Department of Veterans Affairs (VA) 

VA Pandemic Influenza Plan 

March 2006 
 VA Pandemic Influenza Plan 

March 2006 

Table of Contents 

CURRENT SITUATION .......................................................................................................................... V

FOREWORD BY THE SECRETARY OF VETERANS AFFAIRS ...................................................VI

EXECUTIVE SUMMARY .................................................................................................................... VII

ACKNOWLEDGMENTS ........................................................................................................................IX

SECTION 1: INTRODUCTION...........................................................................................................1

1.1 RESPONSIBILITIES OF AND FACTS ABOUT THE DEPARTMENT OF VETERANS AFFAIRS ...................1

1.1.1 Veterans Health Administration (VHA) – Health care .........................................................1

1.1.2 Veterans Benefits Administration (VBA) – Financial assistance..........................................1

1.1.3 National Cemetery Administration (NCA) – Burials and memorials ...................................2

1.1.4 VA Geography – Nationwide, state-to-state, and overseas...................................................2

1.1.5 Workforce..............................................................................................................................2

1.2 RELATIONSHIP OF THIS PLAN WITH OTHER VA EMERGENCY PLANS .............................................2

1.3 BACKGROUND – VA AND PANDEMIC INFLUENZA PLANNING .........................................................3

1.4 PLANNING ASSUMPTIONS ................................................................................................................4

1.5 GOALS OF THE VA PANDEMIC INFLUENZA PLAN............................................................................5

1.6 ORGANIZATION OF THIS PLAN.........................................................................................................6

SECTION 2: PREPARING FOR PANDEMIC INFLUENZA ..........................................................7

2.1 VA-WIDE/VA CENTRAL OFFICE PREPARATIONS............................................................................7

2.1.1 Leadership.............................................................................................................................7

2.1.2 Coordination .........................................................................................................................7

2.1.3 VA Central Office Preparations............................................................................................7

2.1.4 Roles and Responsibilities ....................................................................................................8

2.1.4.1 Public Affairs/Communications..........................................................................................8

2.2 VHA PREPARATIONS .......................................................................................................................9

2.2.1 Leadership.............................................................................................................................9

2.2.2 Coordination .........................................................................................................................9

2.2.2.1 Collaboration ......................................................................................................................9

2.2.2.2 Use of emergency plans....................................................................................................10

2.2.2.3 Acquisition of and allocation policies for vaccines, antivirals, diagnostics, materiel, and 

staffing ..............................................................................................................................10

2.2.3 Roles and Responsibilities ..................................................................................................10

2.2.3.1 Creation of facility and network pandemic influenza plans .............................................10

2.2.3.2 Workforce preparation (education, skill identification, credentialing, Pandemic Response 

Teams) ..............................................................................................................................11

2.2.3.3 Physical site (space planning, building and engineering systems, support for infection 

control, transportation of patients, fatality management) .................................................12

2.2.3.4 Infection control and precautions (heightened surveillance, staff illness, supplies and their 

management, transmission and precautions for health care facility staff)........................13

2.2.3.5 Countermeasures (vaccines, antiviral medications, diagnostics)......................................14

2.2.3.6 Medical materiel (equipment and supplies)......................................................................15

2.2.3.7 Health care delivery (triage, waiting areas, novel/innovative care delivery, including 

home care).........................................................................................................................16

2.2.3.8 Support and management of exposed and ill staff............................................................17

2.2.3.9 Mental health support for patients and staff......................................................................18

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March 2006 

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2.2.3.10 Surveillance and reporting, VHA facility-level (including first case) and VHA Central 

Office-level response (use of diagnostics, data on cases, local collaboration, reporting 

mechanisms) .....................................................................................................................18

2.2.3.11 Security (facilities, supplies).............................................................................................20

2.2.3.12 Communication, VHA facility-level and VHA Central Office-level ...............................20

2.3 VBA PREPARATIONS .....................................................................................................................23

2.3.1 Leadership...........................................................................................................................23

2.3.2 Coordination .......................................................................................................................23

2.3.3 Roles and Responsibilities ..................................................................................................23

2.3.3.1 Creation of VBA regional office pandemic influenza plans.............................................23

2.3.3.2 Workforce (staffing, education)........................................................................................23

2.3.3.3 Infection control................................................................................................................24

2.3.3.4 Security .............................................................................................................................24

2.3.3.5 Communication.................................................................................................................24

2.4 NCA PREPARATIONS .....................................................................................................................24

2.4.1 Leadership...........................................................................................................................24

2.4.2 Coordination .......................................................................................................................24

2.4.3 Roles and Responsibilities ..................................................................................................25

2.4.3.1 Creation of network- and cemetery-level pandemic influenza plans................................25

2.4.3.2 Workforce (staffing, education)........................................................................................25

2.4.3.3 Infection control................................................................................................................25

2.4.3.4 Communication.................................................................................................................26

2.5 VA-WIDE PANDEMIC INFLUENZA OUTBREAK EXERCISES............................................................26

SECTION 3: RESPONDING TO PANDEMIC INFLUENZA........................................................27

3.1 VA RESPONSE ACTIONS.................................................................................................................27

3.1.1 Leadership...........................................................................................................................27

3.1.2 Coordination and Communication......................................................................................27

3.1.3 VA Central Office Response................................................................................................27

3.1.4 Roles and Responsibilities: VA-wide ..................................................................................27

3.1.4.1 Vigilance and notification.................................................................................................27

3.1.4.2 Implementation of emergency plans.................................................................................28

3.1.4.3 Limiting disease spread ....................................................................................................28

3.2 VHA RESPONSE ACTIONS..............................................................................................................28

3.2.1 Leadership...........................................................................................................................28

3.2.2 Coordination and Communication......................................................................................28

3.2.3 Roles and Responsibilities ..................................................................................................29

3.2.3.1 Surveillance, including possible first case ........................................................................29

3.2.3.2 Refocusing of patient care priorities.................................................................................29

3.2.3.3 Infection control (transmission and precautions for health care facility staff, hand and 

respiratory hygiene)..........................................................................................................30

3.2.3.4 Support for and management of exposed or ill staff (monitoring, triage, absences, public 

health measures) ...............................................................................................................31

3.2.3.5 Countermeasures (antiviral drugs, vaccines, diagnostics) ................................................31

3.2.3.6 Workforce (availability, flexible work standards, credentialing, broadened practice 

standards)..........................................................................................................................32

3.2.3.7 Patient care (changing demands and surge, advice lines/telemedicine, triage, diagnosis, 

isolation, expansion to include alternative space and sites, altered standards of care).....33

3.2.3.8 Medical materiel (medications and supplies, access to caches)........................................35

3.2.3.9 Security for health care sites.............................................................................................36

3.2.3.10 Fatality management.........................................................................................................36
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3.2.3.11 Mental health support .......................................................................................................36

3.3 VBA RESPONSE ACTIONS..............................................................................................................37

3.3.1 Leadership...........................................................................................................................37

3.3.2 Coordination and Communication......................................................................................37

3.3.3 Roles and Responsibilities ..................................................................................................37

3.3.3.1 Workforce actions.............................................................................................................37

3.3.3.2 Closure of regional offices................................................................................................37

3.3.3.3 Infection control................................................................................................................37

3.3.3.4 Security .............................................................................................................................37

3.4 NCA RESPONSE ACTIONS..............................................................................................................38

3.4.1 Leadership...........................................................................................................................38

3.4.2 Coordination and Communication......................................................................................38

3.4.3 Roles and Responsibilities ..................................................................................................38

3.4.3.1 Workforce actions.............................................................................................................38

3.4.3.2 Closure of network offices or cemeteries .........................................................................38

3.4.3.3 Infection control................................................................................................................38

3.5 COMMUNICATION WITHIN AND OUTSIDE OF VA DURING A PANDEMIC.......................................38

3.5.1 Leadership...........................................................................................................................38

3.5.2 Coordination .......................................................................................................................39

3.5.3 Roles and Responsibilities ..................................................................................................39

3.5.3.1 VA-wide communication..................................................................................................39

3.5.3.2 VHA communication........................................................................................................39

3.5.3.3 VBA communication ........................................................................................................41

3.5.3.4 NCA communication ........................................................................................................41

SECTION 4: RECOVERING FROM PANDEMIC INFLUENZA.................................................43

SECTION 5: ACRONYMS, ABBREVIATIONS, GLOSSARY......................................................44

5.1 LIST OF ACRONYMS AND ABBREVIATIONS .......................................................................44

5.2 GLOSSARY OF TERMS ..............................................................................................................47

APPENDIX GROUP A: VA BACKGROUND...................................................................................56

APPENDIX A-1: DIAGRAM OF VA ORGANIZATION ...........................................................................56

APPENDIX A-2: MAPS RELATED TO THE THREE ADMINISTRATIONS OF THE DEPARTMENT

OF VETERANS AFFAIRS (VA) ...............................................................................................................57

APPENDIX A-3: FACTS ABOUT VA HEALTH CARE CAPABILITIES.................................................60

APPENDIX GROUP B: LEGAL AUTHORITIES AND RESPONSIBILITIES............................63

APPENDIX B-1: SUMMARY OF POTENTIAL VA EXPANDED RESPONSIBILITIES........................63

APPENDIX B-2: TABLE OF LEGAL AUTHORITIES AND POLICIES RELEVANT TO

EMERGENCIES - ADVICE ON CHANGES IN USUAL VA PRACTICES DURING A PANDEMIC .....................65

APPENDIX GROUP C: REFERENCES ............................................................................................72

APPENDIX C-1: REFERENCE LIST FOR VA EMERGENCY PLANS AND OTHER RESOURCES.....72

APPENDIX GROUP D: PLANNING TOOLS...................................................................................79

APPENDIX D-1: VA PANDEMIC PREPARATION ACTION GRIDS......................................................79

APPENDIX D-2: SAMPLE EMERGENCY MANAGEMENT PROGRAM STANDARD OPERATING

PROCEDURE (SOP)..................................................................................................................................95

APPENDIX D-3: REVIEW AND LIST OF COMMUNICATION PRINCIPLES AND ELEMENTS TO

USE BEFORE, DURING, AND AFTER A PANDEMIC ........................................................................102
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APPENDIX D-4: SUGGESTED INVENTORY OF DURABLE AND CONSUMABLE SUPPLIES FOR

VA HEALTH CARE FACILITIES DURING A PANDEMIC INFLUENZA..........................................106

APPENDIX GROUP E: RESPONSE TOOLS .................................................................................108

APPENDIX E-1: VA PANDEMIC RESPONSE ACTION GRIDS.............................................................108

APPENDIX E-2: CHART OF PANDEMIC INFLUENZA PRECAUTIONS FOR VA HEALTH CARE

FACILITY STAFF ...................................................................................................................................121

APPENDIX E-3: CHART OF PUBLIC HEALTH MEASURES AGAINST PANDEMIC INFLUENZA

FOR INDIVIDUALS, HEALTH CARE PROVIDERS, AND ORGANIZATIONS................................122

APPENDIX E-4: ACTIONS CHECKLIST—FIRST CASE.......................................................................124

APPENDIX E-5: SAMPLE SELF-TRIAGE ALGORITHM......................................................................126

APPENDIX E-6: HOME CARE GUIDE FOR INFLUENZA, SYMPTOM AND CARE LOG, INFECTION 

CONTROL MEASURES FOR THE HOME ........................................................................................................127
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March 2006 

v 

CURRENT SITUATION 

The current situation as this plan is finalized is as follows: 

• A virulent influenza strain, H5N1, is currently causing a pandemic among migratory birds and poultry 

flocks around the world. H5N1 is the subject of focus and concern because humans lack immunity to it, 

because there are no available human vaccines against H5N1, and because there is close contact 

between humans and poultry—conditions that combined could enable the strain to mutate or genetically 

re-assort with a human influenza strain to spark a human pandemic. 

• The National Institutes of Health is testing a candidate human vaccine for the H5N1 strain and the 

Centers for Disease Control and Prevention is evaluating rapid diagnostic tests for the H5N1 avian 

influenza strain. 

• Oseltamivir (Tamiflu®) is an antiviral medication presumed effective for prevention or treatment of the 

H5N1 avian influenza strain and is stockpiled in relatively small amounts in the U.S. VA owns a supply 

of approximately 500,000 treatment courses that is maintained in a manner consistent with the 

requirements of the Shelf Life Extension Program of the Food and Drug Administration. 

• Public health and influenza experts are not certain that the next influenza pandemic will be caused by an 

H5N1 strain. A pandemic could arise from a different novel strain with little warning. Planning and 

preparations need to anticipate both observed threats, like H5N1, and threats from new unrecognized 

strains of influenza viruses. 
 VA Pandemic Influenza Plan 

March 2006 

vi 

FOREWORD BY THE SECRETARY OF VETERANS AFFAIRS 

I am pleased to present this VA Pandemic Influenza Plan, which describes how the Department of 

Veterans Affairs (VA) will protect employees, maintain continuity of operations, communicate with 

stakeholders, and support and coordinate with Federal, national, state, local, and tribal efforts. We are 

proud to build this plan on the foundation of our successful influenza vaccination program and our wellestablished emergency programs, which this plan now augments. We are also pleased that developing 

this plan continues the actions VA has been taking in the past two years to be prepared. I thank the 70-

some VA staff across the country who contributed to this plan and the thousands more that are preparing 

and will be responding all over the Department. 

VA serves millions of veterans in terms of health care, financial assistance benefits, and burial and 

memorial services. VA facilities and staff are located in every state and territory, nearly every 

community, and even overseas. Pandemic influenza will affect VA somewhere in the country at some 

time, and the Department at all levels must coordinate with their government and private sector 

counterparts and be prepared to respond. 

We don’t know when the next pandemic influenza will come to this country or how severe it will be. We 

do know that even the best plans cannot cover all facets of an emergency. VA will continue to take 

whatever actions are needed to protect our veterans and staff, keep vital VA operations going, 

communicate effectively, and contribute to the national response effort to help this country delay and 

lessen the impact of an influenza pandemic. 
 VA Pandemic Influenza Plan 

March 2006 

vii 

EXECUTIVE SUMMARY 

The VA Pandemic Influenza Plan is an operational document that is being added to existing emergency 

plans of the Department of Veterans Affairs (VA) to provide VA and its three administrations with a 

foundation for preparation, response, and recovery stages of an influenza pandemic. The VA’s three 

administrations are the Veterans Health Administration (VHA), the Veterans Benefits Administration 

(VBA), and the National Cemetery Administration (NCA). 

Section 1 – Introduction provides an overview of the functions and nationwide scope of the Department 

of Veterans Affairs. It describes VA’s three major missions of caring for veterans, providing benefits, 

and memorializing them, as well as its fourth mission of assisting with emergencies and disasters. This 

section also explains how this plan augments established emergency plans, describes what VA has 

already done to be prepared for pandemic influenza, and lists planning assumptions about pandemic 

influenza and its impact. 

This section states the goals of VA’s plan, which are: 

• To describe how VA will protect its staff and the veterans we serve, maintain operations, cooperate with 

other organizations, and communicate with stakeholders. 

• To help VA staff at the local level establish and implement pandemic influenza-specific emergency 

procedures. 

• To assist VA, VHA, VBA, and NCA leadership at the national, regional, and network levels to support 

our staff and functions at all levels and all sites. 

• To be clear and understandable, with easy-to-find material that can be rapidly disseminated. 

Section 2 - Preparing for Pandemic Influenza outlines the actions that VA, its three administrations, 

and its regional, network, and local facilities (medical, benefits, and memorial) will take to increase 

understanding of the risks of pandemic influenza, and enhance preparedness for it. The section defines 

procedures and processes that would be used to prepare VA, throughout the Department, for the special 

and dire circumstances that would result from pandemic influenza. VA health care is in the special 

situation of preparing to care for those who are ill with pandemic influenza, so the VHA discussion 

includes: 

• How the workforce and physical sites will be prepared 

• What infection control and countermeasures will be put into to place or enhanced, and assessments of 

what medical materiel will be necessary 

• Identification of essential functions 

• Estimation of the possible surge in demand 

• Plans for health care delivery under the dynamic environment caused by pandemic influenza 

• Support of health care facility staff who are exposed to or become ill with pandemic influenza

• Provision of mental health support for patients and staff 

• Surveillance and reporting 

• Increased security 

• Effective communications 

ce planning, infection control, security, and 

k exercises 

ibes how VA will use its plans to stop, slow, or 

imize care of patients with pandemic influenza 

Subsections for VBA and NCA describe workfor

communication. The section ends with a description of VA-wide pandemic influenza outbrea

that will help the Department test and refine its plans. 

Section 3 – Responding to Pandemic Influenza descr

limit the spread of disease, reduce suffering and death, and sustain operations. The discussion includes:

• Surveillance, including possible first case 

• Refocusing of patient care priorities to max
 VA Pandemic Influenza Plan 

March 2006 

viii 

• Infection control, including the precautions and personal protective equipment by health care facility 

staff 

• Support for and management of exposed or ill staff 

• Use of countermeasures (antiviral drugs, vaccines, diagnostics) 

• Workforce considerations including flexible work standards, credentialing, and approaches to staffing 

• Patient care including changing demands, providing assistance via phone, triage, diagnosis, isolation, 

use of alternative space and sites, and altered standards of care that may become necessary 

• Medication and supply issues 

• Security 

• Fatality management 

• Mental health support 

• Communication within and outside of VA 

Section 4 – Recovering from Pandemic Influenza briefly reviews key steps toward resuming normal 

operations. 

Section 5 provides a list of acronyms and abbreviations, as well as a glossary of terms. 

The last section provides more than 15 appendices in five groups: 

• Appendix Group A includes a diagram and maps of VA and facts about VA health care. 

• Appendix Group B covers VHA’s potentially expanded responsibilities and legal authorities and policies 

relevant to emergencies. 

• Appendix Group C includes references to VA emergency plans and other key documents. 

• Appendix Group D offers planning tools, including sample standard operating procedures for pandemic 

•

influenza, planning action grids, communication principles and elements, and lists of durable and 

consumable supplies for medical facilities. 

Appendix Group E contains response action grids, charts of precautions for health care facility staff and 

T cy plans and provides an operational foundation for 

minate 

public health measures for all, an actions checklist for a first case of pandemic influenza, a sample selftriage algorithm, and a home care guide. 

his plan augments VA’s existing emergen

preparation, response, and recovery stages of an influenza pandemic, VA will develop and disse

more information and planning and response documents and will test our plans to further strengthen our 

preparedness and response. 
 VA Pandemic Influenza Plan 

March 2006 

ix 

ACKNOWLEDGMENTS 

Development of the VA Pandemic Influenza Plan was led by 

Victoria Davey, Connie Raab, and Troy Knighton 

Public Health Strategic Health Care Group 

VHA Office of Public Health and Environmental Hazards 

Contributors to the plan also included the following staff of VA at the Department level and from its three 

administrations, from both Central Office programs and VA facilities across the country: 

John Baffa 

Karen Biancolillo 

Arnie Bierenbaum 

Peter Brewster 

Dan Bruneau 

MaryAnn Bruno 

Joseph Canzolino 

Geraldine Coyle 

Linda Danko 

Kathleen DeRoos 

Pam Del Monte 

Anna Diehl 

Lawrence Deyton 

Noel Eldridge 

Stephen Ezeji-Okoye 

Michael Feeser 

Judy Feldman 

Joseph Francis 

Jeff Gering 

Matthew Goetz 

Robert Grasso 

Kevin Hanretta 

Pam Hebert 

Pam Hirsch 

Michael Hodgson 

Mark Holodniy 

Beverly Johnson 

Jane Joyner 

Douglas Katcher 

Paul Kim 

Joseph Kime 

Linda Kinsinger 

Laurent Lehmann 

Susan Lenz 

Tammy LeSane 

Odette Levesque 

Vicki Macks 

Mary Marchetto 

Carter Mecher 

Trish Moore 

Sandra Murbach 

Nhi Nguyen 

Gina Oda 

Robert O’Hara 

Karen Ott 

Rosemarie Paradis 

Jeffrey Potts 

Abid Rahman 

Robin Rice 

Cathy Rick 

David Rimland 

Fred Rodriguez 

Gary Roselle 

Chris Scheer 

Julie Schroeder 

Sherrie Schuldheis 

Margie Scott 

Virginia A. Sharpe 

Mark Shelhorse 

Steve Sloane 

Mary Standridge 

Rosemary Strickland 

Richard Suchinsky 

Rita Tjoelker 

Virginia Torrise 

William Van Stone 

Michael Vojtasko 

Donna Wells-Taylor 

Keith Wilson 

Bruce Young 

Laurie Zephyrin 
 VA Pandemic Influenza Plan 

March 2006 

SECTION 1: INTRODUCTION 

1.1 Responsibilities of and Facts about the Department of Veterans Affairs 

The Department of Veterans Affairs (VA) provides federal benefits to veterans and their families and 

operates nationwide programs for health care, financial assistance and burial benefits. VA is the second 

largest of the 15 federal-level Cabinet departments. VA is led by the Secretary of Veterans Affairs and 

VA headquarters, known as Central Office, is comprised of several staff offices in Washington, DC and 

other locations. (To see the basic structure of VA, see Appendix A-1: DIAGRAM OF VA 

ORGANIZATION.) 

1.1.1 Veterans Health Administration (VHA) – Health care 

VHA, the VA health care system, is the largest integrated health care provider in the Nation. VHA serves 

the health care needs of veterans by providing primary care, specialized care, and related medical and 

social support services. 

VHA runs more than 1,300 sites of care across the country and in each state, as well as the Philippines, 

Guam, and Puerto Rico. These sites include: 

• Over 150 medical centers 

• Over 800 ambulatory care and community-based clinics 

• Over 130 nursing homes 

• Over 40 residential rehabilitation programs 

• Over 200 readjustment counseling centers (Vet Centers) 

These sites are organized into 21 Veterans Integrated Service Networks (VISNs). VHA is led by the 

Under Secretary for Health and several staff offices based largely in Washington, DC. 

VHA provided care to over 5 million enrolled veterans in 2004, including almost 600,000 inpatients. 

There were about 54 million outpatient visits. VA provides health care (and benefits) to more than 

100,000 homeless veterans each year. VHA supports about 3,000 researchers at 115 VA medical centers 

(see Appendix A-3: FACTS ABOUT VA HEALTH CARE CAPABILITIES). 

The VA health care system serves as a backup to the Department of Defense medical systems to care for 

active duty military during war or a national emergency and as a federal support organization during 

major disasters. These national emergency functions are sometimes known as VA’s “fourth mission” 

after health care, financial benefits, and burial benefits. For more information on these roles, see 

Appendix B-1: SUMMARY OF POTENTIAL VA EXPANDED RESPONSIBILITIES and Appendix B2: TABLE OF LEGAL AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES - Advice 

on Changes in Usual VA Practices During a Pandemic.

For more information on VHA, see Appendix A-3: FACTS ABOUT VA HEALTH CARE 

CAPABILITIES. 

1.1.2 Veterans Benefits Administration (VBA) – Financial assistance 

VBA provides financial assistance to millions of veterans through: 

• Compensation and pension programs, including disability compensation, as well as death compensation 

and pension, for over 3 million people a year 

• Funding for education and training for over 400,000 people a year 

• Home loan assistance for over 300,000 loans a year 

• Life insurance for over 7 million individuals 

• Vocational rehabilitation and employment 

Section 1: INTRODUCTION 1 

1.1 Responsibilities of and Facts about the Department of Veterans Affairs 
 VA Pandemic Influenza Plan 

March 2006 

Section 1: INTRODUCTION 2 

VBA operates through four Area Offices and 57 Regional Offices, with at least one in every state. VBA 

staff members are also located in the Philippines, Guam, Italy, Germany, Japan, and South Korea. VBA 

is led by the Under Secretary for Benefits and staff offices in Washington, DC. 

1.1.3 National Cemetery Administration (NCA) – Burials and memorials 

NCA maintains about 120 national cemeteries in 39 states and Puerto Rico. These are coordinated by 

four Memorial Service Network offices and NCA Central Office. Every year, NCA: 

• Buries about 93,000 people (veterans and in some cases spouses and dependent children) 

• Provides over 300,000 headstones or grave markers a year 

• Issues over 400,000 Presidential Memorial Certificates 

NCA is led by the Under Secretary for Memorial Affairs and staff offices in Washington, DC. 

1.1.4 VA Geography – Nationwide, state-to-state, and overseas 

VA facilities and staff are located in every state, the District of Columbia, Puerto Rico (all three 

administrations), Guam (VHA), and other US territories, the Philippine Islands (VHA and VBA), and 

South Korea, with some staff also providing benefits services in Germany, Italy, and Japan. For a sense 

of where VA facilities and staff are located, see Appendix A-2: MAPS RELATED TO THE THREE 

ADMINISTRATIONS OF THE DEPARTMENT OF VETERANS AFFAIRS (VA). 

1.1.5 Workforce 

Among all the departments and agencies of the federal government, VA is second only to the Department 

of Defense in terms of numbers of employees. VA had about 235,000 employees on the rolls as of April 

2005. Of these employees: 

• 214,000 are in the Veterans Health Administration 

• 13,000 are in the Veterans Benefits Administration 

• 1,500 are in the National Cemetery Administration 

• 3,200 are in the Veterans Canteen Service (snack shops, stores, and cafeterias) 

• 400 support VA Franchise Fund/VA Enterprise Centers (certain central administrative functions) 

• 3,600 are in staff and facility offices. 

Additionally, 83,000 health professionals train in VA medical centers each year. At least 94,000 

volunteers provide service to VA, 90,000 of them working in the facilities of the VHA. VA also hires 

contractors to do a variety of work. 

1.2 Relationship of This Plan with Other VA Emergency Plans 

The VA Pandemic Influenza Plan is intended to augment existing emergency plans of the Department of 

Veterans Affairs and provide VA staff and leadership, particularly at a local level, with additional, indepth information about a single type of emergency – pandemic influenza – and the special circumstances 

that would occur, particularly if the strain is virulent. 

Every major part of VA has well-established, comprehensive, all-hazards emergency management plans 

and Continuity of Operations Plans that provide leaders and staff with guidance and procedures for 

handling a variety of natural, technological, and human-caused emergency events. There are experts in 

emergency planning and preparedness at the national level for VA and all three of its administrations and 

emergency managers guiding operations throughout the country. The VHA Emergency Management 

Program Guidebook has become recognized as a “best practice” by the Nation’s medical emergency 

management community. VA medical centers have had emergency plans in place for a long time, and in 

the last few years, they have adapted to the new standards of the Joint Commission on Accreditation of 

Healthcare Organizations that require an “all-hazards” approach to emergency management. 

1.2 Relationship of This Plan with Other VA Emergency Plans 
 VA Pandemic Influenza Plan 

March 2006 

Section 1: INTRODUCTION 3 

Every VA facility should have a Standard Operating Procedure (SOP) for managing the risks associated 

with each major hazard. This plan provides the basis for developing a VA facility-based SOP that 

addresses pandemic influenza. This plan should serve as a minimum baseline for a facility-based SOP 

and can be modified and enhanced to meet local needs. The goal is to ensure that all VA facilities have a 

comprehensive pandemic influenza plan as part of their emergency management program. (A sample 

SOP for a VA medical center appears at Appendix D-2.) 

VA and its subordinate administrations also have emergency operations plans. In addition, VA essential 

functions are covered by a variety of VA Continuity of Operations Plans required of Executive Branch 

departments and agencies to “provide vital services, exercise civil authority, maintain the safety and well 

being of the general populace, and sustain the industrial/economic base in an emergency,” as specified by 

law. 

Existing VA emergency plans are cited in several places in this document and also are listed under 

Appendix C-1: REFERENCE LIST FOR VA EMERGENCY PLANS AND OTHER RESOURCES. For 

a discussion of how VA responsibilities may be augmented during emergencies, see Appendix B-1: 

SUMMARY OF POTENTIAL VA EXPANDED RESPONSIBILITIES. 

1.3 Background – VA and Pandemic Influenza Planning 

VA has taken several steps to prepare for an influenza pandemic. These steps include: 

• Leading an organized, well-supported, and results-driven national seasonal influenza vaccination 

program that yields patient vaccination rates higher than any other health care organization for which 

there are data. 

• Building on seasonal influenza prevention efforts, combined with well-established emergency 

management programs, as a foundation for leadership, policies, procedures, systems, education, and 

communication, using multidisciplinary teams at the national and local levels. 

• Increasing an emphasis on prevention of respiratory disease, particularly through vaccination for 

seasonal influenza and pneumococcal pneumonia. 

• Creating VA’s own emergency stockpile of oseltamivir to be used if pandemic influenza occurs in our 

medical system. Oseltamivir (Tamiflu®) is the only available, potentially effective antiviral against the 

current strain of avian influenza (H5N1). 

• Establishing a Respiratory Infectious Diseases Emergency Plan for Facilities to supplement the existing 

VHA Emergency Management Guidebook, March 2005. 

• Launching and actively promoting “Infection: Don’t Pass It On,” a VA campaign to engage staff, 

patients, and visitors in preventing infections, particularly through hand and respiratory hygiene. 

• Appraising the use of personal protective equipment (PPE) and developing educational materials on 

PPE in a pandemic, which are also part of the “Infection: Don’t Pass It On” campaign. 

• Participating with other Federal agencies in the development of the Department of Health and Human 

Services National Pandemic Influenza Plan, the National Strategy for Pandemic Influenza, and the 

National Implementation Plan for Pandemic Influenza. 

VA will continue working to prepare for pandemic influenza by: 

• Disseminating and implementing this VA Pandemic Influenza Plan. 

• Accomplishing VA actions in the National Implementation Plan for Pandemic Influenza. 

• Planning and executing a series of pandemic influenza exercises conducted within VA and with relevant 

Federal agencies (HHS, DHS, DoD) and state and local health agencies to focus on patient flow, 

employee needs, and system functionality. 

• Carrying out a clinical study to determine if oseltamivir can be extended by co-administration with the 

drug probenicid (which slows elimination of some drugs) and, if so, extend the effective supply of 

oseltamivir. 

1.3 Background – VA and Pandemic Influenza Planning 
 VA Pandemic Influenza Plan 

March 2006 

Section 1: INTRODUCTION 4 

• Continuing to emphasize and promote public health and other non-vaccine, non-drug measures to 

prevent transmission of infection through the “Infection: Don’t Pass It On” campaign. 

1.4 Planning Assumptions 

For planning purposes, VA is making the following assumptions in concert with experts at the White 

House Homeland Security Council and the Department of Health and Human Services: 

• Efficient and sustained person-to-person transmission that is documented by authoritative US and 

international scientists and that occurs anywhere in the world will be a trigger, that is, it will indicate an 

imminent pandemic that might affect VA (sporadic human cases or outbreaks that are not sustained 

would not constitute a pandemic). 

• Susceptibility to the pandemic influenza virus may be universal. 

• The clinical disease attack rate is assumed to be 30% in the overall population during the pandemic. 

Illness rates may be highest among school-aged children (about 40%) and decline with age. Among 

working adults, it is assumed that an average of 20% may become ill during a community outbreak. 

• Some persons will become infected but may not develop clinically significant symptoms, i.e., they will 

not be aware that they have been infected with the influenza virus. 

• As would symptomatic individuals, individuals who have influenza but no or minimal symptoms 

may be capable of transmitting infection and may become immune to subsequent infection. 

• The typical incubation period (interval between infection and onset of symptoms) for influenza is 

approximately two days. 

• Persons who become ill may shed virus (via respiratory secretions from the nose and mouth) and can 

transmit infection for one-half to one day before the onset of illness. Viral shedding and the risk of 

transmission will be greatest during the first two days of illness. 

• Children will play a major role in transmission of infection as their illness rates are likely to be higher, 

they usually shed more virus, and they control their secretions less well. 

• About 50% of those who become ill will seek care. If effective antiviral drugs are available for 

treatment, more people will be expected to seek medical care. 

