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VHA Emergency Management Capability Assessment Final Report

**Results from** **\< Insert VISN \> Site Visits**

*Submitted to:*

Department of Veterans Affairs

Veterans Health Administration

Office of Public Health and Environmental Hazards, Emergency Management
Strategic Health Care Group

![vaseal](media/image3.png){width="1.0972222222222223in"
height="1.0972222222222223in"}

**\< Insert Date \>**

**VHA Emergency Management Capability Assessment Final Report** **\<
Insert VISN \>**

\* \* \* \* \*

**TABLE OF CONTENTS**

[1 Executive Summary 1](#executive-summary)

[2 Introduction 1](#introduction)

[3 Methodology 1](#methodology)

[3.1 Capability Element Description 2](#capability-element-description)

[3.2 Capability Assessment and Measurement
5](#capability-assessment-and-measurement)

[3.3 Data Collection Methodology 5](#data-collection-methodology)

[4 Overall Program Capabilities 6](#overall-program-capabilities)

[5 Discussion of Facility Profile 8](#discussion-of-facility-profile)

[5.1 Program Level Excellent Practices
8](#program-level-exemplary-practices)

[5.2 Incident management excellent Practices 9](#_Toc200257141)

[5.3 resiliency/continuity of operations excellent practices
9](#_Toc200257142)

[5.4 Program Level Opportunities for Capability Enhancement
10](#operational-level-exemplary-practices)

[6 Program Level Recommendations
11](#program-level-recommendations-and-enhancements)

[Appendix A 13](#appendix-a)

[Acronym List 13](#acronym-list)

[Appendix B 15](#appendix-b)

[Capability Descriptor List 15](#capability-descriptor-list)

Executive Summary
=================

A site assessment was conducted by the Comprehensive Emergency
Management Program (CEMP) assessment team from \< Insert Date of
Assessments \>. The assessment team included **\<List of Assessment
Team\>**. The team appreciated the cooperation and enthusiasm of the
**\<Site Location\>** staff and their willingness to assist in a very
successful visit.

\<Describe how the VAMC met standards/requirements and facility status\>

\<Describe areas for any recommendations and enhancements given\>

Introduction
============

The **\<Site Location\>**, located in **\<Physical Site Location\>**, is
identified as a \<list identifiers and affiliations\>.

\<Describe site location and purpose of visit\>.

Methodology
===========

Prior to the site visits, the assessment team worked closely with
experts in the field of emergency medicine and preparedness to define
the assessment elements for the study. These experts represented VHA,
other federal agencies including the Department of Homeland Security
(DHS), Health and Human Services (HHS), and Defense, academia, and
clinical medicine. Through consultation with these experts the
assessment team defined the 43 capabilities for this assessment as well
as the measurement scheme. The following sections will provide a high
level summary of the overall assessment protocol.

Capability Element Description
------------------------------

To determine the elements for assessment during the site visits and
pre-survey, the VHA capabilities were categorized into six groups. These
included capabilities relevant to:

-   **Program Level** capabilities help to ensure the VISN addresses
    issues relative to planning and preparedness as a crucial building
    block for VISN capabilities. These program level capabilities were
    categorized into the following groups:

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-   Systems-Based Approach to Development, Implementation, Management,
    and Maintenance of the Emergency Management Program

-   Administrative Activities ensure the EMP meets its Mission and
    Objectives

-   Development, Implementation, Management, and Maintenance of an
    Emergency Management Committee Process to support the Emergency
    Management Program

-   Incorporation of Comprehensive Preparedness Planning in the VISN's
    Coordination Activities in Conjunction with the Individual Facility
    Emergency Management Programs

-   Incorporation of Continuity Planning into the Coordination
    Activities of the VISN's Office's Emergency Management Program to
    ensure Organizational Continuity and Resiliency of Mission Critical
    Functions, Processes, and System

-   Development, Implementation, Management, and Maintenance of an
    Emergency Operations Plan

-   Incorporation of Comprehensive Instructional Activity into the
    Preparedness Activities of the VISN's Emergency Management Program

-   Incorporation of a Range of Exercise Types that Test the VISN's
    Emergency Management Program

-   Demonstration of Systems-Based evaluation of the VISN's overall
    Emergency Management Program and its Emergency Operations Plan

-   Incorporation of Accepted Improvement Recommendations into the
    Emergency Management Program and its Components such that the
    Process becomes one of a Learning Organization

    -   **Incident Management** capabilities help to ensure the VISN can
        > manage all incidents regardless of scope. These capabilities
        > were categorized into the following groups:

