36C24419R0074-034.pdf

DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER

Erie, Pennsylvania

Medical Center Memorandum No. 00Q-400 November 22, 2016

EMERGENCY OPERATIONS PLAN

I. PURPOSE: The purpose of this Emergency Operations Plan (EOP) is to describe how the VAMC will respond to emergency threats or events. It provides an all-hazards approach to emergency management with the goal of protecting the life and safety of all patients, employees and visitors to the medical center; and, to provide viable and executable contingency plans for the Continuity of Operations (COOP). COOP planning facilitates the performance of medical center essential functions during any emergency or situation that may disrupt normal operations. The EOP will address policy requirements, assumptions and processes for a VAMC-wide response using the Hospital Incident

Command System (HICS) and Standard Operating Procedures (SOPs). Refer to

Attachments A-H.

II. POLICY:

A. Executive Summary: Presidential Decision Directive (PDD) 67 requires each federal department and agency to develop and maintain a Continuity of

Operations (COOP) Plan. The focus is to ensure that the respective department or agency can continue emergency essential functions, and resume normal operations as quickly as possible, in the event of a natural or man-made disaster or other event that would impact operational capability and capacity.

B. Emergency Operations Plan (EOP). Using an all-hazards approach, this VA

Medical Center (VAMC) has developed an Emergency Operations Plan (EOP) that is consistent with planning guidance furnished by PDD 67, Federal

Preparedness Circular (FPC) 65, Veterans Health Administration (VHA) Central

Office (CO) and VHA Veterans Integrated System Networks (VISNs). This Plan also complies with the Joint Commission Emergency Management Standards under the Environment of Care by coordinating and managing six critical areas:

1. Communications

2. Resources and Assets

3. Safety and Security

4. Staff Responsibilities

MCM 00Q-400, Emergency Operations Plan

5. Utility Management

6. Patient Clinical and Support Activities

C. When to use the EOP. The EOP is to be used for any hazard or threat to this

VAMC, external emergencies, and any community emergency event in which the

VAMC may be asked to assist. The EOP is structured to comply with the

National Incident Management System (NIMS), through the use of the Hospital

Incident Command System (HICS) and implementation of incident-specific

Standard Operating Procedures (SOPs).

D. Exercises and Continual Improvement. As with all emergency plans, it is hoped that it will never be used. As a result, this plan can be used to train VAMC employees, conduct exercises and provide a basis for continual update and improvement.

E. Scope and Applicability:

1. VA’s Role in the Community: As a Federal entity, the Erie VAMC is not a signatory to the current Hospital Mutual Aid Memorandum of

Understanding developed by the North West PA Regional Counter

Terrorism Task Force, Group II due to existing obligations under the

Stafford Act, the National Disaster Medical System (NDMS), and the obligation to assist the Department of Defense (DoD) during a time of war or national emergency. However, this scenario will assuredly result in a

Presidential declaration of a disaster or emergency, and the Erie VAMC will be involved in the community-wide response efforts as permitted by law:

2. The primary source of VA’s authority to respond to disasters and emergencies is the Robert T. Stafford Disaster Relief and Emergency

Assistance Act (the Stafford Act). The Stafford Act is only initiated by a

Presidential declaration, and authorizes the President to direct Federal agencies to use its authorities and resources in support of State and local efforts (personnel, equipment, medicine, food, supplies, facilities, and managerial, technical, and advisory services). Under the Stafford Act, Federal agencies provide this assistance to State and local governments through the Federal Emergency Management Agency (FEMA), and the

National Response Plan Emergency Support Functions (ESF’s). The VA has a support role in four of the fifteen ESF’s:

a. ESF #3, Public Works and Engineering (Primary Agency – DoD and Army Corps of Engineers)

b. ESF #6, Mass Care (Primary Agency – American Red Cross)

c. ESF #7, Resource Support (Primary Agency – General Services

Administration)

d. ESF #8, Health and Medical Services (Primary Agency – Health and Human Services)

3. The National Disaster Medical System (NDMS). NDMS is an integral part of ESF #8 of the National Response Plan. NDMS is an asset sharing partnership among the Dept. of Health and Human Services (HHS), DoD, VA, and FEMA. The NDMS system may be activated during a declared emergency by the President, when military patient levels exceed or are expected to exceed the capability of the DoD and VA medical systems, or when the HHS Assistant Secretary of Public Health Emergency

Preparedness activates the system at the request of a State Health Officer.

Activation of the NDMS may take place separately or in conjunction with activation of some or all of the ESF’s of the National Response Plan.

4. Finally, 38 U.S.C. 1785(a) states that during and immediately following a declared disaster or emergency under the Stafford Act, or following activation of the NDMS, the VA Secretary “may furnish hospital care and medical services to individuals responding to, involved in, or otherwise affected by that disaster or emergency.” This suggests that once the

President has declared a disaster or emergency, or once the NDMS is activated, the VA has discretionary authority to provide hospital care and medical services to individuals affected by the event regardless of whether the care is provided as a tasking under the Stafford Act, or through the auspices of the NDMS. The statute also authorizes VA to provide care and services to Veterans regardless of whether the Veteran is enrolled under 38 U.S.C 1705.

