communication needs of each Patient Care area during a disaster
are reported to the EOC. The EOC will direct the CIO to meet the needs
of Patient Care units, such as the OR, the ICU's, the ER, and the
walking wounded area.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**A[MBULATORY CARE - ESF #5]{.smallcaps}**

Coordinator: ACOS, Ambulatory Care

Alternate: Acting ACOS, Ambulatory Care or assigned ER Physician

Primary Location: Triage Area

External Emergency: Triage Area

**[RESPONSIBILITIES:]{.smallcaps}**

[A.]{.smallcaps} Provide medical and Patient Care to patients sent to
the emergency room from the triage area.

B. Provide medical and Patient Care to patients sent to the Subspecialty
Clinic treatment room for \"walking wounded," type injuries.

C. Contact EOC for additional clinical support personnel (physicians and
nurses) if needed.

D. Normal operation of Admitting and Outpatient Clinics will be
determined contingent upon the nature or severity of the disaster.

**[ANESTHESIA DEPARTMENT - ESF #5]{.smallcaps}**

Coordinator: Anesthesia Department Head

Alternate: Designee, Anesthesia Department

Primary Location: Anesthesia Office

**[RESPONSIBILITIES:]{.smallcaps}**

A. Anesthesia Department will remain in communication with the Surgery
Department in order to provide any necessary emergency anesthesiology
services.

B. Assign a Nurse Anesthetist to the Triage Area.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[RELATIVE WAITING AREA]{.smallcaps}: - ESF #5**

Coordinator: Chaplain Department

Additional Support: Designee, Social Work Department

Primary Location: Chapel

**RESPONSIBILITIES:**

A. Assist in locating relatives and/or friends of casualties.

B. Provide identified crisis intervention to relatives or friends
arriving to see casualties.

C. Initiate list of identified families waiting to see casualties.

**[OUTPATIENT DISCHARGE AREA]{.smallcaps}: - ESF #5**

**Coordinator: Volunteers designated by Voluntary Department**

Primary Location: Extended Care Center ECC Dining Room

**RESPONSIBILITIES:**

Supervises ambulatory patient movement to transportation vehicles or
relocation within medical center.

**[INPATIENT DISCHARGE UNIT]{.smallcaps}: - ESF #5**

**Coordinator: Patient Care Coordinator ECC or designee**

Primary Location: ECC Dining Room

**RESPONSIBILITIES:**

A. Ambulatory patients are sent to the ECC dining room with personal
articles in a paper bag. The medical record and unit dose medications
should accompany each patient.

B. Patient Care Coordinators on the inpatient units will identify
patients who could be discharged. This information will be given to the
secretary to the AD/PCS.

C. ECC Patient Care staff will request ECC patients remain out of the
dining area to allow for use of the dining room as a discharge unit.

D. Social Worker will maintain a log of patients entering or leaving the
inpatient discharge unit.

E. A Social Worker will facilitate transportation home for discharged
patients.

F. A list will be given to Nutrition & Food Production of those patients
in the discharge/holding area so meals can be provided.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[DENTAL DEPARTMENT - ESF #5]{.smallcaps}**

Coordinator: Dental Department Head

Alternate: Designee, Dental Department

Primary Location: Dental Clinic

[**RESPONSIBILITIES:**]{.smallcaps}

A. When directed by EOC, department designee will provide a dental
designee to the Emergency Room for emergency treatment of maxilla‑facial
and dental conditions.

B. Provide a list of on‑call dentists and dental designees who can
report to the Operating Room.

**[CHILD CARE AREA]{.smallcaps}: - ESF #4 & #5**

**Coordinator: Designated ECC Patient Care staff**

Location: ECC 2nd Floor Game Room

**RESPONSIBILITIES:**

In the event of a large community disaster, some Ann Arbor staff will
have to bring their children with them to report for duty. This area
will be established for children of staff. Available volunteers and
employees will assist in providing child-care. A log is kept of names of
children, the parents and the department to which the employee is
assigned. A list of the number of children will be provided to Nutrition
& Food Department so meals can be provided.

**[CHAPLAIN DEPARTMENT - ESF #5]{.smallcaps}**

Coordinator: Chaplain Department Head

Alternate: Available Chaplain

Primary Location: Emergency Operations Center

Secondary Location: Triage Area

**[RESPONSIBILITIES:]{.smallcaps}**

A. Provide ministerial services to casualties, patients, etc., where
necessary. If necessary, will arrange for additional coverage by members
of the clergy of various faiths.

B. Assist in locating relatives or friends of casualties.

C. Provide crisis intervention support to relatives or friends arriving
to see casualties.

D. Initiate list of families, friends, and relatives waiting to see
casualties.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[DERMATOLOGY DEPARTMENT - ESF #5]{.smallcaps}**

Coordinator: Dermatology Department Head

Alternate: Designated staff

Primary Location: Dermatology Office

**[RESPONSIBILITIES:]{.smallcaps}**

A. Determine action to be taken to discharge or place inpatients on
leave of absence to make additional beds available.

B. Remain available to provide clinical personnel at the disaster site,
triage or surgical wards.

C. Provide physician coverage to wards whenever necessary.

**[PATHOLOGY & LABORATORY DEPARTMENT - ESF #5]{.smallcaps}**

Coordinator: Laboratory Department Head

Alternate: Designee Laboratory Department

Primary Location: Laboratory Department

[**RESPONSIBILITIES:**]{.smallcaps}

A. Provide for the expansion of laboratory departments to meet the needs
of the emergency, including phlebotomists obtaining necessary lab tests
if needed

B. Upon notification by the EOC, send a Pathologist to the triage area
to coordinate activation of expanded mortuary and blood donor units.

C. Test priority will be given to casualties except those in ICU or
Surgery.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

[**MEDICINE DEPARTMENT - ESF #5**]{.smallcaps}

Coordinator: Medical Department Head

Alternate: Medical Resident

Designee: AO/Medical Department

Primary Location: Office of the Medical Department

**[RESPONSIBILITIES:]{.smallcaps}**

A. Determine when to discharge or place inpatients on leave of absence
to make additional beds available.

B. Establish communication with the EOC, and provide a list of available
clinical staff for triage or surgical wards.

C. Conduct all necessary training for Medical Department personnel to
assure that the plan can be placed into operation with minimal
supervision and direction.

D. Provide physician coverage to medical or surgical wards whenever
necessary.

**[SURGERY DEPARTMENT - ESF #5]{.smallcaps}**

Coordinator: Surgery Department Head

Alternate: Designee, Surgery Department

Designee: AO/Surgery Department

Primary Location: Office of the Surgery Department

**[RESPONSIBILITIES:]{.smallcaps}**

A. Chief serves as the **Triage Coordinator**, and during irregular
hours, the Surgical Officer of the Day SOD serves in this capacity.

B. Determine discharge of or placement of inpatients on leave of absence
to make additional beds available.

C. Review OR schedule(s) for continuation or non-continuation of all
surgery.

D. Expand existing facilities to provide definitive treatment to
casualties.

E. Conduct all necessary training for Surgery Department staff to ensure
that plan can be placed into operation with minimal supervision and
direction. Training should include Otolaryngology staff.

F. Establish communication with the EOC and provide a list of available
clinical staff. Provide active surgical caseload to the EOC. Establish
and relay a list of available clinical staff for movement to either the
Disaster Site or assignment in Triage. Send other clinical staff
(including Otolaryngology) as requested, to any location identified by
the EOC.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[PSYCHIATRY DEPARTMENT - ESF #5]{.smallcaps}**

Coordinator: Psychiatry Department Head

Alternate: Designee, Psychiatry Department

Primary Location: Psychiatric Outpatient Clinic

**[RESPONSIBILITIES:]{.smallcaps}**

A. Assistance to the Triage Officer for psychiatric problems diagnosed
before or after triaged casualties.

B. Assesses actions to be taken to discharge or place inpatients on
leave of absence to make additional beds available.

C. Assess the need to dispatch a Psychiatrist to the 8 West Day Room for
receiving behavioral, psychiatric emergencies sent from triage area.

D. Psychiatry Department assists Psychology Department, as needed.

E. Provide debriefing to all employees after each drill or actual
scenario, as part of the critique session after each drill, at the call
of the EOC.

**[PSYCHOLOGY DEPARTMENT - ESF #5]{.smallcaps}**

Coordinator: Psychology Department Head

Alternate: Designee, Psychology Department

Primary Location: Mental Hygiene Clinic

**[RESPONSIBILITIES:]{.smallcaps}**

Assigned Psychologists, in conjunction with Psychiatry Department, will
provide staff to provide counseling and support departments to casualty
victims, families, etc. See Psychiatry Department.

**[RADIOLOGY DEPARTMENT - ESF #5]{.smallcaps}**

Coordinator: Radiology Department Head

Alternate: Designated Physician, Radiology Department

Primary Location: Radiology Department Area

**[RESPONSIBILITIES:]{.smallcaps}**

A. Provide emergency diagnostic radiological service for all casualties.
Provide a Radiologist to interpret x‑ray findings.

B. Provide one Radiology Technician to the Emergency Room to coordinate
the provision of radiological services.

C. Maintain communication with EOC for coordination of emergent
radiological procedures.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[NEUROLOGY DEPARTMENT - ESF #5]{.smallcaps}**

Coordinator: Neurology Department Head

Alternate: Designee, Neurology Department

Primary Location: Office of the Neurology Department

**[RESPONSIBILITIES:]{.smallcaps}**

A. Assign clinical staff to assist medical and surgical teams. One
physician is assigned to the triage area.

B. Immediately determine action to be taken to discharge or place
inpatients on leave of absence to make additional beds available.

**[RESPIRATORY THERAPY - ESF #5]{.smallcaps}**

Coordinator: Supervisor, Respiratory Therapy Department

Alternate: Acting Supervisor, Respiratory Therapy Department

Primary Location: Office, Respiratory Therapy Department

**[RESPONSIBILITIES:]{.smallcaps}**

A. Assign one Respiratory Therapist to triage area to assist in oxygen
therapy.

B. Provide one \"H\" tank, three \"E\" tanks and three ambu bags to
Triage site.

C. Two Respiratory Therapists will assist triage team when traveling
off-site.

**[SOCIAL WORK DEPARTMENT - ESF #5]{.smallcaps}**

Coordinator: Social Work Department Head

Alternate: Designee

Primary Location: Office of the Social Work Department

**[RESPONSIBILITIES:]{.smallcaps}**

A. Assist Utilization Management Department in the identification of
patients for relocation to other facilities.

B. Assist in locating relatives and friends of patients.

C. Coordinate out‑placement of patients with community agencies, and
assist in the referral of patients and families to proper agencies.

D. Provide crisis intervention to relatives and friends arriving to see
patients in the chapel.

E. Assist in ECC Dining Room with the discharged inpatients to obtain
transportation home.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[PROSTHETIC AND SENSORY AID SECTION: - ESF #5]{.smallcaps}**

Coordinator: Prosthetic and Sensory Aid Section

Alternate: Prosthetic Clerk

Primary Location: Office of Prosthetic & Sensory Aid Section

[**RESPONSIBILITIES:**]{.smallcaps}

This department will perform its normal RESPONSIBILITIES and duties
unless otherwise notified by the EOC.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

### 

### E.S.F. #6 -- Community Support Services

#### Coordinator: Emergency Preparedness Coordinator

**Alternate: Industrial Hygienist**

**Primary Location: Disaster Scene**

## 

## 

## Responsibilities: 

It is the responsibility of the Emergency Preparedness Coordinator (EPC)
to inform the Emergency Operation Center (EOC) in the event any type of
support is needed from the immediate community, Washtenaw County. The
following services listed have support agreements with the Veterans
Affairs Ann Arbor Healthcare System:

1.  Ann Arbor Police Department -- 994-2911

2.  Washtenaw County Sheriff's Dept. -- (734) 971-1153

3.  Washtenaw County Emergency Operations Center -- (734) 971-1153

4.  Washtenaw County Hazardous Materials Decontamination Team -- (734)
    971-1153

5.  American Red Cross (Washtenaw County)-- (734) 971-5300

6.  Michigan State Police, Ypsilanti Post -- (734) 483-9510

7.  Federal Bureau of Investigation (Ann Arbor) -- (7340 995-1310

8.  Drug Enforcement Administration - (313) 234-4001

9.  Bomb Dog -- Washtenaw County Sheriffs Department -- (734) 971-8400

10. Toledo, Ohio Police Dept. -- (419) 245-3149

## 

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

## 

## E.S.F. \# 7 -- Recovery Procedures

**RESPONDING SERVICES**

# **Coordinator: Service Chiefs or Designee**

Primary Location: Disaster Site

Alternate Location: Service Area of Responsibility

**Responsibilities:**

A.  Recovery procedures start within the response phase by the repair of
    necessary resources, treatment of the wounded or sick or bringing
    systems that are down, back on line.

B.  Once the threat has been met and the disaster situation is primarily
    over, it is the responsibility of all responding services to do
    whatever is necessary to return to normal operations and readiness.

    **Restoring Services and Recovering Costs:**

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A.  **Restoring Operating Systems:**

In the event that operating systems, including data management, utility
or patient services are disrupted because of a direct system malfunction
or as the result of another disaster, the Service Chief or designee for
those systems will take immediate steps to restore service.

1.  Where full service cannot be restored in a timely manner, temporary
    or partial service shall be provided to minimize disruption to
    patient care and other support services.

2.  Full and permanent service shall be restored as soon as possible to
    all affected areas.

3.  Initial funds to cover the cost of restoring operating systems shall
    be taken out of the specific service's operating budget.

4.  If additional funds are needed, emergency requests shall be
    submitted to the Director through the Associate Director for
    Operations.

    **B. Restoring Supplies and Equipment:**

    a\. Service Chiefs are responsible for insuring that all supplies
    and equipment needed to execute

    their particular service related duties during an emergency are
    available at all times.

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1.  The condition of emergency equipment and stock of emergency supplies
    shall be checked at least annually and after all implementations of
    emergency preparedness drills.

2.  Stock supplies that have been depleted shall be replaced within
    thirty days.

3.  Emergency equipment that is not in good condition shall be repaired
    or replaced. If the equipment is not useable, back-up equipment
    shall be provided for use until repairs are completed or a
    replacement is delivered.

    VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

b\. Acquisition & Material Management will process emergency orders for
supplies and equipment needed for disaster management as priority
requests.

c\. During the period of the emergency, telephone requests for supplies
and services will be accepted when needed to expedite services.

C. Recovering Costs of Emergency Response:

After the period of the emergency has ended, Service Chiefs may submit
requests to the Chief Resource Officer/Budget section for reimbursement
of costs associated with restoring operating systems.

D. Medical Care Cost Recovery:

Actions to recover medical care costs will be taken in accordance with
the policies of the Medical Care Cost Recovery (MCCR) program.

**Recovery Process and Post Disaster Activities:**

A.  Remove all supplies and resources that were brought to the disaster
    scene to individual service areas and assist in cleanup as
    necessary.

B.  Place personnel back into a normal working schedule as soon as
    possible.

C.  Inventory all equipment that was used for disaster response and
    reorder supplies that were used as part of the response. Bring
    supplies back to normal operating levels.

D.  Clean all equipment as necessary and place back into a serviceable
    condition.

E.  Review individual service response procedures and resources for
    effectiveness.

F.  Evaluate service response for additional training for emergency
    situations. Each service should ensure their personnel are trained
    on what their response would be in any of the situations covered by
    this emergency preparedness plan.

G.  Provide counseling as needed for employees as needed.

    VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**ADDITIONAL SUPPORT FUNCTIONS**

**[NUCLEAR MEDICINE DEPARTMENT]{.smallcaps}**

Coordinator: Nuclear Medicine Department Head

Alternate: Designee, Nuclear Medicine Department

Primary Location: Office of the Nuclear Medicine Department

**[RESPONSIBILITIES:]{.smallcaps}**

A. Assigned clinical and technical staff will assist other clinical
departments according to their discipline as determined by the Nuclear
Medicine Department.

B. Assure that the emergency preparedness plan can be placed into effect
with minimal supervision and direction.

**[EXTENDED CARE CENTER (ECC)]{.smallcaps}**

Coordinator: Director, ECC

Alternate: Patient Care Manager, ECC

Primary Location: ECC

**[RESPONSIBILITIES:]{.smallcaps}**

A. Prepare ECC Dining Room to receive discharged inpatients. Require ECC
patients to remain in their rooms. ECC Patient Care staff will monitor
and log inpatients in the Discharge Holding Area.

B. The Coordinator will immediately determine action to be taken to
discharge or place inpatients on leave of absence to make additional
beds available, via coordination with Social Work Department. Notify EOC
of available beds.

C. Coordinate preparation of the ECC game room for childcare, in the
event of extensive community or national disaster.

D. Communicate needs for childcare center to the EOC.

**[OTOLARYNGOLOGY DEPARTMENT]{.smallcaps}**

This department reports to the Surgery Department Coordinator for
assignment during an emergency plan activation.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[MEDICAL LIBRARY DEPARTMENT]{.smallcaps}**

Coordinator: Library Department Head

Alternate: Medical Librarian

Primary Location: Office of the Library Department

**[RESPONSIBILITIES:]{.smallcaps}**

This department will perform its normal responsibilities and duties and
provide support to Medical Media, when notified.

**[RADIATION ONCOLOGY]{.smallcaps}**

Coordinator: Radiation Oncology Department Head

Primary Location: Office, Radiation Oncology Department

**[RESPONSIBILITIES:]{.smallcaps}**

This department will perform its normal RESPONSIBILITIES and duties
unless otherwise notified.

**[REHABILITATION MEDICINE]{.smallcaps} [DEPARTMENT]{.smallcaps}**

Coordinator: Rehabilitation Medicine Department Head

Alternate: Coordinator, Rehabilitation Medicine Department

Primary Location: Office of Rehabilitation Medicine Department

**[RESPONSIBILITIES:]{.smallcaps}**

Those employees not assigned to a special team or unit will report to
the manpower pool for assignment.

**[RESEARCH DEPARTMENT]{.smallcaps}**

Coordinator: Associate Chief of Staff for Research

Alternate: Administrative Officer for R&D

Primary Location: Office, ACOS, Research

**[RESPONSIBILITIES:]{.smallcaps}**

A. Physicians and nurses assigned to Research Department will
communicate their availability to the Emergency Operations Center.

B. In the event of a chemical disaster, a research chemist will be
assigned as an advisor to the Hazardous Materials Officer (Industrial
Hygienist).

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[EDUCATION DEPARTMENT]{.smallcaps}**

Coordinator: ACOS for Education

Primary Location: Office of the ACOS for Education

[**RESPONSIBILITIES:**]{.smallcaps}

This department will perform its normal RESPONSIBILITIES and duties
unless otherwise notified. The staff of the ACOS Education may be called
upon to help coordinate training of employees of various departments
about the Emergency Preparedness Plan.

**[AUDIOLOGY AND SPEECH PATHOLOGY DEPARTMENT]{.smallcaps}**

Coordinator: Audiology and Speech Pathology Department Head

Primary Location: Audiology & Speech Pathology Department

**[RESPONSIBILITIES:]{.smallcaps}**

This department will perform its normal RESPONSIBILITIES and duties
unless otherwise notified.

**[CANTEEN DEPARTMENT]{.smallcaps}**

Coordinator: Canteen Department

Alternate: Designee, Canteen Department

Primary Location: Office of the Canteen Officer

**[RESPONSIBILITIES:]{.smallcaps}**

Assist Nutrition and Food Department in providing supplies and services
to patients, personnel and volunteer workers.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**FIRE EMERGENCY - ESF #2, 3, 4, 5, 6 & 7**

**It is the responsibility of every employee to recognize the importance
of fire prevention, and in the event of a fire, the necessity of
ensuring its prompt Information in order to safeguard the lives of
patients, visitors and employees.**

**[IMMEDIATELY AT THE SCENE OF FIRE:]{.smallcaps}**

A. All employees will take immediate action upon discovery of a fire,
after calling the telephone operator (dial 3333).

The acronym **RACE** is used to implement procedures.

[R **Rescue**]{.smallcaps} Rescue any people

[A **Activate** Alarm]{.smallcaps} Pull fire alarm

Call operator, 3333

[C **Close**]{.smallcaps} all windows and doors

[E **Extinguish**]{.smallcaps} fire to best of ability, using fire
extinguisher

B. All ceiling lights in evacuation routes, and patient occupied rooms
are turned on. **Horizontal evacuation to adjacent wings will only be
permitted at this time.**

C. Reassure patients. (DO NOT SHOUT FIRE.)

D. Ambulatory patients will be evacuated horizontally if necessary,
through smoke barrier doors to a safe area as designated by the charge
nurse or person in charge.

E. Doors will be closed to rooms with bed patients. An employee will be
left in the room to reassure the safety of patient(s). If there are not
sufficient employees to assign to these rooms, the charge nurse will
initiate patient movement on the ward to accommodate staffing levels.

**[PERSONNEL ON THE SAME FLOOR OF DRILL OR FIRE]{.smallcaps}:**

A. Close windows, all doors, and turn off fans.

B. Reassure patients. (DO NOT SHOUT FIRE.)

C. Close doors to rooms with bed patients. An employee is assigned in
attendance, in each patient room, to reassure the safety of patients. In
the event of an actual fire, be prepared to receive patients from the
fire area, and evacuate only horizontally to an adjacent wing.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[SPECIFIC RESPONSIBILITIES]{.smallcaps}:**

A. **Facilities Management employees** will respond to the fire and
perform assigned duties.

B. **The doctor or nurse in charge** of the patient area where the fire
occurs will have full responsibility to direct horizontal patient
evacuation and fire fighting until relieved by someone of higher
authority, or arrival of the Ann Arbor Fire Department. **Patient
evacuation will only involve horizontal evacuation to adjacent wings.**

C. **Every supervisor** when the fire occurs in a non-patient area will
have full responsibility to direct horizontal evacuation and fire
fighting until relieved by someone of higher authority, or on the
arrival of the Ann Arbor Fire Department.

D. **Facilities Maintenance Personnel** during regular working hours,
Monday through Friday, 8:00 a.m. ‑ 4:30 p.m., will report to the scene
of the fire as assigned and will assist in fire fighting duties and
assist in horizontal evacuation as directed by the person in charge. In
the event of a fire other than the day tour, Saturdays, Sundays, or
holidays, all Facilities Maintenance employees on duty will report to
the scene and assist in fire fighting duties and assist in horizontal
evacuation as directed by the nurse or person in charge.

E. **Patient Care Department Personnel** in the event of a fire other
than the day tour, Saturdays, Sundays, or holidays, one Patient Care
employee from each Patient Care unit will report to the scene of the
fire and assist as directed by the nurse or person in charge. Only
horizontal evacuation to adjacent wings is permitted.

F. **Laboratory, Radiology & Food Department** if a fire is in the
working areas, persons will perform duties as appropriate under (A) and
(B) above. During irregular duty hours, all available employees will
report to the scene of the fire and assist.

G. **All other employees** are responsible to know the fire alarm
location and be alert for additional instructions. Employees will
refrain from calling the telephone operator and from using the elevator.
**Vertical evacuation is not permitted without the consent of the
Director or direction of the Ann Arbor Fire Chief.**

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[Fire Signals]{.smallcaps}:**

A. Upon activation of any fire alarm device, a light will automatically
show on the corresponding section of the annunciation panel, centrally
located throughout the medical center in Stairway #1, Building #1. Along
with the indicator light on the annunciation panel, the numeric type
bell tone will identify specific locations on the locator chart.

B. Fire alarm locations are located in this manual and on a chart placed
adjacent to all fire alarm pull stations.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

FIRE ALARM CODE SCHEDULE

![](media/image1.wmf)

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**COMMUNITY CASUALTY - ESF #2, 4, 5, 6 & 7**

**NOTE**: This plan is a general guide, and is essential that everyone
concerned maintain an awareness and attitude of complete flexibility to
handle any situation as it develops. This is a general plan to encompass
overall actions for any emergency situation to include a community
disaster or emergency situation.

**[Major]{.smallcaps} [Objectives:]{.smallcaps}**

1\. Provide emergency surgical, medical, and hospital treatment for
casualties without delay.

2\. Administer initial and continued medical care of casualties and
critically ill non-casualty patients.

3\. Treat casualties to the limit of the medical center\'s ability to
expand.

4\. Remain as self‑sufficient as possible for all aspects of operation
during the first 24 hours following the disaster.

5\. Coordinate blood supply requirements with American Red Cross.

6\. Adjust available personnel resources to meet expanding requirements
for an indefinite period of time (12 our shifts).

7\. Coordinate resources (oxygen tanks, feeding pumps, Nebulizers and
Aspirators) for VA outpatients assigned to our medical center.

**OPERATIONS:**

**A. Ambulance Reception**

Location: Ambulance Garage

Alternate Location: Determined by the EOC

**B. Triage**

(l) Location: Ambulance Garage

> Alternate Location: Determined by the EOC

\(2\) Triage is the process of receiving, sorting and classification of
the injured. Staffed by a sufficient number of physicians, nurses and
designees to maintain a rapid movement of casualties.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**C. Ambulatory Casualty Treatment**

\(l\) Location: Administrative hours-Subspecialty Clinic

Non-administrative hours - Emergency Room

\(2\) Provide treatment for injuries such as minor laceration's, minor
fractures, first and some second-degree burns, hysteria, sprains, and
contusions of a relatively minor nature.

**D. Manpower Pool**

\(l\) Location: Basement #1W - Auditorium

\(2\) Provide a ready force of medical center personnel for assignments
as needed.

**E. Public Information Center**

\(l\) Location: A917, Director\'s Conference Room

\(2\) Designated Spokesman: Public Affairs Officer

**F. Elevators**

\(l\) The west freight elevators in the clinical addition will be used
to transport casualties and supplies. Elevator No.5 will operate between
basement and the 3rd floor level for exclusive use in transporting
supplies and patients. Elevator No.6 will operate between 4th and 9th
floors. Freight elevators on the east end of the clinical addition will
be used for routine daily functions during emergencies. Freight elevator
operations during emergencies, is the responsibility of designated
(locksmiths) Facilities Management employees only. West-end freight
elevators are used during emergency scenarios, until the **"all clear"**
is given. Additional need for elevator usage during any emergency will
be determined by the EOC.

\(2\) Monitoring elevator operation, one Facilities Management
supervisor will maintain radio contact with all elevators and relay
instructions from the EOC to elevator operators.

**TRIAGE KIT:**

A triage kit and carts have been assembled and are equipped with
instruments and appliances for dealing with immediate life threatening
situations. The kits are stored in SPD.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**EMERGENCY MEDICAL RECORD:**

Individual disaster record packets will be used at the triage location
to tag and record casualties. These tags will be utilized by the triage
team and will accompany the patient at all times. Each record packet
contains:

1 ‑ Pre-numbered disaster tag with pre-numbered gummed labels

1 ‑ Pre-numbered identification bracelet

1 ‑ Pre-numbered Personal Property envelope

1 ‑ Plastic clothing bag

1 ‑ Pre-numbered identification tag for securing clothing bag

**EXPANSION OF FACILITIES:**

**A. Identification Procedure (Inpatients/Beds)**

\(l\) Immediately upon activation of the Community Casualty Plan, the
Bed Reporting Officer, or the AOD will compile a listing by wards of the
number of empty beds in the medical center.

\(2\) Concurrently, ward physicians under the direction of department
chiefs, will identify patients who can be immediately discharged or
transferred to another health care facility. Identify inpatients that
can be transferred to another ward, via reporting number and ward
location of patients to the AC&P or AOD.

\(3\) A combined listing of items 1 and 2 above will be furnished to the
Physician Triage Officer.

**B. DISCHARGE PROCEDURES:**

Patients identified to be discharged or transferred will be instructed
to collect their personal items at their bedside and report to the ECC
Dining Room.

**C. OUTPATIENTS:**

Clinic physicians will identify scheduled and walk‑in patients who may
be immediately released. These patients will be directed to the ECC
Dining Room where they will be released.