• Rates of serious illness, hospitalization, and deaths will depend on the virulence of the pandemic virus 

and differ by tenfold between more and less severe scenarios. A moderate pandemic, similar to the 1957 

and 1968 pandemics, in the absence of intervention, could cause 200,000 deaths and 900,000 

hospitalizations among Americans. A severe pandemic influenza virus with similar virulence to the 

1918 strain, in the absence of intervention, could cause 1.9 million deaths and almost 10 million 

hospitalizations among Americans over the course of the pandemic. 

• Risk groups for severe or fatal infection cannot be predicted with certainty but are likely to include 

infants, the elderly, pregnant women, and persons with chronic medical conditions. 

• In a severe pandemic, absenteeism may reach 40% attributable to illness, the need to care for ill family 

• ch as staffed hospital beds, mechanical 

• sures of temporarily closing schools and declaring other “snow days” or closures, and 

•

country, lasting many months altogether. 

• enza will require coordinated efforts of a wide variety of 

• ndemic could be initiated by any of a number of known or unknown strains of influenza. 

members, or fear of infection during the peak weeks of a community outbreak, with lower rates of 

absenteeism during the weeks before and after the peak. 

There may be critical shortages of health care resources, su

ventilators, morgue capacity, temporary holding sites with refrigeration for storage of deceased, and

other resources. 

Public health mea

quarantining household contacts of infected individuals are likely to increase rates of absenteeism. 

Epidemics will last 6 to 8 weeks in affected communities. 

• Multiple waves of epidemics are likely to occur across the 

Historically, the largest waves have occurred in the fall and winter, but the seasonality of a pandemic 

cannot be predicted with certainty. 

Effective response to pandemic influ

organizations. 

An influenza pa

1.4 Planning Assumptions 
 VA Pandemic Influenza Plan 

March 2006 

Section 1: INTRODUCTION 5 

• VA will provide personal protective equipment for health care facility staff. 

A note on transmission and precautions: Because the mode of transmission of the virus will not be 

known for some time, VA advises taking a conservative approach that provides a high level of 

protection for staff caring for patients. This level of protection, known as Airborne Infection 

ation and Contact Precautions, include the use of fit-tested N95 masks, as well as gowns, glov

and eye protection, such as goggles. 

Isol es, 

Leadership and responsibilities for a global influenza pandemic are divided in the following manner: 

o The international community

•

 will agree on transparent and mutual reliance to coordinate 

hest 

o ral government

planning and response based on principles that place protection of health and lives in the hig

priority. 

The Fede will work internationally and domestically on: 

nd distribution of vaccine and antiviral 

 ting Federal, state, and local health systems preparation for and response to pandemic 

 private sector on planning and operations during a pandemic 

o

 Surveillance to target and coordinate response and containment 

 Advanced vaccine and antiviral drug development 

 Supporting the production, purchase, stockpiling, a

drugs 

Facilita

influenza 

Guiding the

Federal health care systems, such as those of VA, the Department of Defense, the Indian Health 

o al offices, and facilities

Service, and the Bureau of Prisons, will coordinate their pandemic influenza preparations and 

responses at the Federal, state, and local levels. 

VA Central Office, networks, area and region will coordinate 

local 

o l governments

planning, response, and recovery efforts with each other and with their Federal, state, and 

counterparts. 

State and loca will develop plans, train responders, and incorporate their 

olitical 

o or and critical infrastructure entities

communities into their plans, including health care, law enforcement, local services, and p

leadership. 

Private sect (such as utilities, food distributors and 

s and 

o

medical supply companies) perform key roles in producing and delivering goods and service

will be full participants in planning. 

Individuals and families will employ public health measures that protect them and prevent the 

.5 Goals of the VA Pandemic Influenza Plan 

 follows: 

 serve, maintain operations, cooperate with 

• andemic influenza-specific emergency 

•

ting VA 

emergency plans, such as Continuity of Operations Plans (COOPs) and other emergency management 

plans. 

spread of disease. 

1

The goals of the VA Pandemic Influenza Plan are as

• To describe how VA will protect its staff and the veterans we

other organizations, and communicate with our stakeholders. 

To assist VA staff at the local level establish and implement p

procedures. 

To assist VA, VHA, VBA, and NCA leadership at the national, regional, and network levels support our 

staff and functions at all levels and all sites. 

• To be clear and understandable, with easy-to-find material that can be rapidly disseminated. 

In addition, this plan is intended to be used to supplement and provide additional detail for exis

1.5 Goals of the VA Pandemic Influenza Plan 
 VA Pandemic Influenza Plan 

March 2006 

Section 1: INTRODUCTION 6 

1.6 Organization of This Plan 

This plan is organized consistent with comprehensive emergency management practices and provides: 

• Overview with planning assumptions and useful background information concerning the responsibilities 

 implemented. 

of the Department as well as the scope of the threat of pandemic influenza (Section 1—Introduction) 

• Mitigation and preparedness strategies and actions to reduce the risk of the threat to VA operations 

(Section 2—Preparing for Pandemic Influenza) 

• Response strategies and actions (Section 3—Responding to Pandemic Influenza) 

• Recovery actions necessary (Section 4—Recovering from Pandemic Influenza) 

• References and planning and educational documents (Section 5 and five groups of appendices) 

Additional plans, tools, and educational materials will be developed as this plan is

While an influenza pandemic may have broad effects on VA as a Federal agency, ultimately events 

will be managed in cooperation with local public health agencies. To be most effective, VA staff will 

need to remain innovative, flexible, and responsive to local conditions, and to always act in the best 

interests of veterans. 

1.6 Organization of This Plan 
 VA Pandemic Influenza Plan 

March 2006 

SECTION 2: PREPARING FOR PANDEMIC INFLUENZA 

The aim of this phase of VA’s plan is to increase understanding of the risks of pandemic influenza, and 

enhance our preparedness for it by defining procedures and processes that would be used for the special 

and dire circumstances that would result. 

The major actions described below also appear in Appendix D-1: VA PANDEMIC PREPARATION 

ACTION GRIDS.

2.1 VA-Wide/VA Central Office Preparations 

2.1.1 Leadership 

The VA Secretary will plan to lead the overall Department of Veterans Affairs response to an influenza 

pandemic, assisted principally by the Deputy Secretary and the Under Secretary for Health and their 

designees. 

2.1.2 Coordination 

VA will perform the following: 

• Coordinate its efforts throughout the Department with Federal and national, state, local, and tribal 

agencies and organizations. 

o Meet its responsibilities under the National Implementation Plan for Pandemic Influenza. 

• Establish an ongoing VA-wide Pandemic Influenza Advisory Group to assist with implementing this 

plan and provide advice in the event that responses to pandemic influenza become necessary. The VA 

Pandemic Influenza Advisory Group will be coordinated by the VHA Office of Public Health and 

Environmental Hazards. 

• Coordinate actions and responses under operating structures and guidelines from VA emergency 

management resources. 

o Execute, as needed, the VA Comprehensive Emergency Management Program, including VA’s 

Continuity of Operations Plan (COOP). 

o Execute, as needed, the Incident Command System (ICS), including Emergency Operations Plan 

(EOP) and Standard Operating Procedures (SOP), as developed by VHA, VBA and NCA and 

defined within administration policy (see Appendix D-2: SAMPLE EMERGENCY 

MANAGEMENT PROGRAM STANDARD OPERATING PROCEDURE: Pandemic Influenza 

Affecting a VA Health Care Facility). 

2.1.3 VA Central Office Preparations 

VA Central Office will make plans to prepare for an influenza pandemic that would have the potential to 

interrupt the headquarters and program office functions of the Department and its three administrations. 

VA Central Office actions will include: 

• Planning to follow the guidance outlined in Continuity of Operations Plans for ensuring that essential 

functions are maintained, as well as the guidance of the Office of Personnel Management concerning 

Washington, DC, Federal work status. 

• Identifying essential functions and considering how to get work accomplished in an environment with 

altered work conditions (such as significant absenteeism), including telephone reroute procedures, plans 

to broker work to other locations, plans to reroute mail to alternate facilities. 

• Considering staffing issues including use of employment of flexible work standards, such as 

telecommuting and flexible (shorter) work hours if necessary, and the use of the use of liberal leave, 

authorized absences, advanced sick leave, and family medical leave policies. 

• Planning for education of and communication with staff on the status of pandemic influenza, what 

individuals can do to protect themselves and their families, infection control practices (including 

information from the “Infection: Don’t Pass It On” campaign), and plans and policies regarding staffing, 

and changes in work procedures. 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 7 

2.1 VA-Wide/VA Central Office Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 8 

•

and Responsibilities 

ations 

ies are as follows: 

iples outlined in Appendix D-3: 

Planning to obtain and administer to staff, if possible, countermeasures such as antiviral medications 

and vaccine 

2.1.4 Roles 

2.1.4.1 Public Affairs/Communic

Public Affairs/Communications responsibilit

• VA communication will follow established practices and princ

REVIEW AND LIST OF COMMUNICATION PRINCIPLES AND ELEMENTS TO USE BEFORE, 

DURING, AND AFTER A PANDEMIC, and will take into account the many stakeholders, chan

and tools listed in order to reach veterans, VA staff, and the vast number of organizations and 

individuals concerned with VA programs. 

Communications planning actions at the Network (VHA, NCA) or Area Office (VBA) level and at the 

local facility level, such as medical centers,

nels, 

•

 benefits offices, or cemeteries, will follow the actions 

described under the VHA, VBA, and NCA parts later in this section (specifically 2.2.3.12, 2.3.3.5, and 

2.4.3.4). 

With support and subject-matter expertise of the VHA Office of Public Health and Environmental 

Hazards, C

•

entral Office VA, VHA, VBA and NCA public affairs staffs will collaborate on setting 

w as 

c 

of VA and seek other sites to link to it, including 

artners 

o E c

o Developing and distributing m

illness 

national-level communications priorities for the prepandemic/preparing phase using the actions belo

a starting point for setting these priorities. The VHA Office of Public Health and Environmental 

Hazards and VHA Communications will assist the VA Office of Public and Intergovernmental Affairs 

and VA public affairs officers. Communications actions will include: 

o Providing representatives on the VA Pandemic Influenza Advisory Group and encouraging publi

affairs participation in network, facility, and community planning efforts. 

o Developing a national Internet VA Pandemic Influenza Web site and mirror Intranet site that will: 

 House the VA Pandemic Influenza Plan and related documents 

 Be maintained on a real-time basis 

 Have back up support for making changes 

 Be routinely publicized 

 Have links to Web sites within and outside 

Federal, state, and local p

 Be managed by the VHA Office of Public Health and Environmental Hazards 

n ouraging leadership and public affairs staffs in VA facilities and network and regional offices 

to:

 Develop or adapt communications plans in concert with the VA Pandemic Influenza Plan 

 Maintain regular and emergency contact information for leadership, staff, media, and other 

key stakeholders 

 Assess and enhance resources such as key staff to maintain Web sites, respond to inquiries, 

give presentations, and work with the media 

 Establish contingency plans for increased information demands and back ups for staff and 

technology 

 Keep up to date on developments 

aterials in multiple formats to staff, veterans, outside groups, other 

agencies, and other stakeholders to 

 Provide consistent, timely, and accurate information 

 Explain pandemic influenza and its impact on VA and on individuals 

 Help people know how to protect themselves against 

 Outline steps VA is taking to be prepared 

 Explain roles and responsibilities 

2.1 VA-Wide/VA Central Office Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 9 

o sons, usually medical experts or leaders who are 

ork, and 

o acts and national public health and health care 

ct 

o r materials and providing subject matter experts as needed 

o can be used for basic messages and information 

o ions 

o nd misinformation by providing real time, clear, and open communication 

his 

o ting or receiving questions and preparing answers and information in a variety of formats 

o through pre-, 

o rganizations on the VA pandemic 

o nagers in facilities and offices to make news sources (such as the Internet, TV, 

.2 VHA Preparations 

ponse to an influenza pandemic, assisted by the 

are 

 the 

n

d networks and with national/Federal, state, and local health care agencies and 

• nd coordinate the VA-wide Pandemic Influenza Advisory Group 

ities to name a lead 

• ce efforts against pandemic influenza 

Identifying and training key spokesper

knowledgeable, credible, articulate, willing, and prepared, at the national, regional, netw

local levels. 

Knowing who the federal and state health cont

organizations are, keep current contact information for them, and provide them with VA conta

information as well. 

Disseminating announcements and othe

to be proactive in keeping the media informed. 

Creating communication tools and templates that

in the event of a pandemic and for updates during the pre-pandemic/preparing period. 

Providing regular updates at the national, regional, network, and local levels about situat

having impact on the status of operations and service delivery to VA’s many stakeholders via 

multiple means. 

Avoiding rumors a

about what is known and not known to staff, veterans, the media, and other key stakeholders. T

includes addressing rumors and false reports immediately with factual information and guidance; 

seeking information from and share responses with facilities, media contacts, and state and local 

officials; and encouraging facilities to establish similar rumor control/inquiry response systems 

locally. 

Anticipa

for staff, veterans, the media, Congress, other agencies, and other stakeholders. 

Establishing or renewing relationships with national Federal and private partners

pandemic, and recovery phases. Contact and monitor them for information and policy guidance. 

Encourage state, local, community and tribal contacts. 

Briefing national media outlets and Veterans Service O

response plan. 

Encouraging ma

and radio) available to staff, particularly in emergencies.

2

2.2.1 Leadership 

The Under Secretary for Health will lead the VHA res

Principal Deputy Under Secretary, the Assistant Deputy Under Secretary for Management and 

Operations, the Chief Public Health and Environmental Hazards Officer, and the Chief Patient C

Services Officer, and advised by the VHA Emergency Management Strategic Health Care Group and

VA Pandemic Influenza Advisory Group. 

2.2.2 Coordination 

2.2.2.1 Collaboration

VHA Ce tral Office will: 

• Work across its offices an

organizations 

Participate in a

• Organize VHA state contacts for pandemic influenza and also ask VISNs and facil

contact for pandemic influenza 

Participate in national surveillan

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 10 

2.2.2.2 Use of emergency plans 

VHA Central Office will: 

• Prepare to execute an Incident Command System (ICS) and applicable plans as outlined in VA 

Operations Plan “Safe Harbor” (including the VHA Emergency Management Program Guidebook) and 

in Standard Operating Procedures (SOP) maintained by VHA, VBA and NCA. (See Appendix D-2, 

SAMPLE EMERGENCY MANAGEMENT PROGRAM STANDARD OPERATING PROCEDURE: 

Pandemic Influenza Affecting a VA Health Care Facility.) 

2.2.2.3 Acquisition of and allocation policies for vaccines, antivirals, diagnostics, materiel, and 

staffing 

VHA Central Office will: 

• Support the needs of its medical centers and other facilities to protect patients and VA staff across the 

Department by such actions as 

o Developing plans and Memoranda of Understanding or Agreement (MOUs/MOAs) to acquire 

countermeasures against pandemic influenza, such as vaccines (anticipating their availability), 

antiviral medications, and diagnostics, as well as medical materiel such as personal protective 

equipment and other medications. This will include: 

 Maintaining regular communications with other Federal agencies in order to be aware of 

vaccine availability and systems to acquire the vaccine. 

 Planning to acquire sufficient quantities of FDA-approved vaccine against a pandemic strain 

to vaccinate veterans enrolled for VA health care as well as VA staff in all three 

administrations. 

o Supporting or assisting other Federal agency initiatives to develop domestic vaccine production 

capacity, according to its mission and abilities. 

o Developing criteria and procedures for distribution of these countermeasures and other supplies. 

o Developing criteria and transparent processes for allocation decisions regarding resources that 

may not be available in sufficient quantities during a pandemic: antivirals, respirators, vaccines, 

staff resources 

o Considering the usefulness of acquiring mobile clinics or modular medical stations, such as 

Federal Medical Shelters (FMSs), scalable, modular, 250-bed deployable facilities that require 

approximately 40,000 square feet of space and are configured to provide basic but essential 

medical care. 

2.2.3 Roles and Responsibilities 

2.2.3.1 Creation of facility and network pandemic influenza plans 

• VISNs, medical centers and satellite facilities such as community-based outpatient clinics (CBOCs), 

should be encouraged to develop and test pandemic influenza plans that address the elements described 

in the rest of this subsection and to coordinate with other local organizations. These elements should 

include: 

o How the workforce and physical sites will be prepared; transportation of staff and patients 

o What infection control and countermeasures will be put into place or enhanced, and assessments 

of what medical materiel will be necessary 

o Identification of essential functions 

o Estimation of the possible surge in demand due to a pandemic 

o Plans for health care delivery in the dynamic environment caused by pandemic influenza 

o Support of health care facility staff who are exposed to or become ill with pandemic influenza 

o Provision of mental health support for patients and staff 

o Surveillance and reporting 

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 11 

o Increased security 

o Effective communications 

• Medical centers, CBOCs, other VHA facilities and VISNs will participate in community public health 

and state-sponsored pandemic drills, and carry out drills within their own facilities. Lessons learned 

will be incorporated into response plans. 

• Facilities will take in account the possibility of assisting the community (see Appendix B-1: 

SUMMARY OF POTENTIAL VA EXPANDED RESPONSIBILITIES). 

• Refer also to Appendix D-2: SAMPLE EMERGENCY MANAGEMENT PROGRAM STANDARD 

OPERATING PROCEDURE: Pandemic Influenza Affecting a VA Health Care Facility.

2.2.3.2 Workforce preparation (education, skill identification, credentialing, Pandemic Response 

Teams) 

• VHA facilities recognize that health care providers have a duty to care for the sick even in high-risk 

situations. VHA will provide for the health and safety of front-line providers and other health care 

facility staff. 

• VHA facilities recognize that health care providers have a duty to protect patients by minimizing the 

transmission of disease. VHA will provide personal protective equipment and institute necessary safety 

protocols for front-line providers and other health care facility staff, consistent with the standards and 

requirements of the Occupational Safety and Health Administration (OSHA). 

• VHA facilities will prepare for situations in which work will be done in an environment with altered 

working conditions and constraints. Changes to anticipate include: 

o A substantial decrease in available staff (by as much as 40%) 

o An expanded scope of practice by some staff 

o Use of staff recruited from the community (volunteers, retirees, etc) 

o Delivery of care according to alternative standards 

o The potential need to provide care to enrolled veterans as well as non-enrolled veterans and nonveterans if necessary (see Appendix B-2: TABLE OF LEGAL AUTHORITIES AND POLICIES 

RELEVANT TO EMERGENCIES - Advice on Changes in Usual VA Practices During a 

Pandemic) 

o Creation and training a pool of non-medical responders to support health and medical care 

operations 

• VHA facility workforce planning will include these actions: 

o Identify functions essential to maintain during a pandemic. 

o Provide education for staff concerning: 

 Pandemic influenza and its symptoms and management 

 Infection control and public health measures 

 Emergency procedures 

o Identify skill sets of practitioner groups (e.g., clinical pharmacists, paramedics, nurse clinical 

specialists, nurse educators, etc.), so as to optimize reassignment potential. 

o Consider identifying non-VA providers as potential clinicians prior to an emergency and 

registering and credentialing them in advance through a sponsoring VA entity (see Appendix B-2: 

TABLE OF LEGAL AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES -

Advice on Changes in Usual VA Practices During a Pandemic). 

o Create a system to track skills, location of assignment, location of residence, health status 

(including pandemic influenza immunity status) of VA staff and volunteers to serve in a 

pandemic. 

o Determine which staff members will require N-95 or PAPR-type respirators and fit test all that 

may be called upon to maintain critical systems in situations where they may be exposed to 

influenza virus. 

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 12 

o Name a Pandemic Response Team that will be prepared to work during a pandemic and that 

includes the following disciplines: 

 Intensive care nurses, emergency room/urgent care nurses, primary care nurses

 Nurse practitioners/physician assistants

 Intensive care, emergency room/urgent care, primary care, infectious disease physicians

 Infection control personnel

 Pharmacists

 Respiratory therapists

 Radiology technicians

 Laboratory personnel

 Information technology staff

 Engineers

 VA police or security staff 

 Telephone advice nurses

 Patient safety specialists

 Safety and industrial hygienists

 Occupational health staff

 Transportation staff

 Housekeeping

 Receptionists/clerks/telephone operators

 Mental health professionals, chaplains, social workers

 Hospital administrators

 Public affairs officers

o Consider flexible work standards, such as flexible hours (shorter or staggered shifts), 

telecommuting for some functions such as answering advice lines. 

o Identify shared or facility-based child-care and other home support systems. 

2.2.3.3 Physical site (space planning, building and engineering systems, support for infection 

control, transportation of patients, fatality management) 

VHA facility physical site planning will include the following: 

• Develop plans to free up existing clinical space and consider flexible, creative use of other facility space 

in anticipation of higher workloads. 

• Identify space for separate waiting rooms and separate emergency care areas for patients with pandemic 

influenza. 

• Identify and develop clear plans for alternative space, that is, to expand capacity in space that is 

currently nonoperational or unused and that can be converted to space for triage, waiting, outpatient or 

inpatient (infirmary) care, as well as to locate space outside the facility that might be used if necessary. 

• Consider reactivating closed units or buildings to create surge capacity for isolating pandemic influenza 

patients. 

• Map patient flow to plan for restricted use of areas, visitor restriction. 

• Assess building and engineering systems as follows: 

o Check exhaust air systems and air handling units for proper operation, flow rate and proper fit 

and type of filters. 

o Assure all negative airflow rooms are operationally checked and staff trained to use and maintain 

airflow systems. 

o Prepare air zone diagrams to inform medical center staff of the areas that share the same reservoir 

of air and plan cohorting or isolation of patients accordingly. 

o Maintain spare sets of filters for critical areas (these may become very difficult to obtain in a 

pandemic). Consider keeping a 4-week supply of these filters. 

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 13 

o Obtain appropriate filters for heating, ventilating, and air conditioning units serving areas that 

may be designated as surge areas for patients. 

o Inventory portable exhaust fans used in construction areas for possible use in creating surge 

negative air airflow areas and review the location of exhaust vents relative to intake vents to 

ensure that no infectious recirculation situations exist or are created when areas are converted to 

surge negative air flow rooms. 

o Plan the set-up of hand wash/hand cleaning stations at all entries to the health care facility to 

emphasize the requirement for extraordinary attention to infection control. 

o Plan for cohorting of patients with pandemic influenza; consider identifying physically distant or 

separate space or buildings for infected patients. Such plans will be proportional to the disease 

impact, necessary, relevant, applied equitably, and employ the least restrictive means if options 

are available. 

o Plan for security measure to protect the integrity and safety of structures, staff, equipment, and 

supplies. 

o Plan for transportation of staff/patients. 

 Arrange carpool or van transport systems in the event public transportation breaks down or 

pandemic situation precludes public travel (see Appendix B-2: TABLE OF LEGAL 

AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes 

in Usual VA Practices During a Pandemic).

 Consider that non-health care providers might accompany patients if necessary. 

o Plan for management of large numbers of fatalities. 

 Assess current capacity for refrigeration of remains. 

 Discuss and establish mass fatality plans with local and state health officials and medical 

examiners. 

 Work with local health officials and medical examiners to identify temporary morgue sites, 

such as refrigerated warehouses and trucks. 

 Plan to have staff use Airborne Infection Isolation and Contact Precautions for handling 

remains of individuals who die from pandemic influenza (see Appendix E-2: CHART OF 

PANDEMIC INFLUENZA PRECAUTIONS FOR VA HEALTH CARE FACILITY 

STAFF). 

 Determine the scope and volume of supplies needed to handle an increased number of 

remains. 

2.2.3.4 Infection control and precautions (heightened surveillance, staff illness, supplies and their 

management, transmission and precautions for health care facility staff) 

VHA facilities will plan infection control programs containing the following measures: 

• Ensure that there is ongoing education for employees and information for patients and visitors that 

includes regular updates on basic infection control practices (hand hygiene, respiratory etiquette, and the 

basic principles of infection transmission and isolation strategies) using the materials of the VA 

“Infection: Don’t Pass It On” campaign and other appropriate resources. 

• Establish and maintain active employee seasonal influenza vaccination campaigns each year, making 

use of the annual Influenza Toolkit. 

• Heighten institutional surveillance for influenza, including early recognition of institutional outbreaks, 

increased numbers of patients being seen in ambulatory settings for influenza-like and other respiratory 

illnesses, and increased employee absenteeism. 

• When the VHA Health Care Acquired Infection and Influenza Surveillance System is available, use 

automatically produced data that will identify and track indicators of such infections and provide 

information to VA facilities and leadership and to other national databases. 

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 14 

• Encourage staff to recognize signs and symptoms of influenza before they report for duty and take 

appropriate action; develop a procedure for them to be able to call and report availability for work and 

their health status. 

• Develop criteria for limiting visitor access if it becomes necessary during a pandemic. 

• Develop protocols for tracking and managing staff that are ill with influenza. 

• Develop strategies for maintaining supplies during a pandemic, including security and control measures 

to ensure that supplies are not removed from the facility or used incorrectly. 

• Develop strategies to ensure that adequate supplies of personal protective equipment and hand hygiene 

products are available. 

Note: The mode of transmission of a pandemic influenza strain cannot be known at this writing. 

Transmission may be by large respiratory droplets (particle size > 5 microns) or by very small 

droplets (≤ 5 microns), i.e., aerosol means. The mode of transmission defines the level of precautions 

and isolation required to care for patients in the health care setting. Seasonal influenza strains are 

generally agreed to be transmitted largely by respiratory droplets, requiring wearing of surgical-type 

or procedure masks by health care providers and staff working within 3 feet of infected patients. It is 

possible that a pandemic strain, because of its virulence or potential for aerosol transmission, would 

warrant a higher level of protection. Therefore, until the transmission mode of a pandemic influenza 

is fully understood, the VA Pandemic Influenza Plan advises a conservative approach with the use of 

Airborne Infection Isolation and Contact Precautions for staff caring for patients in the health care 

setting. These precautions include the use of approved respirators (N95 level masks or powered air 

purifying respirators or PAPRs), gowns, gloves, and goggles, and the isolation of patients in negative 

airflow rooms. 

2.2.3.5 Countermeasures (vaccines, antiviral medications, diagnostics) 

VHA facilities will take the following steps to acquire and distribute countermeasures against pandemic 

influenza: 

• Use established acquisition and contracting programs, including local, VISN, and national programs. 

• In the event of difficulties with local acquisition capabilities, plan to go through the National 

Acquisition Center (NAC) or through the Office of Acquisition and Materiel Management (OA&MM). 

• With VHA Central Office, develop criteria and transparent processes for decisions regarding allocation 

of resources that may not be available in sufficient quantities (antivirals, respirators, vaccines, staff 

resources). 

• Plan to administer vaccine, when available, according to established criteria and with guidance issued at 

the time by the Under Secretary for Health. (It is expected that VHA will obtain vaccine from Federal 

sources.) 

• Plan to acquire antivirals and to distribute them according to established criteria and with guidance 

issued at the time by the Under Secretary for Health. 

o VA holds a central supply of oseltamivir (Tamiflu®) that will be made available to patients and 

staff during an influenza pandemic. 

o Use of the central VA oseltamivir supply will be based on an implementation plan issued by the 

Under Secretary for Health. 

o Staff should familiarize themselves with access procedures for VA’s oseltamivir supply. 

Information is available thru VHA Information Letter 10-2005-016, “VHA Oseltamivir 

Stockpile” (see Appendix C-1: REFERENCE LIST FOR VA EMERGENCY PLANS AND 

OTHER RESOURCES). 

o Staff should familiarize themselves with procedures to access supplies of oseltamivir that their 

own facilities have acquired for treatment or prevention of outbreaks of seasonal influenza A or 

B. These supplies may be used as appropriate for pandemic influenza. 

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 15 

o Routine prescribing of oseltamivir by VA clinical staff and dispensing of oseltamivir by VA 

pharmacies for personal stockpiles for veteran patients or VA staff is not authorized as of this 

writing. This decision may be reassessed. 

• Plan to acquire diagnostic and laboratory tests, considering that: 

o At present (early 2006), commercial test kits and protocols that distinguish between specific 

strains of influenza are not widely available. VHA staff may combine use of influenza rapid test 

kits with those for other seasonal respiratory infections, such as respiratory syncytial virus (RSV), 

to narrow the differential diagnoses of respiratory illness. 

o VA participates in the CDC’s Laboratory Response Network. The commitment of the LRN is that 

molecular methods would be available through the nearest LRN facility within 3 months or less 

of a defined pandemic within the United States. VA staff may use LRN as a diagnostic testing 

referral system. 

• VA laboratory staff should: 

o Ensure that adequate testing and specimen collection supplies are available for the anticipated 

patient workload as the pandemic evolves. 

o Ensure that capacity is available for storage of serum, respiratory, and tissue samples for testing 

or epidemiologic studies at a later point in time. 

o Consider developing Memoranda of Understanding (MOUs) with local vendors as needed to 

ensure testing and other critical diagnostic supplies are available and delivered. 

o Test infection control communications and reporting systems within the facility, to the VISN, and 

to local and state health departments. 

o Review proper specimen handling techniques with all appropriate personnel, as well as 

appropriate use of precautions (see Appendix E-2: CHART OF PANDEMIC INFLUENZA 

PRECAUTIONS FOR VA HEALTH CARE FACILITY STAFF). 

o Plan and establish enhanced surveillance systems to monitor for influenza-like illness in all 

personnel handling respiratory samples. 

2.2.3.6 Medical materiel (equipment and supplies) 

VHA facility plans for acquisition of medical materiel should include these actions: 

• Identify all existing and potential intensive care beds, negative airflow rooms; ventilators, personal 

protective equipment, medications, and general medical supplies and equipment needed to treat and care 

for infected individuals (see Appendix D-4 SUGGESTED INVENTORY OF DURABLE AND 

CONSUMABLE SUPPLIES FOR VA HEALTH CARE FACILITIES DURING A PANDEMIC 

INFLUENZA). 

• Be familiar with means of obtaining any centrally stockpiled consumable material and consider creating 

facility stockpiles of durable and consumable materials. 

• Identify how/where to store durable equipment and consumable supplies for a pandemic. Consider how 

to achieve a balance between access to these supplies and security. 

• Evaluate existing contracts for equipment and supplies and, if needed, update contracts or develop 

MOUs to enable rapid purchase of additional quantities should the need arise; identify critical links in 

supply chains and consider whether contingent contracts with additional or alternative vendors would 

provide security against acute shortages. 

• Identify transportation routes to be used and vehicles to be deployed to move equipment and materiel . 

• Identify and address potential security issues. 

• Develop criteria for how equipment and supplies will be distributed in the event of shortages (i.e., who 

will have access, who will make decisions). 

• Participate in VA-wide pandemic influenza tabletop exercises to familiarize criteria personnel with 

criteria and procedures for allocation of scare equipment and supplies. 

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 16 

2.2.3.7 Health care delivery (triage, waiting areas, novel/innovative care delivery, including home 

care) 

• VHA facilities will ensure that their Pandemic Response Teams are prepared, educated, equipped and 

ready in the event of an influenza pandemic. 

• VHA facilities should consider that they may have the first case of pandemic influenza in their area (see 

Appendix E-4: ACTIONS CHECKLIST—FIRST CASE). If so, they should plan to: 

o Assess symptoms and make a clinical or laboratory diagnosis and trigger public health emergency 

plans. 

o Take care of the patient. 

o Take care of their staff members. 

o Let public health authorities and their VISN know. 

o Work to contain the illness through use of isolation in a negative airflow room, staff use of 

personal protective equipment. 

• VHA facilities will estimate the potential surge in demand that may occur in a pandemic and their 

capacity for expanding ambulatory, acute, and medication treatment services to handle this surge. 

• VHA facilities, including medical centers and CBOCs, will plan the following actions for health care 

delivery during a pandemic: 

o Plan for triage systems to: 

 Identify persons who might have pandemic influenza. 

 Separate them from others to reduce the risk of disease transmission (such plans must be 

proportional to the degree of disease, necessary, relevant, applied equitably, and employ the 

least restrictions if options are available). 

 Use emergency rooms, urgent care centers and primary care clinics and other locations for 

triage. 

 Identify the type of care required (e.g., outpatient or home care or hospitalization). 

 Assign staff to work with either “well” patients or ill patients, but not both. 

