So there has been

Mr. TIERNEY. Double digits? Single digits? What?

Dr. WINKENWERDER. That means like somewhere between 60 and 80-something percent. And again, there has been an effort to make sure that those that are deploying are the ones that get the training. So when I describe those statistics, that is across the whole system.

Obviously, not everybody is going, so the training has been targeted more toward people that are serving. But I will-I understand the gist of your question and we will try to get back with that information.

Mr. TIERNEY. Would you get that information?

Dr. WINKENWERDER. Yes, sir. We would be glad to. [The information referred to follows:]

Hearing Date: March 25, 2003

Committee: House Government Reform
Subcommittee on National Security
Member: Rep. Tierney

Witness: Dr. Winkenwerder

IFR: Pages 64-66, lines 1411-1442

Question: My understanding is that, in the Gulf, most of the medical people, the doctors and nurses sent over there, are Reservists, which would raise the specter that their training is one weekend a month or two weekends a month and two weeks in the summer; and I would guess that would probably be barely enough to keep up on their training for medical treatment in the field. Can you give us some assurance that those Reservists have, in fact, been properly trained to meet what might happen in terms of a chemical or biological attack? How is that happening if they are getting one weekend a month and two weeks in the summer, and in that period of time have to keep up with their own medical treatment? How are they getting this additional training? Where are they getting that in a fashion that would give us the comfort that they are really prepared and ready?

Answer: All medical personnel (active and reserve) are fully trained in their medical specialties before being designated for medical occupational specialties in the military. In addition, they receive extensive military-specific training, both medical and non-medical. Reserve Component medical personnel receive the same quality and level of training as their active duty counterparts. The Services have made great strides in the training of medical department personnel in chemical and biological casualty care. We have increased the training opportunities for the seven-day Medical Management of Chemical and Biological Casualties (MCBC) course. In addition to this course, we continue to employ distance learning technologies to train our medical forces and have a large number of web-based, computer-based, video, and satellite courses available. For each of the past three years, we have also produced and widely distributed to medical treatment facility personnel a CD with all chemical biological training materials to broaden our overall medical preparedness to respond to a chemical or biological incident. Today, 42% of Army officer clinicians and 18% of Army enlisted clinicians have completed more than 12-hours of specific chemical and biological casualty care training in addition to the chemical and biological training already incorporated in their mandatory professional development training. Also 72% of Navy clinicians assigned to hospitals received specific chemical and biological casualty care training primarily through the 12-hour Medical Management of Chemical and Biological Casualties satellite course or a 10-hour self-paced learning CD-ROM. And 85% of Air Force clinicians received specific chemical and biological casualty care training primarily through the 12-hour Medical Management of Chemical and Biological Casualties satellite course.

Mr. TIERNEY. Thank you.

And again, because I continue to have concerns about those suits, and even though you've now told me how many suits they have, in ny reading anyway, it indicates that that may well not be enough lepending on how long this conflict goes.

But you put out the impression at least, that Mr. Kucinich mentioned earlier, about the people being ready; and I am wondering, can you give us the assurance that Secretary Rumsfeld, through Under Secretary Aldridge, was not able to give us? Can you give us the assurance here today that the troops have sufficient equipment to protect them against chemical and biological attacks in quantities sufficient to meet the minimum required levels previously established by the Department of Defense?

Dr. WINKENWERDER. Certainly, from a medical standpoint; and by that I mean the medical countermeasures, the antibiotics, the vaccinations and all of that; those are the issues that come directly under my area of responsibility. The others, my understanding from recent conversations with-Dr. Anna Johnson Winegar, who is the chief responsible person within the Office of the Secretary of Defense for those matters and has testified before this committee and others, has indicated that she believes that we are well prepared on the issues that you have just raised.

Mr. TIERNEY. Well, your impression at least was not contained just to the medical end; it also involved the protective suits. Or did it not?

Dr. WINKENWERDER. That is not-and I know from your perspective, as well it should be, you should be concerned about everything, and so I don't want to be bureaucratic here. But

Mr. TIERNEY. I appreciate that.

Dr. WINKENWERDER. It is not directly within my area of responsibility. It is another area that does work under Mr. Aldridge. We work closely, very closely with those people. The responsibility for executing those policies resides within each of those services.

Mr. TIERNEY. Thank you.

And just to finish up my generous 5 minutes, the reason I raised the initial question was that we had an exchange here in committee with Dr. Kingsbury, Nancy Kingsbury, at some point in time; and her answer indicated, to me at least, that in instances of mass casualties she did not believe that the exercises that have been done so far indicated that we could deal with those appropriately. So whatever assurances you could give the committee in terms of medical personnel being ready would be greatly appreciated. Dr. WINKENWERDER. We will do that.