**LIMITATION OF CARE:**

This plan is based on the assumption that this medical center possesses
staff and facilities to meet any type of community related emergency
involving casualties. However, in the event that our facilities are
strained to the limits of our ability to cope with the situation, the
EOC will arrange for transportation of casualties to another facility
where definitive medical care can be administered.

**PHARMACY CACHE:**

The pharmaceutical cache is a stockpile of medication and medical
supplies to support patient care in the event of a significant incident
related to Weapons of Mass Destruction (WMD). The cache is designed to
maintain the infrastructure of the facility and ensure supplies are
available to treat patients, staff, and individuals seeking treatment
during a WMD event. The cache will be made available to the community at
the discretion of the Director. See Appendix A.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**TORNADO - ESF #2, 3, 4, 5, 6 & 7**

**[WATCH PHASE NOTIFICATION]{.smallcaps}:**

**Tornado Watch** ‑ **Severe weather conditions exist which could spawn
a tornado, severe thunderstorms will occur at a minimum, which could
involve strong winds and heavy rainfall, severe lightning, and/or flash
flooding.**

A. Telephone Operator will be notified by the Washtenaw County Sheriff
or City of Ann Arbor Office of Emergency Preparedness via the Quick Call
Device Activation located in the telephone operator\'s area, or by radio
or television media. Sirens will not sound in a watch phase.

B. Upon notification that a Tornado Watch is in effect, the telephone
operator will notify the Chief, Police Service, Secretary to the
Director, and Associate Director for Patient Care during administrative
hours and the AOD during non-administration hours.

C. Tornado Warning Plan will be reviewed by all key staff and/or
Departments notified at this time.

**[WARNING PHASE NOTIFICATION]{.smallcaps}**

**Tornado Warning ‑ A tornado or funnel cloud has been observed and is
within a 10-mile radius of the VAMC.**

A. The telephone operator will be notified via the Quick Call Device
activation, located in the telephone operator\'s area.

B. Local city sirens are activated. This emergency notification alert
tone warns area residents to take cover immediately! This alert tone
must not be taken lightly.

C. Emergency Operations Center (EOC) will be notified by the telephone
operator upon activation of sirens, or Quick Call Device activation, or
notification from a media source (i.e. radio or television broadcast).
**Tornado Warning Plan must be activated at this time.**

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**TORNADO WARNING ACTIVATION PROCEDURES**

**Telephone operator will announce over the PA system:**

**"[ATTENTION PLEASE. THIS IS AN EMERGENCY PREPAREDNESS SITUATION.
PLEASE ACTIVATE TORNADO WARNING PLAN IMMEDIATELY]{.underline}." Repeat
once.**

A. Activate telephone cascade notification IMMEDIATELY.

B. IMMEDIATE notification to all working employees is mandatory.

C. TAKE ALL PATIENTS TO THEIR ASSIGNED ROOMS.

D. Move beds and patients away from windows.

E. Close window shades and/or drapes, and ALL DOORS: i.e., office,
patient room, stairway, and fire doors.

F. Secure patients away from glass sources immediately.

G. Ambulatory patients (including wheelchair patients) will be evacuated
to inside corridors.

H. Patients must remain on the unit until an \"ALL CLEAR\" is issued.

I. All other outpatients, employees, and visitors must take cover away
from any glass source or doorway. Seating in center corridors is
required. Employees in the T-3 trailer will take cover in Building #3
basement.

J. VA Police or other staff will instruct all patients, staff, and
visitors in the smoking shelter (west admissions entrance, Bldg. 1W) to
take cover in the 1North corridor; this includes the offices in T-2,
Ambulatory Care Outpatient Area.

K. Patient Care staff will instruct all patients and visitors in the
smoking shelter at the ECC I west entrance to take cover in the ECC I
center corridor.

L. Cancel elective surgery, secure patients away from glass sources,
anesthetic gas usage, and any doorway.

M. Suspend all unnecessary computer usage and usage of electricity. Turn
off computers outside of patient care areas.

N. Cancel all activities in auditorium and evacuate to the basement
corridor adjacent to the recreation office.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**Prepare to shift to Community Disaster Plan.**

**Resume regular working operations after the \"ALL CLEAR\" is given and
heard! Assessment of damage to the medical center will be done
immediately by Facilities Management Department. This will delay any
immediate issuance of the \"ALL CLEAR\" by the Chief, Police Service or
VA Police.**

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**SNOW EMERGENCY - ESF #2, 3, 6 & 7**

**PURPOSE**:

A. Accommodates patients, employees, and visitors during the time snow
or related inclement weather prevent routine mobility and necessitates
furnishing or arranging for lodging and meals.

B. To enhance visitor identification and information in a snow disaster.

C. Identify and transport critical medical personnel in a snow disaster.

D. To form and maintain a personnel pool during a snow disaster.

E. To facilitate communication with Federal, state, and local disaster
officials and the news media during a snow disaster.

**RESPONSIBILITY**:

A. The EOC will activate this plan in accordance with this policy.

B. The following department heads have the primary responsibility to
implement, upon proper notification, key phases of the snow disaster
plan:

**Department Head Key Phase**

Facilities Management Department Arrange room and board and mobilize
volunteers & visitors

Nutrition & Food Department Provide meals.

Facilities Management Department Arrange general transportation.

Organize and carry out snow removal

Business Office - Bed Reporting Officer Bed Information.

Patient Care Department Identify and mobilize critical medical people.

Human Resources Department Maintain emergency manpower pool.

C. Specific Roles and Responsibilities in a snow disaster will be
itemized in each department\'s internal disaster plan.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**UTILITIES FAILURE - ESF #2, 3, 4, 6 & 7**

Electricity Failure

Elevator/Dumbwaiter Failure

Domestic Water Supply

Steam Distribution

HVAC Systems

Medical Gas Systems

Vacuum Systems

Sanitary Sewer System

Nitrous Oxide & Nitrogen

Oxygen Supply

Communications System ‑ Telephone

Fire Alarm System

**PRIMARY RESPONSE STEPS DURING ANY INTERRUPTION or OUTAGE**

A. Identify type of outage or interruption.

B. Notify immediate supervisor.

C. Reference Utility Failure Response Summary

D. Secure patient care activities. Restrict patient movement to patient
care areas only.

E. Do not interrupt working activities. Continue to adapt to any utility
interruption until it corrected.

F. Be prepared to shift to another plan as directed by immediate
supervisor.

G. Wait for the **\"All Clear\"** before resuming normal working
conditions.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**UTILITY FAILURE RESPONSE SUMMARY**

+------------------+---------------+-----------------------------------+
| **System:**      | **Phone**     | **Actions**                       |
|                  |               |                                   |
|                  | **Contact:**  |                                   |
+------------------+---------------+-----------------------------------+
|                  |               |                                   |
+------------------+---------------+-----------------------------------+
| **Domestic       | **D-5437**    | **D -- Fac Mgmt Svc.**            |
| Water**          |               |                                   |
|                  | **EW --       | **EW -- Notify VA Police**        |
|                  | 7914**        |                                   |
+------------------+---------------+-----------------------------------+
| **Electrical     | **D -- 5437** | **D -- Fac Mgmt Svc immediately** |
| Distribution**   |               |                                   |
|                  | **EW --       | **EW -- Notify VA Police**        |
| **(Power Loss)** | 7914**        |                                   |
+------------------+---------------+-----------------------------------+
| **Elevators**    | **D -- 5437** | **D -- Fac Mgmt Svc**             |
|                  |               |                                   |
|                  | **EW --       | **EW -- Notify VA Police**        |
|                  | 7914**        |                                   |
+------------------+---------------+-----------------------------------+
| **Fire Alarm**   | **D -- 5437** | **D/EW -- Utilize telephone       |
|                  |               | system as back up**               |
|                  | **EW --       |                                   |
|                  | 7914**        | **Dial 333 to report fire**       |
|                  |               |                                   |
|                  |               | **Follow up w/Fac Mgmt Svc for    |
|                  |               | repair**                          |
+------------------+---------------+-----------------------------------+
| **HVAC Systems** | **D -- 5437** | **D -- Fac Mgmt Svc**             |
|                  |               |                                   |
|                  | **EW --       | **EW -- Notify VA Police**        |
|                  | 7914**        |                                   |
+------------------+---------------+-----------------------------------+
| **Medical Air**  | **D --        | **D -- Fac Mgmt Svc**             |
|                  | 5437/5212**   |                                   |
|                  |               | **Respiratory Therapy (5212) for  |
|                  | **EW - 7914** | portable compressor**             |
|                  |               |                                   |
|                  |               | **EW -- Notify VA Police**        |
+------------------+---------------+-----------------------------------+
| **Nitrous Oxide  | **D -- 5437** | **D -- Fac Mgmt Svc**             |
| & Nitrogen**     |               |                                   |
|                  | **EW --       | **EW -- Notify VA Police**        |
|                  | 7914**        |                                   |
+------------------+---------------+-----------------------------------+
| **Nurse Call**   | **D -- 5437** | **D -- Fac Mgmt Svc**             |
|                  |               |                                   |
|                  | **EW --       | **EW -- Notify VA Police**        |
|                  | 7914**        |                                   |
+------------------+---------------+-----------------------------------+
| **Oxygen**       | **D --        | **D -- Fac Mgmt Svc**             |
|                  | 5437/5212**   |                                   |
|                  |               | **Respiratory Therapy (5212) for  |
|                  | **EW --       | portable oxygen cylinder**        |
|                  | 7914**        |                                   |
|                  |               | **EW -- Notify VA Police**        |
+------------------+---------------+-----------------------------------+
| **Pagers**       | **D -- 0**    | **D/EW -- Notify Switchboard      |
|                  |               | operator**                        |
|                  | **EW -- 0**   |                                   |
|                  |               | **Follow up with IRM for repair** |
+------------------+---------------+-----------------------------------+
| **Sanitary       | **D -- 5437** | **D -- Fac Mgmt Svc**             |
| Sewer**          |               |                                   |
|                  | **EW --       | **EW -- Notify VA Police**        |
|                  | 7914**        |                                   |
|                  |               | **Follow up w/Fac Maint for clean |
|                  |               | up**                              |
+------------------+---------------+-----------------------------------+
| **Steam          | **D -- 5437** | **D -- Fac Mgmt Svc**             |
| Distribution**   |               |                                   |
|                  | **EW --       | **EW -- Notify VA Police**        |
|                  | 7914**        |                                   |
+------------------+---------------+-----------------------------------+
| **Telephone**    | **N/A**       | **D -- Notify switchboard in      |
|                  |               | person or by runner**             |
|                  | **N/A**       |                                   |
|                  |               | **EW -- Notify switchboard or AOD |
|                  |               | in person or by**                 |
|                  |               |                                   |
|                  |               | **Runner**                        |
+------------------+---------------+-----------------------------------+
| **Vacuum**       | **D --        | **D -- Fac Mgmt Svc**             |
|                  | 5437/5375**   |                                   |
|                  |               | **SPD (5375) for portable suction |
|                  | **EW --       | pump**                            |
|                  | 7914**        |                                   |
|                  |               | **EW -- Notify VA Police**        |
+------------------+---------------+-----------------------------------+

**D = Day shift or normal working hours EW = Evenings, weekends or
anything other than normal working hours.**

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**CHEMICAL SPILL - ESF #2, 4, 6 & 7**

**GENERAL:**

Unplanned releases of toxic or hazardous chemicals may threaten the
health and well being of hospital employees, patients, and visitors, as
well as the surrounding community. It is the responsibility of all
hospital employees to recognize potential hazards and to be familiar
with the proper actions to take in response to a spill or other
accident.

**RESPONSIBILITIES:**

A. The Industrial Hygienist is responsible for the development and
implementation of an **[on-site spill response program]{.underline}**.

B. The Industrial Hygienist is responsible for training the chief of
each Department in the proper responses to a spill or other emergency.

C. Department heads are responsible for training their employees.

D. The Industrial Hygienist is responsible for coordinating the
**on-site spill response**, and for providing communication with local
police and/or fire (Haz-Mat) officials.

E. All hospital employees are responsible for notifying their supervisor
of potentially hazardous conditions.

**GENERAL PROCEDURES FOR SPILL RESPONSE**:

A. Clear the area of unnecessary personnel.

B. Determine if the spill can be handled with an **on‑site spill kit**.
If the spill cannot be handled with a spill kit, **call extension 3333
for plan activation.**

C. The responding personnel will then decide whether or not to contact
Haz-Mat officials.

D. Shift to Community Disaster Plan if casualties develop due to a large
spill/emergency.

**NOTIFICATION**:

**At all times, the EOC is involved in all communication and decision
making during the activities of this plan.**

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**CHEMICAL, RADIOLOGICAL & BIOLOGICAL TERRORISM --ESF 2, 4, 5, 6 & 7**

General: It is the policy of the VA Ann Arbor Healthcare System to
provide for the safe management of patients contaminated with hazardous
materials in compliance with 29 CFR 1910.120 and recommendations set
forth by JCAHO.

**RESPONSIBILITIES**:

A. The Industrial Hygienist and Radiation Safety Officer are responsible
for the deployment and implementation of an on-site decontamination
team.

B. Only Emergency Treatment Room (ETR) staff that have received patient
decontamination training will be responsible for medical management and
decontamination of patients.

C. All hospital employees are responsible for notifying their supervisor
should they suspect they are dealing with a chemical, radiological or
biological terrorism event.

**GENERAL PROCEDURES**:

A. Should an event occur and a patient(s) requiring decontamination
arrive; they should be restricted to the ambulance bay.

B. The decontamination team shall assemble the decontamination station
in the ambulance bay and prepare to decontaminate.

C. The ETR will be cleared of all patients and non-essential personnel
not involved with the event.

D. The Medical Center Police will secure the ambulance bay and prevent
traffic from entering.

E. All EMS traffic will be diverted to other local hospitals.

F. After decontamination, patients are to be taken to the ETR for
appropriate care and follow-up.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**BOMB THREAT - ESF #2, 4, 6 & 7**

**PURPOSE:**

A. To provide a procedure for proper notification of designated
personnel and non-VA authorities upon receipt of an oral or written
warning that a bomb or similar missile or device has been planted at
this medical center.

B. To provide channels for expanding search operations and evacuation of
patients.

C. To activate emergency care or protective or restoration procedures
should the bomb or similar device explode.

**RECEIPT OF THREATENING TELEPHONE CALLS:**

The telephone switchboard will usually be the means through which these
calls are received. Operators or any person receiving a bomb threat must
remain calm and keep the following in mind:

1\. Do not attempt to have the call traced.

2\. Keep the caller in conversation. This may lead to valuable
information as to their identity. Note anything in the background, such
as music, voices, aircraft, etc., that might distinguish the
perpetrator. Note this information on the \"Initial Bomb Threat Report\"
(see attached).

3\. Ask questions. Note if the caller indicates knowledge of the medical
center by their description of locations. Get them to give a definite
area where the bomb may explode. Note any accent or foreign language.
Remember, the longer a person talks, the more we can learn about them.

4\. All such calls are to be treated as authentic. **[Do not ignore
it]{.smallcaps}** and hope that nothing will happen.

5\. Notify only the VA Police. They will notify EOC and any other
outside agencies on an as‑needed basis.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**MEDICAL CENTER DIRECTOR OR RANKING LAW ENFORCEMENT OFFICER:**

A. Offer full and complete cooperation with all law enforcement
agencies. Activate and open doors to areas that they request.

B. Notify the telephone operator to notify the Chief of VA Police,
Facilities Management Service, Associate Director for Patient Care
Services, and the AOD.

C. Do not inform patients or employees of the incident unless told to do
so by person in charge. In the event the patients do learn of the bomb
threat, reassure them that all is well and being taken care of.

**SEARCH PROCEDURES:**

A. Facilities Management Service has basic responsibility for conducting
a **[visual]{.smallcaps} [search]{.smallcaps} [only]{.smallcaps}**, of
the medical center in cooperation with police and others involved.
**(NOTE: DO NOT TOUCH, MOVE, OR OPEN ANY OBJECT, CONTAINER, OR DOOR
WITHOUT PRIOR NOTIFICATION TO THE RANKING LAW ENFORCEMENT PERSON IN
CHARGE.)** Medical center master keys should be temporarily turned over
to the designated law enforcement officer when asked to do so.

\(1\) **Portable radios and/or cellular telephones should not be used
near the suspected location of explosive device.** VA Police will
coordinate all information transmitted on any portable radio. Telephones
**(not cellular telephones**) should be considered the primary source of
communication outside of verbal communication.

B. The following areas are usually places where a bomb might be left:

\(1\) Public areas (lobby, entrances, Canteen, stairways, hallways,
etc.).

\(2\) Outside areas surrounding building.

\(3\) In the lobby concealed in potted plants, stuffed into or behind
chairs.

\(4\) Public telephone booths on all floors.

\(5\) Admitting office and waiting area.

\(6\) Toilets, male and female.

\(7\) Storerooms and janitor closets.

\(8\) Locker rooms.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

C. In such situations, the decision to evacuate any ward, floor, or
medical center building is up to the Director (or person acting in that
capacity), in conjunction with the ranking law enforcement official. The
police may recommend evacuation of the medical center, the decision to
do so will come from the Director, Associate Director, or Chief of Staff
within the EOC.

**LOCATED BOMB:**

A. Any unusual package or tubular objects are to be suspect.

B. If an unusual object or package is found, **DO NOT TOUCH IT**.

C. Clear the area and attempt to isolate the object by closing doors.
Obtain professional assistance to isolate the area and follow
instructions.

D. When police arrive, allow them to take charge. Offer them full
cooperation and comply with their instructions.

**ASSISTANCE:**

**[[THE VA POLICE]{.underline} WILL CALL 911 FOR ASSISTANCE, IF NEEDED,
WHEN A BOMB THREAT HAS OCCURRED AT THE ANN ARBOR VA MEDICAL
CENTER.]{.smallcaps}**

If the bomb explodes and the resulting injuries and damage are declared
an internal disaster, the Fire Emergency Plan will be used and modified
as the situation dictates.

\* Exclude Picric Acid pick‑up and disposal.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**BOMB THREAT CALL CHECKLIST**

1\. Wording of Threat:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2\. Questions to Ask: (Record response and repeat in sequence).

a\. When will the bomb explode? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_A.M.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_P.M.

b\. Where is the bomb?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

c\. What building is it in?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

d\. What floor is it on?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

e\. What does it look like?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

f\. Where did you place it?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

g\. Who are you?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

h\. Can we help you?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3\. Caller's Voice and Manner Description:

Was he/she:

YES NO YES NO YES NO

Calm \_\_\_\_\_\_ \_\_\_\_\_\_ Laughing \_\_\_\_\_ \_\_\_\_\_ Raspy
\_\_\_\_\_\_ \_\_\_\_\_\_

Angry \_\_\_\_\_\_ \_\_\_\_\_\_ Sobbing \_\_\_\_\_ \_\_\_\_\_ Deep
\_\_\_\_\_\_ \_\_\_\_\_\_

Excited \_\_\_\_\_\_ \_\_\_\_\_\_ Distinct \_\_\_\_\_ \_\_\_\_\_
Crackling \_\_\_\_\_\_ \_\_\_\_\_\_

Slow \_\_\_\_\_\_ \_\_\_\_\_\_ Slurred \_\_\_\_\_ \_\_\_\_\_ Accent
\_\_\_\_\_\_ \_\_\_\_\_\_

Rapid \_\_\_\_\_\_ \_\_\_\_\_\_ Nasal \_\_\_\_\_ \_\_\_\_\_ Disguised
\_\_\_\_\_\_ \_\_\_\_\_\_

Soft \_\_\_\_\_\_ \_\_\_\_\_\_ Stutter \_\_\_\_\_ \_\_\_\_\_ Male
\_\_\_\_\_\_ \_\_\_\_\_\_

Loud \_\_\_\_\_\_ \_\_\_\_\_\_ Lisp \_\_\_\_\_ \_\_\_\_\_ Female
\_\_\_\_\_\_ \_\_\_\_\_\_

Profane \_\_\_\_\_\_ \_\_\_\_\_\_ Incoherent \_\_\_\_\_ \_\_\_\_\_
Familiar\* \_\_\_\_\_\_ \_\_\_\_\_\_

\*If familiar, whom did caller sound like?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4\. Date and Time Call Received:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5\. Receiver's Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**DELIVER TO EMERGENCY OPERATIONS CENTER IMMEDIATELY**

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**THREAT RECORD**

1\. Exact Wording of Threat:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2\. A. Person Making the Threat:

\(1\) Name
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\(2\) Address
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\(3\) Patient \_\_\_\_\_\_ Employee \_\_\_\_\_\_ Visitor \_\_\_\_\_\_
Other \_\_\_\_\_

B. Describe Circumstances Surrounding Threat:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3\. Threatening Person's Voice and Manner:

YES NO YES NO YES NO

Calm \_\_\_\_\_\_ \_\_\_\_\_\_ Laughing \_\_\_\_\_ \_\_\_\_\_ Raspy
\_\_\_\_\_\_ \_\_\_\_\_\_

Angry \_\_\_\_\_\_ \_\_\_\_\_\_ Sobbing \_\_\_\_\_ \_\_\_\_\_ Deep
\_\_\_\_\_\_ \_\_\_\_\_\_

Excited \_\_\_\_\_\_ \_\_\_\_\_\_ Distinct \_\_\_\_\_ \_\_\_\_\_
Crackling \_\_\_\_\_\_ \_\_\_\_\_\_

Slow \_\_\_\_\_\_ \_\_\_\_\_\_ Slurred \_\_\_\_\_ \_\_\_\_\_ Accent
\_\_\_\_\_\_ \_\_\_\_\_\_

Rapid \_\_\_\_\_\_ \_\_\_\_\_\_ Nasal \_\_\_\_\_ \_\_\_\_\_ Disguised
\_\_\_\_\_\_ \_\_\_\_\_\_

Soft \_\_\_\_\_\_ \_\_\_\_\_\_ Stutter \_\_\_\_\_ \_\_\_\_\_ Male
\_\_\_\_\_\_ \_\_\_\_\_\_

4\. Date and Time of Threat:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5\. Person Reporting Threat:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6\. Witnesses:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**DELIVER TO EMERGENCY OPERATIONS CENTER IMMEDIATELY**

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**EARTHQUAKE - ESF #2, 3, 4, 5, 6 & 7**

An Earthquake can occur at any time without any prior notification. An
earthquake of 4.1 to 5.4 Richter Scale is possible in Southeastern
Michigan. This plan is a guide for early response and procedures in the
event an actual earthquake occurs at this medical center.

**INITIAL RESPONSE AND INSTRUCTIONS:**

A. You will not have advance warning, and will not be able to take
action during the initial quake.

B. Respond by stepping under a doorway or take refuge under a desk or
bed.

C. Protect your head from injury.

D. Use these same responses to protect any patient within your work
area.

E. Remain calm. Do not permit patients or your fellow employees to know
that you're excited or scared (so is everyone else).

F. In Building #1, do not be surprised if the fire alarms and sprinkler
system are activated.

G. Tune in am/fm radio (if you have one) for information as to the
extent of community damage.

H. Public Address announcements will be made if the system is
operational and actively manned.

**AFTER THE QUAKE:**

A. Instruct patients, employees, and visitors to take precautions
against additional aftershocks (i.e., stay away from windows and out
from under bookshelves, light fixtures, and equipment which may fall and
hurt someone).

B. Caution against using any elevator. Use stairwells after a vertical
evacuation order has been given by the EOC or Ann Arbor Fire Department.

C. **Do not** allow anyone to run out into the street.

D. Direct movement of bed patients from any obvious hazards.

E. Designate someone who is calm and capable to remain with any person
who is excited or hysterical.

F. Request additional assistance as necessary; set up a runner or other
form of communication between the EOC and your site.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

G. Check patient, visitors, and employees to see if any require medical
attention and provide as needed.

**CONTINUAL OBSERVATION FOR HAZARDS:**

A. Check for fires if you see a fire activate the fire alarm system, or
call 3333, or get a messenger down to the EOC. Get the message out
first; you are already caring for patients.

B. If you smell gas, report it to EOC.

C. If electrical equipment shows damage, report it to EOC.

D. Turn off any electrical equipment not being used except lights and
life support equipment (i.e., computers, equipment, anything that you
are not using and that is drawing electrical current).

E. Report to EOC any broken water or sewer pipes, or any structural
damage to the building.

F. Continue efforts to assure patients, visitors, and employees of their
safety. Make every effort to carry out routine procedures. Remember to
defend in place. You are not the only one experiencing difficulties at
the present time.

**ADDITIONAL PRECAUTIONS:**

A. Do not turn on any additional electrical switches.

B. If you smell gas, do not light matches or a lighter.

C. Do not use in-house telephones until you are cleared to do so.

D. Do not eat or drink anything from an open container near shattered
glass.

E. Watch for wandering patients or employees, control your census of
staff and patients until the evacuation or rescue starts.

**SUMMATION:**

A. Help is on the way; stay safe and alive by not being a hero.

B. As soon as any form of assistance is operational, it will come to
you.

C. Prepare to shift to the Community Casualty Plan.

D. Work together.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**CIVIL DISTURBANCE/TERRORIST ACT - ESF #2, 4, 6 & 7**

**NOTE**: As circumstances dictate, the provisions of Community
Disaster/Terrorist Act Plan will be effected in addition to the
instructions contained in this chapter.

**OBJECTIVES**:

To provide countermeasure for medical center emergencies resulting from
riots, civil disturbances, or individuals threatening violence.

**GENERAL PROCEDURES**:

A. Medical center personnel should be prepared for a possible five‑day
emergency. Since emergencies can last for a long time, it is important
that personnel understand this possibility and be prepared for it.
Working shifts of up to 12 hours is a possibility.

B. Department heads should be prepared for an increased rate of
emergency admissions during the first days of the emergency; staffing
plans should make provision for this contingency.

C. Admissions personnel should expect the number of incoming patients to
increase as darkness approaches.

D. Medical center personnel should draw shades and drapes at dusk and
use a minimum of light throughout the facility.

**RESPONSIBILITIES OF SERVICE CHIEFS:**

A. Nutrition & Food Department:

\(l\) Emergency feeding operation will be implemented.

\(2\) Arrangements will include the possibility of feeding families of
employees, police, and military personnel for up to five days.

\(3\) Disposable dishes/cups/utensils will be used to the extent
possible at the discretion of EOC.

B. Patient Care Department:

\(l\) Regular medical center services/departments will be maintained,
but visitation privileges will be canceled.

\(2\) Patients will be confined to their bedsides/wards.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

C. Surgical Department:

All elective surgery will be canceled until further notice.

D. Utilization Management Department:

Emergency medical records may be utilized.

E. SPD Department:

Emergency sources of supply for food, water, drugs, medical supplies,
and blood will be contacted and provisions made for adequate deliveries.

F. Prepare to shift to Community Casualty Plan.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[HOSPITAL EVACUATION AND RELOCATION - ESF #4, 5, 6 & 7]{.smallcaps}**

If a disaster strikes the medical center building, the Director or EOC
will order evacuation from one part of the building to another, or to an
outside refuge, as appropriate.

**[Ward Evacuation:]{.smallcaps}**

If only part of the medical center is to be evacuated, notify the Chief
Nurse or designee who will notify the Head or Charge Nurse of the
ward(s). The Head Nurse will automatically take charge of the ward in
the emergency and carry out the instructions given for evacuation.
Should a fire break out in a particular ward, the Head Nurse will follow
all fire procedures without waiting for official notification. **[All
non‑Patient Care personnel assigned to the respective ward]{.smallcaps}
(i.e., Social Worker, Physician\'s Designee, etc.) [will assist in the
patient evacuation under direction of the Head Nurse]{.smallcaps}.** It
is the intent of this directive to establish a routine procedure for the
evacuation of the medical center. These procedures will be described as
Horizontal, Vertical, or Total Evacuation.