F. This EOP applies to all VAMC employees. The Community Based Outpatient

Clinics (CBOC), Home Telehealth (HT), and Home Based Primary Care (HBPC) programs will maintain separate EOPs (including annual Hazard Vulnerability

Analyses) that integrate into this plan and address the potential adverse impacts from events occurring in their off-site service areas. This EOP complies with

FPC 65 and the Joint Commission requirements and Commission on

Accreditation of Rehabilitation Facilities (CARF), as well as VHA policies and federal regulations; and implements the VAMC strategy for responding to all emergency events. It is designed to initiate a response to protect the well-being of patients, residents, employees, and all other occupants within the VAMC, protect the physical infrastructure and allow for business continuity to the fullest extent possible.

1. In the event of an emergency or a situation that overwhelms the ability of the facility to respond or maintain normal operations, as in a disaster, the

VAMC will implement the EOP to make certain the necessary services are provided to ensure a safe environment for all patients, employees and visitors. As required, the VAMC will work as closely with the community as possible to ensure effective interaction during response and recovery.

This EOP and all SOPs developed as a result of the Hazard Vulnerability

Analysis (HVA), define the preparedness, response and recovery efforts necessary to minimize the potential adverse impact from all threats and events, and provide a flexible and effective response. The objectives of the EOP are:

a. Provide a scalable approach to manage the event, including the following six critical areas, regardless of the cause(s):

1. Communications

2. Resources and Assets

3. Safety and Security

4. Staff Responsibilities

5. Utility Management

6. Patient Clinical and Support Activities

b. Preventing and/or reducing loss of life and serious injury.

c. Protecting essential facilities, equipment, records and other assets.

d. Ensuring the continuous performance of VAMC essential functions/operations during an emergency.

e. This VAMC is required to provide healthcare services 24/7; and, as such, will not, in most scenarios, relocate to alternate facilities.

However, alternate care sites are in place for movement of patients to another healthcare facility, in the unlikely event evacuation becomes necessary.

f. Executing, as required, succession to office with accompanying authorities in the event a disruption renders agency leadership unable, unavailable or incapable of assuming and performing their authorities and responsibilities of offices.

g. Reducing or mitigating disruption to VAMC operations; and, achieving a timely and orderly recovery from an emergency and resumption of full services.

h. Ensuring and validating readiness through a dynamic, integrated test, training, and exercise program.

2. This EOP ensures the VAMC is capable of:

a. Being maintained at a high level of readiness and being implemented both with and without warning.

b. Scheduling regular testing, training and exercising of personnel, equipment, systems and procedures used to support the VAMC during a COOP event.

c. Including the development, maintenance and annual review of facility COOP capabilities using a multi-year strategy and program management plan.

3. When activated, this EOP will provide for continued performance of essential VAMC functions under all circumstances. It also:

a. Defines a decision process for determining appropriate actions in implementing COOP plans and procedures.

b. Establishes a roster of fully equipped and trained personnel with the authority to perform essential functions and activities.

c. Provides a system for employee advisories, alerts and COOP activation plans with instructions for response with and without warning, during regular duty and non-duty hours.

d. Provides for personnel accountability throughout the duration of the emergency.

e. Establishes reliable policies, processes and procedures to acquire resources necessary to continue essential functions and sustain operations.

G. Essential Functions: This VAMC provides quality healthcare services to all of our eligible Veterans through inpatient and outpatient services in the areas of

General Medicine, Surgery, Extended Care/Nursing Home Care, Behavioral

Health, Physical/Occupational Therapy and Rehabilitation, Radiology, Pharmacy, Laboratory, Dental, etc.

The Emergency Management Task Force (EMTF) performs a Hazard

Vulnerability Analysis (HVA) on an annual basis to determine the types and impact of emergencies that this VAMC may face, and has developed Standard

Operating Procedures to address all high risk emergencies. These emergencies may be internal or external. Internal emergencies may include a fire or a utility failure, etc. During external emergencies (such as a chemical spill in the community), this VAMC may be requested to assist in the initial evaluation and treatment of victims, or to provide supplies or equipment should community resources be unavailable or overwhelmed.

Internal and external emergencies may also be summarized in three categories:

1. Naturally Occurring (such as flood, hurricane or winter storm)

2. Technological (such as cyber attack, power or other utility failure)

3. Human Related (such as terrorist event, employee/workplace violence or a bomb threat)

4. Any event that overwhelms the facility’s resources and/or ability to maintain operations.

The plan is a guide, and it is always expected that those employees who face an emergency will use good judgment.

H. Concept of Operations: If a warning or notification is received that a situation threatens to disrupt continuity of patient care, and/or poses a risk to patients, visitors and staff, the VAMC Director/designee with primary responsibility and key managers (Service Chiefs/Program Officers/Managers) will take appropriate action(s) to protect patients, visitors employees, resources and property based upon the threat.