 Assess urgency of care needs guided by vital signs, clinical assessment and pulse oximetry. 

o Establish separate waiting areas for persons with respiratory symptoms. 

o Plan to address increased demand for negative airflow rooms, intensive care units, and assisted 

ventilation. 

o Develop strategies to provide information to large numbers of patients, such as telephone hot 

lines, automated phone messages, and mailings. 

o Plan to add or enhance telehealth and advice lines to facilitate home care. 

o Plan to staff and promote novel and innovative care delivery strategies: 

 Use self-triage algorithms that enable veterans and staff to help identify symptoms in 

themselves and others to decide who may need emergency care, referral to outpatient care, or 

care at home. Post and promote this algorithm on the Web (see Appendix E-5: SAMPLE 

SELF-TRIAGE ALGORITHM FOR PERSONS WITH INFLUENZA SYMPTOMS). 

 Establish “drive-through” clinics utilizing triage personnel to rapidly assess patients, obtain 

vital signs and pulse oximetry to make decisions about further evaluation, hospitalization, or 

home care. 

 Develop and provide advice via telephone, print material, and the Internet (MyHealtheVet 

and other Web sites) on a variety of pandemic influenza-related topics, including home care, 

with instructions to contact VA facilities if symptoms worsen (see Appendix E-6: HOME 

CARE GUIDE FOR INFLUENZA).

 Consider suggesting the home as a site of care and creating “home care kits” to send to 

veterans and staff being cared for at home that might include supplies such as a thermometer 

with instructions, cough medications, acetaminophen or ibuprofen as appropriate, rehydration 

powders, and information on home care, with a symptom and care log (see Appendix D-4 

SUGGESTED INVENTORY OF DURABLE AND CONSUMABLE SUPPLIES FOR VA 

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 17 

HEALTH CARE FACILITIES DURING A PANDEMIC INFLUENZA and Appendix E-6: 

HOME CARE GUIDE FOR INFLUENZA Symptom and care log).

 Communicate with staff about these strategies and establish training modules, protocols and 

algorithms using the current definitions of possible cases and approaches to treatment. For 

those facilities with capabilities for Telehealth connections, plan to extend current 

collaborations. 

o Be prepared for increased demands for service and for responding to it in this general sequence, 

which may change depending on the geography and epidemiology of the pandemic: 

 Address the needs of the facility’s enrolled patients. 

 Work with the VISN to address any unmet needs of enrolled patients within the network. 

 Work as a system within VHA to meet the needs of enrolled patients. 

 Take care of additional patients as part of VA’s potentially expanded role in an emergency 

(see Appendix B-1: SUMMARY OF POTENTIAL VA EXPANDED 

RESPONSIBILITIES). These include DoD active duty patients, non-enrolled veterans, and 

non-veterans. 

 Consider that altered standards of care may become necessary and include this possibility in 

presentations with stakeholders to ensure a transparent process. (The term "altered standards" 

means a shift to providing care and allocating scarce equipment, supplies, and personnel in a 

way that saves the largest number of lives in contrast to the traditional focus on individuals. 

See further discussion of this concept in Section 3.2.3.7 Patient care (changing demands and 

surge, advice lines/telemedicine, triage, diagnosis, isolation, expansion to include alternative 

space and sites, altered standards of care.) 

2.2.3.8 Support and management of exposed and ill staff 

VHA facilities have a duty to protect patients and staff by minimizing the transmission of disease. VHA 

facilities will plan for the management of exposed, suspected and/or confirmed infectious staff. Actions 

should include: 

• Providing immunizations, medications, and supplies of personal protection equipment to protect staff 

against influenza 

• Developing a call-in system for monitoring staff who are ill 

• Treating suspected and/or confirmed infectious staff 

• Monitoring occurrences and establishing triage and isolation of suspected and/or confirmed cases of 

respiratory illness in staff 

• Implementing plans for laboratory testing and processing of employee specimen 

• Using mechanisms for reporting and disclosure of test results, and maintaining employee confidentiality 

• Excluding staff with symptoms, or after high risk exposures at work or at home, or confirmed diagnosis 

of pandemic influenza from duty 

• Providing home care kits (see Appendix E-6: HOME CARE GUIDE FOR INFLUENZA, Symptom and 

care log, Infection Control for the Home) 

• In the case of a particularly severe pandemic wave, providing personal protective equipment, antiviral 

medications, and vaccine to family members to keep health care facility staff healthy and available to 

take care of patients, depending on the inventory of equipment, supplies, and medications, and the 

facility’s responsibilities and assignments under the National Response Plan (see Appendix B-1: 

SUMMARY OF POTENTIAL VA EXPANDED RESPONSIBILITIES). 

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 18 

2.2.3.9 Mental health support for patients and staff 

VHA facilities should: 

• Develop plans to address mental health and chaplain services for patients and families and for health 

care and emergency workers and their families, especially when workers must be away from home. 

Such plans will include mental health professionals in facilities (such as psychiatrists, psychologists, 

social workers, specialized nurses, and chaplains), readjustment counseling (Vet Center) staff, and staff 

of employee assistance programs, and may also include local psychiatry, psychiatry, psychology, social 

work, nursing, and faith-based or pastoral care organizations. 

• Describe a mental health consultation process to make such expertise available to all who require 

assistance at the local level. This process will include Central Office mental health and readjustment 

counseling services and VISN mental health councils. 

2.2.3.10 Surveillance and reporting, VHA facility-level (including first case) and VHA Central 

Office-level response (use of diagnostics, data on cases, local collaboration, reporting 

mechanisms) 

VHA facility-level surveillance and possible first case 

• VHA facilities (medical centers, CBOCs and other facilities) should plan for the possibility that they 

would have a first case in their region and plan to act accordingly (see Appendix E-4: ACTIONS 

CHECKLIST—FIRST CASE). 

• VHA facilities should understand and plan to use a provisional case definition of pandemic influenza 

from the Centers for Disease Control and Prevention (CDC) (see next page for a hypothetical example 

of such a definition). 

Hypothetical

example of provisional case definition 

of possible pandemic influenza by CDC 

The current definition is an illness that meets criteria for an influenza-like illness: 

Temperature above 38C (100.4F) plus one of the following: sore throat, cough, or dyspnea, 

 AND 

Travel risk—recently visited or 

lived in an area affected by a highly 

pathogenic avian influenza A or 

confirmed human cases of novel 

influenza viruses and had direct 

contact with birds or person(s) with 

confirmed or suspected novel 

influenza. 

OR

Occupational risk—persons who work 

on farms or live poultry markets who 

process or handle poultry infected 

with known or suspected avian 

influenza viruses or health care 

workers in direct contact with a 

suspected or confirmed pandemic 

influenza patient. 

AND 

The maximum interval between potential exposure and symptom onset is less than 10 days. 

Once confirmed pandemic disease is widespread, cases will be identified based on clinical presentation 

alone. 

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 19 

• VHA facilities should plan to use diagnostics if available and recommended, but consider that: 

o Laboratory evaluation for novel influenza A viruses during the prepandemic and early pandemic 

alert periods might be recommended for: 

 Hospitalized patients with severe influenza-like illness, including pneumonia. 

 Non-hospitalized patients with influenza-like illness who have strong epidemiologic 

suspicion for exposure manifested by travel risk or occupational risk. 

o In a pandemic situation VA staff should use any FDA approved test for point-of-care diagnostics 

consistent with good laboratory practices and licensing or recommendation by official oversight 

groups. 

o Non-FDA approved tests may become available for pandemic influenza strains. If so, VA staff 

should follow recommendations of CDC for provisional use of such testing. 

• VHA facilities should plan to use established reporting mechanisms for cases or outbreaks of pandemic 

influenza (Incident or Situation Reports). 

o If staff at a VHA facility suspect or confirm an outbreak of a pandemic strain of influenza, they 

should contact local and state public health authorities. 

• VHA facilities will take the following into account: 

o VA diagnostic and procedure codes data are currently reported to CDC via the BioSense system. 

 VA currently provides transmissions twice daily on weekdays and once daily on weekends to 

CDC of all VA ICD-9-CM codes for diagnosis and procedures from outpatient and 

emergency room visits, sent through a secure electronic conduit. 

 After analysis and evaluation at the CDC, the data are immediately available to state and 

local health departments to enhance the local early warning value of the information. 

 This type of “syndromic” information is important for early warning for influenza like illness 

that can trigger further specific investigation. 

 A VHA Health Care Acquired Infection and Influenza Surveillance System that when 

operational will automatically identify and track indicators of such infections and provide 

information to VA facilities and leadership and to other national databases. 

o Individual VHA facilities may already have other surveillance systems in place for unusual 

disease clusters. 

o Collaboration with state and local health departments in surveillance and reporting should occur 

to the extent possible. 

o Additional active surveillance by VHA facilities is not required by this plan. 

VHA Central Office-level response 

VHA actions in the event of suspected or confirmed cases or outbreaks are as follows: 

• If staff at a VHA facility suspect or confirm an outbreak of a pandemic strain of influenza, they should 

contact local and state health authorities and their VISN leadership, who will communicate the 

information to VA Central Office. 

• If VHA Central Office receives information from a VISN or facility that there is a suspected or 

confirmed case or outbreak, then after consideration of local and national situations, VHA emergency 

plans will be activated and the VA Pandemic Influenza Advisory Group will convene in order to 

provide advice to the Under Secretary for Health, (and the Under Secretaries for Benefits and Memorial 

Affairs). 

• VHA facilities should be familiar with reporting mechanisms and ensure that their staffs are familiar 

with them. 

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 20 

2.2.3.11 Security (facilities, supplies) 

VHA facilities will plan for security of all VA health care facilities to prevent or minimize civil unrest 

and limit visitor access, as necessary, by performing the following: 

• VA Police will apply existing National Threat Level Responses to civil unrest incidents, including 

pandemics. 

• National Threat Level responses specify procedures for facility lock down, entry control requirements, 

and additional police staffing needs. 

• Facility VA Police Chiefs will review support agreements with local law enforcement. 

• These support agreements and threat responses will be part of facility emergency plans and exercised on 

a regular basis. 

• Specific threat responses and support agreement requirements will be part of continuing VA police 

officer in-service training. 

• Storage locations for critical medical supplies will be subject to annual security surveys. 

• VA Police will be trained in the use of personal protective equipment either as first receivers of patients 

with possible pandemic influenza or as first responders to disturbances. 

2.2.3.12 Communication, VHA facility-level and VHA Central Office-level 

VHA facility center-level communication 

• VHA facility center public affairs staff should consider that in the prepandemic/preparing stage 

communications planning and efforts should take into account both: 

o Communicating “now,” i.e., before a pandemic, with the goals of increasing understanding of 

health, prevention, and health care issues and of roles and responsibilities. 

o Planning for communicating during the pandemic, with the goals of being able to provide 

information, address misinformation, facilitate effective operations, and lessen anxiety. 

These efforts should be done in concert with (and with the support of) medical center leadership and 

pandemic influenza planning staff and VHA Central Office. 

Appendix D-3: REVIEW AND LIST OF COMMUNICATION PRINCIPLES AND ELEMENTS TO 

USE BEFORE, DURING, AND AFTER a PANDEMIC, covers general principles for use before and 

during a pandemic, and provides lists of stakeholders, vehicles, and channels to consider in creating plans. 

• Communicating before a pandemic: 

o Steps in communicating now about pandemic influenza preparedness include: 

 Developing consistent and accurate information about: 

ß What pandemic influenza is, what may happen, implications for the medical center 

ß What individuals can do to protect themselves and prevent transmission 

ß What VA, VHA, and the medical center are doing via their planning efforts 

ß Roles and responsibilities as outlined in the medical center plan for before and during a 

pandemic 

ß Local resources including public health departments and health care facilities 

 Identifying key internal and external stakeholders for this information, such as: 

ß Staff – clinical, nonclinical, security, telephone operators and receptionists, medical 

trainees, volunteers, contractors 

ß Patients and their families 

ß Veterans Service Organizations 

ß Local public health and health care agencies 

ß The media 

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 21 

 Engaging stakeholders in a dialogue during the early stages of planning to ensure a clear and 

common understanding of concepts such as rationing of resources, quarantine, and 

obligations of clinical caretakers. 

 Listening to stakeholders to assess their understanding, answer questions and concerns, and 

seek their input and ideas. 

 Using a variety of vehicles to convey information to key stakeholders, such as: 

ß Newsletter articles 

ß Fact sheets and trifolds 

ß Announcements and news release 

ß Email announcements 

ß Presentations/discussions at meetings (staff, community at large, local health 

counterparts) 

ß Slide sets 

ß Briefings 

ß Conference calls 

ß Easily found Internet and Intranet sites where this information is posted 

ß Scripts for receptions and telephone operators – both information on the current situation 

and template for information updates during a pandemic 

 Considering the use of alternative formats for individuals with disabilities, translation for 

staff, patients, and families as necessary and easier-to-read wording for individuals who do 

not read well. 

• Planning for communicating during a pandemic: 

o Steps in planning for communication during a pandemic include: 

 Developing a process to create consistent, accurate, and timely information using a 

streamlined approval procedure. 

 Identifying spokespersons, usually medical or leadership, who are knowledgeable, credible, 

articulate, willing, and prepared to speak to the media and other key stakeholders when 

needed before a pandemic and during a pandemic; rehearsing with them and obtaining media 

training for them as necessary. 

 Updating fact sheets and general information about the medical center (such as key facts, key 

staff). 

 Developing templates to convey information (announcements, status reports, news releases) 

during a pandemic as well as distribution lists for this information. 

 Considering how to work with the media. Besides having one or more identified 

spokespersons, consider telephone or teleconference briefings. 

 Developing a means for staying up to date, including identifying and addressing rumors, 

inaccuracies, and misperceptions. 

 Updating or establishing key contact lists, such as: 

ß For key staff – direct work phone, home phone, cell phone, fax numbers, email addresses 

ß For media – phone, email, fax 

ß For local public health (including communications staff) and health care sites – phone, 

email, fax 

 Establishing ways to seek input from stakeholders and provide information that they need. 

 Establishing or updating ways to communicate in emergencies such as: 

ß Telephone trees; i.e. structured lists of phone numbers (home, cell) that can be used to get 

the word out to staff or other individuals 

ß Call-in systems for use during a pandemic for staff to report availability for work and 

their own health status 

ß Live advice hotlines for patients to call in on 

ß Recorded information lines that patients and staff can use to obtain information 

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 22 

VHA Central Office-level communication 

VHA Office of Communications, the office of the Deputy Undersecretary for Management and 

Operations, and the VHA Office of Public Health and Environmental Hazards will work together to: 

• Ensure that Central Office staff and contractors receive pandemic influenza preparedness messages and 

materials. 

• Convey requirements and responsibilities regarding communication about pandemic influenza to staff 

throughout the VA health care system. 

• Ensure that VHA staff and veterans have consistent, accurate information. 

• Provide information to Veterans Service Organizations and other partners. 

• Provide up-to-date information to Voluntary Service directors. 

• Establish and maintain employee telephone lists and consider using telephone trees for notifications of 

large numbers of staff. 

• Develop procedures for staff unable to work, such as a toll-free number for staff to use to call in about 

work availability and health status. 

• Plan to conduct frequent conference calls with VISNs and facilities affected by pandemic influenza and 

those in immediate risk of a pandemic wave. 

• Plan for efficient communication with Federal, state, local, and community partners. 

• Establish mechanisms for two-way communication with local/state/private health care community 

partners that include: 

o Appointing and announcing facility and state VA points of contacts for local/state/private health 

care agencies, as well as for VHA purposes. 

o Coordinating local planning with needed facilities. 

o Sharing pandemic influenza plans, educational materials, and other resources. 

o Developing mechanisms to share scarce resources and expertise. 

o Developing templates that outline procedures for announcements, such as closing of hospitals, 

restriction of visitors, alternative sites for or approaches to care. 

o Meeting with community partners to assure understanding of plans and responsibilities. 

• Es l tab ish mechanisms for two-way communication with VA facilities that include: 

o Generating pandemic influenza plans in accordance with the VA national plan. 

o Coordinating their local planning with community and state agencies. 

o Locating and utilizing information on ways to prevent the spread of pandemic influenza for staff, 

clinicians, patients, visitors, vendor, supplier and community members. 

o Preparing written/audio information to inform staff of the facility’s pandemic influenza plan and 

how each employee can take part in slowing the pandemic. 

o Providing easy access for clinicians/staff/patients/others on how to protect themselves from 

pandemic influenza. 

o Assuring that clinical staff is aware of the current probability of pandemic influenza, and how to 

prevent the spread of pandemic influenza in the health care setting. 

o Establishing a phone number for staff to use for updates. 

o Providing information on the current status of the influenza. 

• Es l tab ish mechanisms for two-way communication with key stakeholders in and out of VHA, 

including: 

o Developing a prioritized list of these stakeholders. 

o Developing mechanisms to communicate with stakeholders on the status of pandemic 

preparedness. 

o Providing information on how to prevent the spread of pandemic influenza to each audience. 

o Sending information or speakers to each audience present on the status of the epidemic, what can 

be done to slow the transmission of the virus to others (see Appendix E-3: CHART OF PUBLIC 

HEALTH MEASURES AGAINST PANDEMIC INFLUENZA FOR INDIVIDUALS, HEALTH 

2.2 VHA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 23 

CARE PROVIDERS, AND ORGANIZATIONS on public health measures), and the elements of 

the VA Pandemic Influenza Plan. 

o Developing a list of prevention activities that Veterans Service Organizations and other 

community partners could do to assist with or enhance VA’s effort to manage the epidemic. 

2.3 VBA Preparations 

2.3.1 Leadership 

The Under Secretary for Benefits will lead the VBA response to an influenza pandemic, assisted by the 

Under Secretary for Health and advised by the VA Pandemic Influenza Advisory Group. 

2.3.2 Coordination 

VBA central or regional offices will plan to: 

• Utilize existing Continuity of Operations Plans to ensure mission essential functions continue 

uninterrupted. 

o Alternatives for face-to-face meetings with veterans are: 

 PAO announcements to encourage use of toll free line; and 

 Mail drop off points on the exterior of the facility for veteran information. 

• Consider that overall VBA operations are likely to be able to continue and not be affected by the closure 

of one or more regional office as all offices are connected to a centralized data system, and each office 

has procedures in place to reroute telephone connections and veterans’ claims information for 

processing. 

VBA will be represented on the VA Pandemic Influenza Advisory Group. 

2.3.3 Roles and Responsibilities 

2.3.3.1 Creation of VBA regional office pandemic influenza plans 

• VBA regional offices will develop plans that address how work will be done in an environment with 

altered work conditions. These plans should address: 

o Staff telephone tree update 

o Telephone reroute procedures 

o Plans to broker work to other regional offices (if needed) 

o Plans to reroute mail to alternate facility(ies) 

o The placement of vital information on the Internet and Intranet 

2.3.3.2 Workforce (staffing, education) 

VBA regional offices will take these staffing issues into consideration: 

• Daily staff accounting 

• The employment of flexible work standards (telecommuting, flexible work hours, work from alternate 

sites)

• Information technology/computer support for employees who are telecommuting (help desk function)

• The use of liberal leave, authorized absence, and advanced leave policies

VBA central and regional offices will prepare their workforce by taking these actions: 

• Provide education for all employees about the potential for pandemic influenza, including regular 

updates on infection control practices. 

• Encourage receipt of seasonal influenza vaccinations. 

• Develop protocols for managing employees who are ill with influenza. 

• Plan to ensure that sufficient supplies of personal protective equipment and hand hygiene products are 

available. 

2.3 VBA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 24 

VBA may need to close a regional office during a pandemic and if so will take these actions: 

• Prepare plan to reroute telephones to an open regional office. 

VBA employees will be provided with educational materials on pandemic influenza, respiratory and 

y

2

wing actions are needed to maintain VBA offices’ security: 

 is trained on signs and symptoms of influenza to limit visitor access. 

re and safety. 

s will include:

unication plan for all of its employees to alert them to the potential for 

• te ways to communicate with VACO and their staff during times when traditional 

• loyees the areas of their jobs that put them at the greatest risk for pandemic 

• s have access to information on how to protect themselves from the 

• written policies, memos, flyers, brochures, satellite TV, net 

•

2

morial Affairs will lead the NCA response to an influenza pandemic, assisted 

ealth and advised by the VA Pandemic Influenza Advisory Group. 

CA Memorial Service Network offices and National Cemeteries will follow the guidance outlined in 

that mission essential functions are maintained. 

uity of Operations Plans to ensure mission essential functions continue 

 cemetery. 

• Create line of communications to inform VBA Central Office of actions. 

2.3.3.3 Infection control 

•

hand h giene. 

• VBA employees will be provided with information on the availability of pandemic influenza antivirals 

and vaccine from VA sources through their representative on the VA Pandemic Influenza Advisory 

Group.

.3.3.4 Security 

The follo

• Ensure guard staff

• Plan to provide guard staff with appropriate PPE to ensure their welfa

2.3.3.5 Communication 

Two-way communication with VACO employees, contractors, and tenant organization

• VBA will develop a comm

pandemic influenza.

• VBA will coordinate these plans with VACO for refinement and alignment to the VA National 

Pandemic Influenza Plan.

VBA will plan alterna

methods may not be available.

VBA will articulate to emp

influenza and how to minimize these risks.

VBA will ensure that employee

spread of influenza.

Employ methods such as email, V-tel, web, 

meetings to review plans, prevention and home care kits. 

Provide information to Veterans Service Organizations via established telephone trees and other 

mechanisms for dissemination.

2.4 NCA Preparations 

.4.1 Leadership 

The Under Secretary for Me

by the Under Secretary for H

2.4.2 Coordination 

N

Continuity of Operations Plans for ensuring 

• Utilize existing Contin

uninterrupted. 

• Review how overall NCA operations will be affected by the closure of one or more office or

2.4 NCA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 25 

• Review of how burial procedures may need to change because of increased numbers of request

decreased staffi

s and 

ng. 

e 

2

plans 

SN) offices and National Cemeteries will develop plans that address 

nate facility(ies) 

ational Cemeteries will take these staffing issues into 

onsideration: 

te 

/computer support for employees who are telecommuting (help desk function)

Provide education for all employees about the potential for pandemic influenza, including regular 

anaging employees who are ill with influenza. 

ed to close during a pandemic 

• reroute telephones to an open office. 

ffected burials. 

mic influenza, respiratory and hand hygiene (see 

 PUBLIC HEALTH MEASURES AGAINST PANDEMIC INFLUENZA 

• Develop criteria and transparent processes for allocation decisions regarding resources needed 

(cemetery staff, plots) for significant numbers of burials if closure and rescheduling is not an adequat

response. 

NCA will be represented on the VA Pandemic Influenza Advisory Group. 

.4.3 Roles and Responsibilities 

2.4.3.1 Creation of network- and cemetery-level pandemic influenza 

NCA Memorial Service Network (M

how work will be done in an environment with altered work conditions. These plans should address: 

• Staff telephone tree update 

• Telephone reroute procedures 

• Plans to broker work to other Network Offices (if needed) 

• Plans to reroute mail to alter

2.4.3.2 Workforce (staffing, education) 

NCA Memorial Service Network offices and N

c

• Daily staff accounting 

• The employment of flexible work standards (telecommuting, flexible work hours, work from alterna

sites)

• Information technology

• The use of liberal leave, authorized absence, and advanced sick leave policies. 

NCA Memorial Service Network offices and National Cemeteries will prepare their workforce by taking

these actions: 

•

updates on infection control practices. 

• Encourage receipt of seasonal influenza vaccinations. 

• Develop protocols for m

• Ensure that sufficient supplies of personal protective equipment and hand hygiene products are 

available. 

NCA Memorial Service Network offices and National Cemeteries may ne

and if so will take these actions: 

Prepare to 

• Create line of communications to inform NCA Central Office of actions. 

• Develop plan to contact funeral homes and the next of kin of the deceased to notify parties of the 

situation and to reschedule the a

2.4.3.3 Infection control 

Infection control actions for NCA staff will include: 

• Providing staff with educational materials on pande

Appendix E-3: CHART OF

FOR INDIVIDUALS, HEALTH CARE PROVIDERS, AND ORGANIZATIONS and Appendix E-2: 

2.4 NCA Preparations 
 VA Pandemic Influenza Plan 

March 2006 

Section 2: PREPARING FOR PANDEMIC INFLUENZA 26 

CHART OF PANDEMIC INFLUENZA PRECAUTIONS FOR VA HEALTH CARE FACILITY 

STAFF).

Providing staff with information on the availability of pandemic influenza antivirals and vaccine from 

VA sources through their representative on the VA Pandemic Influenza Advisory Group.

•

EVIEW 

2.4.3.4 Communication 

Two-way communication with VACO will include the following (see also Appendix D-3: R

AND L T OF COMMUNI IS CATION PRINCIPLES AND ELEMENTS TO USE BEFORE, DURING, 

AND AFTER A PANDEMIC): 

s with VACO for refinement and alignment to the VA National 

• te ways to communicate with VACO and their staff during times when traditional 

• loyees the areas of their jobs that put them at the greatest risk for pandemic 

•

•

ms 

T eterans Affairs will conduct interactive tabletop exercises of a large-scale outbreak 

of pandemic influenza. The exercises will focus on two or three VISNs of the VA health care system and 

enters, community-based outpatient clinics, 

• Cl y health care partners and public health agencies 

wh 

• Id if as for improvement.

• NCA will develop a communication plan for all of its employees to alert them to the potential for 

pandemic influenza.

• NCA will coordinate these plan

Pandemic Influenza Plan.

NCA will plan alterna

methods may not be available.

NCA will articulate to emp

influenza and how to minimize these risks.

NCA will ensure that employees have access to information on how to protect themselves from the 

spread of influenza.

Employ methods such as: email, V-tel, web, written policies, memos, flyers, brochures, satellite TV, net 

meetings to review plans, prevention and home care kits.

• Provide information to Veterans Service Organizations via established telephone trees and mechanis

for dissemination.

2.5 VA-Wide Pandemic Influenza Outbreak Exercises 

he Department of V

involve VA Central Office, VA facilities (including medical c

a VBA regional office, and a cemetery within each of those VISNs), and the relevant Federal, state and 

local partners. Goals of the exercises are: 

• Practice coordination between VA, other Federal agencies and public health departments and local 

health care delivery partners in the following key response categories: 

o Surveillance and epidemiology 

o Command and control and communications 

o Internal and external risk communication 

o Coordination of surge capacity 

o Infection control and patient care 

arif roles among VA, other Federal agencies and

ile facilitating response. 

ent y strengths of the response and are

2.5 VA-Wide Pandemic Influenza Outbreak Exercises 
 VA Pandemic Influenza Plan 

March 2006 

SECTION 3: RESPONDING TO PANDEMIC INFLUENZA 

Strategic goals of response and containment efforts will be to stop, slow, or limit the spread of disease, 

reduce suffering and death, and sustain the operations of the Department of Veterans Affairs. 

Note that the major actions described here also appear in Appendix E-1: VA PANDEMIC RESPONSE 

ACTION GRIDS. 

3.1 VA Response Actions 

3.1.1 Leadership 

The VA Secretary will lead the overall Department of Veterans Affairs Response to an influenza 

pandemic, assisted principally by the Deputy Secretary and the Under Secretary for Health and their 

designees. 

3.1.2 Coordination and Communication 

VA will: 

• Via the Secretary, the Office of Policy, Planning and Preparedness, the Office of Public and 

Intergovernmental Affairs, and the VHA Office of Public Health and Environmental Hazards, activate a 

coordinated response within the Department and between VA and federal, state, and local agencies, 

health care, and Veteran Service Organizations. 

• Via the Secretary, regularly consult with the VA Pandemic Influenza Advisory Group. 

• Via the Office of Public and Intergovernmental Affairs and VHA Communications, put VA 

communications plans and principles into action (see Section 3.5 Communication Within and Outside 

of VA During a Pandemic and Appendix D-3: REVIEW AND LIST OF COMMUNICATION 

PRINCIPLES AND ELEMENTS TO USE BEFORE, DURING, AND AFTER A PANDEMIC). 

3.1.3 VA Central Office Response 

VA Central Office will use the plans developed under 2.1.3 to respond to pandemic influenza if a wave 

comes through the Washington, DC, area and affects headquarters and program office functions of the 

Department and its three administrations. VA Central Office will: 

• Follow the guidance outlined in Continuity of Operations Plans for ensuring that essential functions are 

maintained, as well as that of the Office of Personnel Management concerning the local Federal work 

status and operating conditions. 

• Carry out essential functions and make use of plans to reroute telephones, get work done via staff at 

other locations, and reroute the mail. 

• Use flexible work standards, such as telecommuting and flexible (shorter) work hours if necessary, and 

the use of the use of liberal leave, authorized absences, advanced sick leave, and family medical leave 

policies. 

• Plan for continued and open communication on the status of the pandemic, Central Office operating 

status and expectations, and changes in policies regarding staffing and work procedures. 

• Obtain and administer to staff, if possible, countermeasures such as antiviral medications and vaccine. 

3.1.4 Roles and Responsibilities: VA-wide 

3.1.4.1 Vigilance and notification 

VA will maintain situational awareness, being vigilant for “trigger” points at which local actions on 

pandemic influenza will escalate from passive to active. 

• A trigger point will be defined by authoritative international scientists and will be relayed by the World 

Health Organization, the Department of Health and Human Services (HHS), and the Centers for Disease 

Control and Prevention (CDC). VA will use HHS/CDC guidance on the definition of a trigger. 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 27 

3.1 VA Response Actions 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 28 

Hypothetical 

example of a trigger point definition from CDC: 

Laboratory confirmation of human influenza virus of pandemic potential with 

epidemiological evidence of two generations of human-to-human transmission. 

Confirmation of two generations of human-to-human transmission should depend on the 

analysis of a cluster of human cases by authoritative international scientists. 

3.1.4.2 Implementation of emergency plans 

VA will activate, as appropriate, its Continuity of Operations Plans (COOPs), this pandemic influenza 

plan, and other emergency plans for the Department, VHA, VBA, and NCA (see Appendix C-1: 

REFERENCE LIST FOR VA EMERGENCY PLANS AND OTHER RESOURCES). 

3.1.4.3 Limiting disease spread 

VA will act to limit disease spread, including taking these steps: 

ass It On” campaign: wash or clean 

 are 

• aff and facilities to follow local public health guidance for action, such as limiting 

s 

• provide antiviral medications to VHA patients and to 

he 

ed by an 

•

.2 VHA Response Actions 

sponse to an influenza pandemic, assisted by 

rate as diligently as possible within VA as well as with 

• Emphasizing the general principles of VA’s “Infection: Don’t P

hands frequently, cover coughs and sneezes, stay home when ill, and avoid contact with persons who

ill, when possible. 

Encouraging VA st

public gatherings, holding “snow days” during which events and activities are closed. Activating plan

for alternative work schedules and staffing. 

Using established distribution mechanisms to

VHA, VBA, and NCA staff. Prioritization will depend on the availability of antivirals and 

characteristics of the pandemic, and will be determined through coordination with HHS and DoD. T

VHA Pharmacy Benefits Management Strategic Healthcare Group will distribute the antiviral 

oseltamivir from the VHA stockpile to local VA facilities in VHA, VBA, and NCA as determin

implementation plan from the Under Secretary for Health. 

Using established distribution mechanisms to provide vaccine, when available, to VHA patients and to 

VHA, VBA, and NCA staff. Prioritization will depend on the availability of vaccine and characteristics

of the pandemic, and will be determined through coordination with HHS and DoD. Distribution of the 

vaccine to local VA facilities in VHA, VBA, and NCA will be determined by an implementation plan 

from the Under Secretary for Health. 

3

3.2.1 Leadership 

The Under Secretary for Health will head the VHA re

Principal Deputy Under Secretary for Health, the Assistant Deputy Under Secretary for Management and 

Operations, the Chief Public Health and Environmental Hazards Officer, and the Chief Patient Care 

Services Officer, and advised by the VA Pandemic Influenza Advisory Group.