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-   Initial Incident Actions (e.g., first four hours)

-   Management of Extended Operations (e.g., after first four hours)

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```
-   **Occupant Safety** capabilities help to ensure the VISN and its
    occupants are protected and out of harm's way. These capabilities
    were categorized into the following groups:

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```
-   Evacuation vs. Shelter-In-Place

-   Perimeter Management of Access/Egress to Facility during an Incident
    > (e.g. Lock Down)

-   Processes and Procedures for Managing a Hazardous Substance Incident

-   Infection Control

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```
-   **Resiliency and Continuity of Operations** **(COOP)** capabilities
    help to ensure the VISN can continue to provide high quality
    healthcare, and that all VISN based operations can continue during
    an emergency. These capabilities were categorized into the following
    groups:

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-   Personnel Resiliency

-   Mission Critical Systems Resiliency

-   Communications

-   Healthcare Service System Resiliency

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```
-   **Medical Surge** capabilities help to ensure the VISN can meet the
    increased demand for health care services during an emergency. These
    capabilities were categorized into the following groups:

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```
-   Processes and Procedures for Expansion of Staff for Response and
    Recovery Operations

-   Management of Volunteers Deployment Support (e.g. DEMPS) during
    Response and Recovery Operations

-   Expansion of Evaluation and Treatment Services

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-   **Support to External Requirements** help to ensure the VISN can
    > integrate with the community and other federal health partners
    > such as HHS, including Centers for Disease Control and
    > Prevention (CDC) and Assistant Secretary for Preparedness and
    > Response (ASPR), DHS, and Department of Defense (DOD).

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```
-   Provision of Supplemental Health Services to Support the National
    Disaster Medical System

-   VA/DOD Contingency Hospital System

-   Support under the National Response Framework

To describe each capability, the assessment team developed a framework
that includes the following components:

-   **Policies or Guidance** that govern, guide, or direct that activity

-   **Resources** (including supplies, facilities, and equipment)
    assigned to maintain or enable that capability

-   **Personnel** designated to manage or staff that area

-   **Processes** in place to allow for consistency across departments
    and organizations

-   **Education/Training** provided to staff regarding that capability

-   **Exercise** activities used to promote evaluation of that
    capability

-   **Evaluation** of the exercise results

-   **Organizational Learning** and process improvement that takes place
    as a result of the exercise and resulting evaluation

An example of this descriptive framework is presented in Table 1 below.

**Table 1. Descriptive Framework for Mobilization Capability**

+------------------------+--------------------------------------------+
| Capability Element     | Assessment components                      |
+========================+============================================+
| Policy                 | The organization has established effective |
|                        | mechanisms to rapidly mobilize essential   |
|                        | personnel, facilities, equipment and       |
|                        | supplies to support emergency response.    |
+------------------------+--------------------------------------------+
| Resources              |                                            |
+------------------------+--------------------------------------------+
| > Supplies             | -   Supplies needed for mobilization       |
+------------------------+--------------------------------------------+
| > Facilities/Equipment | -   Storage facilities for equipment and   |
|                        |     > supplies.                            |
+------------------------+--------------------------------------------+
| > Personnel            | -   The organization has identified        |
|                        |     > qualified and trained personnel to   |
|                        |     > manage mobilization of key response  |
|                        |     > areas.                               |
+------------------------+--------------------------------------------+
| Process                | -   Supplies, equipment and temporary      |
|                        |     > facilities to be mobilized should be |
|                        |     > pre-positioned or staged for         |
|                        |     > response and recovery to allow rapid |
|                        |     > mobilization.                        |
|                        |                                            |
|                        | -   The Emergency Operations Center (EOC)  |
|                        |     > facility is pre-identified and       |
|                        |     > equipped with emergency power,       |
|                        |     > back-up communications, FAX          |
|                        |     > machines, printers, laptops, and     |
|                        |     > other essential equipment (e.g.,     |
|                        |     > satellite phone) and services        |
|                        |     > sufficient to operate throughout the |
|                        |     > duration of the emergency.           |
|                        |                                            |
|                        | -   There are written procedures including |
|                        |     > job descriptions for key EOC         |
|                        |     > personnel                            |
|                        |                                            |
|                        | -   The EOC should have battery powered    |
|                        |     > lighting in case generators don't    |
|                        |     > energize                             |
|                        |                                            |
|                        | -   Laptops should be operational within a |
|                        |     > few minutes of EOC activation        |
|                        |                                            |
|                        | -   There are written procedures for       |
|                        |     > identifying alternative sites for    |
|                        |     > the EOC                              |
|                        |                                            |
|                        | -   VISN has a call back roster for the    |
|                        |     > Incident Management Team (IMT) and   |
|                        |     > each department of the facility.     |
|                        |                                            |
|                        | -   Staff callback rosters are maintained  |
|                        |     > for each Operating Unit.             |
|                        |                                            |
|                        | -   Staff will establish phone bank        |
|                        |     > messaging capability and coordinate  |
|                        |     > message alerts with local media.     |
|                        |                                            |
|                        | -   VISN has job action sheets for the     |
|                        |     > Agency Executive and the IMT         |
+------------------------+--------------------------------------------+
| Education/training     | -   Members of the IMT and other key areas |
|                        |     > need to be trained with respect to   |
|                        |     > their role in mobilizing the actions |
|                        |     > upon incident notification.          |
+------------------------+--------------------------------------------+
| Exercise               | -   Callback rosters are tested at least   |
|                        |     > quarterly                            |
|                        |                                            |
|                        | -   There is an exercise component that    |
|                        |     > practices bringing some key staff    |
|                        |     > back to the facility during regular  |
|                        |     > exercises.                           |
+------------------------+--------------------------------------------+