The Hospital Incident Command System (HICS) will be used to plan, organize, staff, direct and control emergency situations. An HICS organization unfolds in a modular fashion upon the kind and size of an incident. The organization’s staff builds from the top down with responsibility and performance placed initially with the Incident Commander (IC). As the need exists, four separate sections

(Operations, Planning, Logistics and Finance) can be developed, each with several units that can be established, as required. The specific organization structure established for any given incident will be based upon the management needs of the incident. If one individual can simultaneously manage all major functional areas, no further organization is required. If one or more areas require independent management, an individual is named to be responsible for that area.

1. Decision Process. This EOP clearly describes the process of plan activation and the decision making process.

2. Alert, Notification and Implementation Process. Whenever an emergency event or threat occurs that may require response, the IC or designee will acquire information as to the type event and potential impact to the

VAMC. If the IC decides the emergency event will or may have an adverse impact to the VAMC, he or she will activate the EOP, which will require the following: (Note: See Attachment C for a simplified EOP

Activation Flow Chart.)

a. Implement the Mobilization Checklist (see Attachment D): This checklist provides a framework to initiate assessment, planning and emergency response based on current information available.

b. Activate the Hospital Command Center (HCC): The IC or designee will notify the telephone operator to have all supervisors/managers report to the HCC (7th floor Executive

Suite). The switchboard will make notification through the public address system and telephone system. (Alternate procedure:

Instruct VA Police to use the “all call” feature of the fire alarm system).

c. Assess Incident Information and Evaluate: Depending upon the emergency, e.g., warning or real time event, the IC will determine the level of response based on:

1. Type of event and direct impact to the VAMC based on information received from affected internal areas and/or agencies from outside the VAMC.

2. Event magnitude - internally and externally:

Number Injured: _________________________________

Patient Census/Occupancy: _________________________

Essential Resources: ______________________________

Alternate Care Sites: ______________________________

Estimated likely duration: __________________________

3. Determine potential secondary adverse events and impacts:

d. Activate the HICS and Use Appropriate SOPs: Determine which

HICS units are needed (see Attachment D, VAMC HICS Chart) and which SOPs to use.

e. HICS Activities. (Refer to the HICS Position Job Action Sheets)

f. Situation Status. Maintain current information of the emergency event. Coordination with VA and outside agencies. (See

Attachment F, Local/State/Federal Agency Contact Numbers)

g. Additional functions and considerations:

1. Address staff/family support

2. Initiate hazard reduction strategies and resource issues

3. Conduct pre-event planning

4. Conduct training, if applicable

5. Evaluate response actions and act accordingly

6. Initiate recovery actions when warranted

7. Complete Situation Reports (SITREPS)

8. Conduct critique of response actions and make changes as necessary

h. General Do’s and Don’ts:

1. If there is obvious building damage, move patients, employees and visitors to a safe area

2. Use telephones only for emergency calls where a life-threatening situation exists and for damage and fatality reports

3. Ensure that all phones are correctly on the hook, so that they will not indicate a busy signal to incoming calls

4. Follow instructions as listed above

i. Reporting:

1. During any emergency event, communication is a major activity. Emergency communications will be by telephone/cell phone, walkie-talkie, or runner. If the telephone system is inoperable, the staff should contact VA

Police by any means possible and request assistance.

2. The employee discovering the emergency will usually make first notification of an internal emergency. Fire notification can be through pulling the fire alarm box. Any emergency can be reported by dialing the emergency number (911). Know the location and number for the building being reported.

3. During the early stages of an emergency, information about the event may be limited. If the emergency is internal, it is important to communicate with the other staff as soon as possible.

4. If the internal emergency is other than a fire, the person in charge (Incident Commander) will determine if assistance from outside agencies is necessary. Notify VA Police or the facility operator via the emergency number (911).

5. Medical Treatment: Though unlikely, this VAMC may be called upon to provide initial medical support as part of the community emergency response program.

6. Damage Assessment: VAMC Facilities Management

Services will perform damage assessment, and notify the

IC if the buildings are suitable to maintain normal operations.

7. Evacuation: The purpose of this section is to describe how evacuation from the facility should take place. It outlines priorities for evacuation, and sets out in concept how the evacuation should take place. Each situation is different, and the individuals responsible for the evacuation need to consider the actual event and act accordingly.

j. The decision to evacuate is not an easy one. All available staff members and other able-bodied persons should do everything possible at the location of the emergency to assist emergency personnel in the movement of patients to a safe area/facility for care, and the removal of employees and visitors to a point of safety.

k. Exact evacuation procedures to be followed will be dictated by the nature of disaster and the extent of damage to VAMC buildings.

l. Orders for evacuation will be given by the IC or designee. When evacuating, always consider moving horizontally past the fire/smoke doors first, then vertically down, if necessary.