3.2.2 Coordination and Communication 

VHA and its facilities and VISNs will collabo

local authorities (including State and local health care agencies and organizations) for: 

• Information and guidance about surveillance, response, and containment activities. 

• Use of vaccine when available and indicated. 

3.2 VHA Response Actions 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 29 

• Use of antiviral drugs when available and indicated. 

• Effective and timely communication following established plans and principles (see Section 3.5 

Communication Within and Outside of VA During a Pandemic and Appendix D-3: REVIEW AND 

LIST OF COMMUNICATION PRINCIPLES AND ELEMENTS TO USE BEFORE, DURING, AND 

AFTER A PANDEMIC) 

.2.3 Roles and Responsibilities 

ssible first case 

ay see the first case of pandemic influenza in their 

3

3.2.3.1 Surveillance, including po

VHA facilities will consider the possibility that they m

community or region (see Appendix E-4: ACTIONS CHECKLIST—FIRST CASE). If pandemic 

influenza is highly suspected or confirmed, key steps would include: 

• Isolating the patient in negative airflow room on Airborne Infection Isolation and Contact Precautions, if 

•

ol, 

ic. 

VHA facilities will rely on their surveillance plans (developed under 2.2.3.10) and use surveillance 

 report cases to state and local public health departments, according to local agreements and 

•

imens, 

possible, in addition to Standard Precautions. 

Recording information about possible case contacts (patients and staff) within the facility. 

• Implementing the facility emergency plan for pandemic influenza in term of infection contr

notification of key facility staff, local public health, VISN leadership. 

• Convening the Pandemic Response Team, the staff designated to assist in an influenza pandem

• Coordinating with leadership and public affairs to communicate with staff, patients, media, and 

community. 

systems to: 

• Collect and

practices. 

• When the VHA Health Care Acquired Infection and Influenza Surveillance System is available, obtain 

automatically produced data that will identify and track indicators of pandemic influenza and use this 

information for their own purposes. 

If available, use data received from the CDC Biosense program to assist with triggering of local 

containment actions. 

• Carry out plans to use diagnostics, if available, and use care in handling testing and shipping spec

including appropriate precautions (see Appendix E-2: CHART OF PANDEMIC INFLUENZA 

PRECAUTIONS FOR VA HEALTH CARE FACILITY STAFF). 

.2.3.2 Refocusing of patient care priorities 

atients with pandemic influenza, including enrolled 

• de guidance on home 

r the use of home care kits (see Appendix 

3

VHA facilities will maximize ability to care for p

veterans, and in response to the needs of other individuals, such as active duty military, non-enrolled 

veterans, and non-veterans, as necessitated by local situations and as outlined in VA-DoD contingency

plans and the National Response Plan. Actions will include: 

• Postponing elective hospital admissions and appointments. 

Discharging patients capable of being cared for at home. Where possible provi

care, offer advice lines and contact information, and conside

E-6: HOME CARE GUIDE FOR INFLUENZA). 

3.2 VHA Response Actions 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 30 

3.2.3.3 Infection control (transmission and precautions for health care facility staff, hand and 

respiratory hygiene) 

VHA facilities will implement appropriate infection control measures as planned (see also Section 2.2.3.3 

Physical site (space planning, building and engineering systems, support for infection control, 

transportation of patients, fatality management and Section 2.2.3.4 Infection control and precautions 

(heightened surveillance, employee illness, supplies and their management, transmission and precautions 

for health care facility staff). 

At the beginning of a pandemic influenza outbreak, health care facility staff members are advised to use 

Airborne Infection Isolation and Contact Precautions for VHA health care facility staff (see Appendix E2: CHART OF PANDEMIC INFLUENZA PRECAUTIONS FOR VA HEALTH CARE FACILITY 

STAFF): 

• Use fit-tested N95 level masks or powered air purifying respirators—PAPRs, gowns, gloves, and 

goggles. 

• Place patient in negative air flow room to provide maximum protection of VHA staff until the mode of 

transmission has been established. 

A note on transmission and precautions: Because the mode of transmission of the virus will not be 

known for some time, VA advises taking a conservative approach that provides a high level of 

protection for health care facility staff. This level of protection, known as Airborne Infection 

Isolation and Contact Precautions, includes the use of fit-tested N95 respirators or PAPRs, as well as 

gowns, gloves, and eye protection, such as goggles. 

• Adjust level of infection control practices and isolation throughout the pandemic period according to 

capability of the facility and epidemiology of the pandemic. 

• If the epidemiology of the pandemic virus does not warrant Airborne Infection Isolation and Contact 

Precautions or if the Airborne Infection Isolation and Contact Precautions cannot be maintained because 

of staffing, space, supplies, or patient flow, employ Droplet Precautions as follows: 

o Staff wear surgical or procedure-type masks within 3 feet of patients. 

o Patients wear masks, if able; staff with potential body fluid contact wear gloves and gowns. 

o Segregate exposed patients away from non-exposed patients. 

o Isolate or cohort symptomatic/ill patients. 

o Handle soiled linens and waste according to usual health care facility procedures. 

• No matter the mode of transmission, facilities should: 

o Continue to promote and practice hand hygiene (patients and staff wash hands with soap and 

water or alcohol-based hand rub after having contact with respiratory secretions and/or 

contaminated individuals, objects, and materials). 

o Continue to promote and practice respiratory hygiene (patients and staff cover noses and mouths 

when sneezing, use facial tissues to contain respiratory secretions and dispose of them in a waste 

container). 

o Practice contact avoidance; individuals with influenza symptoms should be kept at least three feet 

from others as much as possible. 

o Screen incoming patients for influenza-like illness (ILI) with up-to-date algorithms for clinical 

symptoms and recent exposure and travel history. 

o Implement visitor restriction policies according to criteria. 

o Use rapid testing for influenza A if needed to differentiate pandemic influenza from other 

respiratory illnesses. 

o Follow quarantine measures and other public health measures issued by Federal, State and local 

government agencies (see Appendix E-2: CHART OF PANDEMIC INFLUENZA 

PRECAUTIONS FOR VA HEALTH CARE FACILITY STAFF). 

3.2 VHA Response Actions 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 31 

3.2.3.4 Support for and management of exposed or ill staff (monitoring, triage, absences, public 

health measures) 

VHA will make use of plans developed to manage exposed, suspected and/or confirmed infectious staff 

(see Section 2.2.3.8 Support and management of exposed and ill staff). Facilities have a duty to protect 

patients and staff by minimizing the transmission of disease. Actions will include: 

• Providing immunizations, medications and supplies of personal protection equipment to protect staff 

against respiratory infection. 

• Doing daily fever monitoring of staff exposed to presumptive pandemic influenza cases. 

• Screening staff for influenza-like illness (ILI) with up-to-date algorithms for clinical symptoms and 

recent travel history. 

• Using rapid testing for influenza A. 

• Treating suspected and/or confirmed infectious staff. 

• Monitoring occurrences and establishing triage and isolation of suspected and/or confirmed cases of 

respiratory illness in staff. 

• Laboratory testing and processing of staff specimens. 

• Reporting and disclosure of test results, and maintaining staff confidentiality. 

• Excluding staff with symptoms, or after high risk exposures from duty, or confirmed diagnoses; 

requiring staff to stay home when ill. 

• Encouraging contact avoidance to the extent possible—individuals with influenza-like symptoms should 

be kept at least three feet from others. 

• Granting authorized absences as appropriate (see Appendix B-2: TABLE OF LEGAL AUTHORITIES 

AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes in Usual VA Practices 

During a Pandemic). 

• Following quarantine measures, social distancing measures, or, as possible, closures and “snow day” 

decrees issued by Federal, State and local government agencies (see Appendix E-3: CHART OF 

PUBLIC HEALTH MEASURES AGAINST PANDEMIC INFLUENZA FOR INDIVIDUALS, 

HEALTH CARE PROVIDERS, AND ORGANIZATIONS). 

3.2.3.5 Countermeasures (antiviral drugs, vaccines, diagnostics) 

VHA facilities will activate plans to employ other available countermeasures (see Section 2.2.3.4 

Infection control and precautions (heightened surveillance, employee illness, supplies and their 

management, transmission and precautions for health care facility staff)), including antiviral drugs, 

vaccines, and diagnostic and laboratory tests, following the advice of the VA Under Secretary for Health 

(who will be working closely with HHS and DoD). Such advice cannot be specified at this time, but could 

include: 

• Use of antiviral 

o For pre-exposure preven

medications: 

tion/prophylaxis (generally for the duration of the local outbreak) in 

nt severe illness and death in those persons at highest risk from pandemic influenza. 

is 

For xis (generally for ten days after a possible exposure) in 

l well-defined disease clusters, such as outbreaks in nursing homes, other institutions, 

 sed to pandemic influenza, including health care providers and 

order to: 

 Preve

 Preserve delivery of health care and other essential critical services by providing prophylax

to staff most likely to be exposed. 

o post-exposure prevention/prophyla

order to: 

 Contro

or small communities. 

Protect individuals expo

patients who have had significant exposure. 

3.2 VHA Response Actions 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 32 

 Provide mass prophylaxis (i.e., wide dispensing of antiviral drugs) to VHA staff and patients, 

if supplies are adequate and pandemic situation allows, usually in coordination with local and 

state plans. 

 After a vaccine becomes available, protect persons who might have an inadequate vaccine 

response (e.g., the elderly and those with underlying immunosuppressive disease) and 

individuals with contraindications to vaccination, such as anaphylactic hypersensitivity to 

eggs or other vaccine components. 

o For treatment of staff and patients with pandemic influenza. 

• Use of vaccine against pandemic influenza (when it is available) 

o VHA leadership will maintain regular communications with other Federal agencies in order to be 

aware of vaccine availability and systems to acquire it. 

o VA will acquire sufficient quantities of FDA-approved vaccine against a pandemic strain to 

vaccinate veterans enrolled for VA health care, as well as VA staff in VHA, VBA, and NCA, and 

any others according to guidance in place at the time. 

o In proceeding to distribute and administer vaccine to staff and patients, VA will follow the 

prioritization guidance of the Secretary of VA and the VA Undersecretary for Health, in 

collaboration with HHS and DoD. 

• Use of diagnostic and laboratory tests 

o Combine the use of influenza rapid test kits with those for other seasonal respiratory infections, 

such as respiratory syncytial virus (RSV), to narrow the differential diagnoses of respiratory 

illness. 

o Use CDC’s Laboratory Response Network as a diagnostic testing referral system. 

o Maintain testing and specimen collection supplies for the patient workload as the pandemic 

evolves and use established Memoranda of Understanding (MOUs) to obtain more supplies. 

o Ensure continued capacity for storage of serum, respiratory, and tissue samples for testing or for 

later epidemiologic studies. 

o Make sure that all personnel use proper specimen handling techniques and precautions (see 

Appendix E-2: CHART OF PANDEMIC INFLUENZA PRECAUTIONS FOR VA HEALTH 

CARE FACILITY STAFF). 

3.2.3.6 Workforce (availability, flexible work standards, credentialing, broadened practice 

standards) 

• VHA facilities will implement staffing plans (see Section 2.2.3.2 Workforce preparation (education, 

skill identification, credentialing, Pandemic Response Teams): 

o Track staff availability, credentialing status, skills and training, health and influenza status. 

o Employ flexible worksite standards (e.g., telecommuting for certain functions) and flexible work 

hours (e.g., staggering shifts or using longer or shorter work schedules). 

 Provide information technology support for staff who are telecommuting. 

o Support the physical and mental health of staff and enable healthy staff to provide patient care. 

Develop a triage approach for staff that includes: 

 Morning check of influenza symptoms and other physical and mental health issues 

 Re-assignment or removal of staff based on influenza symptoms and other physical and 

mental health indicators 

• Implement check-in procedures (by phone or email) that enable staff to provide information on 

availability to work, as well as on health status. 

• Supplement staff where necessary and possible with retired or inactive clinicians, and an expanded 

group of providers such as mental health professionals, dentists and dental auxiliary providers, 

pharmacists, social services, and health professional students. (See Appendix B-2: TABLE OF LEGAL 

AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes in Usual 

VA Practices During a Pandemic). 

3.2 VHA Response Actions 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 33 

o Coordinate with local public health/emergency planning office. 

o Allow practice on a temporary basis through the length of the declared emergency period of a 

pandemic. 

Note: Credentials of VA providers who have active credentials and privileges in a VA facility can be 

shared electronically through VA’s computerized credentialing system, VetPro. 

 The receiving facility can use these credentials during the pandemic for the purpose of 

granting “Temporary Privileges for Urgent Patient Care Needs” within VetPro. 

 Verification of licenses and a query of the National Practitioner Database are required for 

Temporary Privileges for Urgent Patient Care Needs. 

 If necessary, the Credentialing and Privileging Team in the Office of Quality and 

Performance (OQP) provides temporary/emergency access and is available under the VA 

Central Office and OQP Emergency Plan. 

 Disaster credentialing appointment processes must be followed for non-VA personnel. These 

processes include the following requirements: 

ß A description of the verification process at the time disaster privileges are granted that 

will include: 

 a current hospital photo identification card AND evidence of current license to 

practice; or 

 identification indicating that the individual is a member of a Disaster Medical 

Assistance Team (DMAT); or 

 identification indicating that the individual has been granted authority to render 

patient care in emergency circumstances, such authority having been granted by a 

federal, state, or municipal entity. 

ß A specified period of time under which these health care professionals granted disaster 

privileges may practice on these disaster privileges. This period may not exceed 10 

calendar days of the length of the declared disaster, whichever is shorter. At the end of 

this period the practitioners needs to be converted to Temporary Privileges as defined by 

VA policy. 

ß A defined process to ensure the verification process of the credentials and privileges of 

health care professionals who receive disaster privileges that will begin as soon as the 

immediate situation is under control. This process will be identical to the process for 

granting Temporary Privileges and ultimately results in complete credentialing of these 

practitioners. 

o Allow broadened scope of practice standards among various trained providers. 

 Staff and volunteers may be needed to function at levels above their formal scope of practice, 

with training as possible, and may do so where additional skills have been verified by an 

appropriate staff member. 

 Volunteers and nonclinical staff may be assigned to perform lower level clinical tasks like 

taking temperatures and other vital signs, changing linen, and assisting with record-keeping. 

It may be necessary to include training and verification of skills by appropriate staff. 

3.2.3.7 Patient care (changing demands and surge, advice lines/telemedicine, triage, diagnosis, 

isolation, expansion to include alternative space and sites, altered standards of care) 

In general, VHA facilities must be prepared for the rapid pace and dynamic characteristics of a pandemic. 

Facilities need to be equipped and ready to care for: 

• A limited number of patients with a pandemic influenza virus, or other novel strain of influenza, as part 

of normal operations 

• A surge or large number of patients in the event of escalating transmission of pandemic influenza 

3.2 VHA Response Actions 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 34 

In addition, facilities may have demands from the community as well (see Appendix B-1: SUMMARY 

OF POTENTIAL VA EXPANDED RESPONSIBILITIES). 

Facilities will: 

• Implement advice lines/telemedicine with pre-developed telephone capabilities and materials. 

o Consider using staff that are recovering or need to be out of from work for quarantine or family 

care. 

• Employ strategies for triage, diagnosis, and isolation of possible pandemic influenza patients. 

o Triage should be conducted to (1) identify persons who might have pandemic influenza; (2) 

separate them from others to reduce the risk of disease transmission; and (3) determine whether 

they can be treated in an outpatient setting, or at home or require hospitalization. 

o Use phone triage to separate patients who need emergency care and those who can be referred to 

an outpatient clinic or non-urgent care facility or to home care. 

o Promote the use of a self-triage algorithm (see Appendix E-5: SAMPLE SELF-TRIAGE 

ALGORITHM FOR PERSONS WITH INFLUENZA SYMPTOMS) that enables patients (and 

staff) to review their own symptoms and consider appropriate settings and use of care. 

o Adopt a “drive-through triage” option to reduce close contact with potentially infected patients. 

o Assign separate waiting areas for persons with respiratory symptoms. 

o Assign separate triage evaluation areas for persons with respiratory symptoms. 

o Assign one or more “triage coordinators” to manage patient flow. 

o Consider that triage duties may require less physical strength and may be possible for staff 

recovering from influenza to perform for less than 8-hour shifts. 

• Expand care delivery to alternative space and sites as identified in the planning period. 

o Employ home-based care strategies. 

o Use telephone advice lines or refer to web-based self-triage algorithms (see Appendix E-5: 

SAMPLE SELF-TRIAGE ALGORITHM FOR PERSONS WITH INFLUENZA SYMPTOMS) 

to provide advice on whether to stay home or to seek care. 

o Update home care advice to reflect the epidemiology and natural history of the pandemic 

influenza (see Appendix E-6: HOME CARE GUIDE FOR INFLUENZA). 

o Document home-based care advice given to patients in the electronic medical record system or by 

other means. 

o Employ drive-through clinics. 

▪ Consider locating such drive-through clinical sites in or near guard stations, mobile clinics, or 

parking lots. 

▪ Provide health care facility staff with equipment to provide care including portable equipment 

to measure vital signs and oxygenation, standardized questionnaires, printed patient advice 

materials, wheelchairs or stretchers for transport of patients who need additional assessment 

or care, and home supply kits (see Appendix E-6: HOME CARE GUIDE FOR 

INFLUENZA). 

• Employ altered standards of care when necessary. 

o The term "altered standards" means a shift to providing care and allocating scarce equipment, 

supplies, and personnel in a way that saves the largest number of lives in contrast to the 

traditional focus on individuals. 

o VA staff should use the following principles as a guide for employing Altered Standards of Care: 

 Principle 1: In planning for a mass casualty event, the aim should be to keep the health care 

system functioning and able to deliver acceptable quality of care to preserve as many lives as 

possible. 

 Principle 2: Planning a health and medical response to a mass casualty event must be 

comprehensive, community-based, and coordinated at the regional level. 

 Principle 3: There must be an adequate legal framework for providing health and medical 

care in a mass casualty event (see Appendix B-2: TABLE OF LEGAL AUTHORITIES 

3.2 VHA Response Actions 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 35 

AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes in Usual VA 

Practices During a Pandemic). 

 Principle 4: Health care providers have a duty to care for the sick even in high-risk situations 

and to not harm patients by transmitting disease. VHA will provide for the health and safety 

of health care facility staff, including providing personal protective equipment and instituting 

safety protocols. 

 Principle 5: The rights of individuals must be protected to the extent possible and reasonable 

under the circumstances. Decisions to restrict or override the right of individuals to achieve 

public health goals must be proportional to the degree of disease or injury, necessary, 

relevant, applied equitably, and should employ the least restrictive means. 

 Principle 6: Clear communication with the public concerning the possible use of altered 

standards of care is essential before, during, and after mass casualty events. 

Provided below is a framework regarding how health care standards may have to be modified during a 

pandemic by the stage of disease and the degree to which the pandemic impacts health care demand. 

Stage of Disease Health Care Standards 

in the Population 

and Demand for 

Medical Services 

Normal Medical 

Care Standards 

Near Normal 

Medical Care 

Standards 

(alternate sites of 

care, use of 

atypical devices, 

expanded scope 

of practice for 

clinicians) 

Focus on Key 

Lifesaving Care 

Total System/ 

Standards 

Alteration 

(triage care 

according to local 

demands and 

capabilities) 

Pre-Pandemic X 

Early Pandemic X X 

Moderate Demand X X 

Severe Demand X X 

Figure 1: Framework for Altered Standards of Care 

Chart adapted from Altered Standards of Care in Mass Casualty Events, Agency for Healthcare 

Research and Quality, HHS, 2005; original source Dr. Michael Allswede, University of Pittsburgh, 

UPMC Medical System 

3.2.3.8 Medical materiel (medications and supplies, access to caches) 

• Activate plans for medical materiel (see Section 2.2.3.6 Medical materiel (equipment and supplies). 

• Assess facility supplies of materiel. 

3.2 VHA Response Actions 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 36 

• Contact VHA Central Office for centrally stockpiled consumable materiel. Determine availability of 

medical materiel, including pharmaceutical and other medical items, through the Pharmacy Benefits 

Management Strategic Healthcare Group and the National Acquisitions Center. 

o VHA Emergency Caches of medications will be made available through the Office of the Deputy 

Under Secretary for Health for Operations and Management. 

o VHA antiviral stockpile (oseltamivir) will be made available and distributed under the guidance 

of the Under Secretary for Health. 

3.2.3.9 Security for health care sites 

VHA facilities will activate security plans (under 2.2.3.11), providing security for critical medical 

supplies and for health care and alternative care facilities, to: 

• Ensure entry to and exit from facilities is limited and secure. 

• Enforce visitor restrictions to health care facilities. 

• Ensure that countermeasures are secure including personal protective equipment, vaccine, and antiviral 

medications. 

• Utilize temporary security procedures, such as lockdowns, to enforce safety. 

• Activate agreements with local law enforcement. 

3.2.3.10 Fatality management 

VHA facilities will manage fatalities according to plan (see Section 2.2.3.3 Physical site (space planning, 

building and engineering systems, support for infection control, transportation of patients, fatality 

management) : 

• Provide personal protective equipment to enable health care facility staff to use Airborne Infection 

Isolation and Contact Precautions for handling remains of individuals who die from pandemic influenza 

(see Appendix E-2: CHART OF PANDEMIC INFLUENZA PRECAUTIONS FOR VA HEALTH 

CARE FACILITY STAFF.

• Use identified refrigeration capacity for remains. 

• Coordinate mass fatality plans with local and state health officials and medical examiners, using, as 

necessary, temporary morgue sites, such as refrigerated warehouses and trucks. 

3.2.3.11 Mental health support 

VHA facilities will activate plans (see Section 2.2.3.9 Mental health support for patients and staff), 

including: 

• Providing mental health and chaplain services for patients and families and for health care and 

emergency workers and their families, especially when workers must be away from home. 

• Deploying mental health professionals such as psychiatrists, psychologists, social workers, specialized 

nurses, and chaplains, as well as readjustment counseling (Vet Center) staff, and staff of employee 

assistance programs. 

• Recruiting local psych

care organizations, as necessary. 

Using a mental health consultatio

iatry, psychiatry, psychology, social work, nursing, and faith-based or pastoral 

• n process to make such expertise available to all who require 

assistance at the local level, including Central Office mental health and readjustment counseling

services and VISN mental health councils. 

3.2 VHA Response Actions 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 37 

3.3 VBA Response Actions 

3.3.1 Leadership 

The Under Secretary for Benefits will head the VBA response to an influenza pandemic, assisted by the 

Under Secretary for Health and advised by the VA Pandemic Influenza Advisory Group, as needed. 

3.3.2 Coordination and Communication 

VBA central and regional offices will follow the guidance outlined in existing Continuity of Operations 

Plan for ensuring that mission essential functions are maintained. 

VBA will work in concert with the other VA administrations and VBA facilities will coordinate with state 

and local public health and other agencies. 

3.3.3 Roles and Responsibilities 

3.3.3.1 Workforce actions 

VBA facilities will make use of emergency plans, as well as pandemic influenza plans. 

VBA staffing considerations will include: 

• Accounting for staff daily 

• Employing flexible work standards to the extent possible, such as flexible work hours

• Using liberal and administrative leave policies (see Appendix B-2: TABLE OF LEGAL 

AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes in Usual 

VA Practices During a Pandemic)

• Granting up to 240 hours of advanced sick leave for employees without sufficient sick leave

3.3.3.2 Closure of regional offices 

If circumstances dictate, VBA will prepare to close regional offices. 

• Reroute telephones to an open regional office. 

• Inform VBA central office of actions. 

• Inform veterans. 

3.3.3.3 Infection control 

• Provide employees with educational materials on pandemic influenza and on respiratory and hand 

hygiene (see Appendix E-3: CHART OF PUBLIC HEALTH MEASURES AGAINST PANDEMIC 

INFLUENZA FOR INDIVIDUALS, HEALTH CARE PROVIDERS, AND ORGANIZATIONS). 

• Provide employees with information on the availability of pandemic influenza antivirals and vaccine 

from VA sources through their representative on the VA Pandemic Influenza Advisory Group.

3.3.3.4 Security 

• Ensure guard staff is trained on signs and symptoms of influenza to limit visitor access; provide them 

and visitors with self-triage algorithm (see Appendix E-5: SAMPLE SELF-TRIAGE ALGORITHM 

FOR PERSONS WITH INFLUENZA SYMPTOMS). 

• Provide guard staff with appropriate personal protective equipment to ensure their welfare and safety. 

3.3 VBA Response Actions 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 38 

3.4 NCA Response Actions 

3.4.1 Leadership 

The Under Secretary for Memorial Affairs will head the NCA response to an influenza pandemic, assisted 

by the Under Secretary for Health and advised by the VA Pandemic Influenza Advisory Group, as 

needed. 

3.4.2 Coordination and Communication 

NCA central and Memorial Service Network office will follow the guidance outlined in Continuity of 

Operations Plans and other emergency plans for ensuring that mission essential functions are maintained. 

NCA will work in concert with the other VA administrations and NCA facilities will coordinate with state 

and local public health and other agencies. 

3.4.3 Roles and Responsibilities 

3.4.3.1 Workforce actions 

NCA staffing considerations will include: 

• Accounting for staff daily. 

• Employing flexible work standards to the extent possible, such as flexible work hours;

• Using liberal and administrative leave policies (see Appendix B-2: TABLE OF LEGAL 

AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes in Usual 

VA Practices During a Pandemic)

• Granting up to 240 hours of advanced sick leave for employees without sufficient sick leave

3.4.3.2 Closure of network offices or cemeteries 

A wave of pandemic influenza may affect the staff of NCA and the surrounding community and may 

make it necessary to temporarily suspend operations. In this case: 

• Reroute telephones to an open office or cemetery. 

• Inform NCA central office of actions. 

• Contact funeral homes and the next of kin of the deceased to notify parties of the situation and to 

reschedule the affected burials. 

3.4.3.3 Infection control 

• Provide employees with educational materials on pandemic influenza and on respiratory and hand 

hygiene (see Appendix E-3: CHART OF PUBLIC HEALTH MEASURES AGAINST PANDEMIC 

INFLUENZA FOR INDIVIDUALS, HEALTH CARE PROVIDERS, AND ORGANIZATIONS). 

• Provide employees with information on the availability of pandemic influenza antivirals and vaccine 

from VA sources through their representative on the VA Pandemic Influenza Advisory Group.

3.5 Communication Within and Outside of VA During a Pandemic 

3.5.1 Leadership 

The VA Secretary and the Office of Public and Intergovernmental Affairs will lead the overall 

communications efforts of the Department of Veterans Affairs during an influenza pandemic, assisted 

principally by the VHA Office of Communications and the VHA office of the Deputy Under Secretary for 

Management and Operations, in coordination with the VA Pandemic Influenza Advisory Group. 

3.4 NCA Response Actions 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 39 

3.5.2 Coordination 

VA will: 

• Build on relationships, channels, and vehicles developed and established during the prepandemic 

planning phase. 

• Adjust communication strategies and practices in accordance with emerging needs, demands, and 

expectations for information caused by a pandemic. (See Appendix D-3: REVIEW AND LIST OF 

COMMUNICATION PRINCIPLES AND ELEMENTS TO USE BEFORE, DURING, AND AFTER A 

PANDEMIC). 

• Focus on being constituent, timely, accurate, and open about providing information and on supporting 

VA staff in the field – the health facilities, regional offices, and memorial services – as they deal 

directly with pandemic influenza and an increased demand for good and clear communication. 

• Consider the information needs of VA staff, veterans, and the many organizations and individuals 

concerned with VA programs and promote a steady flow of information throughout the Department and 

with national and Federal, state, and local agencies. 

3.5.3 Roles and Responsibilities 

3.5.3.1 VA-wide communication 

VA leadership, supported by public affairs and communication officers, will: 

• Continue to provide tools and information through VA Web sites (updated on a real-time basis). 

• Work through pre-identified lead spokespersons and provide talking points and up-to-date information 

on the status of operations and the epidemiology of pandemic influenza within VA. 

• Coordinate information and responsibilities with regional and facility managers and with national and 

international efforts. 

• Provide web and email updates on situations having and impact on status of operations and service 

delivery within facilities and within states. 

• Distribute updated education and information to the effected VA health care community. 

• Address rumors and false reports immediately with factual information and guidance. 

• Make use of its list of national, state, local, and community partners, and share information and updates 

with state, local, and community partners. 

• Brief media outlets and veteran service organizations on the status of VA operations and respond to 

questions, concerns, and offers of assistance. 

• Prepare answers and information in a variety o

• Ensure that VA facilities are prepared to report to the pub

f formats. 

lic specific information regarding the impact 

• support direct communication with staff. 

lities during a global 

.5.3.2 VHA communication 

n

e VHA Office of Public Health and Environmental Hazards will work 

ouncement of the global outbreak. 

telephone operators, and receptionists. 

of the pandemic on operations. 

Provide messages and guidance to

• Work via OA&MM to inform VA contractors and vendors of their responsibi

pandemic. 

3

VHA Ce tral Office actions: 

• VHA Communications and th

with VA public affairs and VHA public affairs officers to: 

o Rapidly produce and update information after the ann

o Update Web sites as needed, daily if necessary. 

o Provide updates to facilities for VA advice lines, 

3.5 Communication Within and Outside of VA During a Pandemic 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 40 

o Disseminate information to VA staff, unions, volunteers and academic affiliates about changes in 

work assignments, call-ins for absentees, and general epidemiological information about 

influenza symptoms. 

o Participate in conference calls between VA central office, VISN directors, chiefs of staff, and 

medical center directors. These leaders will communicate with medical personnel, other staff, 

and volunteers via real or virtual town hall meetings and other means. 

External communication in VHA during a global pandemic will include regular updates for the White 

House, Congress, Congressional oversight committees, other government agencies and news media, local 

and state governments, Veterans Service Organizations, academic affiliates, professional organizations 

and unions, contractors, vendors and community partners. 

VHA facility actions 

• VHA facilities will make use of their pandemic influenza communications plans and other emergency 

communications plans. Aspects of these plans will include: 

o Using consistent and accurate information about the status of what is going on the medical center, 

what individuals can do to protect themselves and prevent transmission, what VA is doing. 

o Regularly informing internal and external stakeholders of news and developments, including 

 Staff – clinical, nonclinical, security, telephone operators and receptionists, medical trainees, 

volunteers, contractors 

 Patients and their families 

 Veterans Service Organizations 

 Local public health and health care agencies 

 The media 

o Using a variety of vehicles to convey this information, such as 

 Announcements and news releases 

 Email announcements 

 Scripts for receptions and telephone operators with basic information for veterans and staff 

who call in 

 Fact sheets 

 Presentations/discussions at meetings (staff, community at large, local health counterparts) 

 Briefings 

 Conference calls 

 Easily found Internet and Intranet sites where this information is posted 

o Using a streamlined but effective process to create and get approval on consistent, accurate, and 

timely information. 

o Making available pre-identified spokespersons, usually medical or leadership to speak to the 

media and other key stakeholders. 

o Using templates to help convey consistent information and standard distribution lists so that there 

is a record of who has been told what. 

o Being proactive with staff, veterans, the media, veterans groups, and the community possibly 

offering telephone or teleconference briefings. 

o Staying up to date, including identifying and addressing rumors, inaccuracies, and misperceptions 

o Having on hand (at work and at home) key contact lists for key staff, the media, and local public 

health departments. 

o Making use of alternative means of communicating in emergencies, such as telephone trees to get 

the word out, call-in systems (live or recorded with or without answering machine capability), 

recorded information on the status of operations. 

3.5 Communication Within and Outside of VA During a Pandemic 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 41 

3.5.3.3 VBA communication 

VBA will: 

• Conduct weekly conference calls with field facilities. 

• Gather regular (weekly or possibly daily) facility status reports through Area offices. Communicate 

frequently with local, state and private health care partners. 

• Collaborate to produce news releases and public service announcements as needed to communicate with 

veterans, staff and the general public in the local area concerning the status of VBA operations and how 

to obtain services in the event of an office closure. 

3.5.3.4 NCA communication 

NCA Central Office (NCACO) will have the following functions. 