\(1\) **[Horizontal Evacuation]{.smallcaps}:** In case of a fire or
other internal disaster on a ward, patients will be evacuated to an
adjacent ward on the same floor. Ambulatory patients will be instructed
to form a chain by holding hands and following a designated person to a
safe area. Non‑ambulatory patients will be removed under the direction
of the nurse in charge. All rooms will be searched to determine that the
ward has been entirely evacuated and doors closed. **Oxygen control
valves will be shut off during evacuation at the discretion of the Ann
Arbor Fire Department.**

\(2\) **[Vertical Evacuation]{.smallcaps}**: **VERTICAL EVACUATION MUST
BE GRANTED, BY THE DIRECTOR OR FIRE DEPARTMENT AUTHORITIES, PRIOR TO
ACTUAL MOVEMENT OF PATIENTS TO ANOTHER FLOOR.** In case it becomes
necessary to evacuate to another floor, ambulatory patients under the
direction of the nurse in charge will form a chain by holding hands and
follow a lead person down the nearest safe stairway. (It is good policy
to evacuate at least two floors.) Only if directed by Fire Department
Authorities, can employees use elevators for non‑ambulatory patients.
Removal of patients by means of blanket carry or drag, stretcher,
mattress, bed, or various carries MUST be anticipated. All rooms will be
searched to determine that the wards have been entirely evacuated and
doors closed.

\(3\) **[Evacuation of Visitors, Volunteers and
Employees]{.smallcaps}:** Any required evacuation of visitors,
volunteers and employees **[will follow]{.underline}** the evacuation of
patients and will be conducted along the same lines (e.g. horizontal,
vertical, total).

\(4\) **[Operating Room Procedure]{.smallcaps}:** The Patient Care
Supervisor, Operating Room, and the EOC will communicate on the progress
or status of surgery in the Operating Room. This is necessary so that
protective measures can be taken for the safety of the surgical team and
the patient. In any case, it is vital that surgery not be interrupted.
In other instances, based upon the decision of the surgeon, surgery may
be discontinued and the operative wound closed. In case of fire,
protective action can be taken by concentrating fire‑fighting equipment
and personnel in the area. The spread of smoke will be contained by
activation of the fire plan.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**Total Evacuation and Relocation:**

A. **EOC** will instruct to evacuate the medical center complex.
Patients, personnel and visitors will be evacuated by means of
Government vehicles, privately owned vehicles and any other means that
may be available from outside sources. Mutual Understanding of Operation
(MUOs) agreements are in place with the facilities listed in paragraph
D, this page.

B. In this situation, all patients must be removed from the building to
an outside area, or contact will be made to the EOC. Designated patient
transfers to local hospitals in coordination with the Chief of Staff,
and Ambulatory Care & Business Office will occur at this time. Depending
on the circumstances, transfer may be made to other VA installations.
Also, local schools or the National Guard Armory can be contacted for
use of transporting vehicles if needed to assist our Transportation
Unit, Facilities Management Department. It can be assumed that Vertical
evacuation is in effect when total evacuation is declared. All patients
should already be grouped on first and second floors (possibly third
also), and evacuation to the outside area can be accomplished quickly by
following the Vertical evacuation procedures issued by the EOC.

C. Food, medical supplies, and other needed equipment will be
transported to the relocation areas for available use as needed.

D. The following relocation areas have been established:

St. Joseph Mercy Hospital

University of Michigan Hospital

VAMC Battle Creek

VAMC Saginaw

VAMC Detroit

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**Medical Center Bed Expansion:**

A. If needed, cots can be obtained from the American Red Cross in Ann
Arbor and Detroit. Cots from the latter location will take from 4 to 6
hours to reach this facility. These cots can be set up as follows:

Auditorium 75 cots

Auditorium Stage 16 cots

Corridor, Bldg 1E 2 West 20 cots

Corridor, Bldg 1E 3 West 17 cots

Corridor, Bldg 1E 3 East 17 cots

Corridor, Bldg 1E 4 West 16 cots

Corridor, Bldg 1E 6 West 17 cots

Corridor, Bldg 1E 6 East 17 cots

Corridor, Bldg 1W 6 North 17 cots

Corridor, Bldg 1E 5 West 16 cots

Corridor, Bldg 1E 5 East 17 cots

Corridor, Bldg 1E 7 East 20 cots

Corridor, Bldg 1E 7 West 17 cots

Corridor, Bldg 1E 8 West 16 cots

TOTAL 298 cots

B. Additional areas can be used are as follows:

Building 1E , 1 North Ambulatory Care

NOTE:

Building 1E -- Clinical Addition

Building 1W -- Original Building

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**[Emergency Evacuation of Records and Documents]{.smallcaps}**

A. **Medical Records Section** will remove patient medical records in
the following priority: Priority 1 ‑ central locator card file; Priority
2 ‑ medical and administrative records.

B. **Ward Administration Section** staff not assigned to duties
elsewhere, will remain in their normal work area and assist in the
movement of medical or related records to a safe area designated by the
person in charge. The priority of removal of patient medical files will
be: Priority 1 ‑ plastic charts, Priority 2 -- soft-back or medical
record folders in file cabinets.

C. **Employee Health** will observe the following priorities in
evacuating employee health records: Priority 1 ‑ employee health cards;
Priority 2 ‑ employee health charts.

D. **Human Resources** will observe the following priorities in
evacuating personnel records: Priority 1 ‑ Official Personnel Folders;
Priority 2 ‑ applications and tests; Priority 3 ‑ receipt records.

E. **Resource Office** will observe the following priorities: Priority 1
‑ employee payroll records; Priority 2 ‑ patient funds records; Priority
3 ‑ receipt records; and Priority 4 ‑ money.

F. **Communication** **Information Officer** will observe the following
priorities in evacuating DHCP records: Priority 1 ‑ backup copies of all
DHCP systems data; Priority 2 ‑ backup tapes of CIO office computers.

G. Efforts will be made to protect other records and documents by the
custodians of those records with due regard to the safety of employees
and the importance of the records.

H. Prepare to shift to the Community Casualty Plan and maintain
communication with the EOC. Directions to return to the medical center
will be given, or a change in emergency preparedness plan will occur.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**COMMUNICATION FAILURE - ESF #2, 3, 6 & 7**

Upon verification of the failure of the telephone system, the following
procedures will be taken:

A. CIO will survey the amount of telephone outages to determine whether
this plan should be activated.

B. Two messengers will distribute portable radios and messages.
Additional messengers are the responsibility of the Communications
Officer. Designated employees will obtain portable radios from the CIO,
and be trained by the Telephone Operator on the operation of the issued
portable radio. Designated employee(s) are to be determined by the user
department supervisor on duty at the time of the communication failure.

C. Communications Officer will survey all forms of communication
available within the community for usage as backup support. Cellular
phone distribution and additional pagers are a temporary solution, and
distribution of available cellular phones or pagers is at the call of
the Communications Officer. Additional pagers would have to be activated
by the University of Michigan Hospital switchboard. This backup network
will be necessary if repair of the telephone system will take longer
than one working day (8 hours).

D. Communication between the EOC will be maintained with portable
radio(s) or cellular phone. **If an explosion caused any telephone
outage, cellular phones will not be distributed and portable radios will
not be used within 30 feet of a suspected bomb threat location.**
**Cellular phones will not be used on any patient care floor.**
Communication between Patient Care and other related patient care areas
will be maintained by the best possible resource.

E. Messenger service and portable radios will be used until the
telephone system is operable.

F. **All portable radios will be returned to CIO once the \"ALL CLEAR\"
is given by VA Police.**

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**EMERGENCY PREPAREDNESS EDUCATION & TRAINING**

**EDUCATION:**

A. A minimum of two emergency preparedness drills will be conducted
annually within the medical center, one for internal emergencies and one
for external emergencies.

B. Each department will review their department‑specific emergency
preparedness plans on an annual basis along with their
department‑specific safety policy.

C. In patient care areas, the fire plan will be reviewed on a quarterly
basis. In non‑patient care areas, semi‑annual review of the fire plan is
required in each department.

D. Each department will conduct annual training of their
department‑specific emergency preparedness plan in the following areas
as they relate to each work environment:

\(1\) Activation(s) of all plans, department response.

\(2\) Emergent care procedures of casualties.

\(3\) Emergency callback of personnel during non-administrative hours.

\(4\) Expanded functions of daily operations.

\(5\) Fire Plan and/or hospital evacuation procedures.

\(6\) Failure of utilities, as they relate to work environment (i.e.,
electricity, telephone system, nurse‑call system, heating and/or air
conditioning, plumbing systems, pressurized steam system, medical gas
system/equipment, and medical/surgical vacuum systems).

\(7\) Documented completion of equipment user/operational training, as
this equipment pertains to patient care usage and treatment.

E. All employees will be trained in the above items as part of their
annual emergency preparedness training program within each department.

F. All documentation of training will be accessible on DHCP or through
the facility Education Department. An annual summary of training will be
forwarded to the Safety Committee when requested (See Appendix B, Policy
Memorandum S-3) as part of the annual safety requirements.

G. All department‑specific emergency preparedness plans will be reviewed
annually within each department and will include procedures on the above
mentioned training topics.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**RESPONSIBILITIES:**

The regular day‑to‑day management organization and department
RESPONSIBILITIES and authority will be applicable at all times. Under
certain emergency circumstances, some department functions are deferred
or canceled pending termination of the emergency. Under these
conditions, employees will be available for other assignments within the
medical center or in the community.

All employees will:

\(1\) Remain familiar with the provisions of the Emergency Preparedness
Plan and execute them in an emergency.

\(2\) Will report for duty upon learning of a large scale disaster if
communication cannot be established.

**PRIORITY OF CARE:**

This program outlines procedures to follow in the event of internal or
external emergencies occurring at this medical center, and seeks to:

\(1\) Prevent injuries to persons.

\(2\) Rescue casualties and entrapped persons.

\(3\) Provide emergency medical care of casualties.

\(4\) Prevent damage and loss of property, and medical records.

\(5\) Maintain and restore necessary services.

\(6\) Investigate and analyze cause of emergency and recommend
corrective action.

**PRIORITY OF ASSISTANCE:**

. Patients

Medical center volunteers and visitors

Employees

Irreplaceable records and valuable property

Other property

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**TYPES OF PLANS:**

The Emergency Preparedness Plan is the master plan outlining procedures
to be followed in the event of internal or external disasters.

\(1\) Fire

\(2\) Community Disaster

\(3\) Tornado

\(4\) Snow Emergency

\(5\) Utilities Failure

(6) Chemical Spill

\(7\) Chemical, Radiological, or Biological Terrorism

\(8\) Bomb Threat

\(9\) Earthquake

\(10\) Civil Disturbance/Terrorist Act

\(11\) Hospital Evacuation and Relocation

\(12\) Communication Failure

\(13\) VA/DoD Contingency Plan

**FIRE DRILLS:**

A. Fire drills are conducted by the Safety Specialist. These drills are
held at varying times during the 24-hour day and will be conducted on
each tour‑of‑duty at least once a quarter in patient care areas. Fire
drills are held in administrative areas once a year. Drills are closely
observed to evaluate the adequacy of training in the activation of the
fire plan. Fire drills will include fire alarm system activation.

B. Drill Signals: Fire drill signals are the same as for an actual fire.

C. Fire drills may be repeated if the Safety Specialist is not satisfied
with employee response during each drill.

C.  Fire drill self-critique is available by accessing the mailman menu,
    typing, "fire" then pressing

enter. Follow instructions for completion.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**FIRE PLAN TRAINING:**

A. The Fire Plan is reviewed at least annually with the rest of the
Emergency Preparedness Plan by the Emergency Preparedness Committee.

B. The Safety Specialist is responsible for rendering technical advice
and assistance in developing, coordinating and directing the medical
center fire protection program.

C. The Safety Specialist will conduct classes covering proper procedures
for turning in a fire alarm, fire fighting equipment, and other basic
fire fighting procedures. A refresher course will be conducted annually
for all employees. Requests for training can be completed by contacting
the Safety Office at extension 3803 or 7772.

D. Supervisors are responsible for removing fire hazards, training
employees to understand how to turn in a fire alarm, use first aid, fire
fighting equipment, and understand fire evacuation routes.

E. Department Heads are responsible to ensure that their employees:

\(1\) Report as scheduled for initial training, quarterly or semi‑annual
fire prevention refresher courses.

\(2\) Know the location and type of fire alarm code and fire fighting
equipment available in their work areas.

\(3\) Participate in all fire drills.

**CHEMICAL, RADIOLOGICAL, OR BIOLOGICAL TERRORISM TRAINING:**

A. Chemical, radiological, and biological terrorism training will be
reviewed annually and new hazards added as they are identified

B. The Industrial Hygienist and, if appropriate, an infectious disease
practitioner, will be responsible for technical advice and assistance in
developing, coordinating, and directing the medical center response to
chemical, radiological, or biological terrorism planning.

C. Classes in specific chemical, radiological, and biological hazards
will be provided by the Industrial Hygienist. The infectious disease
section and/or national resource experts will provide specific
infectious disease training. Media presentations will be available for
off-shift training and especially potential hazardous exposures.

D. Supervisors are responsible for assuring employees are trained on how
to recognize and respond to threats and possible terrorist acts.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**CHEMICAL SPILL PRE-PLANNING:**

A. An emergency response team will be designated by the Safety
Committee. The response team can include, but may not be limited to:

\(1\) Industrial Hygienist

\(2\) Radiation Safety Officer

\(3\) Safety Specialist

B. Spill kit training will be conducted for all employees on a
pre‑assignment basis by their supervisor.

C. The emergency response team will only be called if a spill occurs
**on-site** and cannot be handled with an ordinary spill kit. It will be
the team\'s decision as to whether or not a HazMat team needs to be
called in.

D. **Call 3333 to report a spill that cannot be handled with an ordinary
spill kit.**

E. The Ann Arbor Fire Department is informed of potential hazards, which
they will deal with, in the facility.

**CRITIQUE REQUIREMENTS:**

Upon the issuance of the **\"ALL CLEAR,\"** plan activation(s) will be
critiqued immediately in the ambulance garage or a location determined
by the EOC during administrative hours only. Off shift drills will be
critiqued within two working days via written format.

A. Written critique by each observer assigned to critique each plan
activation will be forwarded to the VA Police Office (07) within two
working days after each plan activation.

B. Each critique should include problems identified during the
implementation of the plan including facility preparedness, staff
preparedness and management of casualties, as well as recommended
corrective actions.

C. All plan activation's that occur each year will also be part of the
annual review of the effectiveness of the emergency preparedness
program. Each annual review will be conducted under the guidelines of
the JCAHO Environment of Care Standard associated with the emergency
preparedness program.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

**SAFETY AND OCCUPATIONAL HEALTH COMMITTEE:**

A. The Safety and Occupational Health (S&OH) Committee will meet to
critique semi‑annual plan activations. Additional meetings may be
required and will be held at the call of chairperson.

B. The S&OH Committee is responsible for conducting semi‑annual plan
activations of the Emergency Preparedness Plan, critiquing each plan
activation, reviewing the effectiveness of the Emergency Preparedness
Plan, and developing training sessions in emergency preparedness in
relationship to supervisory and employee annual training needs.

C. Annual review of the Emergency Preparedness Plan and overall
effectiveness will be conducted by the Administrative Executive Board
and the Safety and Occupational Health Committee.

Appendix A

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

##### [PHARMACEUTICAL CACHE]{.underline}

1\. PURPOSE: The pharmaceutical cache is a stockpile of medication and
medical supplies to support patient care in the event of a significant
incident related to Weapons of Mass Destruction (WMD). The cache is
designed to maintain the infrastructure of the facility and ensure
supplies are available to treat patients, staff, and individuals seeking
treatment during a WMD event. The cache will be made available to the
community at the discretion of the Director.

2\. POLICY:

a\. The Under Secretary for Health has determined that the VA Ann Arbor
Healthcare System (VAAAHS) will maintain a small drug cache to support
1000 casualties for a two to three day period.

b\. The cache is configured and supported centrally by the
Pharmaceutical Benefits Management (PBM) Emergency Pharmacy Service.
Replacement products will be centrally purchased and drop-shipped in
advance of product expiration dates. A stock rotation program will be
centrally managed with local assistance. Cache contents are considered
protected information.

c\. Routine access will be limited to selected individuals with
responsibility to maintain accountability and rotate stock. Pharmacy
will be the primary component for maintenance and operation of the cache
(if activated).

d\. Only the Emergency Operation Center (EOC) or the Director will
initiate activation and use of the cache. Only pharmacy staff is
authorized access to the drug cache. The cache policy will be maintained
as part of the VAAAHS Emergency Management Plan

e\. The response time for personnel to open the cache (from notification
to activation) is expected to be one hour or less. Loading and delivery
of the first items to the triage site is expected to occur in less than
15 minutes.

3\. ACTION:

a\. Cache activation occurs when the Emergency Management Plan is
activated for an incident related to WMD. Notification procedures will
follow a normal duty day (normal staffing) plan and an off-hours (1600
to 0800 hours, weekends, and holidays) plan.

b\. [Activation procedure for normal duty days]{.underline}:

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

\(1\) Normally, the Emergency Operations Center will determine the scope
and nature of the disaster and assess the requirements for patient care.

\(2\) The Chief, Pharmacy Service, or designee will be informed of the
need for pharmaceuticals and supplies. If the Chief, Pharmacy Service
(or designee) is unavailable, a pharmacist present in the Inpatient
Pharmacy will handle the communication (extension 5108).

\(3\) The Pharmacy may conduct a review of on-hand supplies that can
support immediate patient care requirements.

\(a\) If on-hand supplies will handle immediate needs, notification will
continue to prepare for impending cache activation since an incident has
occurred.

\(b\) If on-hand supplies will not handle immediate needs, the Pharmacy
will prepare to open the cache. This may include procuring a radio,
notifying other personnel needed to support operations, and ensuring a
safe environment (no immediate threat of chemicals or weapons in getting
to the cache site).

\(4\) The Emergency Operations Center will direct Pharmacy personnel to
activate the cache when final determination that it is needed is
confirmed. Since the Chief, Pharmacy Service or Inpatient Pharmacy
Supervisor (or designee) normally maintains the cache, these individual
will be the primary staff to deploy the drug cache.

\(5\) Once the cache is opened, the Pharmacy will contact the Emergency
Operation Center for instructions on what items are needed first and
where the delivery point is located.

\(6\) While the cache is being loaded, other pharmacy staff will be
deployed to assist with distribution of cache items at the triage site
(and to account for controlled substances if deployed). All controlled
substances will be accounted for on green sheets.

\(7\) Pharmacy personnel opening the cache will notify the Emergency
Operations Center when cache items leave the storage area. Further
instructions will be provided on delivering more items at this time.

c\. [Activation procedure for off-hours, weekends, and
holidays]{.underline}:

\(1\) The overall procedure is the same as during a normal duty day. The
primary difference is that personnel are not as readily available and
the Pharmacy Service Cascade List (callback roster) must be used to
obtain personnel.

\(2\) During off-hours, the Inpatient Pharmacy will be the primary point
of contact. The pharmacist on duty will be responsible for initiating
the Pharmacy Service Cascade List and communicating with the Emergency
Operations Center until a supervisor arrives on site.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

\(3\) If a supervisor is unable to be contacted, or cannot reach the
medical center, the pharmacist on duty will determine who will open the
cache via the callback roster.

\(a\) The person of first choice will be an individual with additional
training to open the cache (one who assists with maintenance).

\(b\) It is preferred that a pharmacist opens the cache, unless a
technician having additional training is available.

\(c\) During an incident, a minimum of one registered pharmacist must be
maintained in the Inpatient Pharmacy at all times. The pharmacist will
notify the Emergency Operation Center he/she cannot leave the Pharmacy.

\(d\) In the event one pharmacist is on duty the Emergency Operations
Center will determine whether to wait for the Cascade List to obtain
more pharmacy staff, or whether to have the pharmacist leave the
pharmacy to open the drug cache under emergency conditions.

d\. Accessing the Pharmaceutical Cache:

\(1\) The key and electronic codes to the cache will be available in the
Inpatient Pharmacy Vault. The Emergency Operations Center may designate
other individuals to support opening the cache and provide access via
the sealed envelopes.

\(2\) The following keys and codes are needed to access the cache:

\(a\) Service elevator key 2EX1 (needed to access cache floor)

\(b\) Pharmacy key 2SK27 (needed for door deadbolt)

\(c\) Electronic access to open door (or key 2SK33 located in the
Director's safe)

(d). Alarm code for inactivating alarm.

e\. Maintaining the Pharmaceutical Cache:

\(1\) Chief, Pharmacy Service will ensure that all inspections and
inventories are accomplished and documented in accordance with criteria
established by PBM Strategic Health Group (SHG).

\(2\) Inspections of the cache include a visual inspection of the cache
space to ensure security and environmental requirements are still
intact.

\(3\) Cache product rotation and inventory system entries will be
accomplished in a timely manner as required by PBM SHG.

\(4\) All cache controlled substances are subject to the monthly
narcotic inspection process and the inventory must be entered into and
maintained in Veterans Health Information

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

System and Technology Architecture (Vista) Controlled Substance software
as a separate narcotic area of use.

\(a\) Controlled substance inventories do not require a physical count
of the cache contents, but must include the status of seal (intact or
not) and the number on the seal.

\(b\) Morphine totes must be checked preferably daily, but at least
every 72 hours.

\(c\) Diazepam cart must be checked at least weekly.

\(d\) Monthly inspections will require a physical count of the cache
contents done by the Controlled Substance Security Officer and the
Chief, Pharmacy Service (or pharmacist designee).

\(5\) Records will be maintained for each cart and tote:

\(a\) Dates of access, inventories, and seal checks.

\(b\) The number of each seal.

f\. Locating Items in the Pharmaceutical Cache:

\(1\) Carts are color-coded to assist with locating appropriate supplies
for each type of event:

\(a\) Blue = Biological

\(b\) Green = Chemical

\(c\) Red = Explosion/Burn

\(d\) Orange = Radiological

\(e\) Yellow = Medical & Surgical Supplies

\(2\) Each cart has an inventory list for the entire cache.

\(3\) A layout (map) and cart list is located under the alarm panel
inside the door to the cache so individuals can quickly find and deploy
items. All carts have wheels that allow for movement without extra
equipment.

\(4\) Morphine is stored in the inpatient pharmacy vault in sealed
totes. Devices for the syringes and sheets to account for each syringe
are also in the totes. Doses of morphine should indicate patient name or
number, and the provider ordering the morphine.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

##### [CONTINGENCIES FOR DEPLOYMENT OF THE PHARMACEUTICAL CACHE]{.underline}

1\. [PURPOSE]{.underline}: The pharmaceutical cache is a stockpile of
medication and medical supplies to support patient care in the event of
a significant incident related to Weapons of Mass Destruction (WMD). The
cache is designed to maintain the infrastructure of the facility and
ensure supplies are available to treat patients, staff, and individuals
seeking treatment during a WMD event. This policy describes plans for
physical deployment of the cache.

2\. [POLICY]{.underline}:

a\. The cache will be deployed under the conditions described in
Pharmaceutical Cache policy.

b\. Cache will be deployed in either a large-scale or small-scale
deployment.

\(1\) A large-scale deployment is when IV solutions must be moved in
approximately pallet quantities.

\(2\) A small-scale deployment is when IV solutions can be moved by the
case as needed.

c\. The cache will likely be physically deployed to one of three areas,
depending on the scale and circumstances: Auditorium, Emergency Room
area, and Inpatient Pharmacy.

\(1\) The Emergency Room area will be the first area for deployment of
supplies.

\(2\) Auditorium will be used when capacity exceeds the Emergency Room.

\(3\) The Inpatient Pharmacy will be used as a staging area for supplies
and for back-filling the usual inventory of IV solutions.

d\. The cache will be moved via the quickest route that is least likely
to encounter patient traffic.

3\. [PROCEDURE]{.underline}:

a\. Emergency Room Deployment

\(1\) Route of Choice: West Service Elevators (5 & 6) outside the cache
to the first floor then to Emergency Room.

\(2\) 1^st^ Alternate Route (when hall is too crowded for transport):
West Service Elevators (5 & 6) to basement, basement to Main Service
Elevators (S5 & S6) in new building, to first floor to emergency room or
deploy from service elevator lobby.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

b\. Auditorium Deployment:

\(1\) Route of Choice: West Service Elevators (5 & 6) to basement to
Auditorium.

\(2\) 1^st^ Alternate Route: Dependent on functioning elevators.

c\. Inpatient Pharmacy Deployment:

\(1\) Route of Choice: West Service Elevators (5 & 6) to basement,
basement to Main Service Elevators (S5 & S6) in new building, to B1 to
Pharmacy Warehouse

\(2\) 1^st^ Alternate Route: Dependent on functioning elevators.

d\. Deployment Plan for Elevator Malfunctions:

\(1\) West Service Elevator Malfunction:

\(a\) IV Solutions not deployable in pallets. Therefore, they must be
deployed on wire carts using passenger elevators (1, 2, 3, 4, S3, S4,
P3, P4) or main service elevators (S5 & S6). To deploy in pallets
requires removal of the wall in the 6^th^ floor elevator lobby.

\(b\) The cache will not be accessible with Pharmacy Service keys.
Therefore, the Police will use keys to access 6^th^ floor space from
passenger elevators.

\(2\) Main Service Elevator Malfunction (S5 & S6):

\(a\) Deployment cannot occur to ER through basement. Therefore, the
Police must clear 1^st^ floor hall for supply movement or the cache be
moved through the 5^th^ floor to the Main Passenger Elevators (S3, S4,
P3, P4).

\(b\) Cache cannot be deployed to the Inpatient Pharmacy. Therefore,

deploy directly from the cache storage area or to auditorium.

\(3\) Combined Elevator Malfunction:

\(a\) Stairs will be utilized to transport supplies down to the 5^th^
floor. If possible, the pharmacy dumbwaiter or the East Elevators will
be used for transport.

\(b\) If all elevators and dumbwaiters are malfunctioning, the manpower
pool will be used to transport supplies down stairwells.

4\. [RESPONSIBILITY]{.underline}:

a\. Pharmacy Service will transport the cache to the needed areas by the
route of choice.

VA Ann Arbor Healthcare System Policy S-5

May 15, 2003

b\. Police:

\(1\) Will clear hallways as needed to allow transportation of supplies.

\(2\) Open south door in 6th floor elevator lobby to allow access to the
cache service doors if the West Service Elevators are not functional.
The alternative is to obtain the bypass key from the Director's safe to
open the north door of the cache storage area.

c\. Emergency Command Center:

\(1\) Instruct Pharmacy Service where to deploy the cache.

\(2\) Provide assistance from the manpower pool as needed to transport
supplies down stairwells during elevator malfunctions.

