The Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons 

of Mass Destruction was established by Section 1405 of the National Defense Authorization Act for 

Fiscal Year 1999, Public Law 105–261 (H.R. 3616, 105th Congress, 2nd Session) (October 17, 1998). 

That Act directed that a federally funded research and development center provide research, analytical, 

and other support to the Advisory Panel during the course of its activities and deliberations. RAND has 

been providing that support, under contract from the Department of Defense, since the Advisory Panel’s 

inception. 

This Third Annual Report to the President and the Congress is a document of the Advisory Panel, not a 

RAND publication. It was prepared and edited by RAND professional staff and is being submitted for 

review and comment within the U.S. Government Interagency process. It is not copyrighted but does 

contain material from copyrighted sources. Copies of the report may also be obtained via the Internet at: 

http://www.rand.org/nsrd/terrpanel

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III. FOR RAY DOWNEY

THIRD ANNUAL REPORT TO

THE PRESIDENT AND THE CONGRESS OF THE

ADVISORY PANEL TO ASSESS DOMESTIC RESPONSE 

CAPABILITIES FOR TERRORISM 

INVOLVING WEAPONS OF MASS DESTRUCTION

15 December 2001
PHOTO CREDITS FROM COVER PAGE 

1— A New York City ambulance burns in the street near the base of the World Trade 

Center towers. It was one of hundreds completely destroyed in the attacks. Photo by 

Shannon Stapleton/Reuters 

2— Arlington County Fire Department rescue team at the Pentagon. Photo by Jocelyn 

Augustino/FEMA News Photo 

3—Firefighters, rescue workers, and military personnel unfurl the American flag in 

anticipation of a visit to the Pentagon crash site on September 12 by President Bush. 

Photo by Jocelyn Augustino/FEMA News Photo 

4— Rescue workers remove a man from the World Trade Center tower in New York City 

shortly after the attacks on September 11, 2001. Victims of the attack – many suffering 

from extensive burns – were transported to hospitals in New York City within minutes 

after two planes slammed into the twin towers. Photo by Shannon Stapleton/Reuters 

1 

2 

3 

4 
James S. Gilmore, III 

Chairman 

L. Paul Bremer 

Raymond Downey 

George Foresman 

William Garrison 

Ellen M. Gordon 

James Greenleaf 

William Jenaway 

William Dallas Jones 

Paul M. Maniscalco 

John O. Marsh, Jr. 

Kathleen O'Brien 

M. Patricia Quinlisk 

Patrick Ralston 

William Reno 

Joseph Samuels, Jr. 

Kenneth Shine 

Hubert Williams 

Ellen Embrey 

U.S. Department of 

Defense Representative 

Michael Wermuth 

RAND Executive 

Project Director 

 

 December 15, 2001 

To Our Readers: 

 

 The terrorist attacks on September 11, 2001, have become a defining moment for the 

future of the United States and the rest of the civilized world. Today, we continue to mourn 

for the thousands of victims and their families. Yet, in our grief also lies the hope of a more 

secure future. We have an opportunity and an obligation to help to define that future. To 

that end, I am pleased to provide the Third Annual Report of the Advisory Panel to Assess 

Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction to 

support the United States in its leadership role in combating the threat posed by terrorists. 

 America has responded to this assault on our values and character with steadfast 

determination. In our communities, states, and at the federal level, government, the private 

sector, and ordinary citizens have mobilized and begun to work together on many fronts with 

a sense of renewed determination. Our shared goal is protecting every American and others 

beyond our borders from the lawlessness of terrorists. A robust coalition of international 

partners stands united in military, law enforcement, and economic actions designed to 

prevent further attacks and to identify, arrest, and prosecute those who committed these acts 

and continue to threaten people around the world. Those who govern this nation have 

displayed the best in leadership, as they have sought to protect and maintain our fundamental 

civil liberties and constitutional values. Collectively, we know that the underpinnings of our 

democracy remain strong but also make it impossible to secure our nation completely. It is 

the inherent risk we face in our uniquely American way of life. Accordingly, our focus 

remains on protecting ourselves to the extent that we can within the framework of a free and 

open society and on ensuring our ability to respond if more attacks occur. 

Our mission is urgent and clear: We must continue to bolster our capability to thwart 

terrorists wherever and whoever they are. Today, our panel presents its Third Annual Report 

to the President and the Congress as our contribution to the war against terrorism. This effort 

builds on findings and recommendations in our First and Second Annual Reports delivered 

in 1999 and 2000. It reflects a national strategic perspective that encompasses the needs of 

all three levels of government and the private sector. It seeks to assist those who are 

dedicated to making our homeland more secure. We recommend: 

Empowering state and local response by ensuring the men and women on the 

front line of the war against terrorism inside our borders have the tools and 

resources needed to counter the murderous actions of terrorists;

Enhancing health and medical capacities, both public and private, to help 

ensure our collective ability to identify attacks quickly and correctly, and to treat 

the full scope of potential casualties from all forms of terrorist attacks;

THE ADVISORY PANEL TO ASSESS DOMESTIC RESPONSE CAPABILITIES FOR

TERRORISM INVOLVING WEAPONS OF MASS DESTRUCTION

Please address comments or questions to: 

RAND 

1200 South Hayes Street, Arlington, Virginia 22202-5050 Telephone: 703-413-1100 FAX: 703-413-8111 

The Federally-Funded Research and Development Center providing support to the Advisory Panel 
2 

Strengthening Immigration and Border Controls to enhance our ability to restrict 

the movement into this country, by all modes of transportation, of potential 

terrorists and their weapons and to limit severely their ability to operate within our 

borders; 

Improving Security Against Cyber Attacks and enhancing related critical 

infrastructure protection to guard essential government, financial, energy, and other 

critical sector operations against attack; and 

Clarifying the Roles and Missions for Use of the Military for providing critical and 

appropriate emergency response and law enforcement related support to civilian 

authorities. 

The attacks of recent weeks have caused human and physical scars that will be with us 

forever. Our nation, however, remains strong and resilient. Our collective call is to continue 

the momentum to secure our homeland and protect our citizens. While there is more work to be 

done, there is no question that we will be successful. America's strength is in its people, our 

leaders, and our collective commitment, especially during times of crisis. 

 We dedicate this report to our fellow panel member and good friend, Chief Ray 

Downey. Our loss is tempered by the extraordinary opportunity that we had in being informed 

and counseled by Ray during the past three years. We therefore present our recommendations 

with a sense of profound commitment to Ray and all the other victims, that they will not be 

forgotten and that their loss will not have been in vain. 

Sincerely, 

James S. Gilmore, III 

Governor of Virginia 

Chairman 
IN MEMORIAM 

RAYMOND MATTHEW DOWNEY, SR. 

Joined the Fire Department of the City of New York as a regular firefighter in 1962. 

Promoted to officer rank in 1972. 

Named commander of several fire companies. 

Served as fire department Incident Commander for the 1993 World Trade Center attack. 

Elevated to battalion chief in 1994. 

Assigned as Chief of Rescue Operations in 1995. 

Named FDNY Deputy Chief and Chief-in-Charge, Special Operations Command in 2000. 

Married to Rosalie Princiotta Downey, his wife of almost 40 years. 

Father of five children—two are New York City firefighters—and seven grandchildren. 

Trained and mentored firefighters and other responders nationwide.

 A nationally-recognized leader, author, and lecturer on rescue, collapse operations, and terrorism emergency response. 

Responded to the call for help in Oklahoma City, Atlanta, and other disasters outside his home jurisdiction. 

The most decorated firefighter in the entire New York Fire Department—21 times for valor.

Ray Downey 

Husband . . . Father . . . Patriot . . . Hero . . . 

Friend 

And in the final, most courageous moments of his duty-filled life . . . 

Brother to all Humanity 

On September 11, 2001, at a few minutes after 10 o’clock in the morning, Ray Downey, chief in charge of 

Special Operations Command, Fire Department of the City of New York, perished in the collapse of the 

North tower of the New York World Trade Center. Although the impending disaster was obvious 

following the prior collapse of the South tower, and with fearless disregard for his own personal safety, 

Ray stayed at his post with his people, all doing their job. 

Ray served as a dedicated member of the Advisory Panel during its entire three-year tenure, bringing 

insightful first-responders’ perspectives and consistently providing invaluable counsel based on his 

years of training, unequaled leadership, and exceptional experience in the field. 