• Internal Communications: 

o Provide information to NCA staff and other staff (contractors, volunteers, unions, etc.) 

concerning the onset of the influenza pandemic. This information will include, but is not limited 

to: 

 Guidance on preventing or minimizing employee infection or spreading of the influenza 

 Any changes to cemetery operation policy 

 Frequently asked questions regarding the influenza 

o Adopt and amend these communications based on guidance provided by VACO, VHA, CDC, and 

other sources as appropriate for NCA workplaces. 

o Work with VACO staff to implement One-VA communications through all available channels, 

including the use of a 1-800 telephone number and website information. 

o Utilize multiple modes of communication (e-mail, conference calls, flyers, etc.) to ensure that all 

NCA staff members receive these communications. 

o Develop a communications plan to coordinate the communications activities of all NCA field 

sites where current policies and procedures are insufficient. 

o Ensure that NCA provides a consistent message to all parties. 

• External Communications 

o Provide information concerning the onset of the influenza pandemic to external parties, most 

notably funeral home directors, next of kin of individuals scheduled for interment at a national 

cemetery, visitors, and VSOs. Utilize multiple modes of communication to ensure that 

appropriate external parties receive these communications. 

• Communications between NCA facilities and local/state/private agencies 

o Coordinate with local, state, and private agencies to ensure that the spread of an influenza 

pandemic is minimized and that the general public is informed of NCA’s efforts regarding the 

influenza pandemic. 

o Respond to inquiries from local, state, and private agencies in accordance with the NCACO 

communication plan. 

• Communications between NCA facilities 

o Communicate with each other utilizing non-pandemic communications (for example, quarterly 

conference calls) to ensure continuity of operations. Special communications between NCA 

facilities will be either be directed by NCACO or developed at the local level to ensure the flow 

of critical information as needed. 

• Communications between NCA facilities and stakeholders 

o Communicate according to standard policies at the local level or in accordance with the NCA 

communications plan as appropriate. 

• Communications between VACO and NCA facilities 

3.5 Communication Within and Outside of VA During a Pandemic 
 VA Pandemic Influenza Plan 

March 2006 

Section 3: RESPONDING TO PANDEMIC INFLUENZA 42 

o Ensure that all interested parties, both internal and external to NCA, are informed regarding the 

influenza pandemic. NCACO will assist with providing guidance to NCA facilities and with 

communications from NCA facilities to VACO. 

3.5 Communication Within and Outside of VA During a Pandemic 
 VA Pandemic Influenza Plan 

March 2006 

SECTION 4: RECOVERING FROM PANDEMIC INFLUENZA 

The goal of recovery is to resume normal operations and services. 

VA, VHA, VBA, and NCA actions will include: 

• Remaining vigilant for signs of influenza returning to staff, patients, and the community. 

• Keeping staff alert to the possibility of returning to the pandemic state of operations. 

• Possibly providing antiviral medications to patients and staff to prevent recurrences. 

• Restocking depleted supplies. 

• Returning to usual job functions and scopes of practice. 

• Closing alternative health care sites. 

• Resuming usual standards of care. 

• Resuming seasonal influenza programs for patients and staff. 

• Continuing to promote principles of the “Infection: Don’t Pass It On” campaign with adherence to hand 

washing and respiratory hygiene. 

• Analyzing data from the pandemic and drafting or contributing to “after-action” reports at the facility, 

community, network, state, and Federal levels. 

• Completing work for financial reimbursement through national emergency plans. 

• Assessing, providing counseling, and treating veterans and staff for bereavement issues and posttraumatic stress (VA mental health professionals, readjustment counseling staff, and employee 

assistance). 

• Providing de

influenza in the course of their duties. 

Continuing essential partnerships to fos

ath benefits to surviving family members of staff who died from exposure to pandemic 

• ter recovery. 

chological sequelae 

sponses 

• Preparing debriefing materials and data including: 

o Morbidity and mortality rates 

o Lessons learned, including psy

o Uses and roles of VA in local, state, and national re

o Cooperation between VA and its counterparts at all levels 

Section 4: RECOVERING FROM PANDEMIC INFLUENZA 43 
 VA Pandemic Influenza Plan 

March 2006 

Section 5: ACRONYMS, ABBREVIATIONS, GLOSSARY 44 

SECTION 5: ACRONYMS, ABBREVIATIONS, GLOSSARY 

5.1 LIST OF ACRONYMS AND ABBREVIATIONS 

Acronym Description 

AA Authorized absence 

ADC Average Daily Census 

BAL Bronchoalveolar lavage 

CBOC Community-based outpatient clinics (VA) 

CDC Centers for Disease Control and Prevention 

COOP Continuity of Operations Plan 

CPRS Computerized Patient Record System (VA) 

DHS Department of Homeland Security 

DMAT Disaster Medical Assistance Team 

DoD Department of Defense 

Dom Domiciliary 

EMS Environmental Management Services 

EMSHG Emergency Management Strategic Healthcare Group (VHA) 

ER Emergency room 

FDA Food and Drug Administration 

FEMA Federal Emergency Management Agency 

FMS Federal medical shelter 

FTCA Federal Tort Claims Act 

FTE Full-time employee 

HCAI Health care acquired infection 

HHS Department of Health and Human Services 

HR Human Resources 

HVAC Heating, ventilation, air conditioning 

5.1 LIST OF ACRONYMS AND ABBREVIATIONS 
 VA Pandemic Influenza Plan 

March 2006 

Section 5: ACRONYMS, ABBREVIATIONS, GLOSSARY 45 

Acronym Description 

I:DPIO “Infection: Don’t Pass It On” (VA) 

ICD9-CM International Classification of Diseases, 9th Edition, Clinical Modification 

ICU Intensive care unit 

IHS Indian Health Service 

ILI Influenza-like illness 

IT Information technology 

LRN Laboratory Response Network 

MICU Medical intensive care unit 

MOA Memorandum of Agreement 

MOU Memorandum of Understanding 

MSN Memorial Service Network (VA) 

N95 A type of fit-tested respirator 

NAC National Acquisition Center 

NCA National Cemetery Administration (VA) 

NDMS National Disaster Medical System 

NIH National Institutes of Health 

NRP National Response Plan 

NSAIDS Non-steroidal anti-inflammatory drugs 

OA&MM Office of Acquisition and Materiel Management (VA) 

OQP Office of Quality & Performance (VA) 

OSHA Occupational Safety and Health Administration 

OWCP Office of Workers' Compensation Programs 

PAO Public affairs officer 

PAPR Powered air purifying respirator 

PHSHG Public Health Strategic Health Care Group (VHA) 

5.1 LIST OF ACRONYMS AND ABBREVIATIONS 
 VA Pandemic Influenza Plan 

March 2006 

Section 5: ACRONYMS, ABBREVIATIONS, GLOSSARY 46 

Acronym Description 

PPE Personal protective equipment 

PTSD Post traumatic stress disorder

RSV Respiratory syncytial virus

SCI Spinal cord injury 

SICU Surgical intensive care unit 

SNS Strategic National Stockpile 

TAP Telephone Advice Program (VA) 

VA Department of Veterans Affairs 

VACO VA Central Office 

VAERS Vaccine Adverse Event Reporting System 

VAMC VA medical center 

VANTS VA Nationwide Teleconferencing System 

VARO VA Regional Office (VBA) 

VBA Veterans Benefits Administration (VA) 

VHA Veterans Health Administration (VA) 

VISN Veterans Integrated Service Network (VA) 

VistA Veterans Integrated System Technology Architecture (VA) 

VSO Veterans Service Organization 

WHO World Health Organization 

5.1 LIST OF ACRONYMS AND ABBREVIATIONS 
 VA Pandemic Influenza Plan 

March 2006 

5.2 GLOSSARY OF TERMS 

Term Definition 

Aerosol-generating procedures Procedures that spread fine particles suspended in air, such as airway 

suctioning. 

Air zone diagram The flow and control diagrams for air and the sequence of operation 

for all heating, ventilation and, air-conditioning (HVAC) systems and 

sub-systems. 

Airborne Infection Isolation 

Precautions 

Actions to reduce the risk of airborne transmission of infectious agents 

via airborne droplet nuclei (small particle residue [5 μm or smaller in 

size] of evaporated droplets that may remain suspended in the air for 

long periods of time) or dust particles containing the infectious agent. 

Microorganisms carried in this manner can be dispersed widely by air 

currents and may become inhaled by or deposited on a susceptible 

host within the same room or over a longer distance from the source 

patient, depending on environmental factors; therefore, special air 

handling and ventilation are required to prevent airborne transmission. 

Airborne Precautions apply to patients known or suspected to be 

infected with epidemiologically important pathogens that can be 

transmitted by the airborne route. 

Altered standards of care In an emergency situation, a shift to providing care and allocating 

scarce equipment, supplies, and personnel in a way that saves the 

largest number of lives in contrast to the traditional focus on 

individuals. 

Antiviral Medication used for the prevention or treatment of viral infections 

such as influenza. 

Antiviral prophylaxis Medications given to prevent or minimize the effects of a viral 

infection. 

Area Offices (VBA) Responsible for the oversight, support and management of VBA 

Regional Offices. 

Authorized absence (AA) Term used to describe an approved absence granted to an employee by 

a supervisor without charge to sick or annual leave. 

Avian flu A form of influenza that occurs in birds.

Bronchial washing Technique used to obtain secretions and cells from the trachea and 

large bronchi for microscopic examination or culture. 

Bronchoalveolar lavage (BAL) A procedure to sample secretions containing both cellular and noncellular components from the lower respiratory tract; performed 

during a bronchoscopy. 

Section 5: ACRONYMS, ABBREVIATIONS, GLOSSARY 47 

5.2 GLOSSARY OF TERMS 
 VA Pandemic Influenza Plan 

March 2006 

Section 5: ACRONYMS, ABBREVIATIONS, GLOSSARY 48 

Term Definition 

Bronchoscopy Diagnostic procedure in which a tube with a tiny camera on the end is 

inserted through the nose or mouth into the lungs. The procedure 

provides a view of the airways and allows the collections of secretions 

or tissue specimens. 

Cache See VA Pharmaceutical Cache Program. 

CDC BioSense The current designated central reporting site for human data related to 

intentional and non-intentional epidemic threats to the population. 

VA currently provides transmission twice daily on weekdays and once 

daily on weekends of national data from all outpatient and emergency 

room visits from all medical center reporting sites. Simultaneous with 

the analysis and evaluation at the CDC for national surveillance, for 

added value, the data are made available to state and local health 

departments to improve the local early warning value of information. 

Centers for Disease Control and 

Prevention (CDC) 

One of the 13 major operating components of the Department of 

Health and Human Services (HHS); agency for preventing and 

controlling infectious and chronic diseases, injuries, workplace 

hazards, disabilities, and environmental health threats. 

Consumable supplies Items utilized and requiring routine replacement such as gloves and 

hand hygiene supplies. 

Contact Precautions Applies to certain diseases or conditions spread by direct contact, and 

involves placing the patient in a private room, and using gloves and 

cover gown for contact with the patient or any items/surfaces in the 

patient’s immediate vicinity. 

Continuity of operations plan or 

planning (COOP) 

An internal effort within an organization to assure that the capability 

exists to continue essential business functions across a wide range of 

potential emergencies, including localized acts of nature, accidents, 

and technological and/or attack/terrorist-related emergencies. 

Countermeasures (with 

reference to the preparation for 

or response to pandemic 

influenza) 

Materials and actions used to interrupt the course of an influenza 

pandemic; for example, vaccines and antiviral medications. 

Department of Defense (DoD) Responsible for the management of members of the United States 

Armed Forces, to include the Army, Navy, Air Force, Marines, and 

Coast Guard. 

Department of Veterans Affairs 

(VA) 

A Cabinet-level Department that assists veterans through nationwide 

programs for health care, financial assistance, and burial benefits. VA 

is the second largest of the 15 federal departments. 

5.2 GLOSSARY OF TERMS 
 VA Pandemic Influenza Plan 

March 2006 

Section 5: ACRONYMS, ABBREVIATIONS, GLOSSARY 49 

Term Definition 

Domiciliary or “dom” A VA care facility that provides the least intensive level of inpatient 

care for ambulatory veterans disabled by age or illness who are not in 

need of more acute hospitalization and who do not need the skilled 

nursing services provided in nursing homes. 

Drive-through clinic Concept of providing innovative care where health care providers 

would evaluate and provide treatment to selected patients who remain 

in or close to their motor vehicles. Maybe be used in coordination 

with drive-through triage. 

Drive-through triage A process of assessing patients, while they remain in or close to their 

motor vehicles, and directing them to care, based on their need for or 

likely benefit from immediate medical evaluation or treatment. 

Droplet Precautions Actions to reduce the risk of transmission of infectious agents via 

large-particle droplets (larger than 5 μm in size) generated from the 

infected person primarily during coughing, sneezing, or talking and 

during the performance of certain procedures such as airway 

suctioning and bronchoscopy. 

Durable supplies Items or equipment designed for repeated use such as hospital beds 

and wheelchairs. 

Emergency risk communication A discipline involving communication of risks and benefits related to 

an emergency (either in preparation or response) to individuals, 

organizations, and the community to help them make decisions about 

their well being. 

Facility In VA, a medical center or other care setting (VHA), a benefits office 

(VBA), or a cemetery (NCA). 

Federal health care system Direct providers of health care by agencies of the federal government, 

including the medical systems of VA, Department of Defense, the 

Indian Health Service, and the Bureau of Prisons. 

Federal medical shelter (FMS) A temporary unit that is a scalable, modular, 250- or more bed 

deployable facility configured to allow basic but essential medical 

care. 

ICD9–CM The International Classification of Diseases, 9th Revision, Clinical 

Modification. A coding system that allows international comparability 

in the collection, classification, processing, and presentation of health 

data. In the US, ICD9-CM is the system used for medical billing 

purposes. 

Incubation period The period between the infection of an individual by a pathogen and 

the manifestation of the disease it causes. 

5.2 GLOSSARY OF TERMS 
 VA Pandemic Influenza Plan 

March 2006 

Section 5: ACRONYMS, ABBREVIATIONS, GLOSSARY 50 

Term Definition 

Infection: Don’t Pass It On 

(I:DPIO) 

A VA national public health initiative launched in the VA health 

system in fall 2004. This ongoing educational campaign focuses on 

decreasing transmission of infection through hand and respiratory 

hygiene, seasonal influenza vaccinations, and preparedness for 

infectious disease emergencies, including pandemic influenza. The 

goal of the campaign is to involve staff, patients, and visitors in taking 

basic steps to prevent infection, whether occurring daily, seasonally, 

or occurring during infectious disease emergencies (natural or 

manmade). 

Influenza An acute highly contagious disease characterized by sudden onset of 

fever, severe aches and pains, dry cough, and progressive 

inflammation of the respiratory mucous membranes caused by an 

influenza virus. 

Influenza-like illness A clinical definition of influenza used in research and surveillance. 

Typically includes symptoms of upper respiratory infection or 

‘common cold’ with fever or having fever of 100 degrees F lasting at 

least one day along with a cough or sore throat. 

Information technology (IT) The development, installation, implementation and maintenance of 

computer systems and applications. 

Isolation Separation of infected individuals from those who are not infected.

Laboratory Response Network 

(LRN) 

An integrated network of state and local public health, federal, 

military, and international laboratories that can respond to 

bioterrorism, chemical terrorism and other public health emergencies. 

Mask A type of personal protective equipment used in health care to protect 

the wearer from inhaling or respiring droplets of infectious body 

fluids. Surgical masks cover the nose and the mouth of the person 

wearing them and have high air filtration capability, although not as 

high as N95, N99, or N100. Procedure masks usually have less 

filtration. (Full face shields that offer protection for the whole face 

may be used in certain circumstances in addition to a mask.) See term 

Respirator for devices providing more protection. 

Memorandum of Understanding 

(MOU)/ Memorandum of 

Agreement (MOA) 

A written statement outlining the terms of an agreement between two 

or more entities. 

Mode of transmission Mechanism by which an infectious agent is spread through the 

environment or to another person. 

5.2 GLOSSARY OF TERMS 
 VA Pandemic Influenza Plan 

March 2006 

Section 5: ACRONYMS, ABBREVIATIONS, GLOSSARY 51 

Term Definition 

Modular medical stations Temporary units such as Federal medical stations (FMSs), which are 

scalable, modular, 250-bed deployable facilities that are configured to 

allow basic but essential medical care. 

My HealtheVet A VA Web site that provides access to health information, links to 

Federal and VA benefits and resources, the Personal Health Journal, 

and more. 

Nasopharyngeal washing A technique used to obtain secretions and cells from the nose and 

pharynx for microscopic examination or culture. 

National Acquisition Center 

(NAC) 

The largest combined contracting activity within the Department of 

Veterans Affairs, NAC falls under the VA’s Office of Acquisition and 

Materiel Management (OA&MM). It is responsible for supporting 

the health care requirements of VA as well as the needs of other 

Government agencies. The NAC solicits, awards, and administers 

VA's Federal Supply Schedule and National Contract Programs 

including the acquisition and direct delivery of pharmaceuticals, 

medical/surgical/dental supplies, high technology medical equipment 

and just-in-time distribution programs (also known as Prime Vendor 

Distribution Programs). 

National Cemetery 

Administration (NCA) 

The VA administration that provides burial space and interment 

services for veterans and their eligible family members, maintains 

national cemeteries and provides headstones or markers for graves. 

National Disaster Medical 

System (NDMS) 

A federally coordinated initiative that augments the Nation's 

emergency medical response capability. The four federal partners in 

NDMS are Department of Health and Human Services (Public Health 

Service), Federal Emergency Management Agency (FEMA), 

Department of Defense, and Department of Veterans Affairs. The 

overall purpose of NDMS is to establish a single national medical 

response capability for assisting state and local authorities in dealing 

with the medical and public health effects of major peacetime 

disasters and to provide support to the military medical system in 

caring for casualties resulting from overseas armed conflicts. 

National Institutes of Health 

(NIH) 

The primary Federal agency for conducting and supporting medical 

research; a component of the U.S. Department of Health and Human 

Services.

National Response Plan (NRP) An all-hazards approach to enhance the ability of the United States to 

manage domestic incidents. It forms the basis of how the federal 

government coordinates with state, local, and tribal governments and 

the private sector during incidents. 

5.2 GLOSSARY OF TERMS 
 VA Pandemic Influenza Plan 

March 2006 

Section 5: ACRONYMS, ABBREVIATIONS, GLOSSARY 52 

Term Definition 

National Threat Level Responses A five-level system that prompts the implementation of an appropriate 

set of protective measures. Protective measures are the specific steps 

an organization shall take to reduce its vulnerability or increase its 

ability to respond during a period of heightened alert. The authority to 

craft and implement Protective Measures rests with the Federal 

departments and agencies. It is recognized that departments and 

agencies may have several preplanned sets of responses to a particular 

Threat Condition to facilitate a rapid, appropriate, and tailored 

response. Department and agency heads are responsible for 

developing their own Protective Measures and other antiterrorism or 

self-protection and continuity plans, and resourcing, rehearsing, 

documenting, and maintaining these plans. 

Negative airflow area A room with air at negative pressure to its environment, and, where air 

is exhausted to the outdoors or through high-efficiency filtration. 

Oseltamivir An antiviral medication, also known as Tamiflu®, used for the 

prevention and treatment of influenza. 

Pandemic influenza Worldwide epidemic that occurs when a new or novel influenza strain 

emerges for which humans have little or no immunity. The spread can 

be rapid and have severe consequences of illness, death and societal 

disruption.

Pathogenicity The capacity of a microorganism (e.g., bacteria, viruses, or parasites) 

to cause disease in humans, animals, or plants. 

Personal protective equipment 

(PPE) 

Specialized clothing and equipment, such as goggles, gloves, gowns, 

and masks or respirators, designed to protect people against infectious 

diseases or other health hazards. 

Pneumonia Inflammation of the lungs characterized by fever, chills, muscle aches, 

chest pain, cough, shortness of breath, rapid heart rate and difficulty 

breathing. 

Post traumatic stress disorder 

(PTSD) 

An anxiety disorder resulting from direct personal exposure to a 

situation that involves actual or threatened death or serious injury. 

Post-exposure prophylaxis Providing medications to prevent or minimize an infectious disease 

after exposure. 

Probenicid A medication used primarily to treat chronic gout and gouty arthritis. 

It is also used to increase blood levels of some medications by 

preventing the body from passing them in the urine. 

Public affairs officer (PAO) A professional who plans and implements communications strategies 

concerning an organization’s programs, policies, and initiatives within 

and outside of the organization. 

5.2 GLOSSARY OF TERMS 
 VA Pandemic Influenza Plan 

March 2006 

Section 5: ACRONYMS, ABBREVIATIONS, GLOSSARY 53 

Term Definition 

Public health measures Actions to prevent or limit the spread of disease in a population such 

as use of vaccines or hand hygiene techniques. 

Quarantine Separation of individuals who have been exposed to a transmissible 

infection, but are not yet ill, from others who have not been exposed. 

Regional Office (VBA) Field office composed of divisions that carry out the functions of 

VBA. Fifty-seven such offices currently exist, with at least one office 

in every state. 

Respirator A piece of personal protective equipment that covers the nose and 

mouth and filters the air to protect the person from airborne 

transmission of microorganisms. Sometimes referred to as a mask, 

but the term respirator is the preferred term. Types of respirators 

include N95s, which should be fit tested for highest protection and 

which can be disposable, elastomeric respirators, in which the filter 

is attached to a separate face piece made of rubber, silicone, neoprene, 

etc., and positive air purifying respirators (PAPRs), full headcovering, battery-powered units that have HEPA filters purifying air 

coming into the hood; the air is expelled at the edge and through the 

bottom holes of the face seal. 

Seasonal influenza an acute contagious disease characterized by sudden onset fever, 

severe aches and pains, and progressive inflammation of the 

respiratory mucous membranes caused by an influenza virus 

circulating in humans, usually in winter, and against which vaccines 

are developed annually; can cause significant illness and, in some 

cases, death. 

Self -triage algorithm A document that provides guided, step-by-step problem-solving 

procedures for individuals to determine their own need for medical 

care. 

Snow day A public health measure involving closure or cancellation of public 

gatherings (or granting absence from the work place) in order to 

prevent transmission of infection. 

Social distancing A public health measure to reduce the frequency of contact between 

people in order to limit the transmission of infection. 

Stakeholder An organization or individual who has a vested interest in the 

activities of an organization. 

5.2 GLOSSARY OF TERMS 
 VA Pandemic Influenza Plan 

March 2006 

Section 5: ACRONYMS, ABBREVIATIONS, GLOSSARY 54 

Term Definition 

Standard Precautions Precautions that apply to all patients receiving care in hospitals, 

regardless of their diagnosis or presumed infection status. Standard 

Precautions involves the use of appropriate PPE (gloves) and hand 

hygiene when coming in contact with any patient’s 1) blood; 2) all 

body fluids, secretions, and excretions except sweat, regardless of 

whether or not they contain visible blood; 3) nonintact skin; and 4) 

mucous membranes. Standard Precautions are designed to reduce the 

risk of transmission of microorganisms from both recognized and 

unrecognized sources of infection in hospitals. 

Surveillance (public health 

surveillance)

The ongoing, systematic collection, analysis, and interpretation of 

health data. This activity also involves timely dissemination of the 

data and use for public health programs. 

Tamiflu® An antiviral medication, whose generic name is oseltamivir, used for 

the prevention and treatment of influenza. 

Telecommuting The process of working from home or alternative site through 

telecommunications, usually using computer access. 

Telehealth The use of communications and information technology by health care 

providers to deliver health and health care services. 

Telephone Advice Program 

(TAP) 

VA's program monitored with a representative who is "on the line" 24 

hours a day, 7 days a week to assist with medical, pharmacy, 

eligibility, and billing questions by telephone. 

Triage A process of separating patients based on their need for or likely 

benefit from immediate medical evaluation or treatment; used in 

hospital emergency rooms, on battlefields, and at disaster sites when 

limited medical resources must be allocated. 

VA Central Office (VACO) The recognized national headquarters of VA, located in Washington, 

DC, housing leadership personnel and offices, including those of 

VHA, VBA and NCA. 

VA medical center (VAMC) A VA health care facility that may include inpatient and outpatient 

units, and residential units. 

VA Nationwide Teleconferencing 

System (VANTS) 

The primary audio teleconferencing system for VA employees. 

VA Pharmaceutical Cache 

Program 

Stockpiles of pharmaceutical supplies that are maintained and readied 

for deployment, usually during an emergency event. 

VA Regional Office (VARO) a relatively large VA office that generally includes a Veterans Service 

Center, Director's Office, Vocational Rehabilitation and Counseling 

Division, and Support Services Division. 

5.2 GLOSSARY OF TERMS 
 VA Pandemic Influenza Plan 

March 2006 

Section 5: ACRONYMS, ABBREVIATIONS, GLOSSARY 55 

Term Definition 

VA Regional Office and 

Insurance Center (VAROIC) 

An office located in Philadelphia that includes the Director's Office, 

the Veterans Service Center, Vocational Rehabilitation and 

Counseling Division, and Support Services Division. 

Vet Centers Common term for VA’s Readjustment Counseling Centers Program. 

Vet Centers assist veterans and their family members toward a 

successful post-war adjustment in or near their communities; provide 

professional readjustment counseling, community education, outreach 

to special populations, the brokering of services with community 

agencies; and link veterans to other services within VA. 

Veteran (military) A person who has served in the armed forces. 

Veterans Benefits 

Administration (VBA) 

The VA administration that provides financial assistance to millions 

of veterans and their families through compensation and pension 

programs, funding for education and training, home loan assistance, 

life insurance and vocational rehabilitation and employment. 

Veterans Health Administration 

(VHA) 

The VA administration that serves the health care needs of veterans by 

providing primary care, specialized care, and related medical and 

social support services through 21 Veterans Integrated Service 

Networks (VISNs), consisting of hospitals and other facilities such as 

community-based clinics, nursing homes, residential rehabilitation 

programs, and readjustment counseling centers (Vet Centers). 

Veterans Health Information 

Systems & Technology 

Architecture (VistA) 

Veterans Health Information Systems and Technology Architecture, 

VistA, is an integrated system of software applications that directly 

supports patient care within the VHA health care facilities. It 

connects VHA facilities' workstations and personal computers with 

nationally mandated, locally adapted software applications that are 

accessed by end users through a graphical user interface known as the 

Computerized Patient Record System (CPRS). 

Veterans Integrated Service 

Network (VISNs) 

Geographic clusters of VA health facilities; 21 VISNs coordinate and 

support care in a total of over 1300 such facilities throughout the 

Nation. 

Veterans Service Organization 

(VSO) 

An organization dedicated to advocating veterans' causes and 

interests, and assisting veterans in their interactions with VA. 

Examples include the Disabled American Veterans (DAV), American 

Legion (AL), the Veterans of Foreign Wars (VFW), and many others. 

Virulence The ability of any agent of infection to produce disease. The virulence 

of a microorganism (such as a bacterium or virus) is a measure of the 

severity of the disease it is capable of causing. The adjective virulent

implies extremely noxious, damaging, deleterious, disease-causing 

(pathogenic). 

5.2 GLOSSARY OF TERMS 
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group A: VA Background 

Appendix A-1: DIAGRAM OF VA ORGANIZATION 

Under Secretary 

for Benefits/ 

VBA Central 

Office

4 Area Offices 

57 Regional Offices 

5 Memorial 

Service 

Networks 

Under Secretary 

for Health/ 

VHA Central 

Office 

Secretary of Veterans Affairs/ 

VA Central Office

150+ medical centers 

Under Secretary 

for Memorial 

Affairs/NCA 

Central Office 

21 Veterans Integrated 

Service Networks 

(VISNs) 

120+ Cemeteries 

200+ readjustment counseling 

(vet) centers 

40+ residential rehabilitation 

programs 

130+ nursing homes 

800+ ambulatory care and 

community-based clinics 

Appendix Group A:VA Background 56 

Appendix A-1: DIAGRAM OF VA ORGANIZATION
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group A: VA Background 57 

Appendix A-2: MAPS RELATED TO THE THREE ADMINISTRATIONS OF THE 

DEPARTMENT OF VETERANS AFFAIRS (VA) 

Veterans Integrated Service Networks (VISNs) of the 

Veterans Health Administration (VHA) 

VHA runs more than 1,300 sites of care across the country and in each state, as well as the Philippines, 

Guam, and Puerto Rico. These sites are organized into 21 Veterans Integrated Service Networks:

VISN 1: VA New England Healthcare System 

VISN 2: VA Healthcare Network Upstate New 

York 

VISN 3: VA NY/NJ Veterans Healthcare 

Network 

VISN 4: VA Stars & Stripes Healthcare Network 

VISN 5: VA Capitol Health Care Network 

VISN 6: VA Mid-Atlantic Health Care Network 

VISN 7: VA Southeast Network 

VISN 8: VA Sunshine Healthcare Network 

VISN 9: VA Mid South Healthcare Network 

VISN 10: VA Healthcare System of Ohio 

VISN 11: Veterans In Partnership 

VISN 12: The Great Lakes Health Care System 

VISN 15: VA Heartland Network 

VISN 16: South Central VA Health Care 

Network 

VISN 17: VA Heart of Texas Health Care 

Network 

VISN 18: VA Southwest Health Care Network 

VISN 19: Rocky Mountain Network 

VISN 20: Northwest Network 

VISN 21: Sierra Pacific Network 

VISN 22: Desert Pacific Healthcare Network 

VISN 23: VA Midwest Health Care Network 

(VISNs 13 and 14 were combined into VISN 23 

for a total of 21 VISNs) 

Appendix A-2: MAPS RELATED TO THE THREE ADMINISTRATIONS OF THE DEPARTMENT OF VETERANS 

AFFAIRS (VA)
 VA Pandemic Influenza Plan 

March 2006 

Area Offices of the Veterans Benefits Administration (VBA) 

VBA operates through four Area Offices and 57 Regional Offices, with at least one in every state. VBA 

staff members are also located in the Philippines, Guam, Italy, Germany, Japan, and South Korea. The 

Western, Central, Eastern, and Southern Area Offices cover the shaded areas above. 

Appendix Group A:VA Background 58 

Appendix A-2: MAPS RELATED TO THE THREE ADMINISTRATIONS OF THE DEPARTMENT OF VETERANS 

AFFAIRS (VA)
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group A: VA Background 59 

Memorial Service Networks (MSNs) of the National Cemetery Administration (NCA) 

NCA maintains about 120 national cemeteries in 39 states and Puerto Rico. NCA has five Memorial 

Service Networks (shaded areas) and NCA Central Office. The MSNs covered the shaded areas above 

and are I: Philadelphia Memorial Service Network, II: Atlanta Memorial Service Network, III: Denver 

Memorial Service Network, IV: Indianapolis Memorial Service Network, and V: Oakland Memorial 

Service Network. 

. 

Appendix A-2: MAPS RELATED TO THE THREE ADMINISTRATIONS OF THE DEPARTMENT OF VETERANS 

AFFAIRS (VA)
 VA Pandemic Influenza Plan 

March 2006 

Appendix A-3: FACTS ABOUT VA HEALTH CARE CAPABILITIES 

Inpatient Capacity: Operating Beds in VA facilities 

VHA’s “operating” or usable beds are those that are staffed and available for admission of patients. The 

table below shows VHA’s average operating beds and occupancy rates for its formal bed services as of 

the end of FY 05. Overall, occupancy rates for inpatient beds (includes medicine, neurology, 

rehabilitation medicine, blind rehab, spinal cord injury, intermediate medicine, surgery and psychiatry) 

was 67% in FY 05. 