**I. [EXECUTIVE SUMMARY]{.underline}**

**Public Law 97-174, Section 5011A, \"Veterans Administration and
Department of Defense Health Resources Sharing and Emergency Operations
Act\" mandated a fourth mission to the VA to serve as the primary
contingency back-up to Department of Defense medical services. The VA
ANN ARBOR HEALTHCARE SYSTEM is designated as a primary receiving center.
Upon activation of the VA/DoD Contingency Plan, the medical center will
provide primary, secondary, and tertiary medical care to active duty
military personnel in accordance with the requirements of PL 97-174. Due
to its geographical location, the VA Ann Arbor Healthcare System
(VAAAHS) also coordinates support from the secondary centers located at
the Battle Creek and Saginaw, and works closely with the Federal
Coordinating Center at the Detroit VA Medical Center. Military medical
liaison and administrative support services will be provided to the
VAAAHS by Wright Patterson Air Force Base located in Dayton, Ohio.**

**II. [INTRODUCTION]{.underline}**

**A. [PURPOSE]{.underline}: This contingency plan is an overall summary
of the medical center\'s role upon activation of the VA/DoD Contingency
Plan. The plan identifies the process and scope of providing short
notice back-up medical support to the Department of Defense. Specific
responsibilities and responses to formal activation of the plan are
identified in the attachments.**

**B. [SCOPE]{.underline}: This plan is applicable to all persons
employed by the VAAAHS. This is a component plan of our VAMC Emergency
Preparedness Program (EPP), Medical Center Policy Memorandum S-5.**

**C. [IMPLEMENTATION]{.underline}: Upon notification by the Secretary of
Veterans Affairs, the Chief Medical Director (CMD) of the Veterans
Health Administration (VHA) will activate the VA component of the
Contingency Hospital System (CHS). The VISN 11 Network Director will
notify the Medical Center Medical Center Director who will initiate the
Medical Center emergency notification of \"Cascade\" system, as
necessary. Cascade recalls appropriate personnel to provide services
consistent with our mission.**

**D. [POLICY]{.underline}:**

**1. Promulgation. This plan is required reading/study for all key
personnel, service chiefs, and persons assigned specific roles in the
plan or its attachments. It will be included in the orientation of all
persons whose position may require their participation in any way.**

**2. 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 while
continuing to perform the VA\'s mission of providing care to eligible
service-connected veterans who retain the highest priority for VA
admission and care. The primary focus of VA Ann Arbor Healthcare Systems
will shift to the care of patients in accordance with the following
admission priorities:**

**a. Bona fide medical emergencies**

**b. Service-connected (SC) veterans**

**c. VA/DoD contingency casualties/active duty patients**

**d. Other eligible VA beneficiaries**

**e. NSC veterans with no special eligibility**

**f. CHAMP VA and Sharing Agreement patients.**

**3. In order to free up beds for military casualties,
non-service-connected veterans will be discharged or transferred to
other VA or community health care facilities. Transfers will be made in
accord with the procedure outlined in the Medical Center Transfer of
Patients Policy. NOTE: VA WILL MAINTAIN RESPONSIBILITY FOR CONTINUITY OF
CARE FOR PATIENTS OUTPLACED.**

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

**E. [PLANNING ASSUMPTIONS]{.underline}:**

**1. The Medical Center may lose staff to Guard and Reserve activation.
Augmentation by staff transfer will be minimal.**

**2. Casualties could arrive in any of the primary areas within 72 hours
of activation of the VA/DoD Contingency Hospital System (CHS).**

**3. Patients will arrive in the Ann Arbor area 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.**

**4. Additional funding will be made available for the lease of any
special purpose equipment and increased contract ambulance and
hospitalization costs beyond routine medical center operations.**

**F. [SUPPORTING ORGANIZATIONS]{.underline}.**

**1. ASMRO & VACO. The Armed Services Medical Regulating Office (ASMRO),
Scott AFB, Illinois, will gather information on the number and types of
casualties and the availability of transportation and appropriate beds
in the Continental United States (CONUS). ASMRO then directs casualties
to military evacuation points overseas or in the U.S. Patient assignment
is coordinated with medical centers by a designated Patient Airlift
Center (PAC). The VHA Emergency Medical Preparedness Office (EMPO)
Liaison Officer (LNO) at ASMRO facilitates in this process and feeds
advance information back through VHA at Central Office.**

**2. VHA VISN 11.**

**a. The VISN provides policy/ operational direction and technical
assistance to ensure the successful implementation of the VA/DoD CHS.
VISN monitors implementation of Medical Center plans to ensure smooth
operation, and initiates improvements or corrective actions that are
beyond the scope and/or authority of the Medical Center.**

**b. Upon activation of the VA/DoD Contingency Plan (CONPLAN), the VISN
11 Network Director will establish VISN Emergency Operations Center
(VEOC). The key responsibilities of the VEOC include coordination and
resolution of the Medical Center\'s needs as requested by the Center
Medical Center Director. The VEOC will serve as a clearinghouse between
VAMCs in VISN 11 and VACO.**

**3. Primary Receiving Centers (PRCs). VAMC Ann Arbor is designated a
PRC with the following responsibilities:**

**a. Coordination of bed reporting with Secondary Support Center (SSC)
VAMCs.**

**b. Transfer of patients to Secondary Support VAMCs.**

**c. Coordination of bed availability, patient regulation (ward
assignment), airport reception site readiness, etc.**

**d. Coordination of primary and secondary transportation assets to
accomplish patient movement (airport to PRC, PRC to SSC, etc.).**

**e. Coordination with local military hospitals to ensure appropriate
Military Patient Administration Team (MPAT) activities are available.**

**4. Secondary Support Centers (SSC). The Battle Creek and Saginaw VA
Ann Arbor Healthcare Systems are designated as SSC. They perform
essentially the same contingency activities as a PRC; however, they
receive patients relocated from Ann Arbor instead of directly from the
evacuation pipeline.**

**a. Bed availability reports are to be coordinated with the Ann Arbor
VAMC Business Office/Admitting.**

**b. Notification of alert status will be confirmed with secondary
facilities by the Ann Arbor Emergency Preparedness Coordinator
(Emergency Preparedness Coordinator).**

**c. Assignment of military patients to secondary facilities will be
determined by the Ann Arbor VAMC Chief of Staff and beds will be
coordinated by the Bed Coordinator/Admitting.**

**d. Logistical support for DoD patient reception and transfer to
secondary sites will be coordinated with the SSC, by the Bed Control
Coordinator and the Emergency Preparedness Coordinator (EPC).**

**III. [MISSION]{.underline}:**

**A. The Medical Center will operate as a Primary Receiving Center with
secondary support provided by Saginaw and Battle Creek. In this role,
our mission is to receive and coordinate placement of casualties
directed to the facility by the Armed Services Medical Regulating
Office. The Medical Center capability is specified as medical, surgical,
orthopedic surgery and psychiatric.**

**B. The Medical Center will make 50% or approximately 60 of its beds
available to DoD within 72 hours of mobilization. A detailed summary of
beds by category is identified in Appendix B. additionally, we may
receive up to 250 patients for distribution to the SSCs.**

**IV. [OPERATIONS]{.underline}:**

**A. [CONCEPT]{.underline}: This plan outlines a measured response by
VAMC Ann Arbor, which will be functionally organized for emergency
operations. This plan further envisions support for the VA/DoD
Contingency Hospital System (CHS), unfolding in three phases; alert,
activation, and execution. Upon activation of the Medical Center in the
CHS, execution will be controlled by the Emergency Operations Center
(EOC).**

**1. [FUNCTIONAL ORGANIZATION]{.underline}:**

**The following chart shows the functional relationships of activities
supporting the CHS. Lead staff are identified by routing symbol.**

**VA/DoD MEDICAL CENTER FUNCTIONAL ORGANIZATION**

**EMERGENCY OPERATIONS CENTER (EOC)**

**Medical Center Director (00)**

**Associate Director for Operations (50)**

**Chief of Staff (11)**

**ADPCS (30)**

+-----------------------+-----------------+---------------------------+
|                       |                 | **INFORMATION CONTROL**   |
|                       |                 |                           |
|                       |                 | **PUBLIC AFFAIRS OFFICER  |
|                       |                 | (006)**                   |
|                       |                 |                           |
|                       |                 | **MEDIA RELATIONS**       |
|                       |                 |                           |
|                       |                 | **EMPLOYEE FORUMS**       |
|                       |                 |                           |
|                       |                 | **PATIENT/FAMILY AFFAIRS  |
|                       |                 | (122)**                   |
+-----------------------+-----------------+---------------------------+

+------------------------------------+-----+---------------------------+
| **LOGISTICAL/OPERATIONS**          |     | **PLANNING**              |
|                                    |     |                           |
| **NURSING TRIAGE COORDINATOR       |     | **VA/DoD COORDINATOR/EPC  |
| (11A)**                            |     | (07)**                    |
|                                    |     |                           |
| **ASSOCIATE DIRECTOR FOR           |     | **PLAN DEVELOPMENT**      |
| OPERATIONS (50)**                  |     |                           |
|                                    |     | **NEEDS ASSESSMENT**      |
| **CHIEF RESOURCE OFFICER (20)**    |     |                           |
|                                    |     | **DOCUMENTATION**         |
| **CHIEF INFORMATION OFFICER (40)** |     |                           |
|                                    |     | **DAILY SITUATIONS**      |
| **SUP. UTIL. MGMT (43), EMERGENCY  |     |                           |
| PREPAREDNESS COORDINATOR (07)**    |     | **MPAT CONTACT**          |
|                                    |     |                           |
| **BED REPORTING (43, 11U)**        |     | **SECONDARY CENTERS**     |
|                                    |     |                           |
| **TRANSFER & ASSIGNMENT OF         |     |                           |
| PATIENTS (43, 11, 122)**           |     |                           |
|                                    |     |                           |
| **PATIENT ADMINISTRATION (43,      |     |                           |
| MPAT)**                            |     |                           |
|                                    |     |                           |
| **PATIENT RECEPTION: TRIAGE        |     |                           |
| (11,11A, 43, 07)**                 |     |                           |
|                                    |     |                           |
| **SUPPLIES, EQUIPMENT, MEDICATIONS |     |                           |
| (11A, 07)**                        |     |                           |
|                                    |     |                           |
| **NDMS COORDINATOR VAMC DETROIT    |     |                           |
| (07)**                             |     |                           |
|                                    |     |                           |
| **LAYOUT (11A, 07)**               |     |                           |
|                                    |     |                           |
| **COMMUNICATIONS (5OS)**           |     |                           |
|                                    |     |                           |
| **TRANSPORTATION: TRANSFERS (43,   |     |                           |
| 51GT)**                            |     |                           |
|                                    |     |                           |
| **TRIAGE: (07, 51GT)**             |     |                           |
|                                    |     |                           |
| **SECURITY:**                      |     |                           |
|                                    |     |                           |
| **VA POLICE MEDICAL CENTER (07)**  |     |                           |
|                                    |     |                           |
| **TRIAGE (07)**                    |     |                           |
+------------------------------------+-----+---------------------------+

**2. [PHASES]{.underline}:**

**a. [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 herein.**

**b. [ALERT]{.underline}: No formal announcement is expected during this
phase, the period is characterized by heightened international tension.
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 internal
training and rehearsals are encouraged. Central Office could be expected
to initiate the bed reporting and asset inventory requirements. The EOC
may be set-up and exercised.**

**c. [ACTIVATION]{.underline}: The VISN 11 Network Director will notify
the VAMC Medical Center Director or his/her designee when the VA/DoD
Contingency Plan has been activated. The plan may be activated in part
VISN-wide or functionally. The VAMC Medical Center Director will, when
appropriate, initiate the Medical Center \"Cascade\" notification system
indicating the scope of our activation to this \"First Alert to Standby
Status. See Appendix A \'NOTIFICATION\'. This phase is characterized by
making the EOC operational, completion of internal asset inventories,
updating on call rosters, enhanced bed reporting and confirmed readiness
to potentially receive DoD patients within 72 hours.**

**d. [EXECUTION]{.underline}: This phase is initiated with an
announcement that casualties have been assigned to this VAMC
(Notification of Assignment of Patients). This phase is characterized by
patient manifest review, discharge/transfer of patients to free up beds
and actual reception and care of DoD casualties. See RECEPTION
PROCEDURES, below.**

**B. [RECEPTION PROCEDURES]{.underline}:**

**1. Advanced Preparations:**

**a. The Chief of Staff, Bed Control/Admitting Coordinator, Nurse Triage
Coordinator and Emergency Preparedness Coordinator will review the
patient manifest (if available) to coordinate patient transfers, bed
assignments, transportation needs, size of triage team, and support
personnel for patient reception at the airport. Depending on the number
of additional beds needed, elective admissions may be canceled and
inpatients will be selected on a case-by case basis to be discharged,
transferred to the ECC, community nursing homes, or the Saginaw or
Battle Creek VAMCs.**

**b. Triage sheets will be prepared from the manifest for team use with
copies to the appropriate services to prepare for receipt of patients:
(11A); (119); (112); (111); (116A) and (127) and (110) if they have
admissions. Bed Control/Admitting coordinator will front load patient
admissions in the computer and forward bed assignments to Patient Care
Services for bed cleaning.**

**2. Medical Center Staging Area for Support Personnel & Triage Team:**

**a. Equipment, linen, nourishment's, and supplies will be stored in
SPD. The Triage Team and support personnel will assemble in the
Ambulance garage three (3) hours before the estimated time of arrival of
the aircraft. Drivers and litter bearers will load the vehicles, as
directed by the Safety Specialist. The Emergency Preparedness
Coordinator will also ensure required special equipment is
transported.**

**b. Support personnel include drivers, litter bearers, public relations
specialist, the Emergency Preparedness Coordinator and additional
nursing personnel, as required, to monitor patients during transport.**

**c. The Emergency Preparedness Coordinator will ensure each person on
the Transport Triage Team has a picture identification badge displayed
and is checked against a master list a copy of FAXED for airport
security clearance. The group will depart for the airport at least two
(2) hours prior to aircraft arrival.**

**3. Triage: Primary function of patient reception at the airport is to
receive patients from air transport, provide supportive care at the
arrival point, and prioritize patients for transport to the VAMC.**

**a. General team composition - Administrative person in charge is the
Nurse Triage Coordinator. The exact composition of the Team will be
determined after receipt of the patient manifest. The Director of
Primary Care Physician assigned to each Triage Team will be designated
as the physician in charge. In general, the following staff ratio will
compose the reception team based on the manifest type and quantity of
patients:**

**[Staff Assigned By Patient Quantity]{.underline}**

  --------------------------------- ------- -------------- --------- -----------
  **Triage Team**                           **Patients:    **(10 -   **(20+)**
                                            (5 - 10)**     20)**     

  --------------------------------- ------- -------------- --------- -----------

  --------------------------------- ------- -------------- -------- -------
  **Nurse Triage Coordinator**              **1**          **1      **1**
                                                           1\***    

  --------------------------------- ------- -------------- -------- -------

  --------------------------------- ------- -------------- -------- -------
  **Physician**                             **2**          **3      **4**
                                                           3\***    

  --------------------------------- ------- -------------- -------- -------

  --------------------------------- ------- -------------- -------- -------
  **Nurse**                                 **5**          **7      **9**
                                                           5\***    

  --------------------------------- ------- -------------- -------- -------

  --------------------------------- ------- -------------- -------- -------
  **Patient Administrator (43)**            **1**          **1      **1**
                                                           1\***    

  --------------------------------- ------- -------------- -------- -------

  --------------------------------- ------- -------------- -------- -------
  **Patient Service Assistant**             **2**          **3      **4**
                                                           2\***    

  --------------------------------- ------- -------------- -------- -------

  --------------------------------- ------- -------------- -------- -------
  **Pharmacist**                            **1**          **1      **1**
                                                           1\***    

  **Pharmacy Tech**                         **1**          **1      **1**
                                                           1\***    
  --------------------------------- ------- -------------- -------- -------

  --------------------------------- ------- -------------- -------- -------
  **Respiratory Therapist**                 **1**          **1      **1**
                                                           1\***    

  --------------------------------- ------- -------------- -------- -------

  --------------------------------- ------- -------------- -------- -------
  **SPD Technician**                        **1**          **1      **1**
                                                           1\***    

  --------------------------------- ------- -------------- -------- -------

  --------------------------------- ------- -------------- -------- --------
  **Litter bearers (includes                **6**          **8      **12**
  drivers)**                                               4\***    

  --------------------------------- ------- -------------- -------- --------

  --------------------------------- ------- -------------- -------- -------
  **Social Worker**                         **1**          **1      **1**
                                                           1\***    

  --------------------------------- ------- -------------- -------- -------

**(\*) -- Staff sent to support combined Triage Response Team with
Detroit VA. Detroit VA will send a Surgeon and two other Physicians on
combined response team. We will send the Director of Primary Care
Physician, One other General Medicine Physician and One Psychiatrist.**

**[Airport EOC]{.underline}**

**Emergency Preparedness Coordinator**

**Public Affairs (Check with Wayne Counter EOC)**

**Physician**

**Nursing Triage Team Leader**

**b. At the direction of the Chief of Staff, the Emergency Preparedness
Coordinator will activate the Triage Team and support personnel to
assemble in the staging area, [at least three (3) hours
before]{.underline} the estimated time of arrival of the medical airlift
flight.**

**c. Unloading and receipt of casualties from the aircraft will be
performed under the direction of the Air Lift personnel. The Triage
Nurse will receive the updated patient manifest and patient report from
the airlift clinical staff. The Emergency Preparedness Coordinator will
record time of a aircraft arrival and departure.**

**d. The condition of each patient will be assessed briefly at the
airport by the Triage Physician and Nurse. Vital signs and any comments
on the patient\'s condition will be recorded on the DoD 602 or the
Medical Emergency Triage (MET) tag and the tag will be torn to the
correct color to reflect priority for transportation, i.e. red -
urgent/ambulance, yellow - stable/ambulance, green - ambulatory. Changes
in the patient\'s condition during the flight may necessitate changes in
transportation to the hospital and bed assignment. If any casualty in
the Triage Area has a change of medical condition warranting emergency
care and transportation, the Nurse Triage Coordinator will immediately
call the Emergency Preparedness Coordinator for casualty transportation
via A.L.S. Ambulance. This A.L.S. Ambulance will be arranged by the
Airport Emergency Operations Center (EOC).**

**e. Every attempt will be made to transfer patients directly from the
airplane to the transporting vehicle. Stable patients may be transferred
to an airport hanger awaiting transportation.**

**f. See Appendix D for medical center decontamination procedures if any
patients are felt to be a contamination risk.**

**g. The Triage Coordinator has the authority to accept patients not on
the manifest, after confirming with Bed Control Coordinator that
appropriate beds are available.**

**4. Airport & Transportation:**

**a. Ground transportation to and from the airport will be arranged by
VA Police and Grounds & Transportation. If the acuity and/or number of
casualties exceed available vehicles, the nurse triage coordinator may
contact Beneficiary Travel to arrange to augment the team with
commercial ambulance service.**

**b. The Emergency Preparedness Coordinator, in conjunction with the
NDMS Coordinator from the Detroit VAMC, will coordinate security and
logistics to and from the airport.**

**c. Airport security is controlled by the Wayne County Sheriff\'s
Department. All VA vehicles and staff will be processed through this
check point prior to proceeding to the assigned aircraft hanger. The
Emergency Preparedness Coordinator will present a copy of the master
list of the transport team.**

**d. The hanger will be set up for basic patient assessment, as well as
emergency care.**

e.  **Prior to patient departure from the airport, the Nurse Triage
    Coordinator will advise the**

> **Emergency Preparedness Coordinator at the EOC of the number of
> patients, any changes in planned ward assignments, and the number of
> stretchers, wheelchairs, transporters,**
>
> **and clinical escorts required. The Emergency Preparedness
> Coordinator will relay this information to the medical center EOC via
> telephone. The EOC will advise the Associate Director for Patient Care
> to alert the nursing staff to prepare for arrival. Manpower and
> required personnel will be alerted to report to the ambulance garage.
> (See Appendix A, Notification). Police will be advised to barricade
> the area by the ambulance garage when information is received
> regarding airport departure.**

**5. Medical Center Reception of Casualties:**

**a. The Chief of Staff will ensure that physicians assigned for
admissions meet the patients on their assigned wards. The physicians
will be alerted to the planned arrival time from the airport.**

**b. Inpatient Care Units will provide wheeled litters and/or
wheelchairs to the ambulance garage to transport patients to their
wards, as required.**

**c. Upon arrival at the hospital, patients will be transported through
the ambulance garage, or designated reception site, directly to their
assigned beds on the wards. Transportation is through the ambulance
garage and to the ward via the freight elevator.**

**C. [RESPONSIBILITIES]{.underline}:**

**1. [MEDICAL CENTER DIRECTOR]{.underline}: The Medical Center Director
is responsible for all facets of planning and the execution of VA/DoD
plans through designated Medical Center staff.**

**a. Activate the Medical Center plan by initiating the Medical Center
Cascade Call System.**

**b. Direct cancellation of annual leave and training details as
necessary to meet the requirements of this plan.**

**c. Establish the Medical Center\'s Emergency Operations Center (EOC)
in the Medical Center Director\'s suite.**

**d. Coordinate work schedules for 24-hour coverage.**

**e. Notify veterans\' service organizations of the local situation.**

**2. [CHIEF OF STAFF (11)]{.underline}:**

**a. 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 triage and
reception team; evaluation/adjustment of clinical responsibility and
continuity of care, and curtailment of services/clinics.**

**b. Serves as Triage Coordinator with primary responsibility for
establishing the medical center\'s level of response to the patient
manifest.**

**c. Assign the physician component of the patient reception team and
coordinate the composition of the team.**

**3. [ASSOCIATE DIRECTOR FOR OPERATIONS (50)]{.underline}:**

**a. The AD for Operations has responsibility for administrative
planning, training, preparation, and execution of all support functions
associated with this plan through designated administrative staff.**

**b. Upon activation of the plan, the AD for Operations supports the
Medical Center\'s Emergency Operations Center in coordination with the**
**ADPCS,** **Chief of Staff and Medical Center Director.**

**c. Provide support personnel for manpower pool in accordance with
station FPP.**

**d. Ensure readiness of Police and Grounds & Transportation
components.**

**4. [KEY STAFF AND ALL SERVICE CHIEFS]{.underline}:**

**a. Provide to the Emergency Preparedness Coordinator (07) primary and
alternate points of contact for VA/DoD and other disaster/ contingency
planning and implementation with updates as changed.**

**b. Ensure short notice availability of trained staff to provide
complete diagnostic, nutritional and therapeutic assessments for a large
number of admissions.**

**c. Coordinate personnel, supply, and equipment requirements with
counterparts/suppliers. Be alert to the need for inventory changes to
support CHS.**

**d. Review, maintain, and be thoroughly familiar with this plan and its
enclosures.**

**e. Provide Human Resources with up-to-date information on the military
status of all employees.**

**f. Upon activation advise the Emergency Preparedness Coordinator (07)
of manpower needs affecting readiness and the need to replace staff
called to active duty.**

**g. Ensure that key employees are available by phone after hours.**

**h. Where appropriate, prepare and maintain service plans as annexes to
this plan.**

**5. [CHIEF, POLICE SERVICE (07)]{.underline}:**

**a. Designated as \"Emergency Preparedness Coordinator (EPC)\" for
planning and execution, serves as contact for the Military Patient
Administrative Team.**

**b. Coordinate preparation of the Medical Center\'s VA/DoD Contingency
Plan.**

**c. Certifies to Medical Center senior management that VA/DoD
requirements are met by the service plans, this Plan, and Enclosures to
this Plan.**

**d. Keep Medical Center staff advised of changes in VA/DoD requirements
and responsibilities.**

**e. Prepare and conduct the Medical Center Emergency Preparedness
Training Program.**

**f. Coordinate the Medical Center\'s participation in VA/DoD
Contingency Exercises.**

**g. Coordinate availability of communication equipment including
availability of back-up systems. Ensures issue of radios to airport
reception personnel.**

**h. Direct loading, set up and unloading of staff, equipment, and
supplies.**

**i. Coordinate airport patient reception activities.**

**6. [PUBLIC AFFAIRS OFFICER (OOA)]{.underline}:**

**a. Respond to local media inquiries and refer inquiries with VISN or
national significance to VISN 11 Emergency Operations Center (VEOC).**

**b. Designate and advise Police of the location of media room.**

**c. The Public Relations Coordinator is responsible for complying with
DoD and VA guidelines in preparing press releases and handling media
relations. A media station will be established upon activation of the
plan and introduce our facility and provide points of contact.**

**7. [BUSINESS OFFICE MANAGER (50B): ]{.underline}**

**a. Coordinate and submit bed availability reports.**

**b. Ensure staff readiness for patient reception. Designate
Pre-admissions screening staff member to work with patient manifest.**

**c. Coordinate patient assessments with clinical staff to facilitate
transfers.**

**d. Advise secondary facilities of VA patient transfers and potential
for direct transfer of DoD patients at the time of reception.**

**e. Ensure compliance with DoD policies regarding release of
information.**

**f. Coordinate patient transfer transportation with Transportation or
commercial sources.**

**g. Maintain current list of emergency contact points and alternates.**

**h. Ensure staff are trained in response to the cascade and ASMRO
notification system.**

**8. [ASSOCIATE CHIEF OF STAFF FOR AMBULATORY CARE
(ACOS/AC)]{.underline} (11A):**

**a. Serves as alternate Triage Coordinator as back up to the Chief of
Staff.**

**b. Assures adequate space for reception of patients.**

**c. Ensure proper evaluation and assignment of patients to the bed
services.**

**d. Nurse Triage Coordinator organizes nurses on Triage Team,
coordinates necessary supplies, medicine, and equipment, coordinates
layout, and airport triage.**

**9. [ASSOCIATE CHIEF OF STAFF FOR EDUCATION (ACOS/E)
(11E)]{.underline}:**

**a. Depending on the type of potential casualties, confer with the
Chief of Staff and Chief, Infectious Diseases Section to assess the need
for specialty training.**

b.  **Coordinate sensitivity and emotional support training with Chief,
    Psychiatry Service.**

**10. [GROUNDS AND TRANSPORTATION SUPERVISOR]{.underline}
(51G&T[)]{.underline}:**

**a. Transport transfer patients.**

**b. Ensure current on-call listing of trained drivers and litter
bearers to assist patient reception.**

**c. Provide support personnel for traffic control and manpower pool in
accordance with the station EPP.**

**d. Prepare/update transportation section of the medical center
capability assessment (Appendix C).**

**e. Assess potential threats to medical center and PRT and prepare
response plans.**

**f. Coordinate and maintain triage site security at the airport and
VAMC.**

**11. [ASSOCIATE DIRECTOR FOR PATIENT CARE SERVICE (30)]{.underline}:**

**a. Assist Chief of Staff and Business Office Manager (Bed Control) in
patient determination to meet required bed levels.**

**b. Assist Bed Control Coordinator in preparation of required bed
availability report.**

**c. Ensure adequate ward staffing to meet influx of casualties; advise
VA/DoD Coordinator of staffing assessment.**

**d. Provide one or more nursing staff to support duties as required for
the patient reception activities.**

**e. Provide wheeled litters and/or wheelchairs to the manpower pool on
1 West for the movement of patients.**

**12. CHIEF, [SOCIAL WORK SERVICE (122)]{.underline}:**

a.  **Confer with VA/DOD Coordinator, physicians and nursing staff to
    ensure a smooth**

> **transition for patients transferred to other facilities or
> discharged to free beds for incoming casualties. Chief, Social Work
> Service will assigned staff to make transfer/discharge arrangements.**

b.  **Establish and staff an information center to handle inquires from
    families/significant**

**others, etc.**

**c. Provide crisis intervention to incoming relatives and/or friends.**

d.  **Assist in locating next of kin/relatives of casualties.**

> **e. As coordinator of the Employee Assistance Program, Chief, Social
> Work Service will coordinate the EAP Counselors and others to debrief,
> defuse, and counsel staff involved in disaster services. This will be
> coordinated with the Clinical Director of the PTSD Clinic.**

**13. [CHIEF, LABORATORY SERVICE (113)]{.underline}: Establish contact
with local blood suppliers to refine procedures and ensure that
emergency supplies are sufficient.**

**14. [CHIEF, PSYCHIATRY SERVICE (116A)]{.underline}: Ensure current
roster of trained staff to work with the triage team. Assign one
psychiatrist to provide psychological stress debriefing to VAMC
employees.**

**15. [HUMAN RESOURCES SUPERVISOR (05).]{.underline}**

**a. Profile the VAMC work force, its potential for reduction through
medical reserves and its potential for expansion. Complete and update
the manpower Medical Center Capability Assessment.**

**b. Coordinate the reception manpower pool.**

**c. Provide support personnel for traffic control and manpower pool in
accordance with the station EPP.**

**16. [CENTRAL SUPPLY (54):]{.underline}**

**a. Ensure supplies are available for both triage at the airport and a
crash cart is available for reception at the medical center.**

**b. Anticipate and provide for urgent supply inventories and
equipment/maintenance and repair necessitated by the conflict or
implementation of CHS.**

**c. Manage linen needs in support of patient reception at both triage
sites (Det. Metro. and ambulance garage).**

**17. [FOOD PRODUCTION SUPERVISOR (55)]{.underline}: Ensure availability
of short notice meals or refreshments for incoming casualties and staff
coverage for nutritional assessments upon admission.**

