care. The hospitals are developing procedures to ensure that patients coming in would be decontaminated before entering the facility where they would be treated for their exposures. They are also developing procedures to determine which patients should remain in the hospital, and which patients can and should be moved to facilities elsewhere in the city or in other cities for care, if necessary. Through NDMS, DOD can evacuate these patients to VA and DODmanaged NDMS Federal Coordinating Center areas across the country where participating nonfederal hospitals have NDMS beds available should patients need to be relocated out of an affected area. In addition, our response team doctors, nurses and support staff can help relieve or augment overburdened hospital staff. Domestic Preparedness Program As legislated, DHHS' role in the Domestic Preparedness Program was the development of Metropolitan Medical Strike Team systems. The purpose of these systems is to ensure that a city's health system is able to cope with the injuries and chaos that results from a terrorist act. DHHS has contracted with 27 cities to date. Because each city has a public safety and public health system with unique characteristics, the contracts we have awarded to the cities specify that each city will develop an enhanced health and medical response system, within their current emergency response structure. These Systems provide an integrated pre-hospital, hospital and public health response capability to local metropolitan areas. Each system must ensure that health workers be able to recognize a chemical injury, know the proper treatments (or know where to get the information), be able to ensure that medical facilities do not become contaminated, and that the local system is integrated with state plans. Our goal is to develop 120 of these medical response systems across the country. The DHHS program is a health systems development program, not an equipment or training program. If a city identifies equipment as one of its cost elements under the contract, DHHS requests that DOD, FEMA, VA, FBI, Department of Energy (DOE) and the Environmental Protection Agency (EPA) review the list and comment on it, to eliminate any duplicate equipment purchases by the federal government. Training is not usually one of the cost elements under our contracts. In fact, training requirements which are identified are referred to our interagency partners. Biological Incident However, these activities to date have primarily dealt with the consequences of a chemical or nuclear attack, or a bombing. A different response is needed should a biological attack occur. We may not know for days that a biological event has occurred, until state and local health departments have reported clusters of unexplained illness or deaths. In the case of a terrorist attack involving a biological agent, the state and local health departments form the first line of defense. They are, in this case, the first responders. This second chart (Chart 2) shows the necessary actions to effectively respond to an attack with a biological weapon. Local and state health departments must have support in five areas: public health surveillance to detect unusual events, epidemiologic capacity to investigate potential threats, laboratory capacity at the federal and state levels to identify and diagnose suspected agents, 2 communications systems with other government agencies and the general public, and stockpiles of vaccines and antibiotics to treat exposed populations and prevent infection in others. Mass patient care, mass fatality management, and environmental clean up may also be required. The NDMS would mobilize to help assure that patients can access needed services. It may be used to augment local medical resources, including pharmaceuticals, or it may assist in assuring safe transportation of patients to other regions where the hospital systems have unused capacity. General Accounting Office Reports I would now like to offer a few comments about GAO's recent draft report on "Combating Terrorism: Opportunities Exist to Gain Focus and Efficiencies in the Nunn-LugarDomenici Domestic Preparedness Program" (September 1998). The report made reference to the lack of a "sound assessment process, such as a threat and risk assessment" for the 120 cities included in the program. I am concerned that threats are evanescent what may be valid today may not be valid in the future. We believe that population density continues to be a valid basis for measuring risk. Within the funds available for preparedness activities, this interagency approach has focused on population centers of our nation in their descending order of size. The report mentions that the training subcommittee formed by the interagency group made little progress in compiling a list of terrorism related courses. DHHS's Public Health Service (PHS) was represented on this DOD-led training subcommittee and through substantial effort, the subcommittee did, in fact, generate a rather comprehensive compendium of existing courses. The report also recommended consolidating training and equipment delivery locations on a regional basis. In a chemical response, it is important to note that capabilities/assets are almost immediately required. A regional approach could prolong response time for local jurisdictions. The time factor in a chemical response is crucial. Summary The Department of Health and Human Services through the Public Health Service is committed to assuring the health and medical care of our citizens. We are prepared to quickly mobilize the professionals required to respond to a disaster anywhere in the U.S. and its territories and to assist local medical response systems in dealing with extraordinary situations, including meeting the challenge of responding to the health and medical effects of terrorism. Mr. Chairman, that concludes my remarks. I would be pleased to answer any questions you may have. |