VHA Inpatient Bed Occupancy Rates As of End of FY 05 

Bed Service 

Average 

Usable Beds 

Average Daily 

Census(ADC) Occupancy Rate 

Medicine 7,100.70 5,298.85 74.62% 

Neurology 218.9 95.65 43.69% 

Rehab Med. 392 212.05 54.09% 

Blind Rehab 242 195.79 80.90% 

Spinal Cord 1,084.00 740.1 68.28% 

Intermediate 

Med. 1,121.50 476.21 42.46% 

Surgery 2,976.70 2,020.80 67.89% 

Psychiatry 7,218.30 4,558.69 63.15% 

TOTAL 

INPATIENT 20,354.10 13,598.14 66.81% 

Long-term Care Facilities 

Bed Occupancy Rates As of End of FY 05 

Bed 

Service 

Average 

Operating 

Beds 

Average Daily 

Census(ADC) Occupancy Rate 

VA Dom 6,267.30 4,836.32 77.17% 

VA Nurs 

Home 15,109.10 11,957.52 79.14% 

Appendix Group A:VA Background 60 

Appendix A-3: FACTS ABOUT VA HEALTH CARE CAPABILITIES
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group A: VA Background 61 

A 2004 survey of Intensive Care Unit (ICU) beds revealed that VHA has approximately 213 ICUs and a 

total of 2,042 authorized and 1906 operating ICU beds. This survey also estimates that in addition to the 

authorized 2,045 ICU beds, an additional 353 ICU beds could be made available in case of local and/or 

national emergency. 

The table below shows the distribution of the types of authorized and operating ICU beds. 

FY 2004 Operating ICU Beds 

ICU Type 

Authorized ICU 

Beds Operating ICU beds 

MICU 248 244 

SICU 553 518 

CCU 168 165 

MICU/CCU 362 316 

MICU/SICU 275 258 

Mixed 388 358 

Specialty 51 47 

Total 2045 1906 

Outpatient Capacity: Community-Based Outpatient Clinics 

As of the end of FY 05, VHA had 712 community based outpatient clinic (CBOC) sites of care (this 

includes multiple site contracts). In general, CBOCs are structured and managed through primary care 

panels. Staffing may vary depending on the size of the CBOC and types of specialty services offered. 

Typically, the types of staff anticipated include: physicians (primary care and mental health physician), 

nurses (APNs, RNs, and LPNs/LVNs), physician assistants, health technicians, and administrative staff. 

In FY 05, CBOCs had 11.2 million patient visits that accounted for 23% of VHA’s total ambulatory care 

visits. In FY 05, approximately half of the veterans served by VHA received their care at CBOCs (2.5 

million unique patients seen at CBOCs). CBOCs are access points for our high priority veterans that live 

fair distances from other VHA health care sites. 

Appendix A-3: FACTS ABOUT VA HEALTH CARE CAPABILITIES
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group A: VA Background 62 

Definitions 

Term Definition 

Average Daily Census Number of beds that are filled or utilized within a defined period of 

time. 

Average Operating Beds Number of beds that can be utilized within a defined period of time. 

CCU: Cardiac Care Unit An identified unit for the care of patients who have suffered acute 

myocardial infarction (MI) or are experiencing heart related problems. 

MICU: Medical Intensive Care 

Unit 

An identified unit for the care of patients with medical conditions or 

emergencies. 

Mixed Unit ICU An identified multi-purpose unit for the care of patients requiring a 

combination of specialized intensive care services. (Combinations 

include Medical/Surgical/Cardiac, Surgical/Burn, etc.) 

Occupancy Rate The percentage of beds utilized within a defined time period. 

Other ICU Unit Types An identified unit for the specialized care of patients with certain 

diagnoses/classifications/procedures such as Burn ICU; Transplant 

ICU; Neurology ICU; Neuro-Surgery ICU; Cardio-Thoracic ICU; 

Respiratory ICU. 

SICU: Surgical Intensive Care 

Unit 

An identified unit for the care of surgical patients (pre-operative, postoperative, and other non-operative patients such as trauma). 

Appendix A-3: FACTS ABOUT VA HEALTH CARE CAPABILITIES
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group B:Legal Authorities and Responsibilities 63 

Appendix Group B: Legal Authorities and Responsibilities 

Appendix B-1: SUMMARY OF POTENTIAL VA EXPANDED RESPONSIBILITIES 

The primary function of VHA is to provide a complete medical and hospital service for the medical are 

and treatment of eligible veterans. Various provisions in title 38, United States Code, authorize VHA to 

provide care to others, such as family members of veterans under CHAMPVA (the Civilian Health and 

Medical Program of the Department of Veterans Affairs). VHA also has authority to enter into 

agreements to share health-care resources. 

Special circumstances that expand VA responsibilities: 

VA Resource Sharing

• VHA has general authority to share health-care resources with any health care provider or entity 

according to local determination of needs through pre-established sharing agreements. Resources can 

also be provided in accordance with the National Response Plan. The National Response Plan may be 

implemented during a disaster or emergency declared by the President, during other Incidents of 

National Significance, or during a public health emergency declared by the Secretary of the Department 

of Health and Human Services. When the National Response is implemented, VA may be asked to 

provide resources through a Mission Assignment or sub-tasking (either with or without reimbursement) 

or through a request for Federal-to-Federal assistance. Information on Mission Assignments, subtaskings, and Federal-to Federal support is detailed in the Financial Management Support Annex of the 

National Response Plan. (See Appendix B-2: TABLE OF LEGAL AUTHORITIES AND POLICIES 

RELEVANT TO EMERGENCIES - Advice on Changes in Usual VA Practices During a Pandemic and 

Appendix C-1: REFERENCE LIST FOR VA EMERGENCY PLANS AND OTHER RESOURCES.) 

Back Up to the Department Of Defense Medical System

• Under 38 USC § 8111A, VA serves as a back up for the Department of Defense health care system to 

care for active duty service members during war or a national emergency (see Appendix B-2: TABLE 

OF LEGAL AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes 

in Usual VA Practices During a Pandemic). 

Care Provision to Non-Enrolled or Non-Veterans

• As stated above, VA may provide care for non-veterans or non-enrolled veterans through a Mission 

Assignment or sub-tasking, or through a request for Federal-to-Federal assistance, as described in the 

National Response Plan. Hospital care or medical services may also be provided as a humanitarian 

service in emergency cases (38 USC § 1784). The Secretary is obligated to charge for services provided 

under Section 1784. (See Appendix B-2: TABLE OF LEGAL AUTHORITIES AND POLICIES 

RELEVANT TO EMERGENCIES - Advice on Changes in Usual VA Practices During a Pandemic.) 

VA National Response Plan Responsibilities

• VA has expanded responsibilities under the Federal government’s National Response Plan in terms of 

certain Emergency Support Functions (ESFs). An ESF is a response activity established to facilitate 

coordinated Federal delivery of assistance required during the response phase of a catastrophic event 

to save lives, protect property and health, and maintain public safety. These functions represent those 

types of Federal assistance which States, local governments, or tribal authorities will likely need most 

because of the overwhelming impact of a catastrophic event on local and State resources. 

• VA is responsible for providing support under the following Emergency Support Functions: 

o ESF #3 Public Works and Engineering 

o ESF #5 Emergency Management 
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group B:Legal Authorities and Responsibilities 64 

o ESF #6 Mass Care, Housing, and Human Services 

edical Services 

Unless otherwise directed by the Secretary, under the National Response Plan VA provides available 

ral 

roup 

o ESF #7 Resource Support 

o ESF #8 Public Health and M

o ESF #13 Public Safety and Security 

o ESF #15 External Affairs 

•

resources as requested either directly by the Federal Emergency Management Agency (FEMA) or 

through the respective ESF lead agency (for example, HHS is the lead agency for ESF #8). These 

requests, or “sub-tasking,” are provided to the VA Readiness Operations Center (ROC) in VA Cent

Office which, in turn, directs them to the applicable administration or staff office for action. For 

VHA, the VA ROC will forward them the VHA Emergency Management Strategic Healthcare G

(EMSHG) Operations Center. (A table of laws and authorities that apply to VA’s responsibilities in a 

pandemic appear in Appendix B-2: TABLE OF LEGAL AUTHORITIES AND POLICIES 

RELEVANT TO EMERGENCIES - Advice on Changes in Usual VA Practices During a Pandemic.) 
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group B:Legal Authorities and Responsibilities 65 

Appendix B-2: TABLE OF LEGAL AUTHORITIES AND POLICIES RELEVANT TO 

EMERGENCIES - Advice on Changes in Usual VA Practices During a Pandemic 

Table of Legal Authorities Relevant to Emergencies 

Issue Authority Discussion 

I. VA Authority to Provide Hospital Care and Medical Services 

A. Care to veterans 38 U.S.C. Chapters 17 and 73; 38 

C.F.R. §§ 17.36 – 17.38 

The primary function of the 

Veterans Health Administration 

is to provide a complete medical 

and hospital service for the 

medical care and treatment of 

veterans. Enrollment priorities 

are set by Congress. 

B. Care to members of the 

armed forces 

38 U.S.C. §§ 8111, 8111A; 38 

C.F.R. § 17.230; VHA Directive 

2005-045, Treatment of Active 

Duty Service Members in VA 

Health Care Facilities (October 4, 

2005); VHA Handbook 1660.4, 

VA-DOD Health Care Resources 

Sharing 

The Secretary is authorized to 

share health care resources with 

DOD, and to provide care to 

members of the Armed Forces 

during a time of war or national 

emergency. 

C. Care to non-VA beneficiaries 38 U.S.C. § 1784; 38 C.F.R. §§ 

17.37, 17.43, 17.95, 17.102 

The Secretary is authorized to 

furnish hospital care or medical 

services as a humanitarian 

service to non-VA beneficiaries 

in emergency cases. VA must 

charge for such care. 

D. Care to non-VA beneficiaries 

in a disaster or emergency 38 U.S.C. § 1785 

(i) The Secretary is authorized to 

provide hospital care and medical 

services to non-VA beneficiaries 

responding to, involved in, or 

otherwise affected by a disaster 

or emergency. Section 1785 

codifies VA’s existing 

obligations under the National 

Response Plan, including VA’s 

obligations under the Stafford 

Disaster Relief and Emergency 

Assistance Act (42 U.S.C. 

§§ 5121, et seq.), and during 

activation of the National 

Disaster Medical System (42 

U.S.C. § 300hh-11). Regulations 

Appendix B-2: TABLE OF LEGAL AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes 

in Usual VA Practices During a Pandemic 
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group B:Legal Authorities and Responsibilities 66 

Issue Authority Discussion 

to implement this authority are 

currently under development. 

(ii) In a disaster or emergency 

declared by the President under 

the Stafford Act, VA can be 

directed to utilize its authorities 

and resources (including 

personnel, equipment, supplies, 

facilities, and managerial, 

technical, and advisory services) 

in support of State and local 

assistance efforts. This is 

generally done through the 

auspices of the National 

Response Plan through a Stafford 

Act tasking or sub-tasking. The 

Financial Management Support 

Annex of the National Response 

Plan details this process. 

(iii) During non-Stafford Act 

Incidents of National 

Significance, the Financial 

Management Support Annex of 

the National Response Plan 

describes a process for 

signatories of the NRP to provide 

needed support to one another on 

a reimbursable basis. The 

Memorandum of Agreement 

detailing this process is set forth 

in the Financial Management 

Support Annex. The general 

authority for providing this 

assistance is the Economy Act 

(31 U.S.C. § 1535). 

E. VA’s general authority to 

share health care resources 

38 U.S.C. § 8153; VHA 

Directive 1660.1, Enhanced 

Health Care Resources Sharing 

Authority - Selling 

II. Priorities for Providing Medical Care 

Considerations for prioritization 

of VA health care 

A. The explicit language in 38 

U.S.C. § 8111A and the 

legislative history of 38 U.S.C. § 

1785 indicate that during 

When faced with individuals who 

require emergency medical 

treatment (for example, during a 

disaster or emergency situation), 

Appendix B-2: TABLE OF LEGAL AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes 

in Usual VA Practices During a Pandemic 
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group B:Legal Authorities and Responsibilities 67 

Issue Authority Discussion 

declared major disasters and 

emergencies and activation of 

NDMS, the highest priority for 

receiving VA care and services 

goes to service-connected 

veterans, followed by members 

of the armed forces receiving 

care under section 8111A and 

then by individuals affected by a 

disaster or emergency described 

in section 1785 (i.e., individuals 

requiring care during a declared 

disaster or emergency, or during 

activation of the NDMS). 

VHA practitioners generally 

prioritize based on medical need. 

Life-threatening conditions are 

treated prior to less severe or 

routine conditions. This may 

require deferring routine or 

elective care for higher priority 

veterans in order to treat medical 

emergencies. This prioritization 

based on medical need is not 

dictated by a specific statute or 

regulation. Rather, it is derived 

from the general authority 

granted to the Secretary (and 

through delegation to the Under 

Secretary for Health and to health 

care providers) to provide 

“needed care” to veterans. Thus, 

during a disaster or an 

emergency, VA has flexibility 

and discretion in determining 

what constitutes needed care. 

III. Quarantine and Isolation 

A. State law 

A. The authority to compel 

quarantine or isolation is derived 

from a state’s inherent “police 

power,” a power reserved to the 

states under the 10th Amendment 

of the United States Constitution. 

There is significant variation 

among states regarding isolation 

and quarantine laws. Some states 

have laws that include specific, 

detailed procedures and 

provisions to impose and enforce 

mandatory isolation and 

quarantine, while other states 

have broader, more outdated laws 

and regulations. Further, some 

localities within states have laws 

applicable to quarantine and 

isolation. 

If a VHA practitioner seeks to 

isolate or quarantine a VA 

patient, the authority to 

involuntarily isolate or 

quarantine an individual will 

likely be determined, at least 

initially, by state law. Regional 

Counsel must be contacted for 

guidance on applicable state law. 

B. Federal Law 

B. The Secretary of the 

Department of Health and 

Human Services (HHS) has 

statutory authority to prevent the 

introduction, transmission, or 

The Federal government’s 

authority to act under this statute 

is limited to communicable 

diseases identified by the 

President. The current list of 

Appendix B-2: TABLE OF LEGAL AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes 

in Usual VA Practices During a Pandemic 
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group B:Legal Authorities and Responsibilities 68 

Issue Authority Discussion 

spread of communicable diseases 

from foreign countries into the 

United States, or from one state 

or possession into another. CDC 

may intervene in intrastate 

incidents if requested by state or 

if local control efforts considered 

inadequate. 42 U.S.C. § 264; 42 

C.F.R. Part 70, Interstate 

Quarantine and Part 71, Foreign 

Quarantine. 

communicable diseases includes 

Cholera; Diphtheria; Infectious 

Tuberculosis; Plague; Smallpox; 

Yellow Fever; Viral 

Hemorrhagic Fevers; and Severe 

Acute Respiratory Syndrome 

(SARS), and “Influenza caused 

by novel or reemergent influenza 

viruses that are causing, or have 

the potential to cause, a 

pandemic." (Pandemic influenza 

was added in April 2005. See 

Executive Order 13375 (April 1, 

2005)). 

C. 42 U.S.C. § 266. 

Special quarantine powers are 

available to the Surgeon General 

in a time of war. The Surgeon 

General may apprehend, 

examine, and detain individuals 

reasonably believed infected with 

communicable disease if they 

present a probable risk of 

infection to the armed forces or 

its suppliers. 

IV. Liability Issues 

Liability in general 

A. VA personnel acting within 

the course and scope of their 

Federal employment are 

generally protected from personal 

liability under the Federal Tort 

Claims Act (FTCA). A 

determination of whether a 

person’s actions were within the 

scope of employment would be 

made by the Department of 

Justice in the event of legal 

action involving the employee’s 

acts.” 28 U.S.C. §§ 1346(b), 

2670 – 2680; 38 U.S.C. § 7316. 

Liability in declared (Stafford 

Act) emergencies 

B. The Stafford Act includes an 

explicit “nonliability” provision. 

42 U.S.C. § 5148; 44 C.F.R. § 

206.9, that protects the Federal 

Government from liability for 

discretionary acts performed by 

Appendix B-2: TABLE OF LEGAL AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes 

in Usual VA Practices During a Pandemic 
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group B:Legal Authorities and Responsibilities 69 

Issue Authority Discussion 

Federal agencies and employees 

in carrying out their duties. 

V. Transportation of Employees During an Emergency 

Home-to-work transportation of 

employees 

A. Federal law generally 

prohibits home-to-work 

transportation of most 

employees, but authorizes 

agencies to approve such 

transportation in an emergency 

situation. 31 U.S.C. § 1344; 41 

C.F.R. Part 102.5 

(i) The authority to make this 

determination rests with the 

agency head and cannot be 

delegated. The requirement for 

an advance determination can be 

excepted if it is impracticable. 

(ii) If a VA medical center faces 

an emergency requiring 

transportation of personnel in 

order to keep the hospital up and 

running, VA could craft a 

compelling argument that it was 

impractical to obtain the 

necessary permission in 

advance. However, the facility 

must maintain logs of the 

transportation provided, and the 

Secretary’s decision to authorize 

the transportation must be 

submitted to Congress, as 

required by the regulations. 

B. The Secretary has emergency 

authority under title 38, United 

States Code, to use Governmentowned or leased vehicles to 

transport VA employees to and 

from their place of employment 

and the nearest public 

transportation or, if public 

transportation is unavailable or 

not feasible, to and from work to 

home. 38 U.S.C. § 703(f) 

(i) The statute requires the 

Secretary to establish “reasonable 

rates” to cover the cost of such 

services. If VHA wants to utilize 

this emergency authority, VA 

must establish rates to cover the 

cost of such services. 

(ii) To expedite the use of this 

authority, VHA can seek a 

delegation to the Under Secretary 

for Health. 

Appendix B-2: TABLE OF LEGAL AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes 

in Usual VA Practices During a Pandemic 
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group B:Legal Authorities and Responsibilities 70 

Table of Policies Relevant to Emergencies 

Relevant Policy Reference Discussion 

I. Credentialing and Privileging Health Care Providers 

VHA Handbook 1100.19, 

Credentialing and Privileging; 

VHA Directive 2001-022, 

Implementation of VETPRO, 

VHA’s National Credentials 

Databank; 

VHA Directive 2001-005, 

Credentialing and Privileging of 

Telemedicine and Telehealth 

Services provided in Hospitals 

and Clinics 

VHA Directive 2002-042, The 

Credentialing and Privileging of 

VA Health Care Providers 

Remotely Delivering Health Care 

to Patients at Home, in Vet 

Centers, and in Non-Health Care 

Settings Via Telemedicine and/or 

Telehealth 

VHA Directive 2002-076, 

Expedited Medical Staff 

Appointment Process 

Credentialing and privileging 

actions that might be changed in 

a pandemic are described in 

Section 3.2.3.6 

II. VA Provision of Disaster Emergency Medical Personnel 

VHA Directive 2003-052, 

Disaster Emergency Medical 

Personnel System (DEMPS) 

Program and Database 

Database of VHA medical 

personnel who have volunteered 

to be deployed in the event of a 

disaster internal or external to 

VA. 

III. Occupational Health Issues 

Absence for employees affected 

by a pandemic, such as those 

exposed to an infectious disease 

Family Medical Leave Act; 

Authorized Absence in 

emergencies, see VA Handbook 

5011/3 Part II, Chapter 3 (March 

2005); 

Facilities should work with their 

Human Resources staff to 

identify applicable policies 

addressing employee absences. 

VA is authorized to grant 

employees “authorized absence” 

Appendix B-2: TABLE OF LEGAL AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes 

in Usual VA Practices During a Pandemic 
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group B:Legal Authorities and Responsibilities 71 

Relevant Policy Reference Discussion 

VA Handbook 5011/6 Part II 

(January 2006) 

when there is a national 

emergency. An employee’s 

absence that is necessary to 

prevent transmission of an 

infectious disease may meet the 

definition of an emergency. 

Additional Comments on Providing VA Health Care in Emergency Situations 

The organization and delivery of health care is highly regulated. Depending upon the severity of a 

pandemic, it is possible that the Federal, state, or local government entities regulating the delivery of 

health care may temporarily modify some statutory or regulatory requirements. Alternatives may include 

enhancing, modifying, or waiving laws and regulations pertaining to the delivery of health and medical 

care in normal conditions. 

If the VA Secretary (or designate) determines that circumstances require revision of current VA 

regulations governing VA hospital care and medical services, such revision must be made in accordance 

with applicable law. VA has no authority to unilaterally waive non-VA regulations. Further, VA has no 

authority to unilaterally waive statutory provisions or requirements. During an influenza pandemic, VA 

facilities are urged to work with Regional Counsel to monitor any changes, modifications, or waivers of 

the laws and regulations that govern the delivery of hospital care and medical services in VA facilities. 

Any such waivers or modifications are likely to be targeted to the affected area for a temporary and 

specified period of time. In the case of a pandemic that moves form region to region, it will be important 

for VA to correctly and appropriately apply any such waivers or modifications. 

Appendix B-2: TABLE OF LEGAL AUTHORITIES AND POLICIES RELEVANT TO EMERGENCIES - Advice on Changes 

in Usual VA Practices During a Pandemic 
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group C:References 72 

Appendix Group C: References 

Appendix C-1: REFERENCE LIST FOR VA EMERGENCY PLANS AND OTHER 

RESOURCES 

Federal Pandemic Influenza Web site

www.pandemicflu.gov

VA Emergency Plans 

Other Relevant VA Policies 

VA Web sites 

International Agencies 

Federal Departments and Agencies 

State Web sites 

Emergency Preparedness 

Influenza and Respiratory Infectious Diseases 

VA Emergency Plans 

VA Directive 0320, Comprehensive Emergency Management Program, March 24, 2005 

http://www.va.gov/pubs/directives/Policy-Planning-Preparedness/0320dir.doc

VA Handbook 0320, Comprehensive Emergency Management Program, March 24, 2005 

http://www.va.gov/pubs/handbooks/Policy-Planning-Preparedness/0320hbk.Doc

Veterans Health Administration (VHA) Emergency Management Program Procedures

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=326

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=326

VHA Emergency Management Program Guidebook, March 2005 

http://vaww.ceosh.med.va.gov/Guidebooks/EMP2005/2005_EMP.htm

http://www1.va.gov/emshg/page.cfm?pg=114

VHA Directive 2002-026, Pharmaceutical Caches in a Weapons of Mass Destruction Event, May 13, 

2002 http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1134

VHA Directive 2004-046, Inspection of the VHA Pharmaceutical Caches by the Emergency 

Management Strategic Healthcare Group, August 24,2004 

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1149

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1149

 

 VHA Handbook 0320.2, Emergency Management Program Procedures, June 12, 2000 

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=326

 VHA Handbook 0320.3, Disaster Emergency Medical Personnel System (DEMPS), July 21, 2000 

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=334

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=334

 VHA Respiratory Infectious Disease Emergency Plan for Facilities 

http://www.publichealth.va.gov/watch/respiratoryID.htm

Appendix C-1: REFERENCE LIST FOR VA EMERGENCY PLANS AND OTHER RESOURCES
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group C:References 73 

VBA Emergency Preparedness 

http://vbaw.vba.va.gov/bl/20/201f/emer-prep/

VBA Continuity of Operations Plan (COOP) 

http://vbaw.vba.va.gov/bl/20/201f/emerprep/COOP/VBACO%20Revised%20Signed%20MasterCOOP%20Apr%2027.doc

VBA Continuity of Operations Plan Template 

http://vbaw.vba.va.gov/bl/20/201f/emer-prep/ro_coop.htm

VBA Facility Director Order of Succession 

http://vbaw.vba.va.gov/bl/20/201f/emer-prep/Order%20of%20Succession%20Form.doc

NCA Emergency Preparedness Planning 

http://vaww.vairm.vaco.va.gov/ncamis/legis_handdir_pdf/0320_Directive.pdf

NCA Emergency Preparedness Planning Procedures 

http://vaww.vairm.vaco.va.gov/ncamis/legis_handdir_pdf/0320_Handbook.pdf

Other Relevant VA Policies 

VHA Hand Hygiene Practices 2005 

http://vaww1.va.gov/optometry/docs/Hand_Hygiene_Directive.pdf or internet at 

 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1214

VHA Oseltamivir Stockpile, Under Secretary for Health’s Information Letter, September 2005 

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1323

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1323

Telephone Care and Service 

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=79

VHA Handbook 1100.19, Credentialing and Privileging 

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=357

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=357

VHA Directive 2001-022, Implementation of VetPro 

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=87

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=87

VHA Directive 2001-005, Credentialing and Privileging of Telemedicine and Telehealth Services 

Provided in Hospitals and Clinics 

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=127

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=127

VHA Directive 2002-076, Expedited Medical Staff Appointment Process 

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=222

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=222 

Appendix C-1: REFERENCE LIST FOR VA EMERGENCY PLANS AND OTHER RESOURCES
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group C:References 74 

Credentialing and Privileging of VHA Health Care Providers Remotely Delivering Health Care to 

Patients at Home, in Vet Centers, and in Non-Health Care Settings Via Telemedicine and/or Tele 

Health

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=189

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=189

Respiratory Protection Used for Infectious Disease and Annual Fit-testing

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1349

http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=1349

Authorized Absence in emergencies, see VA Handbook 5011/3 Part II, Chapter 3 March 30, 2005 

http://www1.va.gov/ohrm/Directives-Handbooks/Direct_Hand.htm

VA Handbook 5011/6, January 26, 2006 

http://www1.va.gov/ohrm/Directives-Handbooks/Direct_Hand.htm

Spiritual and Pastoral Care Procedures

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1231

http://www1.va.gov/vhapublications/viewpublication.asp?pub_id=1231 

NCA Directives and Handbooks 

http://vaww.vairm.vaco.va.gov/ncamis/legis_handdir.htm

VA Web sites 

Department of Veterans Affairs 

http://www.va.gov/ or http://vaww.va.gov/

VA “Infection: Don’t Pass It On” campaign Web site - hand and respiratory hygiene, personal 

protective equipment information; extensive downloadable, printable material 

www.publichealth.va.gov/InfectionDontPassItOn

VA influenza and pandemic influenza information 

http://www.publichealth.va.gov/flu/

My HealtheVet – VA’s gateway to veteran health and wellness 

http://www.myhealth.va.gov/

VA Emergency Management Strategic Health Care Group 

http://www.va.gov/EMSHG/

VA Public Health Strategic Health Care Group – Public health issues and concerns 

www.publichealth.va.gov

Pharmacy Benefits Management Strategic Healthcare Group 

http://www.vapbm.org/PBM/menu.asp

Appendix C-1: REFERENCE LIST FOR VA EMERGENCY PLANS AND OTHER RESOURCES
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group C:References 75 

VA Office of Acquisition and Materiel Management 

http://vaww1.va.gov/oamm/

http://www1.va.gov/oamm/

NCA Directives and Handbooks 

http://vaww.vairm.vaco.va.gov/ncamis/legis_handdir.htm

International Agencies 

World Health Organization (WHO) 

http://www.who.int/en/

Federal Departments and Agencies 

Department of Veterans Affairs 

http://www.va.gov/ or http://vaww.va.gov/

Department of Homeland Security 

http://www.dhs.gov/dhspublic/theme_home2.jsp

Centers for Disease Control (CDC) 

http://www.cdc.gov 

Department of Health and Human Services (HHS) 

http://www.hhs.gov/

Agency for Healthcare Research and Quality (AHRQ) 

http://www.ahrq.gov/

Federal Emergency Management Agency (FEMA) 

http://www.fema.gov/ 

Food and Drug Administration (FDA) 

http://www.fda.gov/ 

Health Resources and Services Administration (HRSA) 

http://www.hrsa.gov/ 

National Institutes of Health (NIH) 

http://www.nih.gov/ 

NIH, National Institute of Allergy and Infectious Diseases 

http://www.niaid.nih.gov/ 

Department of Defense 

http://www.defenselink.mil/ 

Occupational Safety and Health Administration (OSHA) 

http://www.osha.gov

Appendix C-1: REFERENCE LIST FOR VA EMERGENCY PLANS AND OTHER RESOURCES
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group C:References 76 

State Web sites 

CDC - Web directory for State and Local Health Departments 

http://www.cdc.gov/doc.do/id/0900f3ec80226c7a

Federal Web directory for State-by-State Pandemic Information 

http://www.pandemicflu.gov/plan/tab2.html

Emergency Preparedness 

HHS Office of Public Health Emergency Preparedness (OPHEP) 

http://www.hhs.gov/ophep/index.html

HHS Office of the Assistant Secretary for Public Health Emergency Preparedness (ASPHEP) 

http://hhs.gov/asphep 

HHS Office of Public Health Emergency Preparedness (OPHEP) 

http://www.hhs.gov/ophep/index.html

HHS Office of the Assistant Secretary for Public Health Emergency Preparedness (ASPHEP) 

http://hhs.gov/asphep 

CDC: A Voluntary Rapid Self-Assessment of State and Local Capacity to Respond to Bioterrorism, 

Outbreaks of Infectious Disease, and Other Public Health Threats and Emergencies. 

http://www.phppo.cdc.gov/od/inventory/index.asp

CDC Emergency Preparedness and Response 

http://www.bt.cdc.gov/

CDC Surveillance Guidance 

http://www.bt.cdc.gov/episurv/

CDC Epidemic Information Exchange 

http://www.cdc.gov/mmwr/epix/epix.html

AHRQ Public Health Preparedness 

http://www.ahrq.gov/prep/

Worker Protection: OSHA'S Role During Response to Catastrophic Incidents 

http://www.osha.gov/SLTC/emergencypreparedness/guides/osha_role.html

OSHA Safety and Health Topics: Emergency Preparedness and Response 

http://www.osha.gov/SLTC/emergencypreparedness/index.html

OSHA Best Practices for Hospital-Based First Receivers of Victims 

http://www.osha.gov/dts/osta/bestpractices/firstreceivers_hospital.html

Department of Homeland Security: the National Incident Management System (NIMS) 

http://www.dhs.gov/dhspublic/display?content=3697

Appendix C-1: REFERENCE LIST FOR VA EMERGENCY PLANS AND OTHER RESOURCES
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group C:References 77 

http://www.dhs.gov/interweb/assetlibrary/NIMS-90-web.pdf

Department of Homeland Security: Training & Exercises 

http://www.dhs.gov/dhspublic/display?theme=63

Department of Homeland Security: Response and Recovery 

http://www.dhs.gov/dhspublic/display?theme=15

Influenza and Respiratory Infectious Diseases 

VA Influenza Information 

http://www.publichealth.va.gov/flu/

http://vaww.vhaco.va.gov/phshcg/Flu/Default.htm) 

VA Influenza Vaccine Recommendations for 2005 – 2006 

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1334

VA Influenza Toolkit Manual 2005 - 2006 

http://www.publichealth.va.gov/flu/documents/VA_Flu_Manual.pdf

HHS Pandemic Influenza Response and Preparedness Plan 

http://www.hhs.gov/pandemicflu/plan/

Centers for Disease Control and Prevention (CDC) Influenza Information 

http://www.cdc.gov/flu/index.htm

CDC Guideline for Environmental Infection Control in Health-Care Facilities, 2003

http://www.cdc.gov/ncidod/dhqp/gl_environinfection.html” 

CDC Hand Hygiene in Healthcare Settings 

http://www.cdc.gov/handhygiene/

CDC Severe Acute Respiratory Syndrome (SARS) Information 

http://www.cdc.gov/ncidod/sars/

CDC Preparedness for SARS in Healthcare facility 

http://www.cdc.gov/ncidod/sars/guidance/C/pdf/c.pdf

CDC Information on Avian Influenza 

http://www.cdc.gov/flu/avian/

CDC Recommendations for Infection Control – Avian Influenza - 

http://www.cdc.gov/flu/avian/professional/infect-control.htm

CDC Background and testing/lab information – influenza & SARS 

http://www.cdc.gov/flu/avian/professional/han020302.htm

Department of Health and Human Services (HHS) Pandemic Influenza Preparedness 

http://www.hhs.gov/nvpo/pandemicplan/

Appendix C-1: REFERENCE LIST FOR VA EMERGENCY PLANS AND OTHER RESOURCES
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group C:References 78 

HHS National Vaccine Program Office 

http://www.hhs.gov/nvpo/pubs/pandemicflu.htm

CDC Flu surge calculations 

http://www.cdc.gov/flu/flusurge.htm

World Health Organization Influenza Information 

http://www.who.int/csr/disease/influenza/pandemic/en/

U.S. Food and Drug Administration (FDA)-Center for Drug Evaluation and Research – Discussion of 

influenza antiviral drugs and related information. 

http://www.fda.gov/cder/drug/antivirals/influenza/default.htm 

Occupational Safety and Health Agency (OSHA) Information Regarding Severe Acute Respiratory 

Syndrome (SARS). 

http://www.osha.gov/dep/sars/index.html

OSHA Anthrax e-Tool: Protecting the Worksite Against Terrorism. 

http://www.osha.gov/SLTC/etools/anthrax/index.html

OSHA Guidance for Protecting Workers Against Avian Flu 

http://www.osha.gov/dsg/guidance/avian-flu.html

Appendix C-1: REFERENCE LIST FOR VA EMERGENCY PLANS AND OTHER RESOURCES
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 79 

Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS

Appendix Group D: Planning Tools 

Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS 

Following are several grids that outline planning steps for pandemic influenza. These reflect the text in 

Section 2 and provide numbers of subsections (e.g., 2.1.2 Coordination) for cross reference. 