Capability Assessment and Measurement
-------------------------------------

After the team defined the critical capabilities and used the
descriptive framework to define the capability, the assessment team
developed a measurement scheme. This scheme includes a five level scale
to include the following indicators:

-   **Exemplary:** The facility often performs at a higher level than
    industry standards call for. This would be considered a "best in
    class" or "best practice"

-   **Excellent:** The facility often goes above and beyond the required
    standards

-   **Developed:** When present, the facility meets industry standards
    relative to that capability

-   **Being developed:** The capability is in its infancy, and initial
    attempts to build the capability are underway

-   **Needs attention:** There is no evidence the capability exists.

Table 2 depicts the measurement factors for the above highlighted
mobilization capability.

**Table 2. Measurement Factors for Mobilization Capability**

  4   Exemplary         All of the above assessment components are present including establishing Incident Management teams consistent with the facility's SOPs for high risk hazards. Mobilization plan is practiced semiannually.
  --- ----------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
  3   Excellent         Resources and training are in place and mobilization is practiced at least annually.
  2   Developed         Resources and training are in place including a written mobilization plan.
  1   Being Developed   Some capability elements exist; however mobilization plan is not written or practiced at least annually.
  0   Needs Attention   Absence of mobilization plan.

Data Collection Methodology
---------------------------

To capture data relevant to each of these capabilities, the assessment
team undertook a number of activities, as shown in Figure 1. Each of
these will be discussed in subsequent sections.

**Figure 1. Assessment Methodology**

![](media/image4.wmf){width="5.999305555555556in"
height="2.9277777777777776in"}

**Pre-Survey:**

During the initial assessment phase, the VHA assessment team evaluated
the results of a pre-survey administered to the VISN several weeks
before the visit. During the normal site visit cycle, the VISN would
have a much longer time period in which to complete this survey. Key
parts of this self-reported survey were validated against the findings
of the site visit. During a normal site visit, the assessment team will
inform the agenda by analysis of the pre-survey.

**Site Visit:**

During the site visit the VHA assessment team conducted an opening
briefing, interviewed several key members of the emergency management
team, participated in facilitated discussions, conducted a document
review, and had a closing conference with the VISN management. Based
upon these activities, the VHA assessment team was able to observe and
evaluate a number of competencies needed for an effective EMP.

**Reporting:**

In addition to this final report, lessons learned and best practices
identified in this site visit will be generalized and shared with VHA
Central Office (VHACO). We will also summarize the findings and issues
identified for national attention and will share them with VHA CO senior
management to identify tools, resources, communications, policy, and
programs that leadership should consider for national deployment.

Overall Program Capabilities
============================

Table 2 below provides a summary of the emergency management
capabilities of VISN 8. Detailed discussion of some of these
capabilities is provided in subsequent sections.