[The information referred to follows:]

Hearing Date: March 25, 2003 Committee: House Government Reform Subcommittee on National Security Member: Rep. Tierney Witness: Dr. Winkenwerder IFR: Page 68, lines 1503-1513

Question: What assurances can you give the committee that medical personnel can deal appropriately with mass casualty situations.

Answer: Military medical providers (active and reserve) train for mass casualty situations, both in their installation hospitals and during exercise deployments, and have done so for decades. Since the start of the "Cold War" almost all of their "training scenarios" include weapons of mass destruction. Their training includes the wearing of full chemical/biological protective gear. No civilian hospital staff has near the vast training experience under these conditions. Many local civilian hospitals request copies of our military's medical training and mass casualty exercise programs as a template for some of their training, given the current War on Terrorism, and several exercises are conducted jointly with civilian facilities.

Military mass casualty exercises are designed to "overwhelm the available providers and resources." The military trainers want to test all aspects of evaluation, triage, treatment, evacuation and disposition. The training goals are the same for both deployed medical providers, and those stationed at a fixed military treatment facility.

Military mass casualty exercises are only part of the medical preparation for a deployment. Additional specific medical training is provided in order to further hone their trauma skills. Specifically, DoD has sponsored Tri-Service training on advanced surgical trauma care for the surgeons and nurses deploying to our currently deployed field hospitals (five active duty and two reserve hospitals). Additionally, extensive advanced trauma training is provided through multiple means for both active duty and reservists, and educational aids (e.g., "flash cards”) are made available to assist primary care providers in mass casualty care (since most mass casualties are expected to occur outside the hospitals).

During the most recent war in Iraq this training has been validated. Changes in personnel, equipment and doctrine were effective in the success of the medical mission in Iraq, but training was the paramount reason. Initial feedback further documents this point. As more after-action reports are reviewed, we will enhance the excellent training of our medical providers to assure that the best capabilities are always utilized.

Mr. TIERNEY. Thank you.

Mr. SHAYS. Thank the gentleman.

We are going to do a second round here, and I just want to askso we can close up the issue of the questionnaire, I want to know why our men and women aren't given physicals when they go into battle, so that we know. What is the logic of that?

Mr. JANKLOW. Aren't given what, sir?

Mr. SHAYS. Aren't given physicals. They are given questionnaires, but they aren't given physical examinations.

Dr. WINKENWERDER. I think, Mr. Chairman, that the logic is that a hands-on physical examination yields not a great deal of information in terms of the baseline health status of young, healthy individuals. And far more important and relevant is a series of questions that are asked that can go into greater detail if a flag goes up that indicates that there is some problem with that person's health.

Mr. SHAYS. First off, I am not going to concede that we didn't intend that they weren't going to have physicals. So I understand your doing the questionnaires, and I understand when we talk about a medical examination versus a physical examination, you have decided that you have some flexibility there.

But what about the Reservists and the National Guard folks who simply, you know, might be eating a little differently, might-you get my gist. Why wouldn't they have physicals? They might be older. They might not have been active for a while. Why treat them all the same?

Dr. WINKENWERDER. Why treat them all the same?

Mr. SHAYS. Why treat them all the same? Why not have a little bit more of an interest in giving a physical to someone who may not have been in the Active Service?

Dr. WINKENWERDER. You raise a good point. I think it is something we could certainly take a look at.

Dr. Kilpatrick.

Dr. KILPATRICK. If I could, for the Reservists that are called to Active Duty, there is a more stringent process put in place to look at them, having physical examinations, their periodic physical examinations.

For Reservists under 40, they need to have one every 5 years; over 40, every 2 years. I think there is a recent GAO report that showed that people were not meeting the mark-I mean, the numbers were terrible on doing that. So when people are called to Active Duty at that mobilization center, if they have not had a physical within the last 5 years for under 40 or the last 2 years over 40, they have to have a physical before they go, so they are caught up.

Mr. SHAYS. Why not at least draw blood?

Dr. KILPATRICK. And I think the drawing of blood is we do make sure that everyone has an HIV screening sample done within the previous 12 months prior to deployment. That serum sample is banked in a serum bank. It is kept permanently. There is no sort of portfolio of tests to do on a serum sample, but that is kept in the eventuality there is an exposure, either recognized or unrecognized, and then a determination of a set of tests that could be done.