m. Close all doors and windows.

n. Turn off all unnecessary electrical equipment, but leave the lights on.

o. Evacuate the area/building.

p. Public Information: During an emergency event, the need to disseminate accurate information to the public is essential. All information to be disseminated will be by the Public Affairs

Specialist only. Accurate public information is necessary to keep people informed on what has happened and may/will happen. The information should address misinformation, and provide information to assist the public in their planning.

q. Critical Incident Stress Management: The purpose of this section is to describe a temporary stress management program that may be activated to assist victims and staff during the response phase of an emergency. This section will describe the mission, leadership, when the activity is activated, location, initial staffing and supplies and equipment needed to activate the area.

r. Stress is a normal response to an abnormal situation. During the response phase of an emergency, patients and staff may require psychological support.

s. Long-term support may be provided by internal staff or through the employee assistance contract provider:

1. Levels of stress response/management to be part of this program include: acute disorders, stress intervention, stress debriefing and slowly evolving disorders.

2. Critical incident stress management is designed to provide short-term intervention and support during the response phase of an emergency and for employees during the recovery phase of the emergency. This will be accomplished through intervention and individual and group debriefing sessions.

3. Critical incident stress management resources will be provided to assist staff as deemed appropriate, or if the staff member requests assistance.

t. Family Support Needs of Staff. The Facility does not currently have the capability to provide adequate support of the family needs of the staff. Employees must make prior arrangements to provide for child care, elderly care and pet care during the duration of any emergency situation. The facility will provide assistance in staff family communication during periods when normal communication systems are inoperable.

u. Administration and Implementation: The administration and implementation of the EOP and training on its policies and procedures shall be the responsibility of the VAMC Emergency

Management Task Force (EMTF). The effectiveness of the administration of this plan shall be evaluated through plan implementation during actual emergencies or exercises, and annually, as part of the Environment of Care Annual Effectiveness

Review required by Joint Commission. All employees at the

VAMC receive training on the EOP and their roles commensurate with their responsibilities.

v. Reports: The reporting process is contained in Medical Center

Memorandum 00-21, Crisis Communications Plan.

w. Information Collection and Evaluation System: Drills are conducted at least semi-annually. Critiques of drills and actual emergencies are reviewed, and the information gained from them is used to develop and improve the EOP. Documentation of drills is forwarded to the VAMC Emergency Management Coordinator.

If you have any questions or need additional assistance with the information contained in the EOP, please contact the Emergency

Management Coordinator at (814) 860-2204.

x. Leadership.

1. Order of Succession. The order of succession procedures for this VAMC are as follows: The Medical Center

Director, if on site, will assume the role of Incident

Commander. The Associate Director will assume full responsibility for operation of VAMC upon the absence of the Director. Further successors are identified in the order in which they will assume command when the previous person on the list of successors is unavailable during an emergency. Each successor will be relieved of their temporary responsibilities when either the emergency ends or the next higher successor is available to assume command. The Emergency Management Coordinator is responsible to train potential successors for these emergency duties and to maintain documentation of training. The successors are listed in the chart below.

VAMC Order of Succession

Medical Center Director (Incident Commander)

Associate Director

Associate Director, Patient Care Services

Chief of Staff

Chief, Facility Management Services

2. Delegation of Authority for this EOP:

a. Identifies the programs and administrative authorities needed for effective operations at this

VAMC during an emergency.

b. Documents the necessary authorities at all points where emergency actions may be required.

c. Ensures that officials who may be expected to assume authorities in an emergency are trained to carry out their emergency duties.

3. Vital Files, Records and Databases. Each Program

Leader/Officer/Manager maintains their vital records and provides for their security. Commonly shared information is maintained by the OI&T Supervisor with appropriate checks and security.

y. Critiques: All activations of the EOP will be critiqued by a multidisciplinary group to identify strengths, weaknesses, opportunities for improvement, and needed modifications to the

EOP and/or associated SOPs.

III. RESPONSIBILITY: Listed below are the key personnel and their responsibilities in the

VAMC EOP:

A. Medical Center Director or Designee is responsible for carrying out the duties of the Incident Commander (IC). He/she is responsible for all VAMC response/recovery actions and for coordination with VA and external public officials.

B. Emergency Management Coordinator (EMC) is responsible for carrying out the duties of Planning Section Chief and/or Liaison Officer. He/she ensures that the

EOP is current, assists the IC with internal and external coordination.

C. Chief of Staff is responsible for carrying out the duties of the Medical Care Brach

Director and/or Operations Section Chief for incidents involving significant medical/health issues. He/she is responsible for ensuring proper medical, health, and treatment care services are provided.

D. Associate Director is responsible for carrying out the duties of Deputy Incident

Commander or Operations Section Chief for incidents that do not include significant medical/health issues.

E. Safety Officer is responsible for carrying out the duties of the incident Safety

Officer. He/she monitors and initiates actions to ensure safe actions are taken during the emergency event.