It is with increasing humility, but with a firm sense of our special privilege and high honor, that we 

dedicate this report to the memory of our great colleague and good friend, Ray Downey. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

i 

CONTENTS 

Letter from Chairman 

Dedication 

Contents ........................................................................................................................................... i 

Executive Summary.......................................................................................................................iii 

Second Annual Report ...............................................................................................................iii 

Recommendations in the Third Annual Report ......................................................................... iv 

Empowering State and Local Response................................................................................. iv 

Improving Health and Medical Capabilities........................................................................... v 

Strengthening Immigration and Border Controls ................................................................. vii 

Enhancing Cyber Security ..................................................................................................... ix

Clarifying the Roles and Missions of the Military.................................................................. x 

Chapter I. Introduction.................................................................................................................... 1 

Summary of Recommendations in the Second Report ............................................................... 1 

Recommendations in this Report................................................................................................ 4

Chapter II. Empowering State And Local Response ...................................................................... 6 

General Conclusions and Recommendations.............................................................................. 8 

Sharing Intelligence ................................................................................................................ 8 

Improving Training and Equipment Programs ....................................................................... 8 

Providing Resources More Effectively................................................................................... 9 

Recognizing the Special Requirements of Volunteers.......................................................... 10 

Providing Better Information................................................................................................ 11 

Integrating Military Capabilities More Appropriately.......................................................... 12 

Summary of the Survey of State and Local Response Entities................................................. 12 

Purpose and Design............................................................................................................... 12 

Response Rates ..................................................................................................................... 14 

Technical Notes .................................................................................................................... 14 

Specific Survey Results ............................................................................................................ 15 

Major Survey Findings ......................................................................................................... 15 

Domestic Preparedness Program .......................................................................................... 15 

Use of Other Federal Offices and Training and Equipment Programs................................. 16 

Exercises ............................................................................................................................... 18 

Opinions on the Usefulness and Value of Federal Programs ............................................... 19 

Factors Limiting Participation in Federal Programs............................................................. 19 

Application for and Receipt of Federal Preparedness Support............................................. 20 

Types of Federal Preparedness Support Received................................................................ 20 

Satisfaction with the Distribution of Federal Resources....................................................... 21 

Preferred Types of Federal Preparedness Support................................................................ 21 

Opinions of the Grant Application Process .......................................................................... 23 

Chapter III. Improving Health and Medical Capabilities ........................................................... 25 

Improving Coordination, Communications, Standards, and Protocols................................. 26 

Facilitating Planning, Training, and Exercises ..................................................................... 29 

Improving Stockpiles............................................................................................................ 30 

Expanding Research and Development ................................................................................ 32 

Assessing Capabilities .......................................................................................................... 33 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

ii 

Clarifying Authorities and Procedures for Health and Medical Response ........................... 33 

Developing Public Information Programs ............................................................................ 34 

Chapter IV. Strengthening Immigration and Border Controls..................................................... 35 

Expanding Interagency Coordination ................................................................................... 36 

Improving Intelligence Collection and Analysis .................................................................. 37 

Enhancing Information Sharing............................................................................................ 37 

Strengthening Security Processes and Standards.................................................................. 38 

Enhancing Sensor and Other Detection and Warning Systems............................................ 39 

Increasing Resources for the U.S. Coast Guard.................................................................... 40 

Expanding Cooperation with Our Border Neighbors ........................................................... 40 

Chapter V. Enhancing Cyber Security........................................................................................ 41

Improving National Coordination......................................................................................... 42 

Enhancing Detection, Alert, Warning, and Response........................................................... 42 

Improving Legal and Law Enforcement Processes .............................................................. 44 

Fostering an Effective Research and Development Agenda................................................. 45 

Chapter VI. Clarifying the Roles and Missions of the Military.................................................... 46 

Designating a Federal Civilian Lead Agency ....................................................................... 47 

Understanding the Sequence of Commitment ...................................................................... 48 

Establishing Command Authority and Structures................................................................. 49 

Preparing the Armed Forces for Homeland Missions........................................................... 51 

Expanding the Role of the National Guard........................................................................... 51 

Understanding Legal Authorities.......................................................................................... 52 

Fostering Better Coordination with Other Agencies ............................................................ 54 

Chapter VII. Perspectives on September 11 and Its Aftermath.................................................. 55 

State and Local Capabilities.................................................................................................. 55 

Health and Medical............................................................................................................... 55 

The Smallpox Issue............................................................................................................... 57 

Intelligence and Information Sharing ................................................................................... 57 

Use of the Military................................................................................................................ 58 

General.................................................................................................................................. 58 

Chapter VIII. The Road Ahead.................................................................................................... 59 

State, Local, and Private ....................................................................................................... 59 

Health and Medical............................................................................................................... 59 

Use of the Military................................................................................................................ 60 

Coordination and Other Security Issues ............................................................................... 60 

Table of Appendices ..................................................................................................................... 61 

List of Key Recommendations by Entity...........................................................................Last Page 

List of Key Recommendations by Subject...........................................................Inside Back Cover 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

iii 

EXECUTIVE SUMMARY 

The tragic attacks of September 11, 2001, the subsequent anthrax attacks, and persistent threats 

clearly demonstrate the importance of continuing to prepare our nation to counter more 

effectively the threats of terrorism. These attacks underscore the urgency by which we must act 

to implement fully a comprehensive national approach to preparedness. 

The Advisory Panel began its work in 1999 with an in-depth consideration of the terrorist threats 

faced by the United States. We have continued to analyze and deliberate the issues and to offer 

recommendations that we believe will better prepare the United States to deal with such threats. 

To that end, this third annual report represents three years of focused deliberation and cumulative 

recommendations. Because each set of recommendations builds on the ones contained in the 

previous year’s report, this Executive Summary encapsulates the recommendations in the second 

report and a brief explanation of those contained in the full third annual report. 

SECOND ANNUAL REPORT 

The capstone recommendation in the second report was the need for a national strategy: The 

Advisory Panel recommends that the next President develop and present to the Congress a 

national strategy for combating terrorism within one year of assuming office. We identified 

characteristics essential for an effective strategy: the strategy must be truly national in scope, not 

just for the Federal level; it should encompass the full spectrum of deterrence, prevention, 

preparedness, and response—domestic and international; domestic programs should be fully 

coordinated with State and local officials; the strategy should build on existing emergency 

response systems; it should address issues of intelligence, law enforcement, fire services, 

emergency medical services, public health, medical care providers, emergency management, and 

the military; and it must be fully resourced and based on measurable performance. 

In that second report, we recommended improvements to the Federal structure to help solve the 

broad strategic challenge of bringing together numerous other Federal agencies under a 

comprehensive strategy and of improving coordination with States and localities: We 

recommend the establishment of a senior level coordination entity in the Executive Office of 

the President. Among other functions, we recommended that the office be given certain 

authority over Federal programs and agency budgets directly related to combating terrorism. 

We also determined that there needs to be a focal point in the Congress to which the 

Administration can present its strategy and supporting plans, programs, and budgets, as well as a 

legislative “clearinghouse” where relevant measures can be considered: We recommend the 

establishment of a Special Committee for Combating Terrorism—either a joint committee 

between the houses or separate committees in each house—to address authority and funding, 

and to provide Congressional oversight for Federal programs and authority for combating 

terrorism.

In conjunction with these structural recommendations, we made a number of recommendations 

addressing functional requirements for the implementation of an effective strategy for combating 

terrorism, specifically designed to: 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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Enhance intelligence, threat assessments, and information sharing 

Foster better planning, coordination, and operations at all levels 

Enhance training, equipping, and exercising 

Improve health and medical capabilities

Promote better research and development and the creation of national standards 

RECOMMENDATIONS IN THE THIRD ANNUAL REPORT 

For the past year, we have focused on functional challenges to protecting the United States 

against terrorism in five specific areas: State and Local Response; Health and Medical 

Capabilities; Immigration and Border Control; Security Against Cyber Attacks; and Roles and 

Missions on the Use of the Military. We chose these issues because they need the most attention 

in order to implement an effective national strategy. 

Empowering State and Local Response 

The Advisory Panel commissioned a national survey to help us understand the needs and 

perceptions of State and local responders for terrorism preparedness, especially in connection 

with Federal programs. Survey results substantiated our view that State and local entities need 

threat assessments and better intelligence on potential terrorist activities. We recommend that 

agencies of the Federal government increase and accelerate the sharing of terrorism-related 

threat assessments and intelligence with appropriate State and local officials and response 

organizations. 

More effective response will be achieved not by creating new entities or processes but by 

enhancing existing response systems through all-hazards training and equipment for such 

response organizations. Therefore, we recommend that Federal agencies design related training 

and equipment programs as part of all-hazards preparedness.

In most cases, Federal programs are designed to provide training and equipment support on a 

“one-shot” basis. But equipment requires spare parts and maintenance components, as well as 

replacement mechanisms, and refresher and cyclical training is a key component of 

preparedness. We recommend that related Federal training and equipment programs be 

redesigned to include sustainment components. 

Local and State jurisdictions—those attacked and others who have been on high alert—have 

borne the brunt of increased fiscal outlays for their response entities. We recommend that the 

Congress increase the level of funding to States and local government for combating 

terrorism, especially for the “incremental” or “exceptional” costs of combating terrorism beyond 

those normally required for public health and safety. 

Federal grant programs for terrorism preparedness are uncoordinated and burdensome. 