**18. [FACILITIES MAINTENANCE (51M)]{.underline}:**

**a. Coordinate bed cleaning with Patient Care Service staff for
transfers and new patients.**

**b. Provide linens for triage team (linen cart)**

**c. Confer with nurse triage coordinator regarding cleaning
supplies/support for triage team.**

**d. Inventory DoD patient clothing/possessions and assess the need and
options for temporary patient storage.**

**19. [CHIEF, PHARMACY SERVICE (119)]{.underline}:**

**a. Ensure that the supply of IV solution and administration sets as
well as drugs is adequate to meet an increased demand.**

**b. Recommend alternate sources of procurement to Resource Officer.**

**20. [CHIEF RESOURCE OFFICER (20)]{.underline}:**

**a. Maintain current emergency source list for supplies, equipment and
drugs.**

**b. Track and record the cost of all drugs, medical supplies, services,
and equipment used to support a contingency as outlined in the VISN 11
VA/DoD Contingency Plan.**

**c. Complete all procedures necessary to obtain reimbursement from DoD
for treatment of military personnel and for supplies transferred, via
VACO identified mechanisms in the DHCP system, for submission of a bill
from VA to the respective DoD service. DoD will reimburse the VA for
care provided.**

**21. [MILITARY PATIENT ADMINISTRATIVE TEAM (PAT)]{.underline}: Upon
receipt of casualties, the Air Force will assign military administrative
support personnel to the Detroit area. This team will be responsible for
DoD personnel actions, pay, leave requests, notifications of next of
kin, patient visits, discharge or Medical Boards, and coordination of
discharge transportation. The PAT Team members may be reached through
the Utilization Management Supervisor (43).**

**22. [VETERANS BENEFITS]{.underline}: The Veterans Benefits Counselor
will work with the PAT Team to coordinate benefits counseling for
patients scheduled for Medical Boards and/or discharge.**

**V. [RESOURCE REQUIREMENTS.]{.underline}**

**A. Anticipated manpower shortages to effectively implement the CHS
will immediately be brought to the attention of the Emergency
Preparedness Coordinator and Human Resources Supervisor.**

**B. Assets critical for the initial 72 hours are available within
normal medical center operations. No additional resources are
anticipated at this stage. Depending on the type of conflict and
anticipated condition of the casualties, Service Chiefs will follow
standard procedures to adjust supply inventories, obtain special
equipment or clinical consults, and request additional scarce medical
specialists services. The Chief Resource Officer is responsible for
monitoring these expenditures and ensuring proper reimbursement.**

**VI. [PLAN REVIEW AND REVISION.]{.underline}**

**This plan will be reviewed annually by the Emergency Preparedness
Coordinator. The Medical Center Capability Assessment, Manpower
Assessment Table, and bed availability projections will be updated as
required.**

**VII. [TEST AND EXERCISES.]{.underline}**

**A. This plan will be tested in conjunction with the Detroit Federal
Coordinating Center\'s test of the National Disaster Medical System and
VA/DoD Contingency Plan with EMSHG, Martinsburg, W. VA.**

**B. Upon notification of alert status, all personnel involved with
triage, Police, transportation, and patient dispositions will receive
refresher training on proper procedures. Routine testing and training of
personnel will also be accomplished through annual testing of our
Emergency Preparedness Procedures.**

**Appendix A-1**

**NOTIFICATION**

**1. [FIRST ALERT TO STANDBY STATUS.]{.underline} This will be a general
notice from the VISN 11 Network Director to the Medical Center Director
that the VA/DoD Contingency Plan is being implemented.**

**a. NORMAL DUTY HOURS: Medical Center Director implements the Facility
Cascade Notification Plan to initiate readiness and advise staff of this
standby status.**

**b. AFTER NORMAL HOURS: Medical Center Director will assess the
situation and determine the level of notification, if any, prior to the
full cascade notice at the beginning of the next work day.**

**2. [ASMRO NOTIFICATION OF ASSIGNMENT OF PATIENTS.]{.underline} Notice
from ASMRO/Scott Air Force Base may be made to the Medical Center
Director, Administrative Officer of the Day (AOD), Emergency
Preparedness Coordinator or Chief, Information Officer via telephone,
FAX or E-mail. This notice will alert us to the assignment of DoD
patients to the Ann Arbor VAMC generally with an expected arrival time
of 24 - 72 hours. ASMRO will usually provide a patient manifest
indicating patient name, medical condition and status, transportation
limitations and any special equipment requirements.**

**a. NORMAL DUTY HOURS: The individual receiving initial notification
will assure that complete information is obtained with regard to
expected casualties (complete Appendix A-2 Record of ASMRO Notification)
and will immediately advise the medical center Medical Center Director.
Depending on the number of casualties, the Medical Center Director will
activate the plan and initiate a facility cascade notice such as:**

> **\"We are currently supporting the VA/DoD Contingency Hospital
> System. The medical center will be receiving active duty military
> casualties on (date) at approximately (time). Services with readiness
> responsibilities are to initiate their response. Airport triage and
> support personnel will be contacted with specific details. Implement
> the Facility Cascade Notification Plan\".**

**b. AFTER NORMAL DUTY HOURS: The AOD will ensure complete ASMRO
information is obtained (complete Appendix A-2 Record of ASMRO
Notification) and immediately notify the Business Office Manager who
will contact the triage coordinator to review the scope of our notice
and initiate patient discharge and transfer actions. If notification
indicates receipt of casualties in less than twenty-four (24) hours, the
Medical Center Director will be contacted and full activation of the
plan will be initiated. Otherwise, Facility Cascade notification will be
implemented at 8 a.m. the next workday or sooner at the direction of the
triage coordinator in consultation with the Medical Center Medical
Center Director.**

**3. [ASMRO FLIGHT CONFIRMATION]{.underline} When the plane is confirmed
in route to Detroit, ASMRO will contact the medical center. Telephone
calls are to be directed to the Medical Center Director (EOC) or the
AOD. Any change in expected flight information is to be relayed to the
Emergency Preparedness Coordinator.**

**4. [NOTICE THAT PATIENTS ARE DEPARTING THE AIRPORT]{.underline}.**

**a. Emergency Preparedness Coordinator advises medical center EOC of
expected time of arrival.**

**Appendix A-2**

b\. Medical Center Director implements cascade as appropriate: \"We
expect DoD patient reception at (state time). Implement the Facility
Cascade. Manpower pool and personnel with duties involved in patient
reception are to immediately report to the ambulance garage (or
designated reception site)\".

**Appendix A-3**

**RECORD OF ASMRO NOTIFICATION**

**THE PERSON RECEIVING THE INITIAL NOTIFICATION OF ASMRO\'S INTENT TO
SEND CASUALTIES TO VAMC ANN ARBOR WILL ASSURE THAT THEY HAVE AS MUCH OF
THE FOLLOWING INFORMATION AS POSSIBLE:**

**1. TOTAL NUMBER OF CASUALTIES BEING SENT**

+-------------------------------------------------------+--------------+
| **MM MEDICINE & NEUROLOGY:**                          |              |
|                                                       |              |
| **SS SURGERY (EXCEPT ORTHO):**                        |              |
|                                                       |              |
| **SO ORTHOPEDIC SURGERY:**                            |              |
|                                                       |              |
| **MP PSYCHIATRY:**                                    |              |
|                                                       |              |
| **OTHER**                                             |              |
+-------------------------------------------------------+--------------+

**2. EXPECTED DATE AND TIME OF ARRIVAL OF FLIGHT (ETA)**

**3. CONTACT PERSON COMMERCIAL PHONE NUMBER ( )**

**(MILITARY PERSON WHO CAN ANSWER QUESTIONS ABOUT THE FLIGHT)**

**4. WHEN & HOW MANIFEST\* WILL BE SENT: DATE [/ /]{.underline} FAX
TWX**

**\*LIST OF PATIENTS WITH THE FOLLOWING MINIMAL INFORMATION:**

**NAME: SSN: [- -]{.underline} DIAGNOSIS:**

**TRANSPORTATION REQUIRED:**

**5. MESSAGE RECEIVED BY: DATE & TIME:**

**6. NOTIFICATION DELIVERED TO MEDICAL CENTER Medical Center Director
BY:**

**ON DATE & TIME:**

**Appendix B-1**

**BED REPORTING**

**1. [ANNUAL ASSESSMENT AND PLAN]{.underline}: Annually, the Business
Office Manager (Bed Control Coordinator) determines the average percent
of service connected patients treated by Medicine, Surgery and
Psychiatry services in the hospital and the Nursing Home Care Unit
(ECERC). These percentages are used to determine the maximum number of
beds that can be made available for VA/DoD Contingency use and the
number of beds that can be made available in 24 and 72 hours. (See
Appendix B-2, Bed Availability Plan).**

**2. [QUARTERLY REPORTING]{.underline}: VHA HANDBOOK 0320.1, dated May
1, 1997, defines Quarterly bed reporting requirements.**

**3. [FORUM ACCESS FOR VA/DoD BED REPORTS AND MOBILIZATION
REPORTS]{.underline}: The Business Office (Bed Control Coordinator) has
to submit quarterly and more frequent reports in the event of VA/DoD
Contingency Plan implementation.**

**4. [IMPLEMENTATION OF VA/DoD BED REPORTING]{.underline}:**

**a. Day One.**

**1) Notice is received that VA/DoD Bed Reporting is to be initiated.**

**2) Business Officer Manager (Bed Control Coordinator) or designee
notifies Patient Care Services of the need to identify inpatients who
can be discharged or transferred over the next 3 days for completion of
their care to: VAMC Battle Creek; VAMC Saginaw; our Nursing Home;
Contract Nursing Home and those patients who can be discharged to their
own home to make room for incoming casualties.**

**3) Ward clerks provide ward rosters and identify the nearest VAMC to
the patient\'s home.**

**4) Transfers to Battle Creek and Saginaw for the current day are
called to their individual VA/DoD Bed Reporting offices before 11 a.m.**

**5) Bed Control Coordinator/Admitting reports number of scheduled
admissions LESS all service connected and emergent non-service connected
patients for the current day and next two days.**

**6) Patients who can be discharged or transferred over the next two
days are identified by Unit Managers and reported no later than noon.**

**7) 24/72 HOUR BED AVAILABILITY form is completed by Bed Control
Coordinator or designee with the above information and the report is
entered in the VA/DoD Bed Reporting System on FORUM before 1 p.m.**

**Appendix B-2**

**8) List of patients who can be discharged or transferred is reviewed
by the Attending Physician and additional information is obtained as
necessary so that transfers can be arranged for the following day.**

**9) Reports from FORUM showing Ann Arbor Bed Availability and Secondary
Sites are reviewed at morning meeting.**

**b. Subsequent Days.**

**1) Ward Clerks provide ward rosters and identify the nearest VAMC to
the patient\'s home.**

**2) Nurses identify patients who could be discharged home or
transferred to VAMC Battle Creek or Saginaw, ECC or Contract Nursing
Home for the current day and next two days. They report Diagnosis; Care
requirements and transportation requirements for patients who could be
transferred reviewing this list with attending physicians for
approval.**

**3) Admitting person reports number of scheduled admissions LESS all SC
and Emergent NSC patients for the current day and next two days.**

**4) Admitting person reports number of transfers to Battle Creek and
Saginaw (coordinated with Travel Clerk) and discharges anticipated for
the day broken down by ward/service.**

**5) Transfers to Battle Creek and Saginaw for the current and next two
days are called to their individual VA/DoD Bed Reporting offices before
11 a.m.**

**6) 24/72 HOUR BED AVAILABILITY form is completed by Bed Control
Coordinator or designee with the above information and the report is
entered in the VA/DoD Bed Reporting System on FORUM before 1 p.m.**

**7) Reports from FORUM showing Bed Availability for Ann Arbor and
Secondary Sites are reviewed at morning meeting.**

**Appendix B-3**

**VA/DoD CONTINGENCY HOSPITAL SYSTEM \-- FY PLANNING**

**VA ANN ARBOR HEALTHCARE SYSTEM SUMMARY**

**FACILITY NAME [VAMC Ann Arbor]{.underline} VISN NO. [11]{.underline}**

**STATION NO. [506]{.underline}**

+-----------------------------------------------------------------------+
| **FUNCTIONAL CODE Check appropriate Box(es):**                        |
|                                                                       |
| **FEDERAL COORDINATING CENTER (FCC SUPPORT CENTER) \_\_\_\_\_\_       |
| INSTALLATION SUPPORT CENTER (SIC)**                                   |
|                                                                       |
| **[X]{.underline} PRIMARY RECEIVING CENTER (PRICE) \_\_\_\_\_\_       |
| SECONDARY SUPPORT CENTER (SSMC)**                                     |
+-----------------------------------------------------------------------+

<table style="width:100%;">
<colgroup>
<col style="width: 17%" />
<col style="width: 10%" />
<col style="width: 10%" />
<col style="width: 0%" />
<col style="width: 14%" />
<col style="width: 0%" />
<col style="width: 8%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 11%" />
<col style="width: 0%" />
<col style="width: 10%" />
</colgroup>
<tbody>
<tr class="odd">
<td><strong>VA BED SECTION</strong></td>
<td><strong>FY 98 SECTION OPERATING BEDS</strong></td>
<td colspan="2"><strong>FY 97 AVERAGE % OF SC IN-PATIENTS</strong></td>
<td><strong>PATIENT EVALUATION DoD CATEGORY</strong></td>
<td colspan="7"><strong>NUMBER OF BEDS TO BE MADE AVAILABLE TO
DoD</strong></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="3"><strong>DESCRIPTION</strong></td>
<td><strong>SYMBOL</strong></td>
<td><strong>24 HOURS</strong></td>
<td><strong>72 HOURS</strong></td>
<td colspan="2"><strong>MAXIMUM BEDS IN 30 days</strong></td>
<td><strong>DAYS TO achieve</strong></td>
</tr>
<tr class="odd">
<td><strong>MEDICINE</strong></td>
<td><strong>53</strong></td>
<td><strong>39%</strong></td>
<td colspan="3"><strong>MEDICINE</strong></td>
<td><strong>MM</strong></td>
<td><strong>4</strong></td>
<td><strong>15</strong></td>
<td colspan="2"><strong>41</strong></td>
<td></td>
</tr>
<tr class="even">
<td><strong>PSYCH</strong></td>
<td><strong>24</strong></td>
<td><strong>47%</strong></td>
<td colspan="3"><strong>PSYCHIATRY</strong></td>
<td><strong>MP</strong></td>
<td><strong>4</strong></td>
<td><strong>13</strong></td>
<td colspan="2"><strong>23</strong></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>SURGERY</strong></td>
<td><strong>35</strong></td>
<td><strong>37%</strong></td>
<td colspan="3"><strong>SURGERY</strong></td>
<td><strong>SS</strong></td>
<td><strong>4</strong></td>
<td><strong>10</strong></td>
<td colspan="2"><strong>31</strong></td>
<td></td>
</tr>
<tr class="even">
<td><strong>OTHER HOSPITAL BEDS</strong></td>
<td></td>
<td></td>
<td colspan="3"><strong>ORTHOPEDICS</strong></td>
<td><strong>SO</strong></td>
<td><strong>1</strong></td>
<td><strong>2</strong></td>
<td colspan="2"><strong>4</strong></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>TOTAL HOSPITAL BEDS</strong></td>
<td><strong>112</strong></td>
<td><strong>40%</strong></td>
<td colspan="3"><strong>SPINAL CORD INJURY</strong></td>
<td><strong>SC</strong></td>
<td><strong>0</strong></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td><strong>NURSING HOME</strong></td>
<td><strong>60</strong></td>
<td><strong>42%</strong></td>
<td colspan="3"><strong>BURNS</strong></td>
<td><strong>SB</strong></td>
<td><strong>0</strong></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>DOMICILIARY</strong></td>
<td></td>
<td></td>
<td colspan="3"><strong>OB/GYN</strong></td>
<td><strong>SG</strong></td>
<td><strong>0</strong></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td><strong>TOTAL SITE BEDS</strong></td>
<td></td>
<td></td>
<td colspan="3"><strong>PEDIATRICS</strong></td>
<td><strong>MC</strong></td>
<td><strong>0</strong></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><p><strong>***INSTALLATION SUPPORT CENTERS (ISC)
ONLY</strong></p>
<p><strong>LIST SUPPORTED DoD INSTALLATION(S)</strong></p></td>
<td colspan="3"><strong>NEURO-SURGERY</strong></td>
<td><strong>SSN</strong></td>
<td><strong>0</strong></td>
<td><strong>1</strong></td>
<td colspan="2"><strong>3</strong></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="3"><strong>MAXILLO-FACIAL</strong></td>
<td><strong>SSM</strong></td>
<td><strong>0</strong></td>
<td><strong>0</strong></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="3"><p><strong>NOTE: OPERATING BEDS FOR FY97 WERE USED DUE
TO A REDUCTION IN BEDS WHICH TOOK EFFECT</strong></p>
<p><strong>10-1-96</strong></p></td>
<td colspan="3"><strong>OPHTHAL-MOLOGY</strong></td>
<td><strong>SSO</strong></td>
<td><strong>1</strong></td>
<td><strong>2</strong></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="3"><strong>THORACIC SURGERY</strong></td>
<td><strong>SSCT</strong></td>
<td><strong>0</strong></td>
<td><strong>1</strong></td>
<td><strong>3</strong></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td colspan="3"><strong>UROLOGY</strong></td>
<td><strong>SSU</strong></td>
<td><strong>1</strong></td>
<td><strong>2</strong></td>
<td><strong>3</strong></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="3"><strong>TOTAL BEDS</strong></td>
<td><strong>TOT</strong></td>
<td><strong>15</strong></td>
<td><strong>46</strong></td>
<td><strong>108</strong></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

**\* Specify the number of days required to achieve maximum bed
availability.**

**\*\* Use the most recent full fiscal year data.**

**NAME/TITLE OF INDIVIDUAL PREPARING REPORT: [Mira
Pierson]{.underline}**

**TELEPHONE NO. [(734) 769-7100 ext. 5272]{.underline} DATE OF REPORT:
April 2003**

**Appendix B-4**

**24/72 HOUR BED AVAILABILITY WORKSHEET**

+-------------------+-------------------+--------+----------+----------+
| **VACANT BEDS**   | **MM(MED, NEURO,  | **MP(  | **SS     | **SO     |
|                   | DER**             | PSY)** | (SURG)** | (ORTH)** |
| **FROM TODAY\'S   |                   |        |          |          |
| G&L**             | **[               | **[    | **[-     |          |
|                   | -2]{.underline}** | \--]{. | 2]{.unde |          |
| **ADJUSTMENTS:**  |                   | underl | rline}** |          |
|                   |                   | ine}** |          |          |
| **BEDS NOT TO     |                   |        |          |          |
| COUNT**           |                   |        |          |          |
|                   |                   |        |          |          |
| **EMERG ADMITS &  |                   |        |          |          |
| D/C**             |                   |        |          |          |
+-------------------+-------------------+--------+----------+----------+

**x .15 = \*\***

**- \*\***

  ---------------------------- -------- --------- ------------ -----------
  **1. 24 hour bed                                **\*\*\***   **\*\***
  availability to report on                                    
  FORUM BSR:**                                                 

  ---------------------------- -------- --------- ------------ -----------

**FOR THE NEXT 72 HOURS TODAY (T), T+1, T+2)**

<table style="width:100%;">
<colgroup>
<col style="width: 0%" />
<col style="width: 40%" />
<col style="width: 0%" />
<col style="width: 13%" />
<col style="width: 4%" />
<col style="width: 10%" />
<col style="width: 6%" />
<col style="width: 7%" />
<col style="width: 15%" />
<col style="width: 0%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="3"><p><strong>T</strong></p>
<p><strong>T+1</strong></p>
<p><strong>T+2</strong></p>
<p><strong>2. Less all SC &amp; Emergent NSC</strong></p>
<p><strong>Scheduled Admits TOTAL</strong></p>
<p><strong>3. Discharges to ECERC Home,</strong></p>
<p><strong>NH &amp; Other</strong></p>
<p><strong>4. Transfers to</strong></p>
<p><strong>a. VAMC Battle Creek</strong></p>
<p><strong>b. VAMC Saginaw</strong></p>
<p><strong>5. LESS EMERG ADMITS</strong></p></td>
<td colspan="2"><p><strong><u>-</u></strong></p>
<p><strong><u>-5</u></strong></p></td>
<td colspan="2"><p><strong><u>-</u></strong></p>
<p><strong><u>-1</u></strong></p></td>
<td colspan="2"><p><strong><u>-</u></strong></p>
<p><strong>(TO A MM BED)</strong></p>
<p><strong><u>-3</u></strong></p>
<p><strong>x .15 = **</strong></p>
<p><strong><u>-</u> **</strong></p></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td><strong>6. 72 Hour bed availability to report on FORUM
BSR:</strong></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"><strong>***</strong></td>
<td colspan="2"><strong>**</strong></td>
</tr>
</tbody>
</table>

**\*\* The total Surgery beds to be made available consist of 85%
surgery and 15% Orthopedic Surgery. Since individual specialties are not
monitored here, the most accurate way to report is to use the
calculations shown.**

**Patient Transfers: Adequate transportation: [YES]{.underline} Transfer
comments: Battle Creek: MM MP Saginaw: MM SS**

**Appendix C-1**

**VA/DoD CONTINGENCY PLAN**

**MEDICAL CENTER CAPABILITY ASSESSMENT**

> **1. [PURPOSE]{.underline}: This appendix is a partial survey of
> Medical Center capability, valid as of the date completed. It is
> intended as an aid in planning prior to activation of the contingency
> plan and as a tool for actual assessment upon implementation.**
>
> **2. [RESPONSIBILITY]{.underline}: The responsible Chiefs of Service
> are indicated adjacent to the functional section below. Where data is
> not normally available within the assigned section, it will assume a
> lead role, collect the data from the proponent and complete the
> functional section as assigned. They will update this assessment
> immediately upon implementation of the plan or, as directed, whenever
> implementation appears imminent. They are [responsible for
> recommending additions and changes to this assessment]{.underline} to
> ensure that appropriate information is available for planning and
> that, when required, it provides the Medical Center Director with a
> truly timely and essential assessment of the VAMC to handle
> emergencies. They maintain appropriate systems to update the
> assessment on short notice.**
>
> **a. The assessment will be updated when the plan is reviewed
> annually.**
>
> **b. The assessment will be updated at the call of senior management
> and within eight hours of activation of a contingency plan.**
>
> **3. [BEDS]{.underline} (Business Office-Bed Control Coordinator)**
>
> **a. How many unoccupied beds do you have in your hospital daily?
> [17]{.underline}**
>
> **b. How many of these unoccupied beds are not available because of:**
>
> **(1) Staff (identify category)? (Staffed bed defined at Note): [0
> ]{.underline}**
>
> **(2) Construction: [0 ]{.underline}**
>
> **(3) Equipment: [0 ]{.underline}**
>
> **(4) Support Service: [0 ]{.underline}**
>
> **(5) Other (identify): [0 ]{.underline}**
>
> **NOTE: A staff bed is one with an acceptable patient/staff ration. It
> is currently available for patient care and free from constraints such
> as construction related closure, lack of equipment, lack of support
> service and other factors.**
>
> **c. How many service-connected patients do you average on an annual
> basis? [38% ]{.underline}**
>
> **Appendix C-2**
>
> **d. How many patients could you discharge in each of your bed
> sections to make beds available for incoming casualties within? \***

+-------------------------------------+---+-------------+------------+
| **MM (Medicine)**                   |   | **24        | **72       |
|                                     |   | HOURS**     | HOURS**    |
| **MP (Psychiatry)**                 |   |             |            |
|                                     |   | **4**       | **15**     |
| **SS (Surgery)**                    |   |             |            |
|                                     |   | **4**       | **13**     |
| **SO (Orthopedics)**                |   |             |            |
|                                     |   | **4**       | **10**     |
| **SC (Spinal Cord Injury)**         |   |             |            |
|                                     |   | **1**       | **2**      |
| **SB (Burns)**                      |   |             |            |
|                                     |   | **1**       | **1**      |
| **SG (OB/GYN)**                     |   |             |            |
|                                     |   | **1**       | **2**      |
| **MC (Pediatrics)**                 |   |             |            |
|                                     |   | **15**      | **2**      |
| **SS (Neurology)**                  |   |             |            |
|                                     |   |             | **2**      |
| **SS (Opthy)**                      |   |             |            |
|                                     |   |             | **46**     |
| **SS (Thoracic)**                   |   |             |            |
|                                     |   |             |            |
| **SS (Urology)**                    |   |             |            |
|                                     |   |             |            |
| **TOTAL**                           |   |             |            |
+-------------------------------------+---+-------------+------------+

> **\*Discharge will be addressed case by case. This is strictly a
> planning estimate.**
>
> **e. How many beds do you have assigned in each of the eight
> evacuation categories?**

+-----------------------------------+----+-----------------------------+
| **MM (medicine)**                 |    | **68**                      |
|                                   |    |                             |
| **MP (psychiatry)**               |    | **44**                      |
|                                   |    |                             |
| **SS (surgery)**                  |    | **47**                      |
|                                   |    |                             |
| **SO (Orthopedics)**              |    | **10**                      |
|                                   |    |                             |
| **SC (Spinal Cord Injury)**       |    | **0**                       |
|                                   |    |                             |
| **SB (Burns)**                    |    | **0**                       |
|                                   |    |                             |
| **SG (OB/GYN)**                   |    | **0**                       |
|                                   |    |                             |
| **MC (Pediatrics)**               |    | **0**                       |
+-----------------------------------+----+-----------------------------+

> **f. Do you have flexibility in reassigning beds in these eight
> categories? [Some]{.underline}**
>
> **g. Do you have an area in your medical center where less acute
> patients could be temporarily housed while awaiting disposition to
> another level of care? [No]{.underline}**
>
> **h. What community agencies would allow expansion of existing
> contract to utilize available beds in their agency for VA patient
> workload? [Possibly community nursing homes.]{.underline}**
>
> **i. What potential exists within your community to contract for bed
> services? [N/A ]{.underline}**
>
> **4. [HUMAN RESOURCES]{.underline}: (Human Resources Supervisor)
> Profile the VAMC work force, its potential for reduction through
> medical reserves and its potential for expansion through several
> alternatives.**
>
> **\*a. Age of work force (see Appendix C-2):**
>
> **\*b. Number of Reserve and National Guard staff: [65 ]{.underline}**
>
> **Appendix C-3**
>
> **\*c. Number of retired military subject to recall: [23
> ]{.underline}**
>
> **\*d. Number of staff with dual appointments (list clinical
> specialties represented on medical staff that can be relied upon in a
> contingency): [At first alert, HR Supervisor will survey each service
> for current information.]{.underline}**
>
> **\*e. Number of trainees assigned by service (assess by individual
> service to determine area of vulnerability):**

+--------------------------+-------+-------------------------+--------+
| **SERVICE**              | *     | **SERVICE**             | **TRA  |
|                          | *TRAI |                         | INEE** |
| **DENTAL**               | NEE** | **PSYCHIATRY**          |        |
|                          |       |                         | **15** |
| **DERMATOLOGY**          | **8** | **PSYCHOLOGY**          |        |
|                          |       |                         | **6**  |
| **Medical Center         | **3** | **RADIATION ONCOLOGY**  |        |
| Director's OFFICE**      |       |                         | **3**  |
|                          | **2** | **RADIOLOGY**           |        |
| **MEDICINE**             |       |                         | **12** |
|                          | **    | **PHYSICAL MEDICINE &   |        |
| **NEUROLOGY**            | 110** | REHAB**                 | **1**  |
|                          |       |                         |        |
| **NUCLEAR MEDICINE**     | **5** | **SOCIAL WORK**         | **5**  |
|                          |       |                         |        |
| **NURSING**              | **4** | **SURGERY**             | **30** |
|                          |       |                         |        |
|                          | **    |                         |        |
|                          | 125** |                         |        |
+--------------------------+-------+-------------------------+--------+