F. Public Affairs Specialist is responsible for carrying out the duties of the Public

Information Officer. He/she will act as the point of contact for the media that may request information concerning the incident and its impact upon patients, staff, and facility.

G. Chief, VA Police is responsible for carrying out the duties of the Safety/Security

Branch Director. He/she ensures that lockdown and security procedures; traffic and crowd control; crime scene and investigation; and perimeter control are implemented.

H. Chief, Facilities Management Services is responsible for carrying out the duties of the Infrastructure Branch Director. He/she is responsible for protecting, repairing and maintaining plant utility systems, communications and medical equipment necessary for patient care and VAMC operation.

I. Chief, Logistics is responsible for carrying out the duties of the Logistics Section

Chief. He/she coordinates the logistical function as it relates to providing facilities, transportation, supplies, equipment, services, etc.

J. Chief, Fiscal is responsible for carrying out the duties of the Finance Section

Chief. He/she coordinates funding and tracking expenses that relate to VAMC response to the emergency event.

K. ALL VAMC Staff:

1. Maintain normal operating procedures to the best of their ability.

2. Notify VA Police or facility switchboard operator of any disturbance or emergency (i.e. fire, bomb threat, external community disaster, etc.) that may affect the VAMC.

3. Immediately check for injuries among staff and offer assistance, as practical. Seriously injured persons should not be moved unless they are in danger of further injury.

4. In the event of fatalities, area staff should cover the bodies and report to their supervisor as soon as possible.

5. Secure/protect records and other official files.

6. Ensure forwarded communications.

7. Shall:

a. Be trained on the overall VAMC EOP and procedures for their assigned area.

b. Be familiar with basic fire, Hazardous Materials (HAZMAT) and other emergency responses. Where possible, staff should act to protect the life and safety of visitors and fellow employees.

c. Participate in VAMC training and exercises. These exercises are intended to practice emergency response activities and improve readiness.

d. Make suggestions during the planning phase to the Emergency

Management Coordinator, or their supervisor, on how to improve the planning response activities.

e. Participate in emergency response activities as directed by VAMC leadership.

f. Participate in orientation and education, as required.

IV. PROCEDURES:

A. Logistics:

1. Alternate Location. This VAMC is a medical hospital, providing medical services on a continuous basis (24/7); as such, services will not relocate to an alternate facility during an emergency. However, should conditions warrant evacuation, patients will be moved to a proximal VA facility or community facility for continued care in compliance with alternate care sites plans and procedures.

2. Interoperable Communications. VAMC maintains communications within the facility by cell phone, pagers, hand-held walkie-talkies, and runners. Interoperable communications are available through e-mail, Government Emergency Telephone System (GETS) cards, the 800 MHz radios, Iridium Enhanced Mobile Satellite System (EMSS) satellite phone, and amateur radios, including the two meter VHF and resilient HF radios located in the Office of Performance and Quality.

B. Exercises: Exercises are conducted at least semi-annually by the VAMC. The

VAMC will participate in community-wide exercises when/if scheduled. Records and critiques of the exercises are maintained by the Emergency Management

Coordinator.

C. EOP Maintenance: This VAMC EMP will be evaluated at least annually and updated as needed. There shall be training opportunities provided to all staff regarding emergency management, including elements of the plan.

VI. REFERENCES:

A. Department of Veterans Affairs, Emergency Management Program Guidebook, (http://vaww.ceosh.med.va.gov/01HP/Pages/guidebooks.shtml), (current edition)

B. California Emergency Medical Services Authority, Hospital Incident Command

System (http://www.emsa.ca.gov/), (current edition)

C. The Joint Commission Comprehensive Accreditation Manual for Hospitals, Nursing Care Centers, Home Care, Behavioral Health, and Laboratory & Point-of-Care Testing, (current editions)

D. CBOC Standard Operating Procedure, Emergency Operations Plan, (current edition)

E. HBPC Standard Operating Procedure, Emergency Operations Plan, (current edition)

F. Commission on Accreditation of Rehabilitation Facilities (CARF) Standards

Manuals for Employment and Community Services, and Behavioral Health

(current editions)

VII. FOLLOW UP RESPONSIBILITY: Medical Center Director, Office of Performance and Quality. Annual Review by the Environment of Care Committee.

VIII. REPORTING REQUIREMENTS: All activations of the EOP must be reported to the

VISN. A written critique will be prepared at an ad-hoc meeting following each activation of the Emergency Management Plan. A copy of this report, with recommendations for improvement, will be sent to the Medical Center Director for review and action.

Approved recommendations will be tracked by the EMTF and Environment of Care

Committee.

IX. RESCISSION: MCM 00Q-400, Emergency Operations Plan, dated July 10, 2013

(Note: See Attachment I for revisions made to this MCM).