The grids cover: 

• VA Central Office 

• VHA facilities 

• VBA 

• NCA 

These grids can be a starting point to identify steps, name responsible offices and individuals to carry out 

these steps, and track progress. 
Preparing for Pandemic Influenza: 

VA Central Office Action Grid 

Section Preparation Action Responsible Office Responsible 

Person 

Completion 

(Planned

2.1.2 Coordination 

Coordinate efforts with Federal, state, local, tribal organizations & agencies 

Meet VA obligations under National Implementation Plan Establish VA Pandemic Influenza Advisory Group Plan to respond to pandemic outbreak using emergency management resource plans 

2.1.3 VA Central Office Preparations 

Develop plan to use COOP, identify essential functions, consider flexible work standards, leave options 

Communicate with staff on pandemic influenza, protecting themselves, public health measures, plans, and policies 

Plan to obtain and administer antivirals and vaccine 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Preparing for Pandemic Influenza: 

VA Central Office Action Grid 

Section Preparation Action Responsible Office Responsible Completion 

Person (Planned

2.1.4.1 Public Affairs/Communications 

Develop central Internet and intranet sites Encourage facilities and networks to create communication plans Develop education and information material for distribution Identify & train key lead spokespersons at all levels 

Gather all emergency information from key partners at all levels Disseminate announcements thru subject matter experts to media 

Create tools & templates for basic messages Update all levels on Plan and pandemic influenza Strengthen relationships with national, Federal, and private partners Anticipate and prepare for questions and answers Brief Congress, VSOs, media 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Preparing for Pandemic Influenza: 

VA Central Office Action Grid 

Section Preparation Action Responsible Office Responsible Completion 

Person (Planned

2.2.2 VHA Coordination 

Work across offices, networks, Federal, state, local partners 

Participate in and organize VA Pandemic Influenza Advisory Group 

Prepare to use emergency plans as needed Plan to acquire vaccines, antivirals, diagnostics, and materiel Develop transparent process of allocating these and other resources in a pandemic Assess acquisition of mobile clinics or modular medical stations 

2.5 Develop & Conduct Tabletop Exercises 

Practice coordination within VA and with Federal, state, local and tribal organizations 

Clarify/identify roles and responsibilities 

Identify strengths & areas of improvement 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Preparing for Pandemic Influenza: 

VHA Facility Action Grid 

Section Preparation Action Responsible 

Office 

Responsible Person Completion Da

(Planned) 

2.2.3.1 Facility Pandemic Influenza Plans 

Develop and test plans 

Participate in state/local drills Adapt sample SOP for use during a pandemic (see 

Appendix D-2) 

2.2.3.2 Workforce Preparation 

Identify essential functions 

Provide education 

Identify provider skill sets Recruit & credential non-VA providers Create staff & volunteer tracking system Identify staff able to work using respirators Name & create a Pandemic Response Team Identify child care, home support 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Preparing for Pandemic Influenza: 

VHA Facility Action Grid 

Section Preparation Action Responsible Responsible Person Completion Da

Office (Planned) 

2.2.3.3 Physical Site Preparation 

Develop plans to free clinical space Identify space for new separate waiting and emergency room areas Consider reactivating closed space or buildings Map patient flow to plan use of restricted areas 

Identify and develop plans for alternative usable space 

Assess building & engineering systems Plan locations of hand cleaning stations 

Identify space & plan for cohorting of infected patients Plan for transportation of staff & patients 

Plan for management of fatalities 

2.2.3.4 Infection Control & Precautions Preparation 

Ensure ongoing employee education 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Preparing for Pandemic Influenza: 

VHA Facility Action Grid 

Section Preparation Action Responsible Responsible Person Completion Da

Office (Planned) 

Establish & maintain seasonal influenza vaccinations Heighten institutional surveillance for influenza Plan to educate staff re symptoms and develop call-in system Work with HR on authorized absences and other leave policies Develop protocols to track & manage sick staff 

Develop criteria for limiting visitor access. 

Create strategy for supply maintenance 

Ensure adequate personal protective equipment and hand hygiene supplies 

2.2.3.5 Countermeasure Preparation 

Use established acquisition and contracting systems or the NAC Plan for vaccine administration Plan for antiviral acquisition & distribution 

Plan for lab & diagnostic resources 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Preparing for Pandemic Influenza: 

VHA Facility Action Grid 

Section Preparation Action Responsible Responsible Person Completion Da

Office (Planned) 

2.2.3.6 Medical Materiel Preparation 

Identify all resources, supplies & equipment needed to treat infected patients 

Obtain & stockpile durable & consumable supplies Identify systems for how/where to store supplies 

Evaluate existing contracts for supplies, enhance if necessary 

Identify security issues Assess transportation routes for supplies Develop distribution plan for supplies Participate in table top exercises on supply management 

2.2.3.7 Health Care Delivery Preparation 

Prepare and ready the Pandemic Response Team Know response & “trigger” for first case Estimate potential surge in demand 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Preparing for Pandemic Influenza: 

VHA Facility Action Grid 

Section Preparation Action Responsible Responsible Person Completion Da

Office (Planned) 

Develop triage systems for care delivery 

Identify separate waiting areas for the symptomatic 

Plan for isolation rooms, intensive care & assisted ventilation Plan for novel care delivery strategies 

2.2.3.8 Support for and Management of Exposed & Ill Staff 

Plan provisions to protect staff Plan for treatment of staff 

Create surveillance & triage systems Identify lab diagnostic systems 

Create lab reporting & disclosure system Develop plans for excluding staff from work based on health 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Preparing for Pandemic Influenza: 

VHA Facility Action Grid 

Section Preparation Action Responsible Responsible Person Completion Da

Office (Planned) 

Plan possible provisions for staff’s family members in order to keep staff at work in an emergency, depending on availability of equipment, supplies, and medications and on responsibilities and assignments of facility under the National Response Plan 

2.2.3.9 Mental Health Preparation 

Plan resources for increase in services Plan consultation processes 

2.2.3.10 Surveillance and Reporting Preparation 

Plan for use of available diagnostics Plan to use established reporting mechanisms 

Plan to collaborate with state and local health departments 

2.2.3.11 Security Preparation 

Plan for security of facilities to prevent unrest and assist with flow of crowds Review local support agreements 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Preparing for Pandemic Influenza: 

VHA Facility Action Grid 

Section Preparation Action Responsible Responsible Person Completion Da

Office (Planned) 

Educate on medical procedures, especially use of personal protective equipment 

2.2.3.12 Communications Preparation 

Provide information & education on pandemicrelated issues for stakeholders 

Establish communication plans for use before and during a pandemic 

Develop information on the Plan, roles, responsibilities, pandemic influenza, its mitigation, local resources Identify stakeholders in and out of VA Engage in dialogue where possible Plan streamlined information approval process for emergencies 

Identify and train spokespersons 

Develop information templates Update contact lists Expand emergency communications capabilities 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Preparing for Pandemic Influenza: 

VHA Facility Action Grid 

Section Preparation Action Responsible Responsible Person Completion Da

Office (Planned) 

Other: 

Other: Other: Other: 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Preparing for Pandemic Influenza: 

VBA Action Grid 

Section Preparation Action Responsible 

Office 

Responsible Person Completion Da

(Planned) 

2.3.2 Coordination Preparation 

Be familiar with Continuity of Operations Plans Review how all operations will be affected Be represented on the VA Pandemic Influenza Advisory Group 

2.3.3.1 Creation of Pandemic Influenza Plans 

Plan for operations under altered work conditions 

2.3.3.2 Workforce Preparation 

Plan to provide PPE, hand hygiene supplies, vaccine, 

and antiviral medications 

Prepare policies to cover a range of staffing issues Provide staff education Plan procedures for temporary office closings 

2.3.3.3 Infection Control Preparation 

Provide education 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Preparing for Pandemic Influenza: 

VBA Action Grid 

Section Preparation Action Responsible Responsible Person Completion Da

Office (Planned) 

Develop protocols to track & manage sick staff 

2.3.3.4 Security Preparation 

Educate security on pandemic influenza and the use of PPE 

2.3.3.5 Communication Preparations 

Develop a communications plan Plan alternate pathways of communications for use during a pandemic outbreak Other: Other: 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Preparing for Pandemic Influenza: 

NCA Action Grid 

Section Preparation Action Responsible 

Office 

Responsible Person Completion D

(Planned) 

2.4.2 Coordination Preparation 

Be familiar with Continuity of Operations Plans Review how all operations will be affected Be represented on the VA Pandemic Influenza Advisory Group 

2.4.3.1 Creation of Pandemic Influenza Plans 

Plan for operations under altered work conditions 

2.4.3.2 Workforce Preparation 

Plan to provide PPE, hand hygiene supplies, vaccine, 

and antiviral medications 

Prepare policies to cover a range of staffing issues Provide staff education Plan procedures for temporary office and cemetery closings 

Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS
Appendix Group D:Planning Tools Appendix D-1: VA PANDEMIC PREPARATION ACTION GRIDS

Preparing for Pandemic Influenza: 

NCA Action Grid 

Section Preparation Action Responsible 

Office 

Responsible Person Completion D

(Planned) 

2.4.3.3 Infection Control Preparation 

Provide education Develop protocols to track & manage sick staff 

2.4.3.4 Communication Preparations 

Develop a communications plan Plan alternate pathways of communications for use during a pandemic outbreak Other: Other: 
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 95 

Appendix D-2: SAMPLE EMERGENCY MANAGEMENT PROGRAM STANDARD 

OPERATING PROCEDURE (SOP)

PANDEMIC INFLUENZA AFFECTING A VA HEALTH CARE FACILITY 

(Modify for your facility) 

Emergency Management Program Guidebook Department of Veterans Affairs 

THE DEPARTMENT OF VETERANS AFFAIRS 

MEDICAL CENTER 

(LOCATION) 

EMERGENCY MANAGEMENT PROGRAM (DATE) 

STANDARD OPERATING PROCEDURE NO. ( ) 

SUBJECT: VA Health Care Facility’s Preparation and Response to an Influenza Pandemic 

Description of the Threat/Event. 

a. Agent. A pandemic occurs when a new strain of influenza virus emerges that has the ability 

to infect and be passed between humans. Because humans would have little immunity to the 

new virus, a worldwide epidemic, or pandemic, can ensue. Influenza viruses have threatened 

the health of human populations for centuries. The diversity and propensity for of influenza 

viruses for mutation have thwarted efforts to develop both a universal vaccine and highly 

effective antiviral drugs. As a result, and despite annual vaccination programs and modern 

medical technology, even seasonal influenza in the United States results in approximately 

36,000 deaths and 226,000 hospitalizations each year. A pandemic strain of influenza could 

cause many-fold more. Transmission of influenza is aided by the fact that infected people 

may shed virus and spread the infection for one-half to one day before symptoms begin. 

b. Clinical Disease. Symptoms of influenza typically begin two days after exposure, often 

starting with a sudden onset of fever, severe fatigue or muscle pain, sore throat, and a dry 

cough. Uncomplicated seasonal influenza commonly leads to three to five days of acute 

illness, including fever and prostration, leaving the sufferer feeling weakened and with a 

residual cough for two or more weeks longer. A new strain may present a different clinical 

course and be much more serious, causing severe morbidity and mortality from influenza 

pneumonia or pneumonitis and secondary bacterial infections. 

c. Public Health Response. Public health measures to slow or stop a pandemic influenza will 

likely include a number of actions that will have range of success. A monovalent influenza 

vaccine made for the specific pandemic strain will be manufactured, but this will take several 

months. An antiviral medication, oseltamivir, that can be given to exposed persons to prevent 

illness and help limit transmission is available but supplies are limited and manufacturing is a 

complex process. Oseltamivir may be effective against the H5N1 avian influenza that has 

infected humans in Asia and Europe; VA holds a 500,000 treatment course stockpile of 

oseltamivir. Other public health measures include commonsense actions, like hand washing, 

Appendix D-2: SAMPLE EMERGENCY MANAGEMENT PROGRAM STANDARD OPERATING PROCEDURE (SOP)
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 96 

respiratory hygiene, staying home when sick, and using telework or telecommuting options 

when able. Health care facility actions involve isolating the sick, having staff wear 

appropriate personal protective equipment (PPE), and screening for influenza illness or 

exposure before permitting entry to a facility. Community, regional, and nationally-mandated 

measures may include declaration of snow days, postponing of large public gatherings, 

quarantine of the exposed, and restrictions on travel. 

Impact on Mission Critical Systems. 

• An influenza pandemic can quickly overwhelm a VA medical center’s or community-based outpatient 

clinic’s normal capacity to provide timely and accessible medical care. Because of the ease with which 

influenza is transmitted, health care facilities can quickly become sites of intensive exposure for staff 

and non-infected patients. Breaks in procedure or unanticipated exposures may overwhelm a whole 

Medical Center, for example, by exposing personnel and requiring quarantine of the Medical Center. 

For this reason it is incumbent that VHA facilities prepare for the possibility of an influenza pandemic. 

• An influenza pandemic can quickly overwhelm a hospital’s or CBOC’s mission critical systems, 

causing such problems as 

• Staffing shortages from community quarantine and competing family interests 

• Depleted supplies of vaccines and antivirals 

• Stretched bed capacity and operational space required for patient care or quarantine 

• A pandemic, by definition, will be a widespread—even national—event, so close coordination and 

cooperation with local, county, state public health agencies; and private sector health care facilities will 

be necessary and vital. It will also be necessary for VA medical centers to anticipate VA’s mission to 

back up the Department of Defense (and provide care to designated members of the military) and VA’s 

responsibilities to the National Response Plan (and provide care and resources for care to non-enrolled 

veterans and non-veterans). 

Operating Units and Key Personnel with Responsibility to Manage this Threat. 

• Facility Director-Responsible for assuring the organization implements the necessary preparatory 

measures for a potential influenza pandemic. The Director is also responsible for initiating the 

organization’s disaster plan.

• Infection Control Team/Epidemiology – Key role in: tracking potential and confirmed cases; infection 

control management of patients using airborne precautions (private room, negative airflow, N95 

respirator use by staff) or, when the Medical Center is overwhelmed, using droplet precautions and 

cohorting (isolation of infectious patients together, but away from non-exposed); working with and 

reporting to local and state public health; serving as a VA medical center information resource on 

changing public health recommendations and on the community/outbreak; assisting with vaccination 

decisions affecting staff and patients; advising on mass distribution systems for vaccine and antivirals. 

• Engineering Service – Key role in: assessment of negative airflow rooms and negative airflow systems; 

identification of areas suitable for cohorting patients both in waiting areas and after hospitalization. 

• Clinical Laboratory – Key role in: obtaining and performing diagnostic tests for the pandemic strain; 

knowing availability of reference laboratories for diagnosis (like the CDC’s Laboratory Response 

Network [LRN] or state laboratories); advising on specimen collection; safe handling, storage, and 

shipping of specimens. 

• Safety/Industrial Hygiene – Key role in: support of N95 respirator usage (fit-testing) program. 

• Police and Security – Key role in: crowd control, managing the flow of patients and visitors. If the 

situation warrants, police have key role in perimeter control, site access. Police may be called upon to 

protect the supply of influenza vaccines and supplies like oseltamivir, vaccine, N95 masks, and surgical

or procedure-type masks. Perimeter access and site control may pertain to staff, staff relatives/family, 

and patients and require ingress and egress control. Site control may include assisting with drivethrough triage stations or drive-through clinic sites, and mass distribution of vaccine and antivirals. 

Appendix D-2: SAMPLE EMERGENCY MANAGEMENT PROGRAM STANDARD OPERATING PROCEDURE (SOP)
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 97 

• Medical Service – Key role in: clinical diagnosis of cases; treatment of cases; providing health care 

advice via telephone; staffing innovative care delivery sites, advising/assisting with mass delivery of 

vaccine and antivirals. 

• Nursing Service – Key roles in: staffing and bed support for inpatient, outpatient, and innovative care 

delivery sites; assisting with restriction of non-essential personnel from patient rooms (i.e., 

environmental management service, nutrition and food service personnel); providing health care advice 

via telephone; advising/ assisting with mass delivery of vaccine and antivirals. 

• Emergency Department – Key role in: monitoring incoming patients suspected of exposure or disease; 

making decisions on maintaining separate clinical activities. 

• Pharmacy – Key role in managing the supply of vaccines and antivirals. 

• Employee/Occupational Health – Key role in: employee vaccination/clinical care (identification of 

vaccine contraindications), information flow/risk communication to staff; advising/assisting with advice 

to staff about their ability to work, maintaining health care records for staff, including immune status.. 

• EMS/Safety – Key role in: advising on cleaning of rooms; equipment; communication of advice on 

cleaning measures. 

• Volunteer Service – Key role in: coordinating volunteers (existing and community members) willing to 

assist. Voluntary also should assist in establishing an area for child care and respite for health care 

facility staff unable to leave the facility. 

• Public Affairs – Key role in: keeping staff and patients informed, updating Web site, working with 

VSOs, media 

Mitigation/Preparedness Activities of the Threat/Event. 

The mode(s) of transmission, degree of morbidity and mortality, and amount of societal disruption that a 

pandemic influenza might cause will be uncertain until the specific influenza strain is identified and 

observed. From applying what is known about seasonal influenza, it might be expected that a pandemic 

influenza would follow some of the same transmission patterns: ready transmission by respiratory 

droplets (and perhaps by aerosolized particles) from person to person; shedding and transmission of virus 

before persons are ill, a short incubation period of approximately 2 days, and thus a potential doubling of 

cases every 2 to 3 days. 

a. Hazard Reduction. 

ß Notification/risk communications plan. 

ß Activation of hospital emergency plan. 

ß Perimeter control potential: need for increased security staffing, heightened security 

requirements for access control. 

ß Building systems assessment for cohorting potential and confirmed patients. 

ß Implementation of measures to provide added capacity for a potential surge of inpatient 

and ambulatory care. 

ß Exposure control/Infection control: Airborne Infection Isolation and Contact Precautions 

are advised for a potentially lethal strain of pandemic influenza, in order to maximally 

protect staff. Patients should be placed in room with negative airflow and HEPA 

exhaust; and should wear surgical masks when transported through the Medical Center. 

If facilities are unable to exercise this degree of isolation, cohorting of patients in 

common, exposed areas with HVAC isolation and exhaust (if possible) and use of 

respiratory droplet precautions by staff are advised. 

ß Separation of new, unexposed patients from potential pandemic influenza cases. 

ß Use of Airborne Infection Isolation and Contact Precautions, if possible, or Droplet 

Precautions. 

ß Visitor restriction policies. 

ß If necessary, control of the perimeter: need for increased security staffing, heightened 

security requirements for access control. 

Appendix D-2: SAMPLE EMERGENCY MANAGEMENT PROGRAM STANDARD OPERATING PROCEDURE (SOP)
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 98 

b. Preparedness Strategies and Resources. 

ß Establishment of Pandemic Response Team that will be prepared to work during a 

pandemic. 

ß Vaccination (if available). 

ß Antiviral medications prescribed to prevent illness in the exposed or unvaccinated (if 

available). 

ß Public health measures of hand washing, respiratory hygiene, staying home when ill, 

respecting quarantine, isolation, “snow day” and travel, and public gathering limitations 

ß Education (on public health measures, infection control guidelines, home care, self-triage 

[to determine when medical care is necessary]). 

ß Plan for Airborne infection Isolation and Contact Precautions for all personnel with 

patient contact. 

ß Anticipation of need to manage a large number of fatalities. 

Response/Recovery from the Event/Threat. 

a. Hazard Control and Monitoring Strategies. 

ß First case identified at a VAMC. 

1. Should be immediately reported: any suspected case(s) of pandemic influenza to 

Infection Control for confirmation. Infection Control would then brief the Chief 

of Medicine and the Chief of Staff. If case is confirmed, the Director, Safety 

Officer, Police and Occupational Health would be notified (this will most likely 

occur when a known pandemic virus is circulating elsewhere in the world and a 

VA medical center suspects it has the first US or regional case). 

2. Activate Infection Control Team for initiation of patient/exposed staff tracking 

system, patient/staff educational information. 

3. Clear all patients and employees from the vicinity of the suspected case. 

4. Document details of incident and names of all persons within the immediate “at 

risk” area (i.e., who have become contacts and may require quarantine, antiviral 

medications). 

5. Contact local/state public health contacts for diagnostic sample collection and 

shipping instructions. 

6. Contact local/state public health, Pharmacy Benefits Management, or VACO 

Office of Public Health and Environmental Hazards to obtain vaccine, 

depending on guidance provided at the time (if pandemic vaccine is available). 

7. Contact Pharmacy Benefits Management, or VACO Office of Public Health and 

Environmental Hazards for access to VA’s oseltamivir (antiviral medication) 

stockpile. 

8. Activate Infection Control Team for initiation of patient/exposed employee 

tracking system, patient/employee educational information. 

9. Initiate antiviral medication for all potential exposed persons as appropriate 

after discussion with local/state public health, if appropriate. 

10.Notify internal personnel, as appropriate, including Chief of Staff, Health Care 

Providers, Nursing Service, Pharmacy, Microbiology Laboratory, and 

Engineering for immediate inventory of critical resources. 

11.Immediately assess potential impact of actual event on mission-critical systems 

to include staffing, critical supplies, operational space, potential for patient and 

staff exposures and HVAC system. 

ß Cases already identified among existing enrolled veterans. 

1. VA personnel must maintain communications and awareness with local and 

state public health of progression of the pandemic in the community. 

Appendix D-2: SAMPLE EMERGENCY MANAGEMENT PROGRAM STANDARD OPERATING PROCEDURE (SOP)
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 99 

Information must be shared with internal VA personnel, including VAMC 

Director, Chief of Staff, Police and Security, Chief Nurse Executive, Safety 

Officer/Industrial Hygienist, Employee/Occupational Health, Emergency Room 

Personnel, Health Care Providers, Pharmacy, and Microbiology Laboratory for 

immediate inventory of critical resources. 

A. Perform active surveillance for pandemic influenza appearing among 

hospitalized inpatients, or outpatients according to the prevailing case 

definition. 

B. Notify the Clinical Microbiology Laboratory of potential for use of rapid 

diagnostic tests or sending of specimens to reference laboratories. 

C. Immediately assess potential impact of reported community events on 

mission critical systems to include staffing, critical supplies and 

operational space. 

D. Await follow-up information from local authorities and prepare for 

potential presentation of patients. 

b. Resource Issues. 

ß Staffing needs will be monitored and addressed by Chief of Staff, Chief of Nursing, 

VAMC Director, and other involved Service Chiefs. 

ß Critical Supplies – Vaccine (if available at the time) will likely be distributed through 

state health departments or through VA Central Office Pharmacy Benefits Management 

Strategic Healthcare Group. Additional timely information about vaccine may be 

expected from VACO. Other critical supplies to assess in the event of pandemic influenza 

include respiratory support equipment (oxygen, and oxygen-delivery equipment, 

ventilators), personal protective equipment, antimicrobial soap and alcohol-based hand 

cleaners, antibiotics to treat secondary bacterial pneumonias, morgue kits. 

ß Resource Allocation – Develop criteria and transparent processes for allocation decisions 

regarding resources that may not be available in sufficient quantities during a pandemic: 

antivirals, respirators, vaccines, staff. 

ß Space Management – Assess negative airflow room and cohorting bed and space 

availability; refrigerated space to store bodies. 

ß Emergency Room capabilities, acute care clinic capabilities and current/projected bed 

availability should be immediately assessed. 

ß Exposed patients and staff might expect short-term quarantine on site or relocation to 

alternate care sites or alternate health care facilities. 

ß Consideration should be made to providing pandemic influenza countermeasures that are 

in short supply to staff members’ families (vaccine, antivirals, personal protective 

equipment), depending on availability and on the facility’s responsibilities and 

assignments under the National Response Plan. If staff members’ families can be 

protected, staff will be more available to take care of patients. 

c. Clinical Response. 

ß Treatment protocols will be based upon prevailing knowledge of the pandemic influenza 

strain and will include supportive care (respiratory support, hemodynamic support) and 

use of antivirals. 

ß Clinical admission/treatment decisions will be made by the health care providers. 

ß All quarantine and visitor restriction decisions will be made by the VAMC Director 

based upon recommendations of the Infection Control Team or pandemic influenza 

response team following local/state public health guidance and decisions, and advice of 

regional VA counsel, if needed. Such decisions will be proportional to the disease impact, 

necessary, relevant, and applied equitably, and will employ the least restrictive means if 

options are available. 

Appendix D-2: SAMPLE EMERGENCY MANAGEMENT PROGRAM STANDARD OPERATING PROCEDURE (SOP)
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 100 

ß All patients treated and evaluated for potential pandemic influenza must be reported to 

the Infection Control Team or designated pandemic influenza response team for datacollection. 

ß Patient and staff record-keeping must be maintained according to usual standards, if 

possible. 

ß The Infection Control Team or designated pandemic influenza response team will 

monitor all potential cases and make appropriate reports to the VAMC Director and state 

and local public health. 

Notes: 

1. Vaccination of Health Care Providers: Vaccine for a pandemic influenza strain will be developed 

once the strain is known. This vaccine will most likely be distributed to states and then to public and 

private medical centers. Changes and updates on vaccine availability will be communicated to VISNs 

and VAMCs from VACO. 

i. The Infection Control Team, or designated pandemic influenza response team, 

working with the Chief of Staff and VAMC Director will notify Health Care 

Providers when treatment/exposure guidelines are updated or as new resources 

are made available. The Infection Control Team can monitor the VA pandemic 

influenza web sites for these updates. Note that VA guidance may differ from 

CDC guidance. 

d. Recovery Strategies. 

ß Periodic critical supply inventories with re-supply or supplementation from outside 

facilities, as needed. 

ß Periodic staffing census with workload redistribution, as needed. 

ß Close monitoring of patient census and bed status. 

ß Monitoring of staff and patient mental health. 

External Notification Procedures. 

a. Within VA. VISN, VACO. 

b. Other State and Federal Agencies. Local and State public health departments who will notify 

CDC. 

ß OSHA –follow prevailing rules for notification of employee fatalities and 

hospitalizations. 

c. Community Entities. Neighboring hospitals, emergency response systems (police, 

firefighters, emergency medical services, 911 operators). 

Specialized Staff Training. 

• Health Care Provider Training – Recognition of clinical syndromes associated with influenza, treatment 

protocols, guidelines for personal protective equipment. 

• Infection Control Team Training – Passive and active surveillance systems for monitoring reportable 

infectious disease pathogens. 

• Safety Specialist/Industrial Hygienist – N95 respirator usage. 

• Clinical Laboratories – Diagnostic tests, specimen collection, handling, and shipping. 

• Social Work Service – Introductory training on pandemic influenza, risks, treatments, family 

implications, and follow-up. 

• Police and Security – Introductory training on pandemic influenza, PPE recommendations. 

• Environmental Management Service Personnel – Introductory training on pandemic influenza risks, 

decontamination of environments, bed-clothing management, PPE recommendations. 

References and Further Assistance. 

Appendix D-2: SAMPLE EMERGENCY MANAGEMENT PROGRAM STANDARD OPERATING PROCEDURE (SOP)
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 101 

• The VA Pandemic Influenza Plan. 

• The VA Respiratory Infectious Diseases Emergency Plan (an amendment to the VHA Emergency 

Management Guidebook). Available at http://www.publichealth.va.gov/watch/respiratoryID.htm

• VHA Under Secretary for Health Influenza Advisories. Available at 

http://www.publichealth.va.gov/flu/advisory.htm 

• Local, County, State Health Departments (24/7 contact information must be part of your emergency 

plans for pandemic influenza). 

• VA guidance and Web sites on pandemic influenza www.publichealth.va.gov/infectiondontpassiton

• http://www.publichealth.va.gov/flu/pandemicflu.htm

• Federal Web sites on pandemic influenza www.pandemicflu.gov 

• Phone Numbers. 

o VACO Office of Public Health and Environmental Hazards - 202-273-8575, 8567 

o VACO Pharmacy Benefits Management - 708-786-7886

Review Date 

(NAME) 

Chief, (SERVICE NAME) 

Attachment: 

 Key Activity Management Tool/Structure 

Appendix D-2: SAMPLE EMERGENCY MANAGEMENT PROGRAM STANDARD OPERATING PROCEDURE (SOP)
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 102 

Appendix D-3: REVIEW AND LIST OF COMMUNICATION PRINCIPLES AND ELEMENTS 

TO USE BEFORE, DURING, AND AFTER A PANDEMIC 

General Communication Principles 

VA communications will be carried out in accordance with existing VA public affairs policy and 

guidance and will include the following principles in communicating before, during, and after the 

pandemic period: 

• Aim for maximum disclosure with minimum delay. 

• Be consistent (“speak with one voice”) as well as timely, accurate, and appropriate. 

• Provide regular and direct information about what is known and not known. 

• Keep all key stakeholders informed and engaged: staff, veterans, and stakeholders external to VA. 

• Employ multiple channels and formats for information. 

• Be clear and use plain language. 

•

Emergency Risk Communication Principles 

VA communications will use other principles in addition, particularly during a response to a pandemic, 

which are derived from emergency risk communications practice, such as: 

• Use streamlined approval processes that enable accurate but rapid information. 

• Provide information frequently and proactively. 

• Listen to assess understanding, answer questions and concerns, and seek input and ideas. 

• Be open and transparent. 

• Seek information on and address rumors, inaccuracies, and misperceptions. 

f, and stress. 

f individuals and organizations are concerned with VA and its actions before and during a 

eholders

• Minimize stigmatization. 

• Acknowledge anxiety, grie

• Give people things that they can do. 

Stakeholders 

A wide array o

pandemic. VA communication planning and actions will take into account as many of these stakeholders 

as possible. 