> **\*f. Retired VA employees (local and within 50 miles): [Unknown - HR
> will attempt to contact critical clinical position retirees at last
> known address.]{.underline} HRM Service will also contact OPM to
> obtain a list of retirees in the commuting area.**
>
> **\*g. Identify the potential groups within the medical center that
> could be a source of personnel:**
>
> **(1) Volunteers: HR to coordinate search with the Coordinator,
> Voluntary Services.**
>
> **(2) Veterans organizations: HR to coordinate search with
> Coordinator, Voluntary Services.**
>
> **(3) Red Cross: HR to coordinate contact with Voluntary Services.**
>
> **(4) Other groups: HR to contact Michigan Employment Security
> Commission.**
>
> **h. What potential do you have to expand tours of duty? [Use overtime
> and implement at direction of Medical Center Director.]{.underline}**
>
> **i. What potential do you have to expand the work week? [Implement at
> direction of Medical Center Director.]{.underline}**
>
> **j. Which functions could be curtailed or restricted to increase
> available staff for direct care? [At discretion of Chief of Staff and
> Medical Center Director, restrict clinic, surgeries and recreational
> programs.]{.underline}**
>
> **Appendix C-4**
>
> **k. Will special training be needed for individuals assuming
> additional or new assignments?**
>
> **(1) Nursing Assistants:**
>
> **(2) Escorts: [possible]{.underline}**
>
> **(3) Drivers: [possible]{.underline}**
>
> **(4) Supply Assistants: [possible]{.underline}**
>
> **(5) Other (list):**
>
> **l. Can you identify individuals within employees/staff/volunteers
> having skills gained through hobby activities? [Need to survey
> employees and review OPF\'s to establish a skills
> inventory.]{.underline}**
>
> **m. Could you absorb personnel from other medical centers within your
> work force? (Training credentialling and privileging must be
> considered). [Yes - Adequate support staff exist.]{.underline}**
>
> **n. Describe your preparation to absorb transferred VA employees:**
>
> **(1) Temporary housing: [Canvas staff as volunteer host, use
> hotels.]{.underline}**
>
> **(2) Training: [ACOS for Education will assess and meet requirements
> as needs arise.]{.underline}**
>
> **(3) Support systems:**
>
> **(4) Credentialling and privileging: [Chief of Staff and clinical
> staff support will expedite the process.]{.underline}**
>
> **(5) Feeding: [see (1) above.]{.underline}**
>
> **(6) Other:**
>
> **5. [SUPPLIES AND EQUIPMENT:]{.underline} (AD for Operations and
> Chief Resource Officer) Profile for top management, the VAMC\'s
> ability to sustain operations under emergency circumstances. Plan
> continued development of these links prior to need. Consider the
> following issues when developing the contingency supply and
> equipment/resource procurement plan.**

**a. Source: Supplies and equipment can be obtained from local,
national, VA/DoD depots and other VA Ann Arbor Healthcare Systems.**

> **(1) Local: DETROIT VA Medical Center Owens & Minor Inc.**
>
> **(313) 576-1000 Plymouth, MI (734) 455-9300**
>
> **McKesson Medical Corp. Krasity's Med & Surg Supply**
>
> **Livonia, MI (800) 877-1919 Dearborn, MI (800) 537-1394**

(2) **State: Battle Creek VA Medical Center**

**616-966-5600**

> **Selfridge Air National Guard Base American Diagnostic Supply**
>
> **Selfridge, MI (586) 308-3418 Flint, MI (800) 426-3353**
>
> **Appendix C-5**
>
> **(3) National:**
>
> **Baxter V Meuller Labelco**
>
> **Deerfield, IL (800) 323-9088 Minneapolis, MN (800) 522-3526**
>
> **Abbott Laboratories Johnson & Johnson**
>
> **North Chicago, IL (800) 222-6883 New Brunswick, NJ (800) 932-3026**

**Medline Industries**

**Mondelein, IL (800) 535-4390**

**b. Stock-Levels: 45 days**

**c. Inventory of items maintained by the Generic Inventory Package
(GIP)**

**d. Inventory of station equipment maintained by the Item Locator in
PPM & Ames/Mers.**

**e. Disposable items which could be replaced with non-expendable:
Basins, urinals, suture hits or trays and packs.**

**f. Foreign made parts: Maintenance Contractors for foreign-made
equipment.**

**g. Drugs (Chief, Pharmacy Service):**

> **(1) Available quantities - pre determined**
>
> **(2) Shelf life**
>
> **(3) Variety or variations**
>
> **(4) Storage capacity**

**h. Other Pharmaceutical supplies: See All Sources Listed in Item a.**

**i. Subsistence:**

> **Ann Arbor Produce Burdick Packing Co. Sysco Meisel**

**Ann Arbor, MI (734)662-3101 Battle Creek, MI (616)962-5111 Canton, Mi
(800) 366-3577**

> **Gordon Food Service N Leone & Sons**
>
> **Ypsilanti, MI (734) 677-2500 Livonia, MI (734) 427-7650**

**j. Blood, blood products:**

> **American Red Cross American National Red Cross Ortho Diagnostics**
>
> **Laboratory Blood Services Detroit, MI (734) 833-4690 Raritan, NJ
> (800) 322-6374**
>
> **Detroit, MI 48277 Toledo, OH (419) 242-1541 (Typing Sera)**

**k. Radiology supplies:**

> **University of Michigan Hospitals Bard, Radiology Division Eastman
> Kodac Co.**
>
> **Department of Radiology Murray Hill, NJ Scientific Imaging Systems**
>
> **Ann Arbor MI (734) 936-6939 (800) 526-4455 Rochester, NY. (800)
> 225-5352**
>
> **Appendix C-6**

**l. Laboratory supplies:**

> **Baxter Co. Coulter Corp.**
>
> **Renal Products Division, Deerfield, IL (800) 284-4060 Miami, FL
> (800) 526-7694**

**Edward Division, Irvine, CA (800) 428-3278**

**V Mueller Division, McGaw Park, IL (800) 323-9088**

> **Fuji Photo Film USA Inc. Organon Teknika Corp.**
>
> **Lanham, MD (800) 345-0845 Durham, NC (800) 682-2666**
>
> **Baxter Critical Care Fisher - CMS**
>
> **Edwards Critical Care Division Wooddale, IL (800) 562-9265**

**Brighton, MI (810) 229-0077**

**m. Specialty Item Sources: Ann Arbor\'s proximity to urban suppliers &
manufacturers would facilitate acquisition of specialty items.**

**n. Special Equipment Needs:**

> **(1) Will you need to have different equipment to manage a different
> case mix? [Possibly, depending on patient manifest.]{.underline}**
>
> **(2) Availability of repair technicians: [On staff]{.underline}**
>
> **(3) Portable equipment: [N/A]{.underline}**
>
> **(4) Fixed equipment: [N/A]{.underline}**
>
> **o. Other - Identify: [N/A]{.underline}**
>
> **6. [SPACE]{.underline} (Facilities Management Officer and Facilities
> Maintenance Supervisor)**
>
> **a. Storage capability:**
>
> **(1) Triage supplies - SPD**
>
> **(2) DoD patient baggage, clothing, valuables - [Patients Clothing
> Room would need to be supplemented.]{.underline}**
>
> **b. Combining of functional activities for other needs:**
>
> **c. Rubbish disposal:**
>
> **d. Temporary facilities needed:**
>
> **e. Additional areas:**
>
> **(1) Media room**
>
> **(2) Military patient administration team office**
>
> **Appendix C-7**
>
> **7. [COMMUNICATIONS]{.underline}: (Chief, Information Officer)**
>
> **a. Identify all existing communications presently in use or
> available as backup for your facility:**
>
> **(1) Telephone: Internal PBX with many Direct In Dial (DID) lines.
> Cellular and Wireless phones. Several pay phones. We have four fax
> machines with DID lines.**
>
> **(2) Teletype: Served by the PCTS network. We currently receive DoD
> traffic for the UM ROTC facility.**
>
> **(3) Paging systems: In-house, local (10 mile radius) voice paging
> system. Approximately 15 leased, long-range numeric radio pagers.
> In-house Public Address system.**
>
> **(4) Emergency radio (ham, CB, amateur radio groups): clubs are in
> the area with no direct affiliation with the VAMC.**
>
> **(5) Radio/TV stations (internal & community): There is an internal
> MATV system with one in-house channel. There is a cable company in the
> community with Community Access Channels.**
>
> **(6) The HEAR radio network is a local radio network used by
> community medical centers and the VAMC and ambulance companies. Used
> daily and during local disasters.**
>
> **(7) VA communication linkages: The VA\'s IDCU network connects the
> VA nationwide to FORUM, FOURWORD, etc. These same services are also
> available to a limited extent via modem lines via the public telephone
> system.**
>
> **(8) Messenger services: Federal Express has the contract for
> expedited mail services. In-house mail room staff are available for
> routing high priority hard copy.**
>
> **(9) Other: Mobile radios (car base stations and walkie-talkies) are
> used for internal communications. These are also used for
> communicating with VA receiving teams at the EOC (Emergency Operations
> Center) at Detroit Metropolitan Airport during the activation of the
> VA/DoD Contingency plan. They have the ability to communicate with
> both the Ann Arbor and DETROIT VAMCs by switching between their two
> radio frequencies.**
>
> **b. Review what resources will be needed to replace any of the
> systems that might fail:**
>
> **(1) Items 1, 3, 6, 7 and 9 are under Maintenance Contracts. Item 2
> would require a backup PC that could be pre-loaded with the PCTS
> software.**
>
> **c. Identify all available communication systems in your area that
> would allow your facility to communicate with external agencies:**
>
> **The telephone, FORUM\'s e-mail gateway to the Internet, and Federal
> Express are the communications paths to external federal agencies. The
> HEAR radio system is the path for community disaster\' medical
> communications.**
>
> **d. What is the potential for networking your communications system
> with:**
>
> **(1) Local & state emergency agencies: We can currently communicate
> with them by telephone, fax, or modem. The HEAR radio network is the
> local medical disaster communications network that this VAMC is part
> of.**
>
> **Appendix C-8**
>
> **(2) Other Federal agencies, including the military: Telephone, fax,
> modem, FORUM\'s e-mail gateway to the Internet are the communications
> pathways available to communicate with other Federal agencies,
> including the military.**
>
> **(3) Other VA Ann Arbor Healthcare Systems: Telephone, fax, modem,
> and the IDCU data network are the communication paths that can be used
> to communicate with other VA Ann Arbor Healthcare Systems.**
>
> **e. Are your communication systems in areas where priority needs
> exist? Yes.**
>
> **f. Are you integrated into local community emergency systems? Yes.**
>
> **g. What modification of your existing communication systems would
> enhance your capability? Identify costs associated with modification
> and consider making those modifications.**

**A cellular phone for communications is available in EOC.**

> **8. [CONTRACTUAL SERVICES]{.underline}: (Chief Resource Officer
> lead/coordinate\...)**
>
> **a. Existing contracts and formal and informal MOUs:**
>
> **(1) Services provided:**
>
> **Home Oxygen Service Contract: V553P-9141**
>
> **Rotech Medical Corp Exp: 9/30/03**
>
> **1280 W. Oklahoma, Ulysser, KS 67880 620-356-5451**
>
> **Emergency Contract: V506P-3431**
>
> **Huron Valley Ambulance Exp: 9/30/03**
>
> **2215 Hogback Road, Ann Arbor, MI 48105 (734) 971-4420**
>
> **Non-Emergency Transportation Contract: V506 P-3545**
>
> **Nets Exp: 9/30/03**
>
> **P.O.Box 761, Jackson, MI 49204-0761 888 873-6387**
>
> **Non-Emergency Transportation Contract: V506P-3546**
>
> **Safe Transportation Exp: 9/30/03**
>
> **P.O.Box 98-0737, Ypsilanti, MI 48198 734-481-0838**
>
> **Non-Emergency Transportation Contract: V506P-3547**
>
> **Care Transportation Ext: 9/30/03**
>
> **2866 Golfside, Ann Arbor, MI 48108 734-434-6786**
>
> **(2) Services provided with in-house capacity: Non-critical
> transportation services, all necessary diagnostic & therapeutic
> services.**
>
> **b. Expanded needs: To be determined as needed.**
>
> **c. Revision of regulatory requirements: The public exigency
> authority would be used to bypass normal procedures & expedite
> contracting of services.**
>
> **d. Any contracts that would be affected by increased demands:
> Excessive increased demands would affect all requirements-type
> contracts.**
>
> **Appendix C-9**
>
> **e. Identify other government agencies where contracts could be
> developed: Defense Logistics Agency (DLA) & General Services
> Administration (GSA).**
>
> **f. Identify other government agencies where contracts could be
> developed.**
>
> **9. [TRANSPORTATION]{.underline}: (Transportation Supervisor)**
>
> **a. Available station vehicles: The following vehicles will support
> the VA/DoD CHS: (During initial notification TAG numbers will be
> submitted to the VA/DoD Coordinator):**

+---------------------+-----------+------------------------------------+
| **[VEH              | **[       | **[CAPACITY]{.underline}**         |
| ICLE]{.underline}** | TAG]{.und |                                    |
|                     | erline}** | **8 passengers**                   |
| ###                 |           |                                    |
|  Dodge Caravan 2003 |           | **8 passengers**                   |
|                     |           |                                    |
| **Dodge Caravan     |           | **18 passengers & 2 wheelchairs**  |
| 2003**              |           |                                    |
|                     |           | **Triage Team Supplies**           |
| **Blue Bird Bus**   |           |                                    |
|                     |           |                                    |
| **Ford 2 Ton Truck  |           |                                    |
| 1993**              |           |                                    |
+---------------------+-----------+------------------------------------+

> **b. GSA - Services: N/A**
>
> **c. Air Transport: Serviced by Detroit Metropolitan Airport**
>
> **d. Trains: Ann Arbor AMTRACK station**
>
> **e. Limousine/car rentals: Huron Valley Ambulance**
>
> **f. Taxi Cabs: N/A**
>
> **g. What actions will you need to take to be able to use these
> systems for your needs: Confirm contract specifications and cost.**
>
> **h. Will these systems be available for your use during the time of
> emergency? Yes.**
>
> **Appendix C-10**

**STAFF ASSESSMENT & MOBILIZATION POTENTIAL REPORT**

> **Facility: Ann Arbor As of: 10/01**
>
> **Station number: 506 COIN PAI 112**
>
> **Report dated 10/31/01**

  ----------------------- ---------------- ----------- ----------- ------------- -----------
                          **PHYSICIANS**   **NURSE**   **OTHER     **SUPPORT**   **TOTAL**
                                                       MEDICAL**                 

  ----------------------- ---------------- ----------- ----------- ------------- -----------

  ----------------------- ----------- --------- ----------- --------- ----------
  **1. Total staff on     **104**     **255**   **300**     **531**   **1190**
  board**                                                             

  ----------------------- ----------- --------- ----------- --------- ----------

  ----------------------- ----------- ------- ----------- -------- --------
  **2. On board by age**                                           

  ----------------------- ----------- ------- ----------- -------- --------

  ----------------------- ----------- --------- ----------- --------- ---------
  **18 - 45**             **87**      **200**   **123**     **386**   **796**

  ----------------------- ----------- --------- ----------- --------- ---------

  ----------------------- ----------- -------- ----------- --------- ---------
  **46 - 59**             **13**      **53**   **173**     **140**   **379**

  ----------------------- ----------- -------- ----------- --------- ---------

  ----------------------- ----------- ------- ----------- -------- --------
  **60 & OVER**           **4**       **2**   **4**       **5**    **15**

  ----------------------- ----------- ------- ----------- -------- --------

> **(Total of age groups must equal \"1\" above, by category)**

  ----------------------- ----------- ------- ----------- -------- --------
  **3. In ready reserve                                            
  by age**                                                         

  ----------------------- ----------- ------- ----------- -------- --------

  ----------------------- ----------- ------- ----------- -------- --------
  **18 - 45**             **0**       **2**   **1**       **4**    **7**

  ----------------------- ----------- ------- ----------- -------- --------

  ----------------------- ----------- ------- ----------- -------- --------
  **46 - 59**             **0**       **0**   **0**       **0**    **0**

  ----------------------- ----------- ------- ----------- -------- --------

  ----------------------- ----------- ------- ----------- -------- --------
  **60 & OVER**           **0**       **0**   **0**       **0**    **0**

  ----------------------- ----------- ------- ----------- -------- --------

  ----------------------- ----------- ------- ----------- -------- --------
  **4. Military retired                                            
  by age**                                                         

  ----------------------- ----------- ------- ----------- -------- --------

  ----------------------- ----------- ------- ----------- -------- --------
  **18 - 45**             **0**       **0**   **0**       **2**    **2**

  ----------------------- ----------- ------- ----------- -------- --------

  ----------------------- ----------- ------- ----------- -------- --------
  **46 - 59**             **0**       **1**   **1**       **10**   **12**

  ----------------------- ----------- ------- ----------- -------- --------

  ----------------------- ----------- ------- ----------- -------- --------
  **60 & OVER**           **0**       **0**   **0**       **0**    **0**

  ----------------------- ----------- ------- ----------- -------- --------

> **(Total of age groups for \"3\" plus \"4\" cannot exceed total in
> \"1\" or \"2\" above, by category).**
>
> **MANPOWER TABLE (Refer to and validate Coin Pai 112 Report. VA
> Employees subject to mobilization).**
>
> **Appendix D**

**DECONTAMINATION**

> **See Section 8 of Policy Memorandum S-5 (Emergency Preparedness Plan)
> entitled Chemical, Radiological and Biological Terrorism.**
>
> **Appendix E-1**

AIRPORT RECEPTION/TRIAGE SUPPLIES & EQUIPMENT

+-----------------------------+-------+----------------------+--------+
| **[SPD SUPPLIES FOR         | **1** | **Sterile barrier**  | **5**  |
| TRIAGE]{.underline}**       |       |                      |        |
|                             | **1** | **Alcohol wipes**    | **2    |
| **Crash Cart**              |       |                      | b      |
|                             | **1** | **Sterile kerlix**   | oxes** |
| **Restraints**              |       |                      |        |
|                             | **1** | **Tape 1\" & 2\"**   | **10** |
| **Chest insertion kit**     |       |                      |        |
|                             | **1** | **Bioclusive IV      | **3    |
| **Pleuravac**               |       | dressing**           | each   |
|                             | **1   |                      | 10**   |
| **Chest tube clamp**        | e     | **Trach cleaning     |        |
|                             | ach** | set**                | **1**  |
| **Chest tube 24, 32, 36**   |       |                      |        |
|                             | **1** | **Suction catheter** | **5**  |
| **Large bandage scissors**  |       |                      |        |
|                             | **4** | **Foley cath kit**   | **2**  |
| **Stethoscope**             |       |                      |        |
|                             | **2** | **Urinary drainage   | **2**  |
| **Spyghnomanometer**        |       | bag**                |        |
|                             | **2** |                      | **4**  |
| **Sterile instrument sets** |       | **Foley cath #16**   |        |
|                             | **4** |                      | **10** |
| **Sterile scissors          |       | **Emesis basin**     |        |
| (disp.)**                   | **2** |                      | **4**  |
|                             |       | **Bedpan**           |        |
| **2-0 silk, 3-0 silk        | **4** |                      | **10** |
| sutures**                   |       | **Urinal**           |        |
|                             | **1   |                      | **4**  |
| **Scalpel #10**             | box** | **Toilet paper**     |        |
|                             |       |                      | **25** |
| **IV cath #18**             | **1   | **Cups**             |        |
|                             | box** |                      | **25** |
| **Syringes 3 cc 20 ga       |       | **Straws**           |        |
| needles**                   | *     |                      | **4**  |
|                             | *10** | **Paper bags**       |        |
| **Injection cap**           |       |                      | **10** |
|                             | **4** | **Blue pads**        |        |
| **Sterile gloves 7, 7 1/2,  |       |                      | **2**  |
| 8**                         | **1   | **Oral airway**      |        |
|                             | box** |                      | **2**  |
| **Exam gloves, large**      |       | **Nasal cannula**    |        |
|                             | **1   |                      | **2**  |
| **Masks**                   | box** | **Ventimask**        |        |
|                             |       |                      | **1**  |
| **Goggles**                 | **4** | **Non-rebreather     |        |
|                             |       | mask**               | **2**  |
| **Isolation gowns**         | *     |                      |        |
|                             | *10** | **O2 tank, 2 small** | **10** |
| **Needle disposal box**     |       |                      |        |
|                             | **1** | **EKG electrodes**   | **1    |
| **Plastic bags**            |       |                      | bo     |
|                             | *     | **Electrode jelly**  | ttle** |
| **Tourniquets**             | *10** |                      |        |
|                             |       | **Pocket mask for    | **1**  |
| **4 x 4 gauze pads**        | **4** | CPR**                |        |
|                             |       |                      | **1**  |
| **5 x 9 ABD pads**          | **2   | **Foley cath #16**   |        |
|                             | b     |                      | **1**  |
| **[SPD SUPPLIES FOR         | ags** | **Stethoscope**      |        |
| TRANSPORT:]{.underline}**   |       |                      | **1**  |
|                             | **1   | **Sphygnomameter**   |        |
| **Exam gloves large**       | box** |                      | **4    |
|                             |       | **IV cath**          | each** |
| **Sterile gloves 7, 7 1/2,  | **1   |                      |        |
| 8**                         | box** | **Syringe 3 cc, #20  | **5**  |
|                             |       | needle**             |        |
| **Alcohol wipes**           | **2   |                      | **2**  |
|                             | e     | **Injection caps**   |        |
| **4 x 4 gauze pads**        | ach** |                      | **2**  |
|                             |       | **Nasal cannula**    |        |
| **Tape 1\" & 2\"**          | **1   |                      | **1**  |
|                             | box** | **Non-rebreather O2  |        |
| **5 x 9 ABD pads**          |       | mask**               | **1**  |
|                             | **1   |                      |        |
| **Kerlix sterile**          | box** | **Ambu bag**         | **1**  |
|                             |       |                      |        |
| **Blue pads**               | **2   | **Small O2 tank**    | **1**  |
|                             | e     |                      |        |
| **Tourniquet**              | ach** | **Ventimask**        | **2**  |
|                             |       |                      |        |
| **Masks**                   | **4   | **Sterile scissors** | **1**  |
|                             | e     |                      |        |
| **Goggles**                 | ach** | **Sterile instrument | **1    |
|                             |       | set**                | each** |
| **Isolation gowns**         | **4** |                      |        |
|                             |       | **Arm board (long,   | **4**  |
| **Needle disposal box, 2    | **5** | short)**             |        |
| gal.**                      |       |                      | **4**  |
|                             | **2** | **Emesis basin**     |        |
| **Plastic bags**            |       |                      | **2**  |
|                             | *     | **Urinal**           |        |
| **Oral airway**             | *10** |                      | **2**  |
|                             |       | **Bedpan**           |        |
| **Pocket mask for CPR**     | **2** |                      |        |
|                             |       | **Toilet paper**     |        |
| **Foley cath pack**         | **4** |                      |        |
|                             |       |                      |        |
| **Foley cath #16**          | **1** |                      |        |
|                             |       |                      |        |
|                             | *     |                      |        |
|                             | *10** |                      |        |
|                             |       |                      |        |
|                             | **1** |                      |        |
|                             |       |                      |        |
|                             | **1** |                      |        |
|                             |       |                      |        |
|                             | **1** |                      |        |
|                             |       |                      |        |
|                             | **2** |                      |        |
+-----------------------------+-------+----------------------+--------+

> **Appendix E-2**

+---------------------------------+---------+-------------------------+
| **[DRUG SUPPLIES FOR TRIAGE     | **QUAN  | **[DRUG SUPPLIES FOR    |
| TEAM]{.underline}**             | TITY:** | T                       |
|                                 |         | RANSPORT]{.underline}** |
| **ITEM:**                       | **4**   |                         |
|                                 |         | **Need four sets of     |
| **Albumin 25% 50 ml**           | **2**   | each of the             |
|                                 |         | following:**            |
| **Aminophylline 500 mg 20 ml**  | **4**   |                         |
|                                 |         | **NS 1000cc IV**        |
| **Atropine Sulfate l mg         | **10**  |                         |
| syringe**                       |         | **LR 1000cc IV**        |
|                                 | **2**   |                         |
| **Diazepam 10 mg vial**         |         | **D5W 1000cc**          |
|                                 | **2**   |                         |
| **Diphenhydramine 50 mg         |         |                         |
| ampoule**                       | **1**   |                         |
|                                 |         |                         |
| **Epinephrine 1:1000 vial**     | **5**   |                         |
|                                 |         |                         |
| **Glucose Tolerance Solution**  | **4**   |                         |
|                                 |         |                         |
| **Haloperidol 5 mg vial**       | **1**   |                         |
|                                 |         |                         |
| **Heparin 100 u/ml vial**       | **2**   |                         |
|                                 |         |                         |
| **Insulin Regular V100          | **1**   |                         |
| Humulin**                       |         |                         |
|                                 | **4**   |                         |
| **Lidocaine 1% vial**           |         |                         |
|                                 | **10**  |                         |
| **Metaproterenol Inhaler**      |         |                         |
|                                 | **5**   |                         |
| **Methylprednisolone 125 mg     |         |                         |
| vial**                          | **10**  |                         |
|                                 |         |                         |
| **Morphine Sulfate 10 mg        | **100** |                         |
| tubex**                         |         |                         |
|                                 | **4**   |                         |
| **Nifedipine 10 mg capsule**    |         |                         |
|                                 | **5**   |                         |
| **Nalozone 0.4 mg ampoule**     |         |                         |
|                                 | **2**   |                         |
| **Nitroglycerin 0.4 mg tablet** |         |                         |
|                                 | **2**   |                         |
| **Phenytoin 250 mg vial**       |         |                         |
|                                 | **50**  |                         |
| **Potassium Chloride 20 mEg     |         |                         |
| vial**                          | **2**   |                         |
|                                 |         |                         |
| **Verapamil 5 mg vial**         | **2**   |                         |
|                                 |         |                         |
| **Tubex Injector holders**      | **2**   |                         |
|                                 |         |                         |
| **Chemstrips with lancets       | **4**   |                         |
| (#503)**                        |         |                         |
|                                 | **4**   |                         |
| **Betadine 1% pint**            |         |                         |
|                                 | **8**   |                         |
| **Hydrogen Peroxide pint**      |         |                         |
|                                 | **3**   |                         |
| **Isopropyl Alcohol 70% pint**  |         |                         |
|                                 | **3**   |                         |
| **Sterile water for             |         |                         |
| irrigation**                    | **4**   |                         |
|                                 |         |                         |
| **Sterile 0.9% NACL for         | **6**   |                         |
| irrigation**                    |         |                         |
|                                 | **8**   |                         |
| **IV Solutions:**               |         |                         |
|                                 | **8**   |                         |
| **0.9% NACL l liter**           |         |                         |
|                                 | **1     |                         |
| **0.9% NACL 259 ml**            | box**   |                         |
|                                 |         |                         |
| **0.9% NACL 50 ml**             | **6**   |                         |
|                                 |         |                         |
| **Lactated Ringers 1 liter**    | **6**   |                         |
|                                 |         |                         |
| **5% Dextrose 1 liter**         | **4**   |                         |
|                                 |         |                         |
| **Miscellaneous:**              | **6**   |                         |
|                                 |         |                         |
| **Syringes 3 ml**               | **25**  |                         |
|                                 |         |                         |
| **Syringes 20 ml**              |         |                         |
|                                 |         |                         |
| **4 x 4 sponges**               |         |                         |
|                                 |         |                         |
| **15 drop/ml IV set**           |         |                         |
|                                 |         |                         |
| **60 drop/ml IV set**           |         |                         |
|                                 |         |                         |
| **Albumin IV set**              |         |                         |
|                                 |         |                         |
| **Extension IV set**            |         |                         |
|                                 |         |                         |
| **IV labels**                   |         |                         |
+---------------------------------+---------+-------------------------+