(Original Signed 11/22/16)

John A. Gennaro

Medical Center Director http://vaww.ceosh.med.va.gov/01HP/Pages/guidebooks.shtml http://www.emsa.ca.gov/

Attachments: A. Hazard Vulnerability Analysis

• Naturally Occurring Events

• Technological Events

• Human Related Events

B. CBOC, Home Telehealth and Home Based Primary Care Hazard

Vulnerability Analysis Charts

C. EOP Activation Flow Chart

D. Mobilization Checklist

E. Hospital Incident Command System (HICS) Organizational Chart

F. Local/State/Federal Agency Contact Numbers

G. Erie VAMC Continuity of Operations Plan/Standard Operating Procedures

(SOPs)

H. Report Forms/Job Action Sheets and HICS Forms & Instructions

I. EOC MCM Revision History

ATTACHMENT A

Charts below are current as of the date of the signing of this MCM.

Please contact the Emergency Manager at X2204 for current year charts.

VAMC HVA EVENT/SCORE CHARTS (June 2016)

NATURALLY OCCURRING EVENTS

(Any shaded scoring cells indicate a change from previous year)

TECHNOLOGICAL EVENTS

HUMAN RELATED EVENTS

ATTACHMENT B

CBOC HAZARD VULNERABILITY ANALYSIS CHARTS

Ashtabula CBOC HVA 2016.xlsx

Crawford CBOC HVA

McKean CBOC HVA

Venango CBOC HVA

Warren CBOCs HVA

HOME TELEHEALTH VULNERABILITY ANALYSIS CHARTS

Home Telehealth

HOME BASED PRIMARY CARE VULNERABILITY ANALYSIS CHARTS

HBPC 2016.xlsx

ATTACHMENT C

EMERGENCY OPERATIONS PLAN (EOP) ACTIVATION FLOW CHART

Gather key staff to evaluate threat/event to determine if facility will be adversely impacted.

If yes, activate EOP.

Develop Immediate Operational

Period Actions

Communicate Incident Information: Type of

Threat/Event, Magnitude, Duration, Secondary

Effects, and Actions for Immediate Operational

Period.etc.

Notify VISN of EOP Activation.

Notify Other External Agencies as Needed.

Access and Distribute the Appropriate EOP

Sections (SOP, Job Action Sheets, Report Forms, Identification Vests, radios, etc.)

Schedule Follow Up Meeting

Begin Action Planning for next Operational

Period.

Director or Designee becomes aware of threat or event

Contact VA Police (911) and have them announce all Supervisors/Managers are to report to the 7th floor Exec Suite using the Fire Alarm All Call function

Implement the Mobilization Checklist

All Managers & Supervisors Report to the

Hospital Command Center (Executive Suite)

ATTACHMENT D

MOBILIZATION CHECKLIST

Description

The purpose of this checklist is to guide the decision to activate the Emergency Operations Plan

(EOP); thus, mobilizing the organization, as well as to structure the deactivation or demobilization process.

1. Pre-event planning should include:

• Designating an area that is dedicated to, or can be converted for use as a Hospital

Command Center (HCC), complete with communications and office support equipment (see below)

• Training Key Staff on their roles and responsibilities in the EOP and how to participate as functioning members of the HCC

2. Response and Recovery Strategies.

Situation Assessment: Based upon the information received, the IC will perform an assessment of the situation taking into consideration the following factors:

• What? (Incident Characteristics)

➢ Type of Primary Event (Direct Impact) – Use appropriate SOPs

➢ Magnitude

➢ Expected Duration

➢ Likely Secondary Events (Indirect Impacts)

• When? (Incident Timing).

➢ Warning Period? Length?

➢ Time of Day: Morning - Afternoon - Evening

➢ Day of Week: Weekday - Weekend

➢ Season of the Year

➢ Weather Conditions: Past, Present and Future

• Where is it now, and Where is it going?

➢ Location and scope

➢ What could be impacted?

• What resources might be needed?

Initial Response Actions: The IC will conduct an initial action planning meeting and continue throughout the duration of the event:

• Establish emergency policies

• Set initial shift or operational period

• Establish objectives for that shift (should be measurable and attainable)

• Define immediate priorities

• Level of EOP implementation?

➢ Notify Key Supervisors/Managers

➢ Provide an incident briefing (Situation, Policies, Objectives and Priorities for shift).

➢ Conduct incident action planning meetings to set objectives, staffing and resource needs for each upcoming shift/operational period

➢ Activate/mobilize essential functions/key activities as needed

The IC should establish an HCC if the incident will last more than one shift. The following information is intended as guidance only:

Establishing the Hospital Command Center (HCC)

The Major Functions of an HCC Include:

• Communications

• Information collection, display and documentation

• Action planning

• Coordinated resource management

• Development of public information

Configuration of an HCC should include areas for:

• Check-in

• Message center

• Operations coordination with displays (e.g., easels/flipcharts/dry erase boards)

• Administrative support (copier, files, etc.)

• Planning meetings

Note: Media briefings should not be located near the HCC.