Variations in program requirements put an undue burden on local – particularly rural and 

volunteer – responders. Federal agencies that provide assistance directly to localities, without 

prior coordination with State entities, limit the ability of States to set comprehensive statewide 

priorities and to ensure a more effective allocation of resources. Therefore, we recommend 

consolidating information and application procedures for Federal grant programs for 

terrorism preparedness in the Office of Homeland Security and that all funding and grant 

programs be coordinated through the States.
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

v 

Volunteers, especially those in fire services and pre-hospital emergency medical services (EMS), 

often cannot participate in training programs during normal working hours because of other 

employment commitments. Therefore we recommend designing and scheduling Federal 

preparedness programs so that first responders, particularly those in volunteer-based fire and 

EMS organizations, can participate. 

Lack of awareness of important Federal preparedness programs may inhibit the preparedness of 

State and local organizations. We recommend that the Office of Homeland Security serve as a 

clearinghouse for information about Federal programs, assets, and agencies with 

responsibilities for combating terrorism. 

State and local survey responders prefer that the military perform such supporting roles as 

maintaining order and providing security and logistics support. Federal response assets – 

including the military – need to be trained to operate within the Incident Command System 

(ICS). We recommend that Federal military response assets be configured to support and 

reinforce existing State and local organizational structures and emergency response systems.

Improving Health and Medical Capabilities 

The nation’s health and medical systems, and their related public and private components, are 

under-prepared to address the full scope of potential terrorist attacks. 

In our second report, we recommended that a new office in the White House establish a national 

advisory board of public health officials and medical care providers to assist in developing a 

national strategy. The American Medical Association (AMA) has begun to address our 

recommendation by calling for the creation of a national public-private entity to develop medical 

education on disasters, including terrorism; information resources on such disasters; and model 

plans. The entity must also address timely and adequate reporting of diseases. The AMA report 

also encourages State, local, and specialty entities of the Federation of Medicine to become more 

involved in response planning, training, and education. We recommend that Federal, State, and 

local entities, as well as affected private-sector organizations, fully implement the AMA 

“Report and Recommendations on Medical Preparedness for Terrorism and Other Disasters.”

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) also responded to 

our call for greater health and medical preparation, publishing a standard that requires accredited 

facilities to establish and maintain a comprehensive plan for response to disasters and 

emergencies, including terrorism, within an all-hazards framework. We recommend that 

medical systems fully implement the JCAHO Revised Emergency Management Standard.

The Centers for Disease Control and Prevention (CDC) has developed a plan for preparing 

public health agencies for terrorism. The plan includes enhancing epidemiologic capacity to 

detect and respond; establishing surveillance for critical biological and chemical agents; 

enhancing training, communication and public education programs; and encouraging research. 

We recommend that the Congress provide sufficient resources to the U.S. Department of 

Health and Human Services (DHHS) for full implementation of the “Biological and Chemical 

Terrorism: Strategic Plan for Preparedness and Response” of the CDC.
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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The CDC has also developed a “collaborative partnership” of various Federal agencies, public 

health and emergency management entities, professional associations, and academia. The 

purpose is to develop critical capacity in the public health laboratories, foster appropriate linkage 

with clinical laboratories, and integrate these capacities to enhance the timeliness of the 

laboratories’ overall emergency preparedness and response. We recommend that the Congress 

provide sufficient resources to the DHHS for full implementation of the “Laboratory Response 

Network for Bioterrorism” of the CDC.

The CDC has also created a network specifically designed to improve communications within 

the public health community and with other emergency response entities. We encourage the 

further development and fielding of this and other communication networks, such as Epi-X and 

Pulsenet, to address the need for better vertical and horizontal communications, especially for 

chemical, biological, radiological, and nuclear threats. We recommend that the Congress 

provide sufficient resources to the DHHS for full implementation of the CDC Secure and 

Rapid Communications Networks.

There is also a need to improve training and planning—especially for EMS and in rural 

communities—for better communication and coordination with other nonmedical response 

entities. We recommend that the DHHS, in coordination with the Office of Homeland 

Security, develop models for medical responses to a variety of hazards at Federal, State, and 

local levels and in conjunction with the private sector.

The Federal community needs to support State and local EMS provider organizations for 

professional development, evaluation and planning processes, and other issues of EMS systems 

and operations. No existing Federal office is responsible for addressing all of these issues. 

Therefore, we recommend that the DHHS reestablish a pre-hospital Emergency Medical 

Services program office. We also recommend that the Secretary of Transportation direct the 

National Highway Transportation Safety Administration’s Office of Emergency Medical 

Service to revise the existing Emergency Medical Technician (EMT) and Paramedic National 

Standardized Training Curricula and corresponding Refresher Curricula.

Exercises are critical—to determine the adequacy of training; to test and improve the plans and 

capabilities of individual hospital facilities; to stress coordination between health and medical 

entities and with the other emergency response agencies; and to span the range of response 

entities and threats. We recommend that the Congress increase Federal resources for exercises 

informed by and targeted at State and local health and medical entities. 

Limited research, development, and production capability for certain vaccines is one of the 

largest hurdles currently facing military and civilian responders as they prepare for biological 

threats. The private sector is unlikely to be the answer to some of the more difficult vaccine 

issues. We recommend the establishment of a government-owned, contractor-operated 

national facility for the research, development, and production of vaccines and therapeutics 

for specified infectious – especially contagious – diseases.

The availability of vaccines and other critical medical supplies is likely to make a dramatic 

difference in the level of casualties that result from an attack. The Department of Veterans 

Affairs (DVA) has certain responsibilities for stocking such supplies; the CDC and other DHHS 

entities have other responsibilities, but adequate coordination and planning for the execution of 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

vii 

those responsibilities has not occurred. We recommend that the Office of Homeland Security, 

with advice from its related national advisory board and in coordination with the DHHS and 

DVA, review and recommend appropriate changes to plans for the stockpile of vaccines and 

other critical supplies. 

Many areas of health and medical research and development require special attention—

surveillance, detection, identification, forensics, and psychological considerations. We 

recommend that the Office of Homeland Security, on the advice of its related national 

advisory board, and in coordination with the responsible Federal agencies, develop a 

comprehensive plan for the full spectrum of medical and health research for terrorism-related 

medical issues, including the psychological repercussions of terrorism and pre-hospital 

interventions.

It has been more than five years since a comprehensive inventory of medical capacities under 

NDMS has been conducted. There continues to be difficulties with the structure, location, and 

capabilities of MMRS entities and the Disaster Medical Assistance Teams. We recommend that 

the Secretary of HHS, in conjunction with the Office of Homeland Security and its related 

national advisory board, conduct a thorough review of the authorities, structures, and 

capabilities under the Metropolitan Medical Response System (MMRS) and National Disaster 

Medical System (NDMS). 

Policymakers and response entities face thorny issues, such as quarantine, containment, isolation, 

mandatory vaccination and other prescriptive measures, and scope of practice and other legal 

issues, which create the potential for conflicts among local, State, and Federal authorities. We 

recommend that the Office of Homeland Security develop an information and education 

program on the legal and procedural problems involved in a health and medical response to 

terrorism and, in coordination with the Department of Justice and the American Bar 

Association, consider the efficacy of model laws or other programs to enhance future 

responses to such events. 

The attacks of September 11 and other recent events highlight the need for a public information 

strategy. Public information programs for the coordination of initial and continuing public 

pronouncements during and following an attack require coordination with every response entity 

at all levels of government. We recommend that the Office of Homeland Security develop ongoing programs as part of the implementation of the national strategy for public education 

prior to terrorist events about the causes and effects of terrorism and for coordinating public 

pronouncements during and following an attack.

Strengthening Immigration and Border Controls 

The movement of goods, people, and vehicles across our borders is characterized by vast and 

extremely complex transportation, logistics, and services systems. We should, nevertheless, 

make it harder to exploit our borders for the purpose of doing harm—physical or economic—to 

our citizens. Currently, cooperation is limited among those Federal agencies with border 

responsibilities, State and local entities, the commercial transportation and shipping industries, 

and other private sector organizations. We recommend that the Office of Homeland Security 

create an intergovernmental border advisory group, as part of that office, with representatives 

of the responsible Federal agencies, and with State, local and private sector partners from 

jurisdictions with significant ports of entry. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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At the operational level, Federal, State, and local agencies must act collectively and share critical 

information on all aspects of immigration and border control. We recommend that the Office of 

Homeland Security facilitate the full integration of affected Federal, State, and local entities, 

including Coast Guard “Captains of the Port,” representatives of airports of entry, and border 

crossing communities, into local or regional “port security committees,” as well as into any 

adjacent Joint Terrorism Task Force (coordinated by the FBI), or other interagency 

mechanisms. 

Relevant, timely intelligence is crucial in the campaign to combat terrorism, especially for 

immigration control and border security. We recommend that the President ensure that all 

agencies with border responsibilities are included as full partners in the intelligence 

collection, analysis, and dissemination process, as related to border issues. 