Table 2: Summary of \< Insert VISN \> Capabilities

  **Capability**                                                                                                                                                                                                                  **Exemplary**   **Excellent**   **Developed**   **Being Developed**   **Need Attention**
  ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- --------------- --------------- --------------------- --------------------
  1.1 Systems-Based Approach to the Development, Implementation, Management, and Maintenance of the Emergency Management Program                                                                                                                                                                        
  1.2 Administrative Activities ensure the Emergency Management Program meets its Mission and Objectives                                                                                                                                                                                                
  1.3 Development, Implementation, Management, and Maintenance of an Emergency Management Committee Process to support the Emergency Management Program                                                                                                                                                 
  1.4 Incorporation of Comprehensive Preparedness Planning in the VISN's Coordination Activities in Conjunction with the Individual Facility Emergency Management Programs                                                                                                                              
  1.5 Incorporation of Continuity Planning into the Coordination Activities of the VISN's Emergency Management Program to ensure Organizational Continuity and Resiliency of Mission Critical Functions, Processes, and Systems                                                                         
  1.6 Development, Implementation, Management, and Maintenance of an Emergency Operations Plan                                                                                                                                                                                                          
  1.7 Incorporation of Comprehensive Instructional Activity into the Preparedness Activities of the VISN's Emergency Management Program                                                                                                                                                                 
  1.8 Incorporation of a Range of Exercise Types that Test the VISN's Emergency Management Program                                                                                                                                                                                                      
  1.9 Demonstration of Systems-Based Evaluation of the VISN's overall Emergency Management Program and its Emergency Operations Plan                                                                                                                                                                    
  1.10 Incorporation of Accepted Improvement Recommendations into the Emergency Management Program and its Components such that the process becomes one of a Learning Organization                                                                                                                      
  2.1.1 Processes and Procedures for Incident Recognition, Activation of EOP/EOC, and Initial Notification of Staff                                                                                                                                                                                     
  2.1.2 Mobilization of Critical Staff and Equipment for Incident Response                                                                                                                                                                                                                              
  2.1.3 Situational Assessment of Response and Coordination Efforts Initial Incident Management and Emergency Operations Center Activation                                                                                                                                                              
  2.2.1 Management of Extended Incident Operations                                                                                                                                                                                                                                                      
  2.2.2 Public Information Management Services during an Incident                                                                                                                                                                                                                                       
  2.2.3 Management and Acquisition of Resources for Incident Response and Recovery Operations                                                                                                                                                                                                           
  2.2.4 Processes and Procedures for Demobilization of Personnel and Equipment                                                                                                                                                                                                                          
  2.5 Processes and Procedures for a Return to Readiness of Personnel and Equipment                                                                                                                                                                                                                     
  3.1.1 Processes and Procedures for Evacuation of Patients', Staff, and Visitors'                                                                                                                                                                                                                      
  3.1.2 Processes and Procedures for Sheltering-in-Place                                                                                                                                                                                                                                                
  3.1.3 Processes and Procedures for Sheltering Family of Critical Staff                                                                                                                                                                                                                                
  3.2 Perimeter Management of Access/Egress to Facility during an Incident (e.g., Lock Down)                                                                                                                                                                                                            
  3.3 Processes and Procedures for Managing a Hazardous Substance Incident                                                                                                                                                                                                                              
  3.4.1 Biohazard (Infection) Control Surge Services during Emergencies                                                                                                                                                                                                                                 
  3.4.2 Selection and Use of Personal Protective Equipment for Incident Response and Recovery Operations                                                                                                                                                                                                
  3.4.3 Processes and Procedures for Staff and Family Mass Prophylaxis during an Infectious Outbreak (i.e., Influenza)                                                                                                                                                                                  
  4.1.1 Maintaining Authorized Leadership (Leadership Succession)                                                                                                                                                                                                                                       
  4.1.2 Processes and Procedures for Personal Preparedness and Employee Welfare                                                                                                                                                                                                                         
  4.1.3 Dissemination of Personnel Incident Information to Staff during an Incident                                                                                                                                                                                                                     
  4.2.1 Maintaining Information Technology (IT) and Computing Systems Resiliency during an Incident                                                                                                                                                                                                     
  4.2.2 Maintaining Access to Critical Commodities and Services during Response and Recovery Operations                                                                                                                                                                                                 
  4.3.1 Maintenance of Voice and Data Communication through Satellite link                                                                                                                                                                                                                              
  4.3.2 Interoperable Communications with External Agencies'                                                                                                                                                                                                                                            
  4.3.3 Interoperable Communications with VISN Facilities'                                                                                                                                                                                                                                              
  4.4.1 Management of Primary Care for Special Needs Patients, including Home-Based Care during Incidents                                                                                                                                                                                               
  5.1 Processes and Procedures for Expansion of Staff for Response and Recovery Operations                                                                                                                                                                                                              
  5.2 Management of Volunteers Deployment Support (e.g., DEMPS) during Response and Recovery Operations                                                                                                                                                                                                 
  5.3.1 Development, Implementation, Management, and Maintenance of the VA All-Hazards Emergency Cache                                                                                                                                                                                                  
  5.3.2 Designated Capability for Expanded Patient Triage, Evaluation, and Treatment during Surge                                                                                                                                                                                                       
  5.3.3 Processes and Procedures for Control and Coordination of Mass Fatality Management                                                                                                                                                                                                               
  6.1 Provision of Supplemental Health Services to Support the National Disaster Medical System (NDMS)                                                                                                                                                                                                  
  6.2 VA/DOD Contingency Hospital System                                                                                                                                                                                                                                                                
  6.3 Support under the National Response Framework                                                                                                                                                                                                                                                     