Managing Time. One important initial step is establishing the operational period (could use shift rotation schedules, as an example). Within each operational period, the following sequence should occur:

• Shift change meetings

• Situation briefing

• Incident action planning meeting

• Assign resources

• Track/coordinate progress

• Provide situation updates, as necessary

Managing Information. There are four types of messages:

• Inquiries seeking information

• Advisories providing information

• Requests asking for resources

• Orders directing activities

The Message Center receives, records and routes information to the appropriate functions/operating groups.

What Should be Tracked/Displayed:

• Situation status

• Resource status (assigned, available, out-of-service)

• Reporting times

• Key decisions

Common Mistakes:

• Lack of a viable EOP

• No knowledge of community resources

• Lack of leadership

• Not establishing a control on information flow

• Untrained staff

• Key people leaving the HCC

• A failure to focus on what will be happening in the next operational period

ATTACHMENT E

HOSPITAL INCIDENT COMMAND SYSTEM

Incident Commander

Public Information Officer

Medical/Technical Specialist(s)

Biological/Infectious Disease Legal Affairs Chemical Risk Management Radiological Medical Staff Clinic Administration Medical Ethics Hospital Administration

Liaison Officer

Situation Unit Leader

Personnel Tracking Materiel Tracking

Safety Officer

Staging Manager Personnel Staging Team Vehicle Staging Team Equip/Supply Staging Team Medication Staging Team

Finance Section Chief

Logistics Section Chief

Planning Section Chief

Operations Section Chief

Resources Unit

Personnel Tracking Material/Equip. Tracking

Documentation Unit Leader

Business Continuity Branch Director

Information Technology Service Continuity Records Preservation Business Function Relocation

Safety & Security Branch Director

Access Control Crowd Control Traffic Control Search Law Enforcement

Haz Mat Branch Director

Detection/Monitoring Spill Response Decontamination

Infrastructure Branch Director

M&R Grounds BioMed Housekeeping Food Services

Medical Care Branch Director

Inpatient Units Outpatient Units Casualty Care Behavioral Health Clinical Support Patient Registration

Demobilization Unit Leader

Support Branch

Staff Health/Well-Being Unit Family Care Unit Supply Unit Facilities Unit Transportation Unit Personnel Pool Credentialing Unit

Service Branch

Communications Unit IT/IS Unit Staff Food & Water Unit

Cost Unit Leader

Compensation & Claims Unit Leader

Procurement Unit

Time Unit Leader

ATTACHMENT F

LOCAL/STATE/FEDERAL AGENCY CONTACT NUMBERS

LAW ENFORCEMENT (non-emergency) FIRE & RESCUE

Amity Township....................................1-800-922-1975 Erie Fire Control..............…....454-7163 Edinboro...........................................................734-1712 Millcreek Fire Control........…..838-7771 City of Erie.......................................................870-1125 Perry Hose Company.............864-0680 Girard Borough................................................774-2651 Emergycare Ambulance.........870-1010 Lake City..........................................................774-8341 Millcreek Paramedics.............836-8677 Lawrence Park Township................................898-1634

Millcreek Township.........................................833-7777 EMERGENCY MANAGEMENT -Belle Valley -Kearsarge -Lake Shore -West Lake Erie County Emer. Mgt..........870-9920 -West Ridge After Hours....................….....870-1911 North East Borough........................................725-4407 City of Erie (24 hr).................456-8585 Wesleyville.....................................................899--0681 City of Erie (EOC)..................870-1960

Millcreek Twp...........833-1111 ext. 353

PA STATE POLICE

ENVIRONMENTAL ISSUES

Corry Office.....................................................663-2043 City of Erie -Sewer..................................870-1351 Erie Office........................................................898-1641 -Wastewater Treatment........870-1360 -Greene Township -Greenfield Township -Water Authority..........…......455-1049 -Harborcreek -McKean Pennsylvania (Meadville) -Mill Village -North East Township -Dept. of Env. Protection.....332-6945 -Phillipsville -Summit Township -After hours/wknds....1-800-373-3398 -Venango Township -Waterford -Air Quality.................….......332-6940 -Wattsburg -Env. Cleanup.......................332-6648 -Oil & Gas Mgt..........….........332-6860 Girard Office....................................................774-9611 -Waste Mgt...........................332-6848 -Cranesville -Fairview Township -Water Quality..........…..........332-6942 -Franklin Township -Girard -Water Supply Mgt..…...........332-6899 -Platea -Springfield US EPA (Region 3)....1-800-438-2474

FEDERAL AGENCIES OTHER NUMBERS

Alcohol, Tobacco, & Fire Arms National Weather Svc...…..216-265-2370 (Erie)..............................................................455-4385 PennDot (Erie)...........…............871-4411 (Pittsburgh)..............................................412-395-2911 (Pittsburgh).......…….....332-6880 Drug Enforcement Administration...............412-395-4502 NY Thruway.............….....1-800-847-8929 CIA..............................................................412-281-4009 Poison Control (Pitts)…....1-412-681-6669 FBI (Erie)...........................................................452-4516 US Coast Guard........….............838-2097 (Pittsburgh)...........................................412-471-2000 Secret Service.............................................412-395-6484

OSHA ................................................................835-7283

PENNSYLVANIA EMERGENCY MANAGEMENT AGENCY

2605 Interstate Drive Harrisburg PA 17110-9463

(717) 651-2001

(717) 651-2040 FAX

http://www.pema.state.pa.us/

ATTACHMENT G

ERIE VAMC CONTINUITY OF OPERATIONS PLAN (COOP)

Please contact the Emergency Manager at X2204 to ensure you have the most recent version.