The full, timely analysis and dissemination of information among affected Federal, State, and 

local agencies may be critical in preventing the movement of foreign terrorists and their weapons 

across our borders. Current systems in this area are inadequate. We recommend that the Office 

of Homeland Security create a “Border Security Awareness” database system to collect and 

disseminate information about immigration and border control, and the Congress should 

mandate participation of relevant Federal agencies and provide adequate resources to fund it. 

Existing identification and reporting requirements on the movement of people and goods across 

our borders are outmoded, and after-the-fact reporting and waivers of these requirements are no 

longer acceptable. The vast majority of cargo manifests—outbound bills of lading and related 

documentation—are already in electronic format and readily transmittable to authorities, the 

Congress just needs to legislate that requirement. We recommend that the Congress enact 

legislation requiring all shippers to submit cargo manifest information on any shipment 

transiting U.S. borders at a minimum simultaneously with the arrival of such goods at any 

U.S. port of entry, with the imposition of severe penalties for noncompliance. 

Private sector operators of international transportation and other logistics systems already 

maintain extensive information that could help in the early identification of terrorist activities to 

move people or goods into this country. The Congress should provide authority and resources to 

Federal enforcement agencies for granting incentives to encourage entities to make this 

information available. We recommend that the President direct the establishment of “Trusted 

Shipper” programs within the relevant agencies of government.

The percentage of commercial U.S. “flagged” vessels is a small fraction of the total number of 

commercial vessels in service worldwide. Nevertheless, U.S. persons own fully or in majority 

percentage many commercial vessels flagged by other countries. Currently, the U.S. Coast 

Guard has statutory authority to inspect in international waters only U.S. “flagged” vessels. We 

recommend that the Congress, in consultation with appropriate Executive Branch agencies, 

expand Coast Guard search authority to include vessels that are owned in majority percentage 

by U.S. persons.

No comprehensive, prioritized research and development agenda exists among related Federal 

agencies with immigration and border control responsibilities. Individual agencies have valuable 

research activities under way, but those activities have not been incorporated into a 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

ix 

comprehensive agenda. We recommend that the Office of Homeland Security develop a 

coordinated, fully resourced plan for research and development and for fielding and 

integration of sensor and other detection and warning systems. 

Coast Guard resources to perform its ordinary missions have been reduced in recent budget 

cycles, with no concomitant reduction in mission. With the increased requirement for enhanced 

homeland security, the Coast Guard must be provided adequate resources to accomplish these 

critical tasks. We recommend that the Congress increase resources for the U.S. Coast Guard 

for homeland security missions.

Canada has been a base for terrorists or would-be terrorists for attacks against the United States. 

The illegal movement of people and drugs across our border with Mexico also indicates the ease 

with which terrorists could cross our borders from the south. Some agreements and protocols 

with these countries exist, but more needs to be done. We recommend that the U.S. government 

negotiate more comprehensive treaties and agreements for combating terrorism with Canada 

and Mexico.

Enhancing Cyber Security 

Cyber security involves national security, law enforcement, civil rights, and commercial and 

other private sector interests. Rapidly increasing technological changes continue to add to the 

complexity of the issue. Given the fact that more than 80 percent of information systems are 

owned by the private sector, any solutions will require an unprecedented partnership between 

government and private entities. We recommend that the President direct that the interagency 

panel on critical infrastructure include representatives from State and local governments as 

well as the private sector.

The complexity of cyber security necessitates an independent, objective advisory body to assist 

in the development of strategies, policies, and programs. We recommend that the Congress 

create an independent commission, tasked to evaluate programs designed to promote cyber 

security, to identify areas where requirements are not being met, and to recommend strategies 

for better security. It should be required to report its recommendations to the President and 

the Congress.

The National Infrastructure Protection Center (NIPC) at the Federal Bureau of Investigation 

(FBI) has been ineffective in fully executing its responsibilities for critical infrastructure alert, 

warning, and response coordination, including cyber attacks by terrorists. This is due, in part, to 

NIPC’s status as part of the FBI, encouraging the belief that it is more involved in law 

enforcement activities than information sharing. We recommend that the President establish a 

government-funded, not-for-profit entity that can represent the interests of all affected 

stakeholders, public and private--national security, law enforcement, other government 

functions, and business and industry interests and concerns--to provide cyber detection, alert, 

and warning functions. 

The law has not kept pace with rapid changes in information technology and systems or the need 

for effective response against those who would exploit them. Several Members of Congress 

have developed an understanding of the issues and have introduced legislation to address some 

of those problems. Progress has, however, been slow. We recommend that the Congress and 

the Executive Branch convene a “summit” to address, on an urgent basis, needed changes to a 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

x 

wide range of federal statutes, to provide necessary protection and incentives for enhancing 

cyber assurance.

Federal prosecutors and investigators are often impeded by the lack of direct and timely 

application of existing procedures for obtaining court authority to conduct certain investigative 

activities where criminal cyber conduct is involved. Authority to use investigative tools for 

“tapping” criminal electronic transmissions or tracing electronic signatures often comes too late 

or not at all. We recommend that the Congress create a special “Cyber Court” patterned after 

the court established in the Foreign Intelligence Surveillance Act (FISA). 

A comprehensive research agenda to address the issue of cyber security remains a continuing 

need. The activities of the Institute for Security Technology Studies (ISTS) at Dartmouth 

College are significant first steps toward establishing the type of entity we envision to develop 

such an agenda. We recommend that the President establish an entity to develop and 

implement a comprehensive plan for research, development, test, and evaluation to enhance 

cyber security.

Clarifying the Roles and Missions of the Military 

The U.S. Armed Forces have enormous capabilities and resources that can support efforts to 

combat terrorism. Nevertheless, the roles, missions, and organization of the military to deter, 

prevent, or respond to a terrorist incident inside our borders remain ambiguous. Major issues are 

at stake, including critical civil liberties implications. 

To help clarify the role of the military and coordinate planning activities within the Department 

of Defense, we recommend that the Secretary of Defense seek and that the Congress approve 

the authority to establish a new undersecretary position for homeland security. 

Central to this coordination is the actual command and control of military assets for deterring, 

preventing, or responding to terrorist acts. The existing structure is not sufficient. We 

recommend that the National Command Authority establish a single, unified command and 

control structure to execute all functions for providing military support or assistance to civil 

authorities.

 

Currently, insufficient planning takes place to address the full spectrum of military activities—

deterrence, prevention, response, mitigation, and recovery. Such plans, and training and exercise 

to support those plans, are critical to address future threats and attacks. We recommend that the 

Secretary of Defense direct the development of more detailed plans for the use of the military 

domestically across the spectrum of potential activities and coordinate with State and other 

Federal agencies in the creation of more State- or regional-specific plans. We further 

recommend that the Secretary of Defense direct the military departments to institute specific 

training in military units most likely to be involved in military support to civil authorities and 

to expand military involvement in related exercises with Federal, State, and local agencies.

The National Guard is a logical “bridge” between the military and civil authorities. Accordingly, 

National Guard units may need to be reconfigured to better support Homeland Security missions. 

This will inevitably require new training doctrine, instruction, and exercises for Guard units. We 

recommend that the Secretary of Defense direct specific new mission areas for the use of the 

National Guard for providing support to civil authorities for combating terrorism.
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

xi 

Considerable misunderstanding continues to exist about the legal bases for military activities, 

including the use of the National Guard, inside the United States. Several statutes provide for the 

use of the military for assistance to civil authorities in a variety of emergencies. We recommend 

that the Secretary of Defense publish a compendium, in layman’s terms, of the statutory 

authorities for using the military domestically to combat terrorism, with detailed explanations 

about the procedures for implementing those authorities. 

Although the Department of Defense now has liaison offices in the various Federal Emergency 

Management Agency (FEMA) regions, those have not been fully effective in coordinating with 

State and local emergency management agencies and need to be improved. We recommend that 

the Secretary of Defense improve the full time liaison elements located in the ten FEMA 

regions and assign those elements expanded missions to enhance coordination with State and 

local agencies in planning, training, and exercising emergency response missions.
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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CHAPTER I. 

INTRODUCTION 

Only at a few times in our history have the people of the United States been so resolved and so 

united in seeking solutions to issues of such sweeping national importance. Governments at all 

levels, business and industry, other private organizations, and ordinary citizens are engaged and 

ready to assist in implementing a truly national approach to combating terrorism. The attacks of 

September 11 and subsequent events present us with a unique opportunity to harness our national 

unity to advance our preparedness to deter, detect, and respond to terrorists to provide more 

effectively for public health and safety. 

The conclusions and recommendations in this report are the result of almost three years of 

research and deliberation. The Advisory Panel began its work in 1999 by an in-depth 

consideration of the threats posed to the United States by terrorists, both individuals and 

organizations. A key finding in the first annual report was the urgent need for a comprehensive 

national strategy for combating terrorism. 

 

By the second year, the Advisory Panel shifted its emphasis to specific policy recommendations 

for the Executive and the Congress and a broad programmatic assessment and functional 

recommendations for consideration in developing an effective national strategy. These 

conclusions and recommendations are presented in detail in the Second Annual Report, 

published December 15, 2000, including the comprehensive research and analytical foundation 

for each recommendation. 