Internal Stak

ber, including those in 

 Administration 

 (VBA) 

 Offices 

d outpatient clinics, nursing homes, domiciliaries 

BA benefits offices) 

• VA e 

 and key staff 

ealth, Benefits, and Memorial Affairs and key staff 

• Every VA staff mem

o Central Office 

o Veterans Health

o Veterans Benefits Administration

o National Cemetery Administration 

o Veterans Integrated Service Network

o Medical centers 

o Community base

o Readjustment counseling (vet) centers 

o VBA Area Offices 

o Regional Offices (V

o Memorial Network Offices 

o National cemeteries 

 leadership, including th

o Office of the Secretary

o Offices of the Under Secretaries for H

Appendix D-3: REVIEW AND LIST OF COMMUNICATION PRINCIPLES AND ELEMENTS TO USE BEFORE, DURING, 

AND AFTER A PANDEMIC
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 103 

• VA l

itions such as residents and interns 

d advisory committees 

aff 

rprise Centers 

 c inical staff, including doctors, nurses, and other health care providers 

• VA nonclinical staff in health settings 

• VA contract staff 

• Staff in special pos

• Volunteers 

• Unions 

• VA chartere

• Telephone operators 

• VA emergency planners 

• VA security and police st

• VA Canteen Service 

• VA Franchise Fund/VA Ente

• VA public affairs officers and professional and patient educators and trainers 

Veteran Stakeholder Groups

• Veterans enrolled in VA hea

• Veterans in general, from the old

lth care or served by VBA or NCA 

est veterans (World War I) to the newest (veterans of Operations 

• al, state, and local 

Enduring Freedom and Iraqi Freedom) 

• Families of veterans – parents, children, spouses, significant others 

Veterans Service Organizations – nation

• Veterans Service Officers – local and state 

• County veteran service officers 

External Stakeholders

• The White House 

• Congress and Congressional Staffs 

h care systems 

ry health care system 

e system 

• Ot 

or Disease Control and 

ealth, and other components 

• St g uding health and veterans affairs departments, and state legislators 

• Lo 

partments, health facilities, and health care providers 

nd community partners 

io at the international, national and local levels 

• Other Federal healt

o Indian Health Service 

o Department of Defense/milita

o Bureau of Prisons health car

her Federal Agencies 

o Department of Health and Human Services, including the Centers f

Prevention, the National Institutes of H

o Department of Defense 

o Department of State 

o Department of Homeland Security 

ate overnment officials, incl

cal government officials 

• Indian tribes 

• National Guard units 

• Community public health de

• Private sector health care a

• Academic affiliates of VA medical centers (i.e., universities) 

• Vendors (pharmaceutical firms, suppliers) 

• VA building tenants and tenant organizations 

• Local law enforcement 

• Local emergency management and response

• The media – print, Internet, television, and rad

Appendix D-3: REVIEW AND LIST OF COMMUNICATION PRINCIPLES AND ELEMENTS TO USE BEFORE, DURING, 

AND AFTER A PANDEMIC
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 104 

Channels for Reaching Stakeholders 

A will use a variety of channels to communicate both before and during a pandemic to insure that its 

ed. Channels of communication during a pandemic will need to 

nd reach people in nontraditional ways. During a pandemic, 

lls, recorded messages for incoming calls, recorded messages for 

n systems) 

e 

ideoconference 

•

cards, pocket cards, flyers, trifolds, posters, 

nd ham radio clubs throughout country 

one tree system for each organization and facility 

V public service air time 

l) – for national and local veteran service 

ealth 

V

d event of a pandemic, to provide this information plus 

us. Of the list below, tools most useful in a pandemic will be those that 

aterials and templates that have been prepared in advance will help 

ming — VA News, The American Veteran, public 

uestions and answers 

 and locally and shared via email) 

V

many concerned stakeholders are reach

include those that can be used rapidly a

traditional channels may work for parts of the country or community not currently affected by the 

pandemic and others may work for parts of the country or community that are affected. Information 

needed to access these channels should be up to date (for example, email lists, phone numbers). 

Communications channels include: 

• Email (individual as well as Outlook groups) 

• Internet (and VA Intranet from VA computers only) 

• Telephone - hotlines, conference ca

outgoing calls, call trees (cascades or call dow

• Satellite conferences/videoconferences 

• Meetings – small to large, including all-employee or “town hall” meetings that may involve staff or th

community or both 

• Media briefings – face to face, phone, v

• Faxes 

Mailings (of letters, postcards, trifolds, notices) 

• Printed materials (such as brochures, fact sheets, wallet 

notices, tent cards, tray liners) 

• Newsletters and magazines 

• Public service announcements (via print, Web, radio, TV) 

• Public address system 

• Closed circuit TV 

• Employee home email and home phone numbers 

• Ham radio system based on collaboration of VA facilities a

• Employee email/teleph

• Commercial radio/T

• Emergency contact call/email list (national and loca

organizations, local military installations, public safety organizations, public health organizations, h

facilities outside VA, municipal governments 

Communication Tools/Vehicles 

A will use a variety of tools that will be employed to describe pandemic influenza, what individuals can 

o, and what VA is doing to prepare, and in the 

updates on VA responses and stat

can be used quickly and widely. M

speed up the process of providing information. Templates can also help ensure consistency of messages. 

• Vanguard magazine (4-8 week lead time needed) 

• Hey VA all-employee daily email/intranet messages 

• Earnings and leave statement messages (2 or longer week lead time needed) 

• VA Internet — National VA site and MyHealtheVet 

• VA Intranet 

• VA Knowledge Network satellite TV system program

service announcements, education programs, including those with audience q

• VA Content Delivery System (i.e., posted video material on demand) 

• Brochures, posters, fact sheets, trifolds (produced centrally

• Organizational channels 

Appendix D-3: REVIEW AND LIST OF COMMUNICATION PRINCIPLES AND ELEMENTS TO USE BEFORE, DURING, 

AND AFTER A PANDEMIC
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 105 

• Management communications channels: VA headquarter program offices and administrations down to 

ions channels at mid-level and local facility levels – newsletters, email, web 

•

•

l, state 

•

and up from regional and local levels via conference calls, meetings, newsletters, email 

• Management communicat

sites 

Cross disciplinary communications channels; e.g., for infection control professionals, occupational 

health, public affairs, prevention managers via conference calls, meetings, newsletters, email 

Education and training programs - in person, by phone, by teleconference, and Web-based 

• Facility level – town hall meetings (hosted by director with involvement of facility and community 

experts and local veterans, media, and community), health fairs, planning meetings, participation in

local meetings of first responder and health organizations communications channels at nationa

and local levels 

• Veteran services organizations at national state, and local levels – newsletters, Web sites, email, 

meetings, gatherings, annual and other regular conferences and events 

News media at national and local levels and print, Web-based, TV, and radio via briefings, public 

service ads and announcements 

• VA Canteen Service – posters, tray liners, etc. 

Appendix D-3: REVIEW AND LIST OF COMMUNICATION PRINCIPLES AND ELEMENTS TO USE BEFORE, DURING, 

AND AFTER A PANDEMIC
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 106 

Appendix D-4: SUGGESTED INVENTORY OF DURABLE AND CONSUMABLE SUPPLIES 

FOR VA HEALTH CARE FACILITIES DURING A PANDEMIC INFLUENZA 

Durable resources 

• Mechanical ventilators 

• Manual resuscitators (bag-valve mask) 

• Beds 

• Stretchers/gurneys 

• IV pumps 

• Positive air purifying respirators (PAPRs) or other equivalent respirators 

Consumable resources (consider stockpiling a 4-week supply) 

• Hand hygiene supplies (antimicrobial soap and alcohol-based [>60%], waterless hand hygiene gels or 

foams) 

• Disposable fit-testable N95 respirators 

• Elastomeric respirators with P100 filters 

• Surgical and procedure-type masks 

• Goggles 

• Gowns 

• Gloves 

• Facial tissues 

s 

nd solutions 

cine administration 

w meters 

, cannulae, masks 

 tubes 

uction and portable suction machines 

• In s

y) 

l and liquid forms 

, 

 seasonal influenza, pneumococcal) 

• Central line kit

• Morgue packs 

• IV equipment a

• Syringes and needles for vac

• Respiratory care equipment 

o portable oxygen 

o regulators and flo

o oxygen and ventilator tubing

o Endotracheal tubes, various sizes 

o Suction kits 

o Tracheotomy

o Vacuum gauges for s

ten ive care unit (ICU) monitoring equipment 

Medications (consider stockpiling a 4-week suppl

• Nonsteroidal anti-inflammatory drugs (NSAIDs), pil

• Acetaminophen (pill, suppository, liquid) 

• Antibiotics (consider ciprofloxacin, levofloxacin po and iv, vancomycin, piperacillin/tazobactam

ceftriaxone) 

• Antivirals (oseltamivir) 

• Vaccines (pandemic and

• Vasopressors 

• Benzodiazepines, propofal 

• Proton pump inhibitors 

• Bronchodilators 

Appendix D-4: SUGGESTED INVENTORY OF DURABLE AND CONSUMABLE SUPPLIES FOR VA HEALTH CARE 

FACILITIES DURING A PANDEMIC INFLUENZA
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group D:Planning Tools 107 

Items to consider including in home care kits 

•

• Thermometers 

• NSAIDs or acetaminophen 

• Cough suppressants 

• Oral re-hydration mix packs 

• Surgical or procedure-type masks for the patient to wear around others and for care providers to wear 

around the patient 

• Printed home care instructions, including VA facility contact information and information about 

symptoms that should prompt the patient to see a health care provider 

Appendix D-4: SUGGESTED INVENTORY OF DURABLE AND CONSUMABLE SUPPLIES FOR VA HEALTH CARE 

FACILITIES DURING A PANDEMIC INFLUENZA
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group E:Response Tools 108 

Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS

Appendix Group E: Response Tools 

Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS 

Following are several grids that list steps in responding to pandemic influenza. These reflect the text in 

Section 3 and provide numbers of subsections (e.g.; 3.1.2 Coordination) for cross reference. 

The grids cover: 

• VA Central Office 

• VHA Facilities 

• VBA 

• NCA 

These grids provide a snapshot of key actions and enable the user to note responsible offices and 

individuals to carry out these steps and keep records of what was done. 
Responding to Pandemic Influenza: 

VA Central Office Action Grid 

Section Response Action Responsible Office Responsible Person Completion 

(Planned

3.1.2 Coordination 

Activate a coordinated response within and outside of VA Consult with VA Pandemic Influenza Advisory Group Put communication principles & plans into action 

3.1.3 VA Central Office Response 

Activate plan 

3.1.4.1 Vigilance and notification 

Be vigilant for “trigger” points throughout the country 

3.1.4.2 Implementation of Emergency Plans 

Activate emergency plans 

3.1.2.3 Limiting Disease Spread 

Emphasize infection control measures such as those from I:DPIO campaign 

Appendix Group E:Response Tools Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS
Responding to Pandemic Influenza: 

VA Central Office Action Grid 

Section Response Action Responsible Office Responsible Person Completion 

(Planned

Encourage use of local public health guidance 

Distribute vaccine and antiviral medications 

3.5.3.1 VA-Wide Communication 

Post the latest information on Web sites Provide regular updates to staff, veterans, other stakeholders by multiple vehicles 

Address rumors and false reports 

Share information with Federal, state, and local partners 

Brief Congress, VSOs, and media Ensure facilities can report important information on operations to stakeholders 

Appendix Group E:Response Tools Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS
Responding to Pandemic Influenza: 

VHA Facility Action Grid 

Section VHA Response Action Responsible 

Office 

Responsible 

Person 

Completion Date 

(Planned) 

3.2.2 Coordination Response 

Collaborate on information, guidance, vaccines, antivirals with VISNs and facilities as well as Federal, state, and local partners 

Act on VA Communications Principles in Appendix 

D-3

3.2.3.1 Surveillance Response 

Implement surveillance plans 

Access & use provisional CDC case definition 

Use recommended diagnostics Use CDC diagnostic and procedure codes for surveillance 

3.2.3.2 Refocusing Patient Care Priorities 

Postpone elective admissions & appointments 

Discharge patients capable of being cared for at home 

Appendix Group E:Response Tools Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS
Responding to Pandemic Influenza: 

VHA Facility Action Grid 

Section VHA Response Action Responsible Responsible Completion Date 

Office Person (Planned) 

3.2.3.3 Infection Control Response 

Implement appropriate infection control measures (e.g., airborne/contact, droplet) Ensure use and availability of PPE Continue to promote and practice respiratory & hand hygiene practices Screen incoming patients for influenza-like illness Implement visitor restriction policies according to criteria 

Use rapid testing for influenza A 

Follow quarantine & other public health measures according to Federal, state, and local agencies 

3.2.3.4 Support and Management of Exposed and Ill Staff 

Initiate surveillance & triage systems Use lab diagnostic systems Utilize lab reporting & disclosure system 

Appendix Group E:Response Tools Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS
Responding to Pandemic Influenza: 

VHA Facility Action Grid 

Section VHA Response Action Responsible Responsible Completion Date 

Office Person (Planned) 

Treat & monitor suspected and/or confirmed infectious staff 

3.2.3.5 Countermeasure Response 

Use antiviral medications 

Administer available vaccine Utilize lab & diagnostic resources 

3.2.3.6 Workforce Response 

Implement staffing plans 

Implement check-in procedures for availability of work and health status Supplement staffing where necessary Allow broadened scope of practice standards 

3.2.3.7 Patient Care Response 

Expect surge of patients 

Execute telephone advice lines 

Appendix Group E:Response Tools Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS
Responding to Pandemic Influenza: 

VHA Facility Action Grid 

Section VHA Response Action Responsible Responsible Completion Date 

Office Person (Planned) 

Employ plan for triage, diagnosis, and isolation of infected patients Expand & use alternative space and sites Employ altered standards of care as needed 

3.2.3.8 Medical Materiel Response 

Activate plans for use of medical materiel 

Assess & track supplies 

Consider use of national supply stockpiles of consumable materiel 

3.2.3.9 Security Response 

Ensure entry to and exit from facilities is limited & secure 

Enforce visitor restrictions 

Ensure security of countermeasures & supplies 

Activate agreements with local law enforcements 

Appendix Group E:Response Tools Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS
Responding to Pandemic Influenza: 

VHA Facility Action Grid 

Section VHA Response Action Responsible Responsible Completion Date 

Office Person (Planned) 

3.2.3.10 Fatality Management Response 

Provide supplies such as PPE to staff 

Use identified refrigeration 

Coordinate mass fatality plans with local and state agencies 

3.2.3.11 Mental Health Response 

Provide increased services 

Locate additional providers as needed Use consultation process 

3.5.3.2 Communications Response 

Produce up to date information on status of operations, how people can protect themselves, what VA is doing Regularly inform stakeholders, including staff, patients, VSOs, and the media 

Use a variety of information vehicles; keep Web site up to date 

Appendix Group E:Response Tools Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS
Responding to Pandemic Influenza: 

VHA Facility Action Grid 

Section VHA Response Action Responsible Responsible Completion Date 

Office Person (Planned) 

Use streamlined information approval process 

Make pre-identified spokespersons/subject matter experts available 

Use templates to convey consistent information and standard distribution lists; keep track of dissemination Stay up to date, address rumors Have on hand up to date contact lists for key staff, public health departments, media Use alternative means to get the word out, such as telephone trees, call-in systems with live or recorded messages Other: Other: 

Appendix Group E:Response Tools Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS
Responding to Pandemic Influenza: 

VBA Action Grid 

Section Response Action Responsible 

Office 

Responsible 

Person 

Completion Date 

(Planned) 

3.3.2 Coordination Response 

Implement Continuity of Operations Plans or other emergency procedures 

Coordinate information and actions within VA and with other agencies 

3.3.3.1 Workforce Response 

Use staffing plans, including flexible work standards, leave policies 

3.3.3.2 Closure of regional offices 

Act on plans, such as rerouting phones, informing veterans and Central office 

3.3.3.3 Infection Control Response 

Provide PPE as needed, as well as hand hygiene and other supplies. Provide information on availability of antivirals and vaccine 

Appendix Group E:Response Tools Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS
Responding to Pandemic Influenza: 

VBA Action Grid 

Section Response Action Responsible Responsible Completion Date 

Office Person (Planned) 

Provide information to employees on the status of the pandemic, and on public health measures, including hand and respiratory hygiene. 

3.3.3.4 Security Response 

Inform on the status of the pandemic and on operations; Train on signs and symptoms of influenza 

Provide PPE, hand hygiene supplies 

3.5.3.3 Communication Response 

Rapidly produce and disseminate updated information 

Update Web sites Disseminate information to stakeholders in and out of VA Hold regular conference calls 

Other: 

Appendix Group E:Response Tools Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS
Responding to Pandemic Influenza: 

NCA Action Grid 

Section Response Action Responsible 

Office 

Responsible 

Person 

Completion Date 

(Planned) 

3.4.2 Coordination Response 

Implement Continuity of Operations Plans or other emergency procedures 

Coordinate information and actions within VA and with other agencies 

3.4.3.1 Workforce Response 

Use staffing plans, including flexible work standards, leave policies 

3.4.3.2 Closure of network offices or cemeteries 

Act on plans, reroute phones as necessary Contact funeral homes, next of kin, notify, reschedule 

3.4.3.3 Infection Control Response 

Provide PPE as needed, as well as hand hygiene and other supplies. Provide information on availability of antivirals and vaccine 

Appendix Group E:Response Tools Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS
Appendix Group E:Response Tools Appendix E-1: VA PANDEMIC RESPONSE ACTION GRIDS

Responding to Pandemic Influenza: 

NCA Action Grid 

Section Response Action Responsible 

Office 

Responsible 

Person 

Completion Date 

(Planned) 

Provide information to employees on the status of the pandemic, and on public health measures, including hand and respiratory hygiene. 

3.5.3.4 Communication Response 

Rapidly produce and disseminate updated information 

Update Web sites Disseminate information to stakeholders in and out of VA Hold regular conference calls 

Other: 
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group E:Response Tools 121 

Appendix E-2: CHART OF PANDEMIC INFLUENZA PRECAUTIONS FOR VA HEALTH 

CARE FACILITY STAFF 

Airborne Infection Isolation and Contact Precautions, in addition to Standard Precautions 

This combination of precautions offers the best protection for health care facility staff, especially at the 

onset of a pandemic before transmission patterns are well understood. 

Hand cleaning Gloves Gowns Eye 

protection 

Respiratory 

protection 

Room 

Airborne 

Infection 

Isolation 

+ 

Contact 

• Between patients 

• Immediately after 

glove removal 

• Whenever hands 

may be 

contaminated by 

secretions/body 

fluids 

• Use an alcoholbased hand rub or 

wash with 

antimicrobial soap 

and water 

• When caring 

for patients 

• When 

touching 

areas/handli

ng items 

contaminate

d by patients

• With 

patient 

contact 

• When 

within 3 

feet of 

patient 

• With 

aerosolgenera-ting 

procedures 

• Use fit-tested N95 

mask OR positive 

air purifying 

respirator (PAPR) 

or fit-tested elastomeric respirator 

Patients 

• Wear masks during 

transport. 

• Use masks with 

elastic straps; 

avoid masks that 

tie on. 

• Negative 

airflow private 

room when 

possible 

• Air exhausted 

outdoors or 

through highefficiency 

filtration. 

• Door kept 

closed. 

Droplet Precautions, in addition to Standard Precautions 

This combination of precautions should be used if droplet transmission appears to be the common mode 

of transmission or when incapable of using Airborne Infection Isolation and Contact Precautions. 

Hand cleaning Gloves Gowns Eye 

protection

Respiratory 

protection 

Room 

Droplet • Between patients 

• Immediately after 

glove removal 

• Whenever hands 

may be 

contaminated by 

secretions /body 

fluids 

• Use an alcoholbased hand rub or 

wash with 

antimicrobial soap 

and water 

• When caring 

for patients 

• When 

touching 

areas/handli

ng items 

contaminate

d by patients

• Not 

required 

• With 

aerosolgenera-ting 

proce-dures

• Wear surgical or 

procedure-type 

masks in patient 

rooms or when 

within 3 feet of 

patients; change 

when moist 

• Wear fit-tested N95 

respirator or 

equivalent with 

aerosol-genera-ting 

procedures 

Patients 

• Wear masks during 

transport. 

• Use masks with 

elastic straps; avoid 

masks that tie on. 

• Private room 

when possible 

• Door may be 

open. 

Appendix E-2: CHART OF PANDEMIC INFLUENZA PRECAUTIONS FOR VA HEALTH CARE FACILITY STAFF
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group E:Response Tools 122 

Appendix E-3: CHART OF PUBLIC HEALTH MEASURES AGAINST PANDEMIC 

INFLUENZA FOR INDIVIDUALS, HEALTH CARE PROVIDERS, AND ORGANIZATIONS 

The measures in the chart below may be important to reduce transmission of pandemic influenza in VA 

facilities and other settings. 

Who Can Act? What Public Health Measures? Why? 

Individuals Cleaning hands regularly. Reduces transfer of microorganisms 

from the hands to the eyes, nose, or 

mouth. Reduces transmission of 

microorganisms carried on hands 

from person to person. 

Following respiratory hygiene rules 

(covering the mouth and nose with tissues 

when coughing or sneezing). 

Prevents dispersal of respiratory 

viruses in the air. 

Getting seasonal influenza vaccinations. Prevents individuals from 

getting/transmitting seasonal 

influenza, which reduces burden on 

health care system, and keeps the 

individual well and able to conduct 

daily business. Reduces likelihood of 

genetic re-assortment of influenza 

strains when a person is infected with 

more than one strain. Helps people 

become accustomed to getting 

vaccinations. 

Avoiding contact with sick persons—

staying at least three to five feet away. 

Reduces likelihood of one’s getting 

and transmitting influenza. 

Staying home when sick—from work, 

school, public places 

Reduces transmission of influenza to 

other persons. 

Wearing masks when sick with influenza, 

if able to tolerate. 

Reduces transmission to others. 

Who Can Act? What Public Health Measures? Why? 

Health care 

providers 

Tracing contacts. Locates and allows potentially 

exposed persons to be informed and 

able to take measures to avoid 

exposing others. 

Isolating people with suspected or 

confirmed influenza. 

Reduces transmission of influenza to 

others. 

Appendix E-3: CHART OF PUBLIC HEALTH MEASURES AGAINST PANDEMIC INFLUENZA FOR INDIVIDUALS, 

HEALTH CARE PROVIDERS, AND ORGANIZATIONS
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group E:Response Tools 123 

Who Can Act? What Public Health Measures? Why? 

Health care 

providers 

(continued)

Quarantining people exposed to influenza. Reduces transmission of influenza to 

other persons. Because the incubation 

period of influenza is about 2 days, 

quarantine time would also be short 

(actual time will be determined by the 

characteristics of the pandemic 

influenza virus). 

Wearing personal protective equipment—

masks or respirators, gowns, gloves, 

goggles. 

Reduces risk of getting influenza and 

potential of transmitting it to others. 

Who Can Act? What Public Health Measures? Why? 

Business, 

community, 

regional, and 

national 

organizations and 

leaders 

Developing, manufacturing, stockpiling, 

and distributing antiviral medications. 

Treats influenza or prevents its 

spread. 

Developing, manufacturing, stockpiling, 

and distributing vaccine. 

Prevents influenza 

Reducing non-essential travel. Reduces the number of persons an 

individual has contact with and slows 

the spread of influenza from region to 

region. 

Closing schools. Children usually have many more 

close contacts than adults; closing 

schools greatly reduces transmission 

of influenza within schools, within 

families, and within communities. 

Declaring “snow days” (temporarily 

closing businesses, offices), postponing 

public gatherings 

Reduces contacts among persons; has 

potential to reduce transmission 

Enabling employees to work from home; 

making teleworking/telecommuting 

possible. 

Reduces contacts among persons; has 

potential to reduce transmission 

Partitioning space. Limiting access to a building or 

facility by screening those who enter 

for fever, respiratory symptoms, and 

possible recent exposure. 
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group E:Response Tools 124 

Appendix E-4: ACTIONS CHECKLIST—FIRST CASE 

If the region’s first case of pandemic influenza comes to this 

VA health care facility (Modify for your facility) 

Actions (these may be done concurrently) Details Assigned to 9

Isolate the patient in negative airflow room on Airborne 

Infection Isolation + Contact Precautions, if possible. 

Record names and address/phone/email of possible case 

contacts within your facility (patients and staff). 

Implement your facility’s emergency plan for pandemic 

influenza. This will likely include the following steps: 

Contact infection control. Name1 at 

(phone; email) 

etc. 

Contact others pertinent to your facility (for example, VAMC 

leadership, emergency manager, safety officer, occupational 

health, clinical laboratory, public affairs etc). 

Name1 at 

(phone; email) 

etc. 

Contact local public health per your plan to: 

• Review epidemiology. 

• Plan diagnostic testing: specimens, handling, transport. 

• Review patient care strategies, including use of antivirals. 

• Review your VA facility’s responsibilities in public health 

measures likely to be used (vaccine, quarantine, contact 

tracing, etc). 

Name1 at 

(phone; email) 

etc. 

Contact VISN leadership per your plan. Name1 at 

(phone; email) 

etc. 

Assemble team per plan to prepare for surge of patients. 

Consider: 

• Space availability (triage space, negative airflow or 

isolation rooms; cohorting areas) 

• Staffing 

• Critical supplies 

Appendix E-4: ACTIONS CHECKLIST—FIRST CASE
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group E:Response Tools 125 

Actions (these may be done concurrently) Details Assigned to 9

Coordinate with leadership and public affairs to communicate 

with staff, patients, media, community at large. 

Update, download, print, and distribute instructions, 

educational materials, and signage for patients and staff 

(screening on entry, hand and respiratory hygiene, home care, 

self-triage, what is pandemic influenza?) available on Web 

from VA (www.publichealth.va.gov/infectiondontpassiton ), 

and from Federal government at www.pandemicflu.gov 

Appendix E-4: ACTIONS CHECKLIST—FIRST CASE
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group E:Response Tools 126 

Appendix E-5: SAMPLE SELF-TRIAGE ALGORITHM 

FOR PERSONS WITH INFLUENZA SYMPTOMS 

You may have influenza (flu). 

When should you seek additional help from a health care provider? 

The symptoms of influenza are: 

• Fever—low (99 F) to high (104 F), usually for 3 days, but may persist for 4 to 8 days. Sometimes fever 

will go away and return a day later. 

• Aching muscles 

• Cough 

• Headache 

• Joint aches 

• Eye pain 

• Feeling very cold or having shaking chills 

• Feeling very tired 

• Sore throat 

• Runny or stuffy nose 

If you have some of these symptoms: 

Stay home 

o Rest 

o Drink fluids 

Take fever re

fluids 

o ducers (acetaminophen or ibuprofen) 

 

 

But IF you Or IF you 

 

• Are unable to drink enough fluids 

(urine becomes dark; you may feel 

dizzy when standing) 

• Have the fever for more than 3 to 5 

days 

• Feel better, then develop a fever 

again 

• Become short of breath or you develop wheezing 

• Cough up blood 

• Have pain in your chest with breathing 

• Have heart disease (like angina or congestive heart failure) 

and you develop chest pain 

• Become unable to walk or sit up, or function normally 

(others might be the ones to notice this—especially in 

elderly persons) 

 

CALL your health care provider GO RIGHT AWAY for health care 

Appendix E-5: SAMPLE SELF-TRIAGE ALGORITHM
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group E:Response Tools 127 

Appendix E-6: HOME CARE GUIDE FOR INFLUENZA, Symptom and care log, Infection 

control measures for the home 

A person with influenza will often become ill very suddenly. Fever and the worst symptoms often last 

three days, but sometimes last as many as eight days. The person may feel weak, tired, or less energetic 

than normal for weeks afterward, and may have a long-lasting hacking cough. 

Common symptoms: 

• Fever—low (99 F) to high (104 F), usually for 3 days, but may persist for 4 to 8 days. Sometimes fever 

will go away and return a day later. 

• Extreme fatigue 

• Muscle and body aches 

• Feeling very cold or having shaking chills 

• Joint aches 

• Headache (may be severe) 

• Eye pain 

• Sore throat 

• Stuffed nose or runny nose 

• Dry cough initially, may become a deep, hacking, and painful cough over the course of several days 

• No appetite for food or desire to drink fluids 

Supplies to have on hand: 

• Thermometer 

• Acetaminophen or ibuprofen 

 soda, tea 

e 

aring for a person with influenza: 

ent rest in bed. 

e the amount of bed covers needed; when fever is high the person 

mes) or ibuprofen (Advil, Motrin, or other brand 

• Fluids replace body fluids that are lost as a result of fever. 

e light foods as the person wants; fluids are more important than food especially in the first 

hen to seek additional medical advice: 

• Cough suppressants/cough syrup 

• Drinks—fruit juices, sports drinks,

• Light foods—clear soups, crackers, applesauc

• Blankets; warm covers 

C

• Comfort measures 

o Have the pati

o Allow the sick person to judg

may feel very cold and want several blankets. 

o Give acetaminophen (Tylenol or other brand na

names) according to the package label or a health care provider’s direction to reduce fever, 

headache, and muscle, joint or eye pain. 

—give frequently, extremely important to

• Feeding 

o Giv

days when the fever may be highest. 

W

g rapidly at rest 

s difficult (in a person who was able to walk before the 

• If the person is short of breath or breathin

• If the person’s skin is dusky or bluish in color 

• If the person is disoriented (“out of it”) 

• If the person is so dizzy or weak that standing i

illness) 

• If the person has not urinated in 12 or more hours 

Appendix E-6: HOME CARE GUIDE FOR INFLUENZA, Symptom and care log, Infection control measures for the home
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group E:Response Tools 128 

Symptom and Care Log for Home Care 

(Copy, fill out, and bring log sheets to health care provider visits) 

Name of patient__________________ Name of health care provider___________________ 

Date Time Observations* Temperature Medications 

 

 

 

 

 

 

 

 

*How the person looks; what the person is doing; fluids or foods taken since the last observation 

Appendix E-6: HOME CARE GUIDE FOR INFLUENZA, Symptom and care log, Infection control measures for the home
 VA Pandemic Influenza Plan 

March 2006 

Appendix Group E:Response Tools 129 

Infection control m

• Persons who have not been exposed to pandemic influenza and who are not essential for the sick 

Sick persons should be separated from other household members as much as possible. Consider 

designating o

• hold rs should b evelopme symptoms

Consult with health care providers to determine whether a pandemic influenza vaccine (if available) or 

preventive antiviral medications should be considered. 

• The sick person should follow respiratory hygiene/cough etiquette—cover the mouth and nose when 

coughing and sneezing. 

• Care providers should wash their hands with soap and water, or use alcohol based hand cleaners, before 

and after attending to sick persons. 

• Care providers may wear surgical or procedure-type masks during interactions with the sick person if 

masks are available. 

• The sick person may wear a surgical or procedure-type mask when others are around if masks are 

available and the sick person can tolerate wearing it. 

Sick persons should not leave the home unless they must seek additional m care during the period 

when they are most likely to be infectious to others, which is when they have a fever or for about 5 days 

after they first became ill. 

• If the sick person must leave the household to see a health care provider, attempt to contact a health care 

provider phone or email so that appropriate advice can be given and isol tion arrangements can be 

made at the health care site. When movement outside the home is necessar d follow 

respiratory hygiene/cough etiquette and should wear a mask if available and can be tolerated. 

• Tissues used by the ill patient should be placed in a bag and disposed with other household waste. 

• Eating utensils should be washed in a dishwasher or by hand with soap and warm water; other 

separation or sterilization is not necessary. 

• Laundry may be washed in a standard washing machine with warm or cold water and detergent. It is not 

necessary to separate soiled linen and laundry used by a patient with influenza from other household 

laundry. Care should be used when handling soiled laundry (i.e., avoid “hugging” the laundry) to avoid 

self-contamination. Wash hands after handling soiled laundry. 

Surfaces in the home ould be cleaned using regular household cleaning sprays or solutions. 

easures for the home to prevent spreading of infection 

person’s care or support should not enter the home – especially while the sick person still has a fever. 

• If unexposed persons must enter the home, they should avoid close contact with the patient. 

•

ne person as the prim

membe

ary care provider. 

House e vigilant for the d nt of influenza in themselves.

• edical

by a

y the patient shoul

• sh

Appendix E-6: HOME CARE GUIDE FOR INFLUENZA, Symptom and care log, Infection control measures for the home
 VA Pandemic Influenza Plan 

March 2006 

130 

• The VA Pandemic Influenza Plan and related materials will be posted at 

http://www.va.gov and http://www.publichealth.va.gov/flu/

Leads for the development and dissemination of this plan, as well as resulting material, are: 

Victoria Davey, RN, MPH 

Deputy Chief Consultant, Public Health Strategic Health Care Group 

victoria.davey@va.gov - (202) 273-8590 

Connie Raab, BA 

Director, Public Health Communications 

connie.raab@va.gov - (202) 273-6368 

Troy Knighton, EdS, LPC 

Senior Project Manager/Director, Training and Education 

troy.knighton@va.gov - (202) 273-8382 

Public Health Strategic Health Care Group 

VA Pandemic Influenza Advisory Group 

c/o Office of Public Health and Environmental Hazards (13) 

Veterans Health Administration 

Department of Veterans Affairs 

Washington, DC 20420 

(202) 273-8567 

March 2006

Office of Public Health and Environmental Hazards (13) 

Veterans Health Administration, Department of Veterans Affairs