title: Emergency management program operational responses to weapons of mass destruction: Veterans Health Administration, 2001-2004.
abstract: BACKGROUND
  Despite the recognition of chemical emergencies, terrorist events, and ongoing threats, little practical guidance exists for healthcare facilities.
  
  
  METHODS
  An approach and materials developed by the Veterans Health Administration in a five-element program over the last 2 years to enhance the existing emergency management program is outlined. Nine steps to the development of a comprehensive all-hazards, emergency plan and program, with auditing and improvement tools are offered.
  
  
  RESULTS
  Cognitive aids for clinical use are available on-line and in hard copy. A hazard assessment modeled patients as emission sources documenting the operations strategies under which level C personal protective equipment will protect healthcare workers. The development of this response program appears to support a broader, long-standing VHA approach to problem solving. This involves bringing together individual talented field staff, representing specific skills, geographic regions, and work styles; investing in face-to-face consensus development; and developing programs with extensive internal peer-review ("field-based," "bottom-up and top-down," and external reviews).
  
  
  CONCLUSIONS
  Comprehensive and effective programs can be constructed at low cost with reasonable speed within large systems with a public mandate, leading to responsible use of public funds internally, and as models for private sector programs. It is the long-term operational cost implications, under budget constraints in health care, which often present the true challenge.
authors.affiliation: Office of Public Health and Environmental Hazards (including Occupational and Environmental Health Strategic Healthcare Group, Environmental Hazards and Occupational Health Programs, Washington, District of Columbia 20420, USA. muh7@mail.va.gov
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hodgson
authors.forename: Arnold
authors.initials: A
authors.lastname: Bierenbaum
authors.forename: Susan
authors.initials: S
authors.lastname: Mather
authors.forename: Mark A
authors.initials: MA
authors.lastname: Brown
authors.forename: John
authors.initials: J
authors.lastname: Beatty
authors.forename: Margie
authors.initials: M
authors.lastname: Scott
authors.forename: Peter
authors.initials: P
authors.lastname: Brewster
mesh_terms: D003666:Decontamination / Q000379:methods / Q000592:standards; D004189:Disaster Planning / Q000458:organization & administration*; D017408:Guidelines as Topic; D006801:Humans; D007318:Inservice Training; D011482:Protective Devices; D023481:Terrorism; D014481:United States; D014493:United States Department of Veterans Affairs