To understand the key conclusions and recommendations in this third annual report, it is 

important to place the recommendations in the context of our previous research and analysis. 

We begin, therefore, with a brief summary of the recommendations contained in our Second 

Annual Report. 

SUMMARY OF RECOMMENDATIONS IN THE SECOND REPORT 

The capstone recommendation in the second report was the need for a comprehensive, coherent, 

functional national strategy: The President should develop and present to the Congress a 

national strategy for combating terrorism within one year of assuming office. As part of that 

recommendation, the panel identified the essential characteristics for a national strategy: 

It must be truly national in scope, not just Federal. 

It must be comprehensive, encompassing the full spectrum of deterrence, prevention, 

preparedness, and response against domestic and international threats. 

For domestic programs, it must be responsive to requirements from and fully coordinated 

with state and local officials as partners throughout the development and implementation 

process. 

It should be built on existing emergency response systems. 

It must include all key functional domains—intelligence, law enforcement, fire services, 

emergency medical services, public health, medical care providers, emergency 

management, and the military. 

It must be fully resourced and based on measurable performance.
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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The Second Annual Report included a discussion of more effective Federal structures to address 

the national efforts to combat terrorism. We determined that the solutions offered by others who 

have studied the problem provide only partial answers. The Advisory Panel has attempted to 

craft recommendations to address the full spectrum of issues. Therefore, we submitted the 

following recommendation: The President should establish a senior level coordination entity 

in the Executive Office of the President. The characteristics of the office identified in that 

recommendation include: 

Director appointed by the President, by and with the advice and consent of the Senate, at 

“cabinet-level” rank 

Located in the Executive Office of the President 

Authority to exercise certain program and budget controls over those agencies with 

responsibilities for combating terrorism 

Responsibility for intelligence coordination and analysis 

Tasking for strategy formulation and implementation 

Responsibility for reviewing State and local plans and to serve as an information 

clearinghouse 

An interdisciplinary Advisory Board to assist in strategy development 

Multidisciplinary staff (including Federal, State, and local expertise) 

No operational control 

We included a thorough explanation of each of these characteristics in our Second Annual 

Report. For instance, we determined that it is essential that this office have the authority to 

direct the creation, modification, or cessation of programs within the Federal Interagency. It 

must also have strict authority to direct modifications to agency budgets and the application of 

resources. Only through such a process can there be any prospect of coherence and effective 

execution of implementation plans to support a national strategy once it is developed. 

A critical role for this new entity is the coordination and advocacy for related foreign and 

domestic intelligence activities, including the development of national net assessments of threats. 

The entity must have authority and responsibility for tasking related intelligence collection and 

analysis, compiling related intelligence products from the various agencies, providing national 

threat assessments as a part of the national strategy, and for producing composite products for 

dissemination to designated Federal, State, and local entities as appropriate. 

In addition to certain authority over the Federal Interagency, we recommended that the new 

entity have authority to review State and geographical area strategic plans and, at the request of 

State entities, to review local plans or programs for combating terrorism for consistency with the 

national strategy. 

 

Finally, we determined that this entity does not need to be “in charge” of operations to combat 

terrorism. As the attacks of September 11 have clearly demonstrated, that responsibility will fall, 

at least initially, to State and local jurisdictions. The Federal Response Plan, which provides for 

Lead Federal Agency and functional responsibilities, works. That process does not need to be 

supplanted. 

To complement our recommendations for the federal executive structure, we also included the 

following recommendation for the Congress: The Congress should establish a Special 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

3 

Committee for Combating Terrorism—either a joint committee between the Houses or 

separate committees in each House—to address authority and funding, and to provide 

congressional oversight, for Federal programs and authority for combating terrorism.

The philosophy behind this recommendation is much the same as it is for the creation of the 

office in the Executive Office of the President. There needs to be a focal point in the Congress 

for the Administration to present its strategy and supporting plans, programs, and budgets, as 

well as a legislative “clearinghouse” where relevant measures are considered. There are at least 

40 committees and subcommittees that have some jurisdiction over the issue of terrorism. No 

existing standing committee can or should be empowered with all of these responsibilities, 

because each existing committee is limited in its jurisdictional scope. Despite some attempts in 

this direction by the leadership of both Houses, no such entity has been created. In the House, 

the “Speaker’s Working Group” on terrorism was transformed, following the September 11 

attacks, to a regular subcommittee of the House Permanent Select Committee on Intelligence—a 

useful first step. In the Senate, the leadership has only established an informal working group, 

although at the time of this writing there appears to be some movement toward a special 

committee. Under this recommendation, most existing committee authorities can be preserved. 

In conjunction with these structural recommendations, the Advisory Panel made a number of 

recommendations addressing functional requirements for the implementation of an effective 

strategy for combating terrorism. The recommendation listed below are discussed thoroughly in 

the Second Annual Report: 

Enhance Intelligence/Threat Assessments/Information Sharing 

Improve human intelligence by the rescission of that portion of the 1995 guidelines, 

promulgated by the Director of Central Intelligence, which prohibits the engagement of 

certain foreign intelligence informants who may have previously been involved in human 

rights violations 

Improve Measurement and Signature Intelligence (MASINT) through an expansion in 

research, development, test, and evaluation (RDT&E) of reliable sensors and rapid 

readout capability and the subsequent fielding of a new generation of MASINT 

technology based on enhanced RDT&E efforts 

Review statutory and regulatory authorities in an effort to strengthen investigative and 

enforcement processes 

Improve forensics capabilities to identify and warn of terrorist use of unconventional 

weapons 

Expand information sharing and improve threat assessments 

Foster Better Planning/Coordination/Operations

Designate the senior emergency management entity in each State as the focal point for 

that State for coordination with the Federal government for preparedness for terrorism 

Improve collective planning among Federal, State, and local entities 

Enhance coordination of programs and activities 

Improve operational command and control of domestic responses 

The President should always designate a Federal civilian agency other than the 

Department of Defense (DoD) as the Lead Federal Agency 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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Enhance Training, Equipping, and Exercising 

Improve training through better coordination with State and local jurisdictions 

Make exercise programs more realistic and responsive 

Improve Health and Medical Capabilities

Establish a national advisory board composed of Federal, State, and local public health 

officials and representatives of public and private medical care providers as an adjunct to 

the new office, to ensure that such issues are an important part of the national strategy 

Improve health and medical education and training programs through actions that include 

licensing and certification requirements 

Establish standards and protocols for treatment facilities, laboratories, and reporting 

mechanisms 

Clarify authorities and procedures for health and medical response 

Medical entities, such as the Joint Commission on Accreditation of Healthcare 

Organizations, should conduct periodic assessments of medical facilities and capabilities 

Promote Better Research and Development and Create National Standards

That the new office, in coordination with the Office of Science and Technology Policy, 

develop a comprehensive plan for RDT&E, as a major component of the national strategy 

That the new office, in coordination with the National Institute for Standards and 

Technology (NIST) and the National Institute for Occupational Safety and Health 

(NIOSH) establish a national standards program for combating terrorism, focusing on 

equipment, training, and laboratory processes 

RECOMMENDATIONS IN THIS REPORT 

For the past year, we have focused on several functional challenges, in five specific areas, in 

protecting the United States against terrorism: 

State and Local Capabilities 

Health and Medical Capabilities 

Immigration and Border Controls 

Security Against Cyber Attacks 

Roles and Missions for the Use of the Military 

 

The vast majority of the recommendations in this report were adopted at the panel’s regular 

meeting on August 27 and 28, 2001—two weeks prior to the September attacks. 

In arriving at the final set of recommendations that are detailed in the following chapters, we 

considered undertaking a critical analysis of the structure, authorities, and activities to date of the 

new Office of Homeland Security in the White House.1

 We deferred that analysis. This 

Advisory Panel, if extended, and others will certainly undertake that task at some point. 

 

1

 The Executive Order creating the Office of Homeland Security (OHS) is in Appendix D. The Executive Order for 

“Citizen Preparedness in War on Terrorism” is in Appendix E. Presidential Decision Directive-1, “Organization 

and Operation of the Homeland Security Council,” is in Appendix F. Additional information on the activities of 

OHS and other homeland security initiatives are on the White House website at http://www.whitehouse.gov/
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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This panel has never contended that it has all the answers or the best answers for the full range of 

these issues. Our recommendations are, nevertheless, based on the cumulative experience of our 

members, informed by exceptionally valuable research and analysis from our support staff at 

RAND, and are offered in the belief that they can contribute materially to the critical current 

debate. 

 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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CHAPTER II. 

EMPOWERING STATE AND LOCAL RESPONSE 

“Be aware that all WMD events are local events with national 

ramifications. They can be most successfully addressed by local 

responders who are properly trained and equipped and who deal with 

hazardous chemical, explosives, biological outbreaks (flu). . . Federal 

resources can assist them in their efforts but never supplant them.” 

