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.

FIRST RESPONDERS

POLICE/FIRE/EMS
INITIAL ACTIONS

MEDICAL TRANSPORT

"CLEAN PATIENTS"

AMBULATORY, NON-AMBULATORY

CONTINUING CARE

Mr. SOUDER. Thank you very much for your testimony, and I just want to make a couple of opening comments. I appreciate the amount of time this has taken, but this is one of those things that isn't glamorous or necessarily as news-demanding as right after the bombing in Africa or some of the more dramatic things, but this is the kind of preparation we go into to try to minimize the impact of those kinds of actions, and avoid them whenever possible.

Because we didn't talk about this in the first panel in any of the questions, I just want to say for the record, my background discussions with a number of you have suggested that it's basically understood in the administration that we have grave concerns about the lack of caste clustering, and the degree that we can cluster in some of the training, as was advocated by GAO and how FEMA does it and others, would be very helpful.

Because this has all the earmarks to those of us who were growing up during the nuclear scares of the early 1960's or in World War II of the ranking of a city on Hitler's bomb list, that the biggest cities are going to be covered. I think, Fort Wayne, my home area, is 4 years out. Some States don't have any cities in the 120, and we hear that there may be some vulnerabilities. Well, it's kind of scary for Americans.

We need to look at some creative ways to do cluster training, then how to spin that into the second nature of training, whether it's conferences or a training school where local governments, if they wanted to train, certainly have some of the response stuff already through FEMA and other agencies, but to the degree that it could hit the level of sophistication.

I had the privilege a few weeks ago to attend an air guard unit in Fort Wayne doing a training in this particular area, because they'd been assigned in the Middle East, and they're headed to Panama and other places. I saw, for example, in an exercise, they had four real life casualties because the uniforms are so hot. Let me say, Fort Wayne is not Africa, or the desert, or for that matter, Arizona or Florida. They had some people move too fast and they passed out; they went through the process of trying to identify first what hit-they were trying to get the F-16's in and out; these are not easy matters. Furthermore, the number of variations of the size of what it was, and then down to the emergency tents of where you go with the first victims and the first identification. What if there's seepage in those areas?

This is something that requires a fairly sophisticated-type training, which in the first panel we had some fair questions raised as to whether the training that was being done was sufficient. What can be done to supplement that? What can be done beyond this first training? I know there are other materials provided-what are they? Do you have more sophisticated variations? I know there are people trained in some areas to do that. How can they be interrelated? Specifically, there's been a pass-off from the Department of Defense to the Department of Justice, and I wondered if Mr. Dalich, you in your testimony said that you were continuing thathave you made any changes, or are you revamping, what are you looking at in some of these areas?

Mr. DALICH. Our training program uses a different 120 cities, which in the beginning, caused us some difficulties. We are looking

at trying to revamp the program to make it more compatible across the board. Just by way of explanation, our differences-we include counties in addition to cities, and we have 120 of them, but it's the largest jurisdictions under the legislation that established the program.

Mr. SOUDER. Can I ask you a specific question on that?

Mr. DALICH. Yes.

Mr. SOUDER. For example, Washington, DC, has about roughly 700,000 people; Fairfax County, over 1 million; Montgomery in the Maryland suburbs, over 1 million.

Mr. DALICH. Right.

Mr. SOUDER. When you say a county, how would Washington be treated?

Mr. DALICH. Washington is not treated under that list-Washington, DC, specifically.

Mr. SOUDER. So, would Fairfax County?

Mr. DALICH. Fairfax County would be. It's one of the larger counties.

Mr. SOUDER. Montgomery County?

Mr. DALICH. Montgomery County as well.

Mr. SOUDER. Would they be treated at the same time, or separately?

Mr. DALICH. No, they are eligible for the program, but it's not necessarily done at the same time. And that's an excellent suggestion, although the idea of training at the individual location we believe is quite useful, and that doesn't necessarily make it convenient to do it for both of them at the same time necessarily.

Mr. SOUDER. I would like to ask you a question following up on that. For example, in Fort Wayne, they were training. They'd made an assumption that they were based somewhere overseas at the time where this facility was. It doesn't seem to me that necessarily the most critical part of this training is where you are; it's helpful to know how far you are from the hospital and those different things, but there are certain basic fundamental things and then the second tier is where you are. Because you have no idea really where it's going to occur. It could occur right on the border between two places.

Mr. DALICH. That's correct. I think a lot of the firefighters and local first responders feel comfortable training in their jurisdiction. We've done the training both ways, through the National Fire Academy and onsite. I think arguments can be made either way. We've not settled on which of those is necessarily the best way to go, although we've trained about 1,100 first responders; about 400 at the National Fire Academy, and a little over 700 onsite.

Mr. SOUDER. Have you looked at-in other words, they're not necessarily mutually exclusive, and what other materials do you provide for followup? Have you thought about proposing some of these types of things where cities that aren't going to be covered either in counties for the next 4 years, or quite frankly maybe for the next 10 years, would have access to this information, or if, particularly if they were willing to pay for the training, what kind of thought process? We all understand that when Congress passed the bill, and everybody said, jump fast, you partly plunged into it, did