00Q-400 Erie VAMC COOP Plan.docx

STANDARD OPERATING PROCEDURES (SOPs)

Please contact the Emergency Manager at X2204 to ensure you have the most recent SOP.

Naturally Occurring Events Earthquake Large Scale Fire Response Severe Thunderstorm / Tornado

\\Vhaericlu1\office of performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\44.Naturally Occurring Events Earthquake SOP.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\45.Naturally Occurring Evnets Fire Response SOP.doc

Tornado Thunderstorm SOP.doc

Windstorm/Blizzard Pandemic Influenza/Influx of Patients Ebola performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\47.Naturally Occurring Events Winterstorm Blizzard SOP.doc

SOP Pan Flu 9-12.doc

Ebola.docx

Human Related Events Bomb Threat Cyber Attack Hostage Barricade Situation performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\49.Human Related Events Bomb Threat SOP.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\50.Human Related Events Cyber Attack SOP.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\51.Human Related Events Hostage Barricade Situation SOP.doc

Violence in the Workplace Biological Terrorism Chemical Terrorism performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\52.Human Related Events Violence in The Workplace SOP.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\53.Human Related Events Biological Terrorism SOP.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\54.Human Related Events Chemical Terrorism SOP.doc

Radiological Terrorism Incendiary Terrorism (Explosion) Facility Lock Down performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\55.Human Related Events Radiological Terrorism SOP.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\56.Human Related Events Incendiary Terrorism Explosion SOP.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\57.Human Related Events Facility Lock Down SOP.doc

Continued on the next page.

Technological Events Hazardous Materials Loss of Information Systems Steam Loss performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\58.Technological Events Hazardous Material Spills Leaks SOP 4-7-05.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\59.Technological Events Loss of Information Systems SOP 4-7-05.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\60.Technological Events Steam Loss SOP.doc

Loss of Communications Water Loss Sewer Loss performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\67.Technological Events Loss of Telecommunications SOP.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\61.Technological Events Water Loss SOP.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\62.Technological Events Sewer Loss SOP.doc

Medical Gas Loss HVAC Loss CPRS Contingency (air oxygen vacuum) (heating, ventilation and air-conditioning) performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\63.Technological Events Medical Gas Loss Air Oxygen Vacuum SOP 4-7-05.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\64.Technological Events Heat Ventilation Air Condition Loss SOP.doc

CPRS Contingency Guide Erie.docx

Electrical Power (generator failure) Flooding (internal) Emergency Red Phone Use performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\65.Technological Events Generator Failure ElectrPower Loss SOP.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\66.Technological Events Internal Flooding SOP.doc

Emergency_Red_Pho ne.docx

Other Plans Cascade Call Back System Evacuation Plan Erie County Disaster Plan performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\68.Cascade Call Back SOP 4-7-05.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\70.Evacuation Plan.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\71.Erie County Disaster Plan.doc

Temporary Credentialing of Practitioners/Disaster VA DOD Contingency

Volunteer Practitioners SOP.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCM Updated ROUTING for APPROVAL\00Q-400 VA-DoD Contingency Plan 1-16-08.doc

HBPC Emergency Operations Plan (SOP) CBOC Emergency Operatios Plan (SOP)

HBPC-EmergencyMa nagementSOP.doc performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\72.CBOC Emergency Management.doc

Other Plans (Cont)

Care Coordination Home Telehealth (CCHT) Healthcare First Receiver Decontamination

CCHT- Emergency Management SOP.doc

Decontamination SOP.doc

ATTACHMENT H

REPORT FORMS

performance & quality\OP&Q Team Only\00Q MCMs\00Q MCMs SIGNED & PUBLISHED\00Q-400, EM Plan Attachments\5.Report Forms Attachment 4.doc

JOB ACTION SHEETS

AND

HICS FORMS/INSTRUCTIONS

Due to the size of the file, please contact the Emergency Manager at X2204 to obtain a copy of a specific form.

You may also access the forms at the following link:

http://emsa.ca.gov/hospital_incident_command_system_forms_2014 http://emsa.ca.gov/hospital_incident_command_system_forms_2014

ATTACHMENT I

EOC MCM REVISION HISTORY

11/21/16 EOC triennial revision: Minor changes to policy; Corrected format to match facility standardized MCM; Verified and revised references; Updated

Attachments; Added Attachment I, EOC MCM Revision History.