A State EMS survey respondent2

A distinctive characteristic of this panel, both in terms of its charter3

 and its composition,4 is its 

focus on State and local aspects of preparedness and response. A significant percentage of panel 

members have relevant State and local expertise, including a sitting State governor and State 

emergency management, State public health, municipal government, law enforcement, fire 

services, and pre-hospital emergency medical services officials. 

In considering measures for improving State and local capabilities, panel deliberations have been 

guided by a number of principles:5

All terrorist incidents are local or at least will start that way. Effective response and 

recovery can only be achieved with the recognition that local responders6 are the first line 

of defense, and through the proper integration of State and Federal assets into existing 

response networks. 

Building effective and sustainable response and recovery capabilities requires an “allhazards” approach that integrates planning and response with existing processes. 

To be most effective, plans and programs for combating terrorism should build on 

existing State and local management structures and command and control mechanisms. 

Capabilities for combating terrorism should be designed to the greatest extent practicable 

for dual- or multi-purpose applications, for maximum utility and fiscal economies of 

scale. 

Effective preparedness for combating terrorism—planning, training, exercises, and 

operational structures—requires a fully-integrated network of Federal, State, and local 

organizations. At the local level, this network includes the traditional “first 

responders”—law enforcement, fire, and emergency medical services personnel—and 

also must include other State and local agencies, such as public health departments, 

hospitals and other medical care providers, and offices of emergency management. 

 

2

 See Tab 8 to Appendix G for a comprehensive listing of comments provided by survey respondents. 

3

 Appendix A. 

4

 Appendix B. 

5

 Others have applied similar principles in framing their own conclusions and recommendations. As examples, see 

the report of the Executive Session on Domestic Preparedness of Harvard University’s John F. Kennedy School of 

Government, November 20, 2001 (Appendix H), and the recommendations of the National Emergency Management 

Association, October 1, 2001 (Appendix I). 

6

 As noted in its First Annual Report, the panel has chosen to use “local responders”—as opposed to “first 

responders”—to characterize those persons and entities most likely to be involved in the early stages following a 

terrorist attack. That characterization includes not only law enforcement, fire services, emergency medical 

technicians, emergency management personnel, and others who may be required to respond to the “scene” of an 

incident, but also other medical and public health personnel who may be required to provide their services in the 

immediate aftermath of an attack.
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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Improving the nation’s public health systems must be a priority for government at all 

levels. Public health entities, especially for incidents of bioterrorism, may be critical in 

saving lives. 

Strategies and plans must take into consideration that a majority of personnel in certain 

response disciplines, especially fire services and pre-hospital emergency medical services 

(EMS), are volunteers. 

Governments at all levels must share in the costs of domestic preparedness and response, 

but the Federal government should be prepared to provide resources for the “incremental” 

or “exceptional” costs of combating terrorism beyond those normally required for public 

health and safety. 

Federal support for States and localities must be designed and administered for maximum 

flexibility in its application at the State and local levels. 

This chapter contains several general recommendations for improvements in Federal programs 

that provide assistance to State and local entities for combating terrorism, as well as other 

changes at the Federal level that would enhance State and local preparedness.7

 The 

recommendations are based on the collective expertise of the panel; extensive interviews and 

briefings; and significant research and analysis performed by support staff at RAND, most 

particularly information collected via a first-of-its-kind, scientifically constructed and validated 

nationwide survey of State and local response organizations: EMS organizations, law 

enforcement entities, fire departments, public health agencies, hospitals, and offices of 

emergency management. 

This chapter contains an overview of the survey, including a description of the survey purpose 

and design, the survey process, survey response rates, and selected survey results.8 At the time 

the survey was in the field for response, States were engaged in a continuing dialogue with 

Federal agencies about the process for receiving support and the ways in which those resources 

could be used at the State and local level. Program fragmentation and inconsistent guidance 

from certain agencies were hampering the ability of States to advise local officials about Federal 

programs. The vast majority of State agencies designated by Governors to coordinate the 

application of Federal support share the resources that they receive with local entities consistent 

with Federal guidelines. It is, however, not always clear to local agencies that the original source 

of that support is Federal. Survey results discussed below substantiate the dilemma faced by 

States and localities in the administration of Federal programs. 

In addition to the recommendations in this chapter, each other chapter in this report contains 

specific recommendations dealing with State and local preparedness and response related to the 

subject matter of those chapters.9

 

7

 Unless otherwise indicated, these conclusions and recommendations apply to all State and local response 

organizations. 

8

 Complete details of the survey process and results can be found in Appendix G. 

9

 The Health and Medical, Use of the Military, and Cyber Security chapters also present information collected in the 

survey of State and local responders. That information is not duplicated here. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

8 

GENERAL CONCLUSIONS AND RECOMMENDATIONS 

Sharing Intelligence 

All State and local organizations surveyed strongly indicated that the Federal government should 

provide threat and risk assessment information and that the Federal government should provide 

intelligence about terrorist activities. We recommend that agencies of the Federal 

government increase and accelerate the sharing of terrorism-related threat assessments 

and intelligence with appropriate State and local officials and response organizations. 

Recent steps taken by the Attorney General to develop protocols for sharing more information 

developed at the Federal level with States and localities, provisions in the USA PATRIOT Act of 

2001, and related initiatives pending in the Congress could significantly enhance preparedness 

and response. In making the announcement of new Justice Department initiatives, the Attorney 

General said, “Increased sharing of information among law enforcement and national security 

personnel at all levels of government are critical to the common effort to prevent and disrupt 

terrorist acts. To win the war on terrorism, Federal prosecutors and law enforcement personnel 

must develop and implement effective procedures for information-sharing and cooperation with 

their State and local counterparts.”10 The challenge will be to put protocols effectively into 

practice. It is critical that procedures for sharing appropriate information with non-law 

enforcement entities also be developed. State and local agencies response agencies must be 

equal and fully informed partners in the national effort to identify potential incidents and to 

respond effectively when they occur. For example, when a possible biological threat is 

identified, sharing information with public health entities will facilitate targeted disease 

surveillance, resulting in more rapid identification and treatment of potential victims. The Office 

of Homeland Security should monitor such activities to ensure that appropriate information is 

being shared at the State and local levels. 

Improving Training and Equipment Programs 

According to the survey responses, State and local organizations that have participated in Federal 

training programs value the training and equipment and tend to give them high marks for being 

both relevant and useful. They agree, however, that the training and equipment are not sufficient 

to prepare fully for response to a significant terrorist incident. 

Furthermore, training and equipment are often dedicated to preparations for so-called “WMD” 

incidents. If more emphasis were placed on designing training and equipment programs for 

application to a broad range of hazards, communities and responders would be more effectively 

prepared for all emergencies. This concept will be especially important in the aftermath of 

September 11; care must be taken to ensure that programs implemented in the current national 

emergency environment11 are not ineffective because they are fragmented, uncoordinated, or too 

narrowly focused.12

For natural disasters, accidents, or intentionally perpetrated events, it will be the State and local 

responders, including both traditional “first responders” as well as public health, medical care, 

 

10 Memorandum from The Attorney General of the United States to all United States Attorneys, Subject: 

Cooperation with State and Local Officials in the Fight Against Terrorism, November 13, 2001. 

11 For a description and discussion of the emergency supplemental appropriations enacted post-September 11, see 

Appendix J. 

12 That was a significant problem following the bombing in Oklahoma City in 1995. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

9 

and other State and local personnel, who will be “on scene first and the last to leave.” More 

effective response will be achieved not by creating new entities or processes but by enhancing 

existing response systems through all-hazards training and equipment for such response 

organizations. We recommend that Federal agencies design related training and equipment 

programs as part of all-hazards preparedness. Embedding training for combating terrorism 

into existing training will also reduce costs, as the additional training will represent an 

incremental increase in existing programs, not the establishment of new, stand-alone programs. 

In our second report, we recommended that the new office in the White House that we proposed 

conduct inventories of State and local programs for capabilities that can be utilized in a national 

context, especially training and exercise programs. We reemphasize that point as an item for 

action by the Office of Homeland Security and note that the inventory should include Federal 

programs as well. 

In most cases, Federal programs are designed to provide training and equipment support on a 

“one-shot” basis. Refresher training for the initial training audience is important but cyclical 

training for new personnel is also required. Equipment programs must be designed to include 

spare parts and maintenance components, as well as replacement mechanisms. In direct response 

to the emerging threat of terrorism, the Nunn-Lugar-Domenici (NLD) initiatives13 provided 

training and equipment directly to certain local response organizations.14 Since its inception, the 

initiative has resulted in an aggregate of several thousand hours of training and millions of 

dollars of equipment being provided to targeted communities. While the initiative served its 

intended purpose of heightening awareness to the threat and serving as a starting point to 

enhance the response capacity throughout the United States, the lack of sustainment support in 

that and similar programs makes maintaining a high level of readiness more difficult. We 

recommend that Federal agencies with training and equipment programs design or 

redesign those programs to include sustainment components. 