Discussion of Facility Profile
==============================

Based on the above table, there were several capabilities that were
identified as areas in which there were potential best practices as well
as opportunities for continued enhancement. These are discussed in
subsequent sections.

Program Level Exemplary Practices
---------------------------------

**\<Site Location\>** exhibited very strong capabilities in several
areas. Examples are discussed below.

\<Create Sub-headings here to describe each of the program level
practices in which excellence was observed\>

Operational Level Exemplary Practices
-------------------------------------

\<Create Sub-Headings here to describe each of the operational level
practices in which excellence was observed\>

Program Level Recommendations and Enhancements
==============================================

The VHA Assessment Team has composed a listing of recommendations based
on the site visit and capability assessments. VISN 8 should utilize the
VHA EMP Guidebook as the principle resource to developing and enhancing
their EMP along with recommendations discussed below:

\<Create Sub-Headings here to describe each of the program level
recommendations\>

Operational Level Recommendations and Enhancements
==================================================

\<Create Sub-Headings here to describe each of the program level
recommendations\>

Appendix A {#appendix-a .list-paragraph}
==========

Acronym List {#acronym-list .list-paragraph}
------------

  **Acronym**   **Definition**
  ------------- ------------------------------------------------------------
  AAR           After Action Report
  AD            Associate Director
  APR           Air Purifying Respirator
  ASPR          Assistant Secretary for Preparedness and Response
  CBOC          Community-Based Outpatient Clinic
  CBRNE         Chemical, Biological, Radiological, Nuclear, and Explosive
  CDC           Centers for Disease Control and Prevention
  CEM           Certified Emergency Manager
  CIO           Chief Information Officer
  CO            Central Office
  COOP          Continuity of Operations
  DEMPS         Disaster Emergency Medical Personnel System
  DHS           Department of Homeland Security
  DOD           Department of Defense
  ECG           Electrocardiogram
  EMC           Emergency Management Committee
  EMP           Emergency Management Program
  EMSHG         Emergency Management Strategic Healthcare Group
  EMT           Emergency Medical Technician
  EOC           Emergency Operations Center
  EOP           Emergency Operations Plan
  EPC           Emergency Planning Coordinator
  FCC           Federal Coordinating Center
  FEMA          Federal Emergency Management Agency
  HAZWOPER      Hazardous Waste Operations and Emergency Response
  HBPC          Home-based Primary Care
  HHS           Health and Human Services
  HVA           Hazard Vulnerability Analysis
  ICS           Incident Command System
  IMT           Incident Management Team
  IT            Information Technology
  TJC           The Joint Commission
  MOU           Memorandum of Understanding
  NDMS          National Disaster Medical System
  NFPA          National Fire Protection Association
  NIMS          National Incident Management System
  OPC           Out Patient Clinic
  OSHA          Occupational Safety and Health Administration
  PAO           Public Affairs Officer
  PAPR          Powered Air Purifying Respirator
  PPE           Personal Protective Equipment
  PRC           Primary Receiving Center
  SOP           Standard Operating Procedure
  VA            Veterans Affairs
  VAMC          Veterans Affairs Medical Center
  VHA           Veterans Health Administration
  VISN          Veterans Integrated Service Network
  VSAT          Very Small Aperture Terminal

Appendix B {#appendix-b .list-paragraph}
==========

Capability Descriptor List {#capability-descriptor-list .list-paragraph}
--------------------------

> **[Program Level Capabilities]{.underline}**

-   Systems-Based Approach to Development, Implementation, Management,
    > and Maintenance of the Emergency Management Program

-   Administrative Activities ensure the EMP meets its Mission and
    > Objectives