> **Appendix F-1**

**Medical Center Director\'s Office**

**POSITION: Medical Center Director**

**ALTERNATE: Associate Director for Operations**

**1. Activate appropriate cascade notification plan (see VA/DoD
Contingency Plan Appendix A, Notification).**

**2. Activate the Emergency Operations Center and staff as required.**

**3. Advise Veterans Service Organizations of the local situation.
Activate Public Affairs hotline.**

**4. Assess medical center staffing and restrict or cancel staff
leave.**

> **a. Confer with Chief of Staff, Associate Director for Operations and
> ADPCS to assess manpower requirements.**
>
> **b. Issue policy statement, reassess policy throughout activation of
> the Contingency Plan.**
>
> **c. Implement recall of staff, mandatory overtime, etc. as
> required.**
>
> **d. Assess the need for staff details from Saginaw and Battle Creek
> secondary VAMCs and coordinate implementation with other VAMC Medical
> Center Directors.**
>
> **e. Contact VISN Emergency Operation Center (VEOC) to identify
> additional personnel required to provide care for incoming casualties
> or to fill positions created by employee mobilization.**

**5. Refer any of the following significant issues to the VEOC:**

> **a. Clinical issues.**
>
> **b. Problems/incidents encountered with VA beneficiaries, DoD
> beneficiaries or families of same.**
>
> **c. Supply, equipment or pharmaceutical issues.**
>
> **d. Personnel/staffing issues.**
>
> **e. Public affairs activities.**
>
> **f. Security concerns.**

**6. During receipt of casualties, man the medical center EOC to
facilitate status reports, changes and command decisions as situations
may require at the airport.**

> **Appendix F-2**

**CHIEF OF STAFF**

**POSITION: CHIEF OF STAFF ‑ TRIAGE COORDINATOR**

**ALTERNATES: ACOS FOR AMBULATORY CARE**

**CHIEF, SURGERY SERVICE**

**FIRST ALERT TO STANDBY STATUS:**

> **1. Assess clinical staffing and advise the Medical Center Director
> on the need for specialists, details needed to cover military
> mobilization, or cancellation of leave.**
>
> **2. Review the bed availability process with the Bed Control
> Coordinator.**
>
> **3. Confer with the Chief, Infectious Disease depending on the
> location of the military operation and level of conflict to assess
> decontamination plans, antibiotic treatment plans, and potential
> infectious diseases the casualties may develop.**
>
> **4. Confer with the ACOS for Education to assess needs for special
> training, ie. infectious diseases update, sensitivity, stress.**

**NOTIFICATION OF RECEIPT OF CASUALTIES:**

**1. Review patient manifest with Medical Response Team, Nursing Triage
Coordinator, and VA-DoD Coordinator.**

**Action:**

> **a. Coordinate bed availability by determining patients who might be
> discharged or transferred to a secondary or community facility.**
>
> **b. Issue directives to curtail non‑emergent, non-service‑connected
> veterans\' admissions.**
>
> **c. Designate bed classifications for each patient on the manifest
> and assign physicians.**
>
> **d. Assess non-routine manpower requirements and Services to be
> alerted to facilitate patient admission; determine need for on-call
> support staff or mandatory overtime.**
>
> **e. Review the type of transportation required and any special
> equipment needs. The Nurse Triage Coordinator will advise
> Transportation and Beneficiary Travel.**

**[TRIAGE COORDINATOR]{.underline}**

**2. Review patient manifest to designate composition of the airport
triage team and determine the scope of our response, including the need
for support from the secondary facilities.**

**Action:**

> **a. Determine the number or triage teams required (Minimum: 1
> physician, 1 RN, 1 Clerk representative) and the need for additional
> RN\'s or physician staff. Details identified in plan under Reception
> Procedures, pg 5.**
>
> **Appendix F-3**
>
> **b. Establish the time for triage team(s) to report to the ambulance
> garage (at least 3 hours before the planned aircraft arrival time).
> Advise Nurse Triage Coordinator, and Emergency Preparedness
> Coordinator.**
>
> **c. Man the medical center command center to facilitate decisions on
> acceptance or transfer of casualties not on our manifest or to confer
> on urgent clinical decisions.**

**3. Medical Center Patient Reception**

**Action:**

> **a. Establish patient reception teams and alert physicians of patient
> assignments. The Emergency Preparedness Coordinator at the airport
> Emergency Operations Center will notify the medical center command
> center as patients depart the airport.**
>
> **b. Coordinate patient flow through the ambulance garage. Patients
> will be transported to their assigned bed/ward.**
>
> **Appendix F-4**

**POSITION: EMERGENCY PREPAREDNESS COORDINATOR (EPC) - Emergency
Preparedness Coordinator**

**ALTERNATE: Industrial Hygienist**

> **1. Follow up with key services and positions to ensure effective
> notification and responses, i.e., Utilization Management, Facilities
> Management, Chief of Staff, Patient Care, Public Affairs, Social Work,
> Police and Transportation, Food Production, Central Supply, VAMC
> Battle Creek, VAMC Saginaw.**
>
> **2. Brief Medical Center Director and Chief of Staff:**

**Action:**

> **a. Obtain initial risk assessment of medical center security
> position from Emergency Preparedness Coordinator.**
>
> **b. Obtain manpower reports from key services (11, 11A, 30, 51, 53,
> 43).**
>
> **3. Initiate contact with the Military Patient Administrative Team.
> Assist with planning for an MPAT office if necessary.**
>
> **4. Convene a meeting of key staff to assess medical center
> readiness, i.e., the VA/DoD coordinator, Emergency Preparedness
> Coordinator, AA to the Chief of Staff, Public Affairs Specialist, and
> representatives from Utilization Management, Patient Care and Social
> Work Services. The group will meet as necessary to identify and
> resolve any problems encountered throughout plan activations.**
>
> **5. Coordinate an update to the Medical Center Capability Assessment,
> Appendix C.**
>
> **6. Ensure VISN 11 and DETROIT FCC have been advised of our
> notification.**
>
> **7. Attend Utilization Management and Chief of Staff review of
> patient manifest; ensure decisions of the Chief of Staff are
> effectively communicated to responsible officials.**
>
> **8. As requested, coordinate support personnel or vehicles etc. from
> the VAMC Battle Creek or Saginaw. Ensure triage teams and support
> personnel are advised of meeting time for departure to the airport.**
>
> **9. At least 4 hours prior to departure for the airport, confirm
> readiness of each key group.**
>
> **10. Obtain a master list of triage and support personnel from the
> Emergency Preparedness Coordinator prior to departure for the airport.
> FAX the master list to the airport Emergency Operations Center/Wayne
> County Sheriff\'s Department to facilitate security clearance.**
>
> **11. Document Medical Center response to receipt of DoD patients.
> Ensure completion of all readiness and activation reports.**
>
> **12. Document resource requirements for drills and activations.
> Assist Chief, Financial Administrator with billing details for DoD
> patients.**
>
> **Appendix F-5**
>
> **13. Contact FCC representative at VAMC DETROIT to confirm airport
> availability and procedures.**
>
> **14. Review security risk assessment for our airport reception team
> and patients. Develop options and implementation procedures for
> briefing with the Medical Center Director.**
>
> **15. Confirm proper operation of all communications equipment.**
>
> **16. Coordinate refresher training as required for triage team
> support personnel.**
>
> **17. Confirm location of the storage area for equipment, linen and
> supplies to be used by the triage team and support personnel. Advise
> all parties of the purpose and location of this room.**
>
> **18. Review patient manifest decisions of the Chief of Staff.
> Coordinate revisions to transportation and support personnel as
> indicated by the number and acuity levels of patients.**
>
> **19. Confirm logistics for airport reception, contact the airport,
> and coordinate response with the FCC at DETROIT.**
>
> **20. Advise triage support personnel of meeting and departure time
> for the airport. Remind staff to wear picture identification badges to
> the airport. If necessary obtain Food Production Service storage key
> or have Food Service staff load emergency beverages, etc.**
>
> **21. Obtain and issue radios to appropriate triage personnel. Ensure
> all supplies and equipment are properly loaded, transported to and
> returned from the airport.**
>
> **22. Coordinate airport reception from the airport EOC. Facilitate
> transportation, dispatch of critical patients, and communications
> between the airport and VAMC. Document aircraft arrival time and
> departure time, triage times and any problems.**
>
> **23. Advise VAMC EOC of departure time from the airport and
> anticipated arrival at the medical center.**
>
> **Appendix F-6**

**ACOS AMBULATORY CARE**

> **POSITION: NURSE TRIAGE COORDINATOR**

**FIRST ALERT TO STANDBY STATUS:**

> **1. Confer with Associate Director for Patient Care and other
> clinical coordinators to establish and prepare the nurse triage team.
> Confirm current phone numbers.**
>
> **2. Initiate refresher training for nursing staff.**

**NOTIFICATION OF ASSIGNMENT OF CASUALTIES:**

> **1. Review patient manifest with Medical Response Team and Chief of
> Staff. Coordinate revisions to triage supplies identified in Appendix
> for necessary equipment, medications and supplies.**
>
> **2. Assemble triage team at the ambulance garage three hours prior to
> expected arrival of aircraft at Metro-Airport.**
>
> **3. Direct loading of Triage and transport supplies from SPD. A crash
> cart, SPD triage box, and pharmacy triage box will go to the Triage
> site at the airport. There are four separate transport boxes of
> Pharmacy and SPD supplies for transport from the airport to the VA.
> One pharmacy and SPD box should be placed in each van, and two of each
> in the bus.**
>
> **4. The Nursing Triage Coordinator, or her designee, is responsible
> for [obtaining a Doppler]{.underline} from the Emergency Room Drug
> Drawer. The beeper for the ER Nurse is 707 if the Nursing Triage
> Coordinator, or her designee, is unable to obtain the Doppler.**
>
> **5. The Nurse Triage Coordinator, or her designee, is responsible for
> [signing MS 10 mg]{.underline} injectable, a box of ten, from the
> Pharmacy. A green Controlled Substance Administration Record should be
> brought to the scene to record narcotics given.**
>
> **6. Airport reception:**
>
> **a. Reviewing any changes in patient manifest or change in patient
> condition from the Airlift Clinical Personnel.**
>
> **b. Briefly assessing the patients\' condition. They will need to be
> placed on our stretchers with assistance of litter bearers.**
>
> **c. Document time last patient is off loaded from aircraft and
> triaged advise Emergency Preparedness Coordinator.**
>
> **d. Transport stable patients directly to transport vehicles.**
>
> **Appendix F-7**
>
> **e. Unstable patients, or patients requiring further evaluation or
> urgent treatment, will be moved to a treatment area. If necessary
> notify the Emergency Preparedness Coordinator in the Emergency
> Operations Center via cellular phone of the need for ACLS ambulance
> support.**
>
> **f. Admitting/Bed Control Coordinator will administratively process
> patients at the Triage site.**
>
> **g. Don\'t give any information to the media.**
>
> **h. The entire Triage team will return together.**
>
> **i. Handle any potentially contaminated dressings as hazardous waste.
> Use red bags.**
>
> **7. Transport to the VA consists of monitoring patients enroute.
> Supplies will be available in transport vehicles.**
>
> **8. Upon return to the VA:**
>
> **a. Patients will be brought in through the Ambulance garage and
> admitted directly upstairs via the freight elevator if possible.**
>
> **b. Unstable patients sent by Advance Life Support (ALS) will be
> taken to the ER.**

9.  **Families of victims will be escorted to the chapel or social work
    area and be kept informed of**

> **casualty status by either Chaplins or Social Work staff.**
>
> **10. A de-briefing will be held in the Ambulance garage after all
> patients have been admitted.**
>
> **Appendix F-8**

**PATIENT CARE SERVICE**

**POSITION: ASSOCIATE DIRECTOR FOR PATIENT CARE**

**ALTERNATE: DIRECTOR OF NURSING**

**FIRST ALERT TO STANDBY STATUS**

> **1. Upon notification of implementation of VA/DoD contingency plan:**
>
> **a. During Administrative hours:**
>
> **1) Contact unit Managers and Nursing Triage Coordinator.**
>
> **2) Direct secretarial staff to initiate Facility and Service Cascade
> plan.**
>
> **3) Notify interdisciplinary staff of plan implementation.**
>
> **b. During non-administrative hours:**
>
> **1) Facility cascade notification will be implemented at 8 a.m. the
> next working, or sooner at the discretion of the Triage Coordinator if
> notification indicates receipt of casualties in less than 24 hours.**
>
> **2. Report manpower data to Emergency Preparedness Coordinator.**
>
> **a. Direct time keeper or secretarial staff to contact each Unit
> Manager to determine if staffing is at adequate levels if the plan is
> activated. Obtain numbers of staff on AL \> 3 days, extended sick
> leave and numbers of vacant positions.**
>
> **b. If supplemental staff may be required, advise Emergency
> Preparedness Coordinator of such.**
>
> **c. Assess need to cancel annual leave.**
>
> **3. Upon activation of contingency plan, submit monthly report to
> Chief, Resource Officer related to plan action by COB the 3rd workday
> following the close of each month (i.e., OT, special items, or
> equipment).**
>
> **4. Confer with ACOS, Education; Chief, Infectious Disease and/or
> Chief of Staff to determine special education needs, i.e., infectious
> disease update, chemical decontamination, new skills for change in
> patient population (burns). Discuss this information with Unit
> Managers for provision of education based on identified needs.**
>
> **5. Confer with Nursing Triage Coordinator on establishing and
> preparing an active Nursing Triage Team.**
>
> **6. Remind Unit Managers and other key staff to review Emergency
> Preparedness with staff.**
>
> **Appendix F-9**

**NOTIFICATION OF ASSIGNMENT OF CASUALTIES**

**1. Upon notification by Facility Cascade Plan that a patient manifest
has been received and that we will be receiving casualties:**

**Delegate secretarial staff to notify Unit Managers and
interdisciplinary staff.**

> **2. Review patient manifest with Admitting/Bed Control Coordinator
> and Chief of Staff.**
>
> **a. Coordinate bed availability by reviewing patients who might be
> transferred or discharged.**
>
> **b. Designate bed classification for each patient on the manifest.
> Assess potential OR and ICU requirements for patients.**
>
> **c. Determine type of transportation required and special equipment
> needs.**
>
> **3. Confer with Nursing Triage Coordinator to ensure he/she is aware
> of patient manifest and that Nursing Triage Team is prepared and is
> aware of special equipment/supply needs and patients clinical
> condition.**
>
> **4. Confer with Unit Managers to determine staffing needs to provide
> patient care, including transfer and discharge of current patients,
> and reception and admission of casualties.**
>
> **a. Assess need to cancel annual leave, require mandatory overtime,
> reassign staff to other units.**
>
> **b. Assess need for special equipment or supplies based on patient
> manifest. Notify Central Supply Supervisor; Chief, Pharmacy; Chief,
> Respiratory Therapy of identified needs.**

**MEDICAL CENTER PATIENT RECEPTION:**

> **1. Report to EOC at the time airport triage is occurring to receive
> information on change of patient condition and change in patient
> manifest. Based on changes in the patient manifest, reassess
> assignments of staff and equipment needs; communicate changes via
> radio.**
>
> **2. Ensure adequate staffing levels for reception, admission,
> stabilization and ongoing care of casualties and current patients.**
>
> **3. Contact Chief, Psychiatry Service, Social Work and Chief Chaplain
> to provide stress management or debriefing related to reception and
> treatment of casualties.**
>
> **4. Continue to confer with other services based on needs of DoD
> casualties.**
>
> **5. Instruct all staff that release of patient information is
> limited. Social security numbers and conditions are considered
> national security.**

6.  **Instruct all staff to not give any information to media sources.**

7.  **Assign each unit to bring stretchers and wheelchairs to the
    ambulance garage based on the**

> **number of patients and their clinical condition from the patient
> manifest.**
>
> **Appendix F-10**

8.  **Determine which units can send additional staff to assist in
    triage in the ambulance garage**

> **when casualties arrive from the airport. Patients will be briefly
> assessed for changes in clinical condition. Vital signs are taken and
> stable patients are taken to their assigned bed. Unstable patients are
> taken to the ER or ICU (if a bed is available).**
>
> **9. Assign transport staff if required for large numbers of
> casualties traveling from the airport.**
>
> **10. Obtain a portable radio from the VA Police.**
>
> **11. Confer with Unit Managers regarding unit readiness for reception
> of casualties. Assess potential changes in staffing due to sick leave.
> Assure each unit is adequately staffed through use of over time,
> reassignment of staff, supplemental staff.**
>
> **12. Inform Unit Managers that the Emergency Preparedness Signal (the
> 4 ten ring fire alarm) is the signal that the EOC has received word
> that the casualties are enroute from the airport. At that time, staff
> delegated to triage in the ambulance garage should report there,
> stretchers and wheelchairs should be taken to the ambulance garage,
> and Interdisciplinary staff should report to the Clinical Pool in the
> Patient Care Service Office for reassignment.**
>
> **13. Inform EOC of problems or developing situations as they arise.**
>
> **14. Contact the Emergency Preparedness Coordinator via radio or
> relay messenger for staffing, equipment, or transport needs.**
>
> **15. Upon completion of triage in the ambulance garage, make walking
> rounds on each unit. Assess problems, concerns and clinical issues.**
>
> **16. Ensure adequate staffing levels for reception, admission,
> stabilization and ongoing patient care.**
>
> **Appendix G-1**

**SURGERY SERVICE DoD CONTINGENCY PLAN**

> **1. Upon notification of the activation of the DoD Contingency plan,
> the Chief, Surgery Service will identify and notify the triage team
> leader(s) that will be responsible for triage duties at the receiving
> airport.**
>
> **2. The following individuals will be notified of the activation of
> the contingency plan and will be put on alert:**

**Chief, PV Section**

**Chief, Ophthalmology Section**

**Chief, Neurosurgery Section**

**Chief, Orthopedic Section**

**Chief, ENT Section**

**Chief, Plastic Surgery Section**

**Chief, Cardiothoracic Surgery Section**

**Chief, Urology Section**

**Chief, Anesthesiology Service**

**Operating Room Head Nurse**

> **3. After receipt of the manifest, the appropriate section chiefs
> will be notified of the anticipated casualties that will necessitate
> their treatment assistance. The chiefs of the sections that will be
> receiving casualties will be responsible for assuring that a surgeon
> from their specialty is available at the VA Ann Arbor Healthcare
> System at the time of arrival of patients.**
>
> **4. In the event that the medical center is designated to receive
> casualties that will require surgery, all elective operations will be
> canceled starting on the date that casualties are scheduled to arrive
> at the medical center.**
>
> **5. The triage physician in charge will coordinate the triage of
> patients at the receiving airport and determine the need for immediate
> transport by advanced life support ambulance. The condition of each
> patient will be assessed briefly at the airport by the Triage
> physician and nurse. Vital signs and pertinent patient information
> will be recorded on the DoD 602 or Medical Emergency Triage tag which
> will be torn to the correct color to reflect priority for
> transportation. Stable patients will be transported for processing
> directly to their ward.**
>
> **6. The Chief, Surgery Service or his/her designee will be assigned
> to the medical center triage area and will be assigned to triage
> incoming patients at the triage/receiving area. Patients requiring
> emergent surgery will be sent directly to the operating room where
> they will be received by the OR staff and the surgeon from the
> appropriate specialty. Other patients will be sent to the Intensive
> Care Unit or general units as appropriate.**
>
> **7. The Surgery Service Administrative Officer will confer with the
> Chief of Staff\'s office to verify when the DoD Contingency Plan has
> been deactivated.**
>
> **Appendix G-2**

**PHARMACY SERVICE PROCEDURES**

> **1. [PURPOSE]{.underline}: To establish procedures for providing
> pharmacy services during an AAVAMC Department of Defense emergency.**
>
> **2. [PROCEDURES:]{.underline}**
>
> **a. All pharmacy staff will comply with procedures outlined in
> medical center policy 00-10, Medical Center Emergency Preparedness
> Plan. In specific, VA/DoD Contingency Plan will be followed.**
>
> **b. Notification will be through the medical center\'s facility
> cascade plan. When Pharmacy Service is contacted, the individual
> receiving the call will be responsible for recording an accurate,
> complete message and will:**
>
> **1) Call the next person on the cascade to pass along the message.**
>
> **2) Alert the Chief Pharmacy (in his/her absence a pharmacy
> supervisor) who will coordinate the response.**
>
> **c. The response coordinator will initiate the Pharmacy Service
> Emergency Telephone Chain of Communication and will call in as many
> pharmacists and technicians in their opinion are necessary to provide
> services.**
>
> **d. Pharmacy Service\'s main responsibility during the external
> disaster is to ensure that an adequate supply of medications, IV
> solutions, and IV tubing are available to the physicians and nurses
> providing patient care at the triage site. Pharmacy personnel will
> also be responsible for preparing IV Admixtures and providing drug
> information to the other health care team members.**
>
> **e. A designated clinical pharmacist will be responsible for
> contacting key members of the disaster team to review any special drug
> needs or IV solution needs above the beyond those regularly supplied
> during a disaster. These drugs will be urgently obtained with the
> assistance of the management assistant and procurement technician.**
>
> **f. As soon as the plan is activated, a pharmacist will prepare the
> necessary drugs, IV solutions and tubing for transport to the disaster
> site. A triage drug locker will be maintained and updated on a regular
> basis. Drugs needed for the disaster have been determined by a
> multi-discipline committee of physicians, nurse and pharmacists.
> Approved drugs and supplies will be reviewed and updated at least
> every two years.**
>
> **g. A pharmacist and pharmacy technician may accompany the drugs and
> supplies to the triage site. The pharmacist should contact the Nurse
> Triage Coordinator (Head Nurse Ambulatory Care) for direction and to
> ensure transportation. Additional staffing will be contingent on the
> complexity of the disaster.**
>
> **h. The disaster pharmacist will be responsible for maintaining a
> record of all drugs, IV solutions and tubing issued to disaster
> patients. This includes high cost products. the Pharmacy Service
> disaster coordinator will ensure that a supply line is maintained with
> the disaster pharmacist and/or technician to ensure a continued supply
> of drugs and supplies.**
>
> **i. A list of all drugs, IV solutions and tubing will be submitted to
> the Chief, Pharmacy at the conclusion of the disaster.**
>
> **Appendix G-3**
>
> **j. Pharmacy Service staff will receive an initial orientation to the
> emergency preparedness plan within the medical center and will receive
> an annual refresher course thereafter.**
>
> **Appendix G-4**

**[FOOD PRODUCTION DoD CONTINGENCY PLAN]{.underline}**

**1. [PURPOSE:]{.underline} To provide information/instructions on
obtaining nutrition services and support from the department.**

**2. [POLICY:]{.underline} To provide nutritional and support services
as indicated by the nature of the emergency.**

**3. [PROCEDURES:]{.underline}**

> **a. Food Production Supervisor (extension 5680/7968) shall be
> officially notified of the nature of the emergency by the EOC.**
>
> **b. During regular hours (8 a.m. to 4:30 p.m.), activate the
> following:**
>
> **1) Prepare \"ready to consume\" beverages and supplies to be
> provided for patients and emergency personnel.**
>
> **2) These items will be packed for transport and taken to the
> designated site.**
>
> **3) Beverages and supplies will include, but not be limited to:**

+-----------------------------+----------------------------+----------+
| **Items**                   | **Containers**             | **A      |
|                             |                            | mounts** |
| **Coffee, Decaffeinated**   | **Individual packages**    |          |
|                             |                            | **100 (1 |
| **Tea bags**                | **Individual packages**    | box)**   |
|                             |                            |          |
| **Sugar, granulated**       | **Individual packages**    | **100 (1 |
|                             |                            | box)**   |
| **Sugar, substitute         | **Individual packages**    |          |
| (Equal)**                   |                            | **250**  |
|                             | **Individual packages**    |          |
| **Creamer, non-dairy**      |                            | **100**  |
|                             | **64 oz plastic jugs**     |          |
| **Water, bottled**          |                            | **150**  |
|                             | **12 oz cans**             |          |
| **Carbonated beverages,     |                            | **4**    |
| clear**                     | **Cambro**                 |          |
|                             |                            | **12**   |
| **\*Hot water**             | **8 oz, 50/sleeve**        |          |
|                             |                            | **6      |
| **cups**                    | **Plastic containers**     | gal**    |
|                             |                            |          |
| **\*fruit juice**           | **Each**                   | **100**  |
|                             |                            |          |
| **\*Fresh fruit**           | **Round**                  | **12/4   |
|                             |                            | oz**     |
| **\*Cheese**                | **Packages**               |          |
|                             |                            | **25     |
| **\*Crackers**              |                            | pieces** |
|                             |                            |          |
|                             |                            | **2**    |
|                             |                            |          |
|                             |                            | **50**   |
+-----------------------------+----------------------------+----------+

> **4) All the above items will be stored in the storeroom located
> adjacent to the service elevators. Items will be located inside the
> storeroom to the left on the second and third shelves, labeled
> \"Emergency Beverage Supplies\". Exceptions - (\*) items.**
>
> **5) After patients are admitted to the medical center, meal schedules
> will be followed according to established policy.**
>
> **c. Procedures for irregular hours.**
>
> **1) (4:30 p.m. to 7:30 p.m., 6 a.m. to 8 a.m.) Food Production
> Supervisor or Food Service Foreman (extension 7969) will be notified
> by the EOC of the nature of the emergency.**

2)  **Procedures will be followed as outlined above procedures in b. 1,
    2, 3.**

> **Appendix G-5**
>
> **3) (7:30 p.m. to 6 a.m.) The transportation coordinator and assigned
> medical center police will sign for and obtain two (2) sets of
> Dietetic keys, labeled \"Storeroom/basement\" and \"Supervisors\" from
> the switchboard.**
>
> **4) Procedures shall be followed as outlined above procedure in b. 2
> and 3.**
>
> **5) Keys must be returned to the switchboard for the service\'s use
> for the next work shift.**
>
> **6) Assess and evaluate the need for Call Back of Food Production
> personnel to provide nutritional services and support.**

**4. [RESPONSIBILITIES:]{.underline} The Food Production Supervisor has
the overall responsibility for the implementation of the service VA/DoD
Contingency Plan.**

**5. [TEST AND EXERCISES:]{.underline} Test and exercises will be
activated in conjunction with the Medical Center Emergency Preparedness
Plan.**

> **Appendix G-6**

**[VA/DoD CONTINGENCY PLAN - LABORATORY SERVICE]{.underline}**

**1. [PURPOSE:]{.underline} To outline the functions and
responsibilities of Laboratory Service in the event of a VA/DoD
contingency.**

**2. [POLICY:]{.underline} To provide Laboratory service personnel with
instructions which would enable them to provide services in the event of
a VA/DoD contingency.**

**3. [FIRST ALERT TO STANDBY STATUS]{.underline}**

> **a. Evaluate the Laboratory Service staffing to be able to provide
> optimal staffing on all shifts upon receipt of casualties.**
>
> **b. All sections will assure that there will be adequate supplies,
> specialized equipment, reagents and test kits, etc. available in the
> event that the hospital receives casualties.**
>
> **c. The Chief, Laboratory Service/Supervisor of Blood Bank will
> assure that adequate blood and blood products will be available in the
> event that the receives casualties.**

**4. [NOTIFICATION OF RECEIPT OF CASUALTIES]{.underline}**

**a. Blood Bank Section: Supervisor: Joe Mraz**

> **1) Check on the availability of blood and blood products on station
> and from the American Red Cross.**
>
> **2) Request additional blood bank qualified personnel to supplement
> type and crossmatch capabilities.**
>
> **3) Request one or two additional persons to serve as couriers to
> transport specimens to Laboratory Service and blood/blood products to
> the operating room.**

**b. Hematology Section: Supervisor: Nancy Hacker**

> **1) Realign staff as needed to maintain essential services and
> release persons as needed for phlebotomy or courier service.**
>
> **2) Realign staff, if required, to send two persons capable of
> performing phlebotomy, microhematocrit determinations and routine
> urinalysis to the 4W treatment room with the appropriate supplies
> (phlebotomy tray, microhematocrit centrifuge, capillaries, sealant,
> reader, bottle of N-Multistix plus reader card.**

**c. Chemistry Section: Supervisor: Roger Smith**

> **1) Realign staffing as needed to provide optimum support for blood
> gas and Chem-7 determinations.**

2)  **Prepare to release persons as needed to supplement the Phlebotomy
    Team and/or other sections of the Laboratory Service.**