Providing Resources More Effectively 

The response to the attacks of September 11 proves, more eloquently than we could express, that 

local and State responders truly are the first line of defense. Moreover, local and State 

jurisdictions—not only those attacked, but others who have been on high alert since that time—

have borne the brunt of increased fiscal outlays for their response entities. Better preparedness at 

the local and State level is critical. We recommend that the Congress increase the level of 

funding to States and local government for combating terrorism. This will require funding 

to support both preparedness and actual response operations. This action is necessary to ensure 

that States and localities are better prepared to work in partnership among themselves and with 

the Federal government in protecting public health and safety from these extraordinary threats.15 

 

13 Public Law 104-201, National Defense Authorization Act for Fiscal Year 1997, Title XIV—Defense Against 

Weapons of Mass Destruction, September 23, 1996. 

14 Many public health and medical entities have not participated in NLD programs. None has received direct 

funding. 

15 See “Protecting Our Nation: The Immediate Needs of America’s Fire Service,” a joint publication of 

Congressional Fire Services Institute, International Association of Arson Investigators, International Association of 

Fire Chiefs, International Association of Fire Fighters, International Society of Fire Service Instructors, National 

Fire Protection Association, National Volunteer Fire Council, and North American Fire Training Directors, in 

Appendix K. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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A common refrain from State and local responders is that Federal grant programs for terrorism 

preparedness are uncoordinated, have different rules and requirements, and are unduly 

burdensome. This is consistent with earlier General Accounting Office (GAO) findings and our 

previous reports. The variations in grant program requirements place a significant administrative 

burden on local – particularly small rural and volunteer – organizations. Said one survey 

respondent, “Process and paperwork is too much to ask of a volunteer Chief.” We recommend 

consolidating information and application procedures for Federal grant programs for 

terrorism preparedness in the Office of Homeland Security and that all funding and grant 

programs be coordinated through the States. Consolidation within the Office of Homeland 

Security is necessary so that State and local officials can more readily determine what assistance 

is available. It can also help streamline and standardize the grant process to eliminate 

unnecessary or duplicative requirements. 

For several years, the administration of Federal grant programs has been inconsistent. Some 

have called for direct funding to local organizations, bypassing State entities. Further 

fragmentation of the process, one that does not recognize the role of States in planning and 

coordination, is not likely to solve existing problems in this process. Efforts should ensure that 

States integrate the needs of their communities into the development of statewide strategies that 

target limited federal resources most effectively. 

State organizations have valid reasons for arguing that Federal programs be coordinated through 

State offices, not only to ensure that they complement State plans and requirements, but also 

because State entities are more likely to understand how and where and in what priority Federal 

resources should be applied. As the GAO has said, “Some of these programs initially were 

implemented without appreciation for existing State and regional structures for emergency 

management.”16 While the GAO reports that “the Department of Justice has taken a number of 

steps to improve the delivery of the [domestic preparedness] program to better leverage existing 

State and local programs,”17 more can be done to ensure better coordination efforts across all 

related Federal programs and offices. 

In addition, Federal funding and other resources must be flexible enough to allow State and local 

entities to apply them most effectively to improve their response capabilities. This means 

allowing State and local organizations greater flexibility in the use and timing (beyond the 

constraints of the Federal fiscal year) of the application of Federal resources. 

Recognizing the Special Requirements of Volunteers 

Volunteers, especially those in fire services and EMS, often cannot participate in training 

programs during normal working hours because of other employment commitments. 

Furthermore, their organizations often do not have sufficient funding for travel. As one survey 

respondent from a volunteer fire department said, “There needs to be a special program at low/no 

cost to local volunteer response groups for training, exercises and equipment done at a local 

level.” Similarly, a combination (part paid/part volunteer) fire department chief said, “Offer 

training on the weekends [regionally] so paid call and volunteer personnel can attend.” We 

recommend designing and scheduling Federal preparedness programs so that first 

responders, particularly those in volunteer-based fire and EMS organizations, can 

 

16 Combating Terrorism: Selected Challenges and Related Recommendations, GAO-01-822, September 2001, p. 90. 17 Ibid, at p. 96. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

11 

participate. Training and exercise programs should be scheduled for nights and weekends and, 

where practicable, designed to go to volunteer organizations, rather than the other way around. 

More emphasis should also be placed on “distance learning” techniques, such as Web-based, 

televised, or direct mail applications 

Providing Better Information 

State and local responders strongly indicate that they are not aware of what is available from the 

Federal government, both in terms of programs and offices to promote preparedness and, to a 

lesser degree, what specialized assets are available to support response to a particular type of 

incident. This lack of awareness of important Federal preparedness programs may inhibit the 

preparedness of State and local organizations. It also may delay the summoning of Federal 

support assets by local and State responders in the event of an incident. Furthermore, in the short 

term, as the Federal government reorganizes to combat the terrorist threat, confusion about 

Federal preparedness programs and Federal response assets could increase. We recommend 

that the Office of Homeland Security serve as a clearinghouse for information about 

Federal programs, assets, and agencies with responsibilities for combating terrorism. 

Coordination problems could be reduced considerably through the creation and distribution of 

various resource handbooks. These resources should be available in hard copy and in Webbased and other electronic formats. In each case, they should be developed with input from 

States and localities. These resources should include: 

Emergency Response Guidebook. The Office of Homeland Security should compile a 

comprehensive Emergency Response Guidebook for State and local responders, similar to 

the DOT Emergency Response Guidebook, that includes flexible guidelines and models 

for response to terrorist incidents and a complete list of Federal assets available to respond 

to such incidents. This response guidebook should be distributed annually to each related 

State and local response agency.

Federal Preparedness Resource Guide. The Office of Homeland Security should also 

compile a comprehensive resource guide with a complete list of Federal training courses,18

funding and grant programs, and other resources available to State and local emergency 

response organizations, including program requirements, deadlines, and Federal contacts. 

This Federal Preparedness Resource Guide should also be distributed annually, or more 

frequently during times of significant program and organizational change, to every related 

State and local response agency.

Fundamentals of Response to Terrorist Incidents. For rural and volunteer 

organizations, the Federal government should provide information specially tailored for 

such organizations. It should provide a compendium of model plans, basic procedures, and 

operational checklists for those communities that do not have sufficient resources to 

develop plans on their own. A local EMS survey respondent said it best: 

Most volunteers in small rural or semi-rural departments do not have the 

background, the expertise, to fully absorb and/or use the type of information being 

given out by Federal organizations. If they do receive booklets or information, it 

seems to be geared toward large departments in large cities with a great deal more 

equipment to handle large disasters. Suggestions: (1) [Provide] several relatively 

 

18 Including those Federally approved programs conducted by States. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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simplistic examples of basic preparedness guidelines/SOPs . . . Emergency plans in 

some communities date back to the Cold War; (2) [Provide] examples of exercises 

for mutual aid communities with small departments . . . Don’t just tell them to hold 

[exercises], tell them how; and (3) [Provide] booklets discussing basic equipment 

that small departments should have or have access to . . .Volunteers are very 

capable of doing many things and are willing to give their all, they just may not 

have the type of training necessary to initiate disaster preparedness guidelines for 

WMD and could use some help with the paperwork. Help to get things set up—

then they will run with it.

Integrating Military Capabilities More Appropriately 

The Federal military19 should provide support to State and local responders during response to a 

terrorist incident. As described in Chapter Six, “Clarifying the Roles and Missions of the 

Military,” the State and local survey respondents predominantly want the military to perform 

such supporting roles as maintaining order and providing security, providing personnel and 

equipment, and setting up kitchens, clinics, and mass care facilities.20 We recommend that 

Federal military response assets be configured to support and reinforce existing State and 

local organizational structures and emergency response systems. Federal military assets 

must also be trained and exercised to operate within the Incident Command System (ICS) during 

response to an incident. ICS should be employed by all Federal agencies when responding to a 

disaster involving State or local response organizations. For example, the Coast Guard has 

successfully implemented ICS when responding to various disasters, such as oil spills or the 

crash of Egypt Air flight 900.21 The success of the Coast Guard in implementing ICS should be 

used as a model for other Federal agencies, including the military. 

SUMMARY OF THE SURVEY OF STATE AND LOCAL RESPONSE ENTITIES22

Purpose and Design23

The survey was designed to elicit State and local response organizations’ assessments of Federal 

programs intended to improve State and local preparation and readiness to respond to a terrorism 

incident inside our borders. The survey was fielded between March and September of 2001. All 

 

19 As compared to the National Guard operating in its Title 32 or “State” status, under the control of the governors. 

20 Such military supporting roles are consistent with the recent report on Quadrennial Defense Review (QDR) 

released on September 30, 2001: “Those who respond first to any incident will likely be those closest to the event—

local law enforcement and emergency response personnel. It was clear from the diverse set of agencies involved in 

responding to the September 11, 2001, terror attacks on the World Trade Center and the Pentagon that the 

Department of Defense does not and cannot have sole responsibility for homeland security . . . In particular, the 

Defense Department will place new emphasis upon counter terrorism training across Federal, State, and local first 

responders, drawing upon the capabilities of the Reserve and National Guard” (p. 19). And on p. 42: “The 

Department must be prepared to provide support to State and local authorities, if Webster requested by the lead 

federal agency.” 