-   Development, Implementation, Management, and Maintenance of an
    > Emergency Management Committee Process to support the Emergency
    > Management Program

-   Incorporation of Comprehensive Preparedness Planning in the VISN's
    > Coordination Activities in Conjunction with the Individual
    > Facility Emergency Management Programs

-   Incorporation of Continuity Planning into the Coordination
    > Activities of the VISN Office's Emergency Management Program to
    > ensure Organizational Continuity and Resiliency of Mission
    > Critical Functions, Processes, and Systems

-   Development, Implementation, Management, and Maintenance of an
    > Emergency Operations Plan

-   Incorporation of Comprehensive Instructional Activity into the
    > Preparedness Activities of the VISN's Emergency Management Program

-   Incorporation of a Range of Exercise Types that Test the VISN's
    > Emergency Management Program

-   Demonstration of Systems-Based Evaluation of the VISN's overall
    > Emergency Management Program and its Emergency Operations Plan

-   Incorporation of Accepted Improvement Recommendations into the
    > Emergency Management Program and its Components such that the
    > Process becomes one of a Learning Organization

> **[Incident Management Capabilities]{.underline}**
>
> **Initial Incident Actions (e.g., first four hours)**

-   **Processes and Procedures for Incident Recognition, Activation of
    EOP/EOC, and Initial Notification of Staff**

-   **Mobilization of Critical Staff and Equipment for Incident
    Response**

-   **Situational Assessment of Response and Coordination Efforts for
    Initial Incident Management and Emergency Operations Center
    Activation**

> **Management of Extended Operations (e.g., after first four hours)**

-   **Management of Extended Operations**

-   **Public Information Management Services during an Incident**

-   **Management and Acquisition of Resources for Incident Response and
    Recovery Operations**

-   **Processes and Procedures for Demobilization of Personnel and
    Equipment**

-   **Processes and Procedures for a Return to Readiness Personnel and
    Equipment**

> **[Occupant Safety Capabilities]{.underline}**
>
> Evacuation vs. Shelter-in-Place

-   **Processes and Procedures for Evacuation of Patients', Staff, and
    > Visitors'**

-   **Processes and Procedures for Sheltering-in-Place**

-   **Processes and Procedures for Sheltering Family of Critical Staff**

> **Perimeter Management of Access/Egress to Facility during an Incident
> (e.g., Lockdown)**
>
> **Processes and Procedures for Managing a Hazardous Substance
> Incident**
>
> **Infection Control**

-   **Biohazard (Infection) Control Surge Services During Emergencies**

-   **Selection and Use of Personal Protective Equipment for Incident
    > Response and Recovery Operations**

-   **Processes and Procedures for Staff and Family Mass Prophylaxis
    > during an Infectious Outbreak (i.e., Influenza)**

> **[Resiliency/Continuity of Operations Capabilities]{.underline}**
>
> **Personnel Resiliency**

-   **Maintaining Authorized Leadership (Leadership Succession)**

-   **Processes and Procedures for Personal Preparedness and Employee
    Welfare**

-   **Dissemination of Personnel Incident Information to Staff during an
    Incident**

> **Mission Critical Systems Resiliency**

-   **Maintaining Information Technology (IT) and Computing Systems
    Resiliency during an Incident**

-   **Maintaining Access to Critical Commodities and Services during
    Response and Recovery Operations**

> **Communications**

-   **Maintenance of Voice and Data Communication through Satellite
    link**

-   **Interoperable Communications with External Agencies'**

-   **Interoperable Communications with VISN Facilities'**

Healthcare Systems Resiliency

-   **Management of Primary Care for Special Needs Patients, including
    Home-Based Care during Incidents**

> **[Medical Surge]{.underline}**
>
> **Processes and Procedures for Expansion of Staff for Response and
> Recovery Operations**
>
> **Management of Volunteers Deployment Support (e.g., DEMPS) during
> Response and Recovery Operations**
>
> **Expansion of Evaluation and Treatment Services**

-   **Development, Implementation, Management, and Maintenance of the VA
    All-Hazards Emergency Cache**

-   **Designated Capability for Expanded Patient Triage, Evaluation and
    Treatment during Surge**

-   **Processes and Procedures for Control and Coordination of Mass
    Fatality Management**

> **[Support to External Requirements Capabilities]{.underline}**
>
> **Provision of Supplemental Health Services to Support the National
> Disaster Medical System**
>
> **VA/DOD Contingency Hospital System**
>
> **Support Under the NRF**