> **Appendix G-7**

**d. Microbiology Section: Supervisor: Mike Rosloniec**

> **Be prepared to release persons to supplement other sections of the
> Laboratory Service as needed.**

**e. Phlebotomy/Central Receiving Sections; Supervisor: Rose Yurko**

> **1) Ensure adequate staffing of the Outpatient Phlebotomy Team.**
>
> **2) Dispatch, on request, 2 or 3 persons qualified to perform
> phlebotomy to the Triage Area near the admitting entrance.**
>
> **f. Morgue Section: Attendant: Bill Everette**

**Be prepared to process bodies into and out of Morgue.**

**[SOCIAL WORK RESPONSIBILITIES - VA/DoD CONTINGENCY PLAN (Appendix
G-8)]{.underline}**

+------------------+--------+-----------+-----------------+----------+
| **[Activity      | **[C   | **[Time   | **[Decision     | **[Staff |
| /Responsibilitie | ontact | Fr        | Points Service  | As       |
| s]{.underline}** | Per    | ame]{.und | Interaction(s)  | signment |
|                  | son]{. | erline}** | ]{.underline}** | s]{.unde |
| **a. Placement   | underl |           |                 | rline}** |
| and/or transfer  | ine}** | **In      | **Business      |          |
| of patients who  |        | a         | Office (Bed     | **Those  |
| are non-acute    | **SW   | ccordance | Control) is     | Social   |
| and non-service  | Of     | with      | lead service.   | Work     |
| connected, to    | fice** | Medical   | SWS will        | staff    |
| community or     |        | Center    | coordinate with | assigned |
| other VA         | **Ext  | VA/DoD    | Business Office | to       |
| facilities, in   | ension | Co        | and ward        | specific |
| order to vacate  | 7930** | ntingency | teams.**        | bed      |
| beds needed for  |        | Plan**    |                 | ser      |
| VA/DoD           | **SW   |           | **SWS will      | vices.** |
| Contingency      | Of     | *         | coordinate with |          |
| Plan**           | fice** | *Initiate | Psychiatry and  | **To be  |
|                  |        | within    | Psychology      | as       |
| **b.             | **Ext  | first     | Services, and   | signed** |
| Facilitating a   | ension | week of   | Employee        |          |
| support group(s) | 7930** | casualty  | Health.**       | **To be  |
| for employees    |        | ad        |                 | as       |
| who experience   | **SW   | mission** | **SWS will      | signed** |
| stress from the  | Of     |           | coordinate with |          |
| situation, i.e.  | fice** | *         | Public          | **To be  |
| reaction to      |        | *Initiate | Relations,      | as       |
| working with     | **Ext  | within    | Chaplain        | signed** |
| trauma           | ension | first     | Service and     |          |
| patients.**      | 7930** | week of   | other services  |          |
|                  |        | casualty  | as              |          |
| **c. Lodging and | **SW   | adm       | appropriate.**  |          |
| counseling       | Of     | issions** |                 |          |
| (support groups) | fice** |           | **Social work   |          |
| service for      |        | **Upon    | representative  |          |
| families.**      | **Ext  | (or prior | will work with  |          |
|                  | ension | to)       | VA/DoD          |          |
| **d. Participate | 7930** | a         | Coordinator,    |          |
| in Joint         |        | ctivation | and             |          |
| Conference       |        | of the    | representative  |          |
| Center to        |        | Co        | from COS        |          |
| identify/resolve |        | ntingency | office,         |          |
| problems.**      |        | Plan**    | Business Office |          |
|                  |        |           | and Patient     |          |
|                  |        |           | Care.**         |          |
+------------------+--------+-----------+-----------------+----------+

**VA Ann Arbor Healthcare System VA/DoD Contingency Plan**

**Ann Arbor, Michigan April 2002**

**Appendix G-9**

**[FACILITIES MAINTENANCE]{.underline}**

**POSITION: Facilities Maintenance Supervisor**

**[FIRST ALERT TO STANDBY STATUS:]{.underline}**

**1. Confer with Nurse Triage Coordinator regarding cleaning supplies
and linen requirements for patient reception (will also maintain
increased levels of supplies and linens).**

**2. Upon activation of plan, a total of 40 each (towels, pillows, wash
cloths, sheets, pillow cases, blankets) will be stored for a minimum of
25 casualties in the Equipment/Supply Triage Area, SPD.**

**a. The Clothing Room Clerk will put the cart off to the side of the
Triage Area and return to the Linen Room to stand by.**

**b. Confer with VAMC Battle Creek Laundry to replace inventory of
linens that are needed.**

**3. Confer with Facilities Management to identify options for temporary
storage of patient clothing, if required.**

**[NOTIFICATION OF ASSIGNMENT OF PATIENTS]{.underline}**

**1. Bed Cleaning -- Collaborate with Patient Care Services to determine
bed cleaning needs. Coordinate staff to accomplish bed cleaning.**

**2. Inventory of Patient Belongings - Realign staffing as needed to
inventory clothing, and coordinate with Facilities Management for
storage if there is not enough storage available in the Clothing Room.**

**Appendix G-10**

**[ADMISSIONS QUICK REFERENCE]{.underline}**

**[VA/DoD PREPARATION AND TRANSPORT]{.underline}**

**1. Implementation of VA/DoD Contingency Plan**

**a. Call from ASMRO received by AOD/Operator who completes ASMRO
notification report**

**b. A manifest is received showing name, social security number,
diagnosis and whether litter, w/c or ambulatory.**

**c. Manifest is reviewed by the Triage Response Team consisting of COS,
Chief of Surgery, Ambulatory Care Clinical Coordinator, ADPCS, Chief of
Surgery, Emergency Preparedness Coordinator, Admitting and Associate
Director to determine**

**1) where patient should be admitted and**

2)  **transportation required**

3)  **supplies, equipment, medication and personnel required**

**d. Preliminary Disposition & Airport Triage Worksheet is prepared from
manifest for team use with copies to appropriate services to prepare for
receipt of patients.**

**e. Transportation is arranged by the Bed Control Coordinator with
Grounds & Transportation and Huron Valley Ambulance, if necessary.**

**f. Beds are made available for admission of these patients by
discharging and transferring patients to secondary facilities Battle
Creek and Saginaw.**

**2. Prepare for Patients**

**a. Patients are frontloaded in computer for admission**

**b. Records and ID bands are made up for admission**

**1) Civil defense tags will also be made up for each patient**

**2) The ID band will not have ward entered on it.**

3)  **Packets placed in bins for trip to airport.**

**c. Other items needed for**

1)  **Laptop for communicating back and forth with medical center**

2)  **Cellular Phones**

3)  **Blank Admitting packages**

**d. Prior to leaving for airport, number of stretchers required and
wards they are tentatively going to will be reported to Associate
Director for Patient Care.**

**Appendix G-11**

**3. At the Airport:**

**a. The administrative team member assigned to the Nurse Triage person
triaging patients off the plane will have a Preliminary Disposition &
Airport Triage Worksheet to update information.**

**b. Patients will be tagged with a Medical Emergency Triage Tag and ID
band.**

**c. Administrative team members will ask patients if they have
valuables they want to turn in and receipt for them with another VA
employee.**

**d. Administrative team member will check off baggage received with
each patient.**

**e. Administrative team member will check off military medical record
received with each patient.**

**f. When all patients have been triaged and dispositioned, Business
Office administrative team leader notifies Emergency Preparedness
Coordinator in EOC that all patients are going to original disposition
except . . . (give changes in ward) and the number of stretchers needed
is the same or give additional number of stretchers or equipment needed
on arrival.**

**g. Prior to departure, Business Office administrative team leader will
verify that all patients have been accounted for.**

**[VA/DoD CONTINGENCY PLAN - PRELIMINARY DISPOSITION & AIRPORT TRIAGE
WORKSHEET]{.underline} (Appendix G-12)**

**TIME TRIAGE TEAM ARRIVED: TIME PLANE ARRIVES: TIME TRIAGE TEAM
DEPARTED AIRPORT:**

+------------+------+------+------+--------+------+------+---------+
| **NAME S/S | **D  | **T  | **AC | **TRF  | **   | **   | **P     |
| NUMBER**   | IAGN | RANS | TUAL | TO     | TIME | TIME | ERSONAL |
|            | OSIS | PORT | WA   | NON    | PAT  | PAT  | VALU    |
|            | WA   | \*   | RD** | -VAH** | IENT | IENT | ABLES** |
|            | RD/S | \*** |      |        | LEFT | LEFT |         |
|            | ERVI |      |      | **H    | A    | AUDI | **YES / |
|            | CE** | **RE |      | OSP/ER | IRPO | T.** | NO**    |
|            |      | QUIR |      | NAME** | RT** |      |         |
|            |      | EMEN |      |        |      |      |         |
|            |      | TS** |      |        |      |      |         |
|            |      |      |      |        |      |      |         |
|            |      | **AC |      |        |      |      |         |
|            |      | LS/B |      |        |      |      |         |
|            |      | LS/V |      |        |      |      |         |
|            |      | AN** |      |        |      |      |         |
+------------+------+------+------+--------+------+------+---------+

  ------------- ------- ------- ------- -------- ------- ------- ----------
                                                                 

  ------------- ------- ------- ------- -------- ------- ------- ----------

  ------------- ------- ------- ------- -------- ------- ------- ----------
                                                                 

  ------------- ------- ------- ------- -------- ------- ------- ----------

  ------------- ------- ------- ------- -------- ------- ------- ----------
                                                                 

  ------------- ------- ------- ------- -------- ------- ------- ----------

  ------------- ------- ------- ------- -------- ------- ------- ----------
                                                                 

  ------------- ------- ------- ------- -------- ------- ------- ----------

  ------------- ------- ------- ------- -------- ------- ------- ----------
                                                                 

  ------------- ------- ------- ------- -------- ------- ------- ----------

  ------------- ------- ------- ------- -------- ------- ------- ----------
                                                                 

  ------------- ------- ------- ------- -------- ------- ------- ----------

  ------------- ------- ------- ------- -------- ------- ------- ----------
                                                                 

  ------------- ------- ------- ------- -------- ------- ------- ----------

  ------------- ------- ------- ------- -------- ------- ------- ----------
                                                                 

  ------------- ------- ------- ------- -------- ------- ------- ----------

  ------------- ------- ------- ------- -------- ------- ------- ----------
                                                                 

  ------------- ------- ------- ------- -------- ------- ------- ----------

  ------------- ------- ------- ------- -------- ------- ------- ----------
                                                                 

  ------------- ------- ------- ------- -------- ------- ------- ----------

  ------------- ------- ------- ------- -------- ------- ------- ----------
                                                                 

  ------------- ------- ------- ------- -------- ------- ------- ----------

**REVISED 4/03 \*\* ACLS - Advance Life Support Ambulance BLS - Basic
Life Support Ambulance VAH - Bus or Van**

**VA Ann Arbor Healthcare System VA/DoD Contingency Plan**

**Ann Arbor, Michigan April 2003**

**Appendix G-13**

**[VA POLICE]{.underline}**

**1. [PURPOSE:]{.underline} To establish procedures for Police Service
to follow when the medical center VA/DoD contingency plan is
activated.**

**2. [VA POLICE TEAM PROCEDURES:]{.underline}**

**a. Upon Initial notification of plan activation the VA Police officer
on duty will:**

-   **Notify the Chief, VA Police and Police Supervisor.**

-   **Initiate a recall of all VA Police officers as directed by the
    Chief, or higher command authority using the call back list located
    in the Police office.**

**b) Advise on availability of staff.**

**c) Advise local authorities of plan activation and coordinate
assistance as required.**

**d) The Chief of Police or Police Supervisor will assess the potential
for external threats to the medical center\'s security associated with
the conflict and VA\'s support role. Consider restriction of entrances
to the medical center.**

**2. [UPON NOTIFICATION THAT THE VA WILL BE RECEIVING PATIENTSTHE VA
POLICE WILL:]{.underline}**

**a. Chief of Police or Police Supervisor will have all available VA
police officers report for duty.**

**b. Prepare for the following functions as directed by the command
authority and in accordance with the Medical Center\'s Emergency
Preparedness Plan:**

**1) Control ingress to the medical center.**

**2) Direct all media to the designated media center.**

**3) Provide traffic control.**

**4) Provide emergency communication equipment.**

**5) Meet and direct incoming emergency vehicles.**

**6) Provide security at casualty treatment areas.**

**7) Contact the manpower pool for assistance as required.**

**8) Provide other assistance as needed or directed by command
authority.**

**3. [ANNUAL TRAINING]{.underline}: This plan will be reviewed with
staff annually. Recommendations and documentation of training will be
recorded in staff meeting minutes.**

**Appendix G-15**

# Transportation Section

**This supplement provides specific instructions regarding preparations,
transporting, receipt and processing of casualties upon formal
activation of the VA/DoD Contingency Plan. Where specific instructions
are not provided, following procedures currently established in the
Emergency Preparedness Plan.**

**ACTIVATION OF PLAN -- PHASE I -- PLANNING**

**1. Upon notification of the activation of the VA/DoD Contingency Plan,
Transportation Foreman will implement the appropriate notification of
personnel commensurate with the scope of the activation (i.e., alert
status vs. implementation). The foreman will identify and coordinate
assignment of additional personnel as needed from Facilities
Management.**

**2. The Foreman and designated personnel will assess the readiness of
all vehicles and staff. Passenger vehicles and buses will be converted
to litter vehicles as required.**

**FUNCTIONS & RESPONSIBILITIES --PHASE II & EARLY WARNING**

**1) The Foreman is responsible for maintaining a current assessment
(see Appendix G-8a) of available government vehicles and for
coordinating appropriate transportation for DoD casualties and veteran
patients with the Admitting/Business Office Coordinator and will contact
commercial resources, if required.**

**2) The Foreman is responsible for designation and training of drivers
and litter bearers. Assigned drivers and litter bearers are indicated on
Appendix G-11b. Training will be conducted in conjunction with annual
testing of the Emergency Preparedness External Casualty Reception
Plan.**

**3) In preparation for casualties, patients that can be discharged will
be. Discharge patient transportation will be conducted as directed and
coordinated with the bed control officer and social work service.
Patients reassigned to other facilities will be transported as
required.**

**4) Each vehicle will have the capability of radio communications, with
the medical center dispatcher prior to departure to in response to this
plan activation. All radios must be left on during any plan
activation.**

**5) Designated litter/stretcher bearers will be assigned to accompany
each driver.**

**Appendix G-16**

**PROCEDURES - PHASE III - FULL PLAN ACTIVATION - IMPLEMENTATION**

**a. Medical Center Staging Area for Support Personnel & Triage Team**

**1) Equipment, linen, and supplies cart(s) and pharmacy cart(s) will
respond the Ambulance entrance in preparation for response to airport.
The Triage Patient Reception Team and support personnel will assemble in
the ambulance garage three hours prior to the estimated time of arrival
of the aircraft. Drivers and litter bearers will load the vehicles, as
directed by the Triage Team Leader. The Team Leader will also ensure
required special equipment is transported. All personnel will then be
transported to the Wayne County Emergency Operations Center to be
processed through prior to going to the patient reception hanger.**

**2) The support personnel includes driver, litter bearers, the Safety
Specialist, Public Relations Specialist and additional nursing
personnel, as required, to monitor patients during transport.**

**3) All personnel responding to the airport for patient reception will
wear their VA picture ID badges.**

**b. Airport & Transportation**

**1) Drivers shall check all fourteen items on the driver
instructions/checklist (see Appendix G-20) prior to leaving the facility
for the airport.**

**2) Airport security is controlled by the Wayne County Sheriff
Department. All VA vehicles and staff will be processed through this
check point prior to proceeding to the assigned aircraft hanger.**

**3) If any of the vehicles requires emergency road service, refer to
Appendix G-19 for list of current service stations and procedures.**

**c. Patient Reception Area:**

**1) Unloading and receipt of casualties from the aircraft will be
performed under the direction of the Military Air Lift personnel.**

**2) Changes in the patient\'s condition during the flight may
necessitate changes in transportation to the hospital and bed
assignment. The Team Leader (Director of Primary Care or Surgeon) will
immediately call the Emergency Preparedness Coordinator for casualty
transportation. In the event Air Life Support (ALS) is needed, the ALS
ambulance will be arranged by the Airport Emergency Operations Center.**

**d. Upon arrival at the hospital**

**1) Stable patients will be brought through the ambulance garage and
directly admitted to their assigned beds and units.**

**2) Unstable patients will be brought through the ambulance entrance
and taken directly to the ETR and turned over to the triage reception
team.**

**A Ann Arbor Healthcare System VA/DoD Contingency Plan**

**Ann Arbor, Michigan April 2003**

**Appendix G-16**

**VA/DoD VEHICLE INVENTORY**

+---------------+-----------------+-------+----------+---------------+
| **VEHICLE     | **CAPACITY**    | *     | **CALL   | **REMARKS**   |
| ID**          |                 | *PORT | SIGN**   |               |
|               |                 | -ABLE |          |               |
|               |                 | RA    | **KLM    |               |
|               |                 | DIO** | 478**    |               |
+---------------+-----------------+-------+----------+---------------+

  ---------------- ------------------ -------- ---------- ----------------
  **Dodge Caravan  **8 passengers**                       
  2003**                                                  

  ---------------- ------------------ -------- ---------- ----------------

  ---------------- ------------------ -------- ---------- ----------------
  **Dodge Caravan  **8 passengers**                       
  2003**                                                  

  ---------------- ------------------ -------- ---------- ----------------

  ---------------- ------------------ -------- ---------- ----------------
  **Blue Bird      **26 passengers**                      **To be used to
  Bus**                                                   transport Triage
                                                          Team**

  ---------------- ------------------ -------- ---------- ----------------

  ---------------- ------------------ -------- ---------- ----------------
  **1993 Ford      **2 ton**                              **To be used for
  Truck Covered**                                         transport of med
                                                          equip &
                                                          supplies**

  ---------------- ------------------ -------- ---------- ----------------

**VA Ann Arbor Healthcare System VA/DoD Contingency Plan**

**Ann Arbor, Michigan April 2003**

**Appendix G-17**

**DRIVER & STRETCHER BEARER LIST**

**Coordinator**

  ----------------- ---------------------------- -------------------------
  **Normal Duty                                  
  Hours**                                        

  ----------------- ---------------------------- -------------------------

  ----------------- ---------------------------- -------------------------
  **Van Team        **Driver**                   **Helper**
  Number**                                       

  ----------------- ---------------------------- -------------------------

  ----------------- ---------------------------- -------------------------
  **1**             **Bob Furgason**             **Russ Fulmer**

  ----------------- ---------------------------- -------------------------

  ----------------- ---------------------------- -------------------------
  **2**             **Bill Bennett**             **Phil White**

  ----------------- ---------------------------- -------------------------

  ----------------- ---------------------------- -------------------------
  **Supply Van**    **Driver**                   **Passenger**

  ----------------- ---------------------------- -------------------------

  ----------------- ---------------------------- -------------------------
  **1**             **Carmen Saucedo**           **Rick Steed**

  ----------------- ---------------------------- -------------------------

  ----------------- ---------------------------- -------------------------
  **Irregular                                    
  Hours**                                        

  ----------------- ---------------------------- -------------------------

  ----------------- ---------------------------- -------------------------
                                                 

  ----------------- ---------------------------- -------------------------

  ----------------- ---------------------------- -------------------------
  **Van Team        **Driver**                   **Helper**
  Number**                                       

  ----------------- ---------------------------- -------------------------

  ----------------- ---------------------------- -------------------------
  **1**             **Bob Furgason**             

  ----------------- ---------------------------- -------------------------

  ----------------- ---------------------------- -------------------------
  **2**             **Bill Bennett**             **Lem Frye**

  ----------------- ---------------------------- -------------------------

  ----------------- ---------------------------- -------------------------
  **Supply Van**    **Driver**                   **Passenger**

  ----------------- ---------------------------- -------------------------

  ----------------- ---------------------------- -------------------------
  **1**             **Rick Steed**               

  ----------------- ---------------------------- -------------------------

**NOTE: All healthy Facilities Management employees may be asked to
serve as alternates to the above position, with the exception of bus
drivers.**

**Transportation team leader for each activation will be the driver of
the primary patient vehicle. If multiple vehicles are used, the bus
driver will assume leader duties.**

**Appendix G-18**

**EMERGENCY ROAD SERVICE CONTACTS FOR VA/DoD VEHICLES**

**1. If any patient transport vehicle becomes disabled for any reason,
perform the following immediately:**

**a. Notify AOD or Operation\'s Foreman by radio of status and
location.**

**b. Request that private ambulance be dispatched immediately to pickup
patients.**

**c. Request the following garages be contacted for assistance:**

**1) Trucks and Vans (mobile units #1, #2, #3 and #4):**

**(a) Plymouth & Broadway Shell**

**1800 Plymouth Rd.**

**Ann Arbor, Michigan 48105**

**(734) 662-2444**

**Appendix G-19**

**DRIVER INSTRUCTIONS/CHECK LIST**

**MOBILE UNITS #1, 2, 3, 4 ONLY**

**1. Check in with AOD or Operations Foreman upon arrival at VAMC.**

**2. Place VA ID Badge on outside of coat.**

**3. Ensure vehicle is clean, full of gas and tires are inflated.**

**4. Retrieve and load.**

**5. Check status of accompanying Triage Team Vehicle and Supply Van.**

**6. Perform radio check with AOD or Operations Foreman prior to
departure.**

**7. Proceed to Wayne County EOC at Detroit Metro Airport and identify
yourself and purpose.**

**8. Follow escort to appropriate hanger.**

**9. Follow instructions of Triage Team Leader or Military personnel.**

**10. Upon arrival at VAMC, deliver patients to ambulance entrance and
perform unloading procedure.**

**11. Fill vehicle with fuel (utilize GSA credit card at Amoco station
at Plymouth and Green road intersection) for gas vehicles. All diesel
vehicles will be filled at the VAMC boiler plant.**

**12. Clean and restock van (blankets, sheets, PPE kit, et.)**

**13. Park vehicle in designated area and turn in keys.**

**14. Check out with EOC, AOD or Operations Foreman prior to leaving
facility.**

**Appendix G-20**

**[HUMAN RESOURCES]{.underline}**

**POSITION: Human Resources Supervisor**

**[FIRST ALERT TO STANDBY STATUS:]{.underline}**

**1. As notified via facility cascade system, activate service level
cascade notification plan.**

**2. Review and update medical center capability assessment.**

**3. Confer with key services and brief management on key staffing
issues.**

**4. Advise AFGE Local of necessary policy variations.**

**[NOTIFICATION OF RECEIPT OF PATIENT:]{.underline}**

**Upon receipt of patients, activate manpower pool.**

**Appendix G-21**

**[CHAPLAIN]{.underline}**

**1. [STAFFING:]{.underline}**

**a. Personal leave for chaplains will be approved on a limited basis.
Leave will be judiciously monitored throughout the national crisis so
that at least one staff chaplain is scheduled for a daily tour and
available on an on-call basis.**

**b. Present staff will be supported by minister/rabbis from the
different faith groups:**

**1) Protestant:**

**(a) Inter-Faith Council**

**(b) Contact persons:**

**(1) The Reverend Charles Booker-Hirsch, (734) 663-5503**

**(2) The Reverend Anna Marie Austin (Kidder?), (734) 662-4466**

**2) Catholic:**

**(a) Washtenaw Vicarate**

**(b) Contact person:**

**(1) Father Roger Prokof, St. Thomas (A2) - (734) 761-8606**

**3) Jewish:**

**(a) Hillel Foundation - Conservative, Reformed, Orthodox (check on
this)**

**(b) Contact person:**

**(1) Rabbi Bob Levy (734) 665-4744**

**4) Islam:**

**(a) Islamic Center, (734) 665-6772**

**5) Mormons:**

**(a) Church of Jesus Christ of Latter Day Saints**

**(b) Contact person:**

**c. Volunteers will be used for pastoral care.**

**1) First Presbyterian Church, (734) 662-4466**

**2) Calvery Presbyterian Church, (734) 971-3121**

**Appendix G-22**

**3) Zion Lutheran Church, (734) 994-4455**

**4) Second Baptist Church, (734) 663-9369**

**5) First Methodist Church, (734) 662-4536**

**2. [TRAINING:]{.underline}**

**a. Present staff is trained/prepared to deal with diverse
spiritual/religious needs of the soldier/veterans.**

**b. Present staff is familiarized in dealing with military protocol
regarding funerals.**

**c. Volunteers are trained in pastoral care, sensitivity to diversity
of faith, appropriateness of pastoral care, distribution of devotional
materials and recording of visits.**

**3. [IMPLEMENTATION:]{.underline}**

**a. Present staff are trained/prepared to deal with diverse
spiritual/religious needs of the veterans.**

**1) Chaplain Service will be notified of the arrival of soldiers at the
medical center and their religious preference.**

**2) Chaplains will meet each new arrival in a timely manner offering
prayers and spiritual guidance as requested.**

**3) Daily tours will prioritize seriously ill, surgery, PCU, intensive
and new admit patients.**

**4) Chaplains will be available to family and next of kin to greet them
upon arrival when possible. They will actively seek out family and next
of kin offering prayers and spiritual guidance as requested.**

**5) Families and next of kin will be assisted in locating local
churches/temples, etc., as requested.**

**b. Chaplain Service will interface with other services where feasible
and needed and will assist in identifying those needs not specifically
religious and will support veterans and family in accomplishing those
goals.**

**1) Chaplains will assist in housing requests by directing such
requests through Social Work Service.**

**2) Chaplains will assist in monetary requests by directing such
request through Voluntary Service.**

**Appendix G-23**

**3) Chaplains will assist in benefits request by directing such
requests through the locally assigned Service Officers and Benefits
Officers of the DoD Patient Assistance Team (PAT) as appropriate.**

**c. Chaplain Service will interface with local churches and service
organizations.**

**1) Local main-line congregations and temples have been identified and
will be notified of arrival of veterans from their particular faith
group.**

**2) Local congregations and temples as volunteers.**

**3) Local service organizations are identified and will interface with
Chaplains as requested.**

**(a) Catholic Social Service**

**(b) Friends In Deed**

**d. Chaplain Service will interface with military counterparts.**

**1) Local retired, semi-retired and inactive Army & Navy Chaplains are
identified and will be contacted for support and input.**

**2) Local military counterpart, Selfridge Air National Guard Base, will
be notified for support as needed.**

**3) DoD Chaplains will be utilized and supported as needed.**

**Appendix H**

##  GLOSSARY

**ASMRO Armed Services Medical Regulating Office, Scott AFB IL. A Joint
agency of the Army, Navy and Air Force responsible for authorizing and
coordinating transfers of military patients.**

**CHS Contingency Hospital System - Combined health services of the
Department of Defense and Department of Veterans\' Affairs.**

**EOC Emergency Operations Center - Medical Center command center for
coordination of this plan, public affairs, and information associated
with implementation of CHS.**

**EPC Emergency Preparedness Coordinator/VA/DoD Coordinator - Emergency
Preparedness Coordinator.**

**EPP Emergency Preparedness Plan - Current medical center policy for
response to emergencies.**

**FCC Federal Coordinating Center - VAMC DETROIT; Medical treatment
facility responsible for initiating and coordinating all NDMS
activities.**

**NDMS National Disaster Medical System - A joint National medical
mutual aid system developed by DoD, DHSS, DVA and FEMA to provide for
medical needs of victims of a major disaster.**

**PAC Patient Airlift Center - Air Force facility which will coordinate
distribution of patients throughout the Continental United States.**

**PAT Patient Administration Team (military) - Military personnel
detailed from Wright Patterson AFB, Dayton, Ohio, to handle soldiers\'
administrative matters, i.e., leave, pay, discharge, travel, and return
to duty.**

**PRC Primary Receiving Center - VAMC Ann Arbor is a PRC responsible for
direct assignment of patients from ASMRO.**

**PRT Patient Reception Team - The medical center triage team
responsible for receiving and processing patients at the airport.**

**SSC Secondary Support Centers - VAMC Saginaw and VAMC Battle Creek are
SSCs. Their bed availability, assignment of patients, and coordination
with DoD is accomplished through the VAMC Ann Arbor.**