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The 2001 terrorist attacks in the United States and subsequent concerns about terrorist attacks at other US locations led the US Department of Veterans Affairs (VA) to determine that preparing for emergency mass-casualty events is part of the cost of operating the 163 VA hospitals across the nation. This report describes how VA assembled internal and external policy experts and developed a comprehensive hospital-wide emergency masscasualty decontamination program, entitled ‘‘Emergency Mass-Casualty Decontamination Program.’’ The program is cost-efficient, protective of hospital staff, and suitable for implementation at other US hospitals. The VA’s primary goals for creating a program are (1) to protect facilities, staff, and patients to ensure continuity of health care capabilities, and (2) to respond to emergency needs of civilian casualties overflowing from local community emergency capabilities. The VA program includes (1) formal evaluation of emergency decontamination needs at each VA hospital, (2) selection of equipment, and (3) development of an appropriate staff training program. The long-term program also addresses the sustainability, reporting requirements, oversight, and certification of the participants.