21 W.R. Webster, Captain, United States Coast Guard, “The Next Disaster: Ready to Respond?” Proceedings, United 

States Naval Institute, vol. 127, pp. 48-51 (September 2001). Nevertheless, transfer of control of that incident from 

the Coast Guard to another Federal agency was delayed because the incident command and control structure had to 

be reorganized so that it would fit the other organization’s structure rather than the ICS. 

22 Survey results reported here do not reflect those questionnaires returned after September 11. Hence, the following 

discussion does not reflect changes in the opinions or priorities of local and State response agencies that may have 

occurred as a result of the terrorist attacks or subsequent events. 

23 For additional information about the survey, see Appendix G. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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but 24 of the 1,104 surveys completed—almost 98 percent—were returned prior to September 

11, 2001. 

Organizations surveyed included local law enforcement, fire departments, offices of emergency 

management, public health departments, and hospitals; local, regional, and State emergency 

medical services; and State offices of emergency management and public health departments. 

Surveys were distributed to 1,687 organizations—150 at the State level and 1,537 at the local 

and regional levels.24 The survey instrument was divided into five sections, as outlined in Figure 

2.1. 

Section 1: Organizational Information 

Relevant organizational demographics 

Section 2: Organizational Experience and Threat Perceptions 

Expectation of a terrorist incident: 

Within the U.S. in the next five years 

Within their jurisdiction in the next five years 

Organizational experience with actual incidents and hoaxes 

Section 3: Emergency Response Planning Activities 

Organizational participation in emergency response planning 

Existence of emergency response plans 

Relevant training 

Section 4: Responding to Specific Terrorist Incidents 

Measures of preparedness for incidents: 

Conventional explosives 

Chemical 

Biological 

Radiological 

Specific questions for the scenario above deemed most important by each respondent 

Section 5: Assessment of Federal Programs 

Application and/or receipt of Federal support 

Evaluation of Federally sponsored exercises 

Assessment of various aspects of Federal programs 

Use of the military and cyber-terrorism 

Figure 2.1. Survey Instrument Outline 

The sample was constructed by randomly selecting 200 counties throughout the United States 

and then randomly selecting one of each type of local response organization (law enforcement, 

fire services—paid, volunteer, and combination—EMS, public health, hospitals, and offices of 

emergency management (OEM)). All relevant State-level organizations (public health, OEMs, 

EMS) were surveyed, including those in U.S. territories and Washington, D.C. Regional EMS 

entities that contained one or more of the 200 counties in the sample were surveyed. In addition 

to the random sample of counties, 10 counties were handpicked based on past terrorist incidents 

or upcoming events that might have heightened their sensitivity to terrorism (e.g., the 

Olympics).25 The most prominent of each type of response organization within each of these 

counties was then also surveyed.26 

 

24 The District of Columbia was also sent all three State-level surveys, and State-level OEM and public health 

surveys were sent to the U.S. territories of Puerto Rico, Guam, Virgin Islands, and Northern Marianas Islands. 25 Tab 1 to Appendix G provides additional information about the survey design process, and Tab 2 to Appendix G 

contains a sample of the fire department survey instrument. Survey instruments were tailored to the individual types 

of responder groups. Major differences were: 

Public health agencies were not given the narrative and questions on conventional explosives. 

Hospitals were questioned only about biological and chemical incidents in their scenario. 

Public health was additionally questioned about in-house laboratory capabilities and their capacity to distribute 

information to other responder groups. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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Response Rates 

Two of every three recipients who received a survey completed and returned it—an overall 

response rate of 66 percent. Most groups achieved better than a 70 percent response rate. A few 

performed considerably better, including State public health departments and combination fire 

departments, whose response rates exceeded 80 percent. A few of the more difficult-to-survey 

populations, with additional effort, only exceeded 50 percent response rates: volunteer fire 

departments, hospitals, and local/regional responding EMS. In each case, however, the response 

rates were exceptional when compared to rates achieved with these organizations in other survey 

efforts. The final sample of survey respondents is representative of local and State responders 

both geographically and across the different emergency response and health disciplines. Surveys 

were received from every State in the Union and the District of Columbia.27

Technical Notes28

Unless otherwise indicated, the survey results have been statistically adjusted to represent the 

entire population in that discipline (e.g., law enforcement). However, the phrases “survey 

respondents” and “of those surveyed” are used to indicate that figures refer only to those 

organizations that actually completed the survey. Table 2.1 below provides the margins of error 

for the survey. 

Table II.1. Survey Margins of Error Rounded to the Nearest Percent30

Margins of error are useful for judging the likely range of the true value: the actual value for the 

entire population is highly likely to lie within the observed survey percentage plus or minus the 

margin of error. Even though all State-level organizations were surveyed—a census rather than 

a sample—calculation of the margin of error is still relevant, because some State-level 

organizations did not reply to the survey. 

 Local OEM, State OEM, and State EMS agencies were questioned about whether their jurisdiction as a whole 

received training or equipment. 

26 Complete details of the sample selection methodology are contained in Tab 4 to Appendix G. Additional 

information about the fielding methodology is contained in Tab 3 to Appendix G. 

27 As described in Appendix G, each region of the country was well represented, and the final results can be 

generalized to all State and local response organizations nationwide. 

28 Additional technical details of the survey can be found in Appendix G. 

29 These margins of error are a conservative estimate. Results for some questions will have lower margins of error. 

30 Since convenience sampling was used to select regional EMS organizations no margin of error can be calculated. 

 

Organization 

Margin of 

Error29

(percent) 

Law Enforcement 8 

Fire Departments (all) 6 

 Combination only 9 

 Volunteer only 10 

 Paid only 10 

Hospitals 10 

OEM 8 

Local 

Public Health 8 

OEM 7 

Public Health 6 

State 

EMS 9 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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SPECIFIC SURVEY RESULTS 

Major Survey Findings 

State and local response organizations value Federal training, exercises, and equipment. 

They find them relevant, useful, and judge the costs of participating worth what they 

must invest to participate. In particular, the Domestic Preparedness Program is clearly 

valued by the State and local responders who participated in that program. These 

judgments also apply generally to Federal training and exercises. However, State and 

local organizations say that the training and equipment programs did not or do not train 

or equip an adequate number of personnel to respond to a moderately sized terrorist 

incident. 

State and local organizations tend to think that Federal programs to improve local 

responder preparedness are not well organized. They strongly feel that such programs 

should be better coordinated between the Federal government and response 

organizations. 

The main factor limiting participation in Federal programs is lack of awareness of those 

programs. Depending on the type of response entity, from just under one-half to almost 

three-quarters of such organizations reported lack of awareness of Federal programs as a 

reason for nonparticipation. 

Federal support is reaching important State agencies: OEMs and public health 

departments. Virtually all of these organizations apply for and receive some Federal 

support. Furthermore, local public health agencies and OEMs seem to benefit from their 

State colleagues’ interaction with and knowledge of Federal grants processes because 

they report higher levels of Federal support compared to other local organizations. 

State agencies receive more of all types of Federal support—funding, equipment, 

training, exercises, and reference materials—than do local response organizations. In 

contrast, the fraction of local organizations that reported receiving Federal equipment or 

funding is significantly smaller, both among all local organizations and among those that 

received any Federal support. 

Some Federal support may go unrecognized at the local level. For example, Federal 

support delivered indirectly through the States or other means may not be recognized as 

Federal. Some survey respondents may also have indicated only support directly

received by their organization, thereby underrepresenting the impact of shared resources. 

Domestic Preparedness Program31

As reported by the GAO, by October 2000, 105 cities had received training in the 120 Cities 

program, of which 68 cities also received equipment. By design, this program was targeted at 

cities, hence the training and equipment was provided to organizations in urban areas (GAO-01-

822, September 2001). However, many local responder organizations felt that the focus on cities 

was inappropriate and so commented in the survey. 

 

31 Also known as the Nunn-Lugar-Domenici (NLD) or “120 Cities” program. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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“A large amount of money, training and effort has been directed at the 

120 largest cities in America. From my perspective it appears that there 

is either no thought or very little thought given to the fact that other 

areas of our country can be vulnerable to terrorist attack.” 

A fire department responder 

“Absolute need to target states (such as ours) that have been completely 

left out of Nunn-Lugar-Domenici funding.” 

A State public health official 

State and local participants in the 120 Cities training program gave that program high marks in 

many respects. Virtually all organizations find the training relevant, with average ratings by 

responder group ranging from 3.4 to 3.9 (on a 1 to 5 scale in which 3 is neutral and 5 is highly 

relevant).32 The program’s training also received generally high marks in the following areas: (1) 

that the training improved each local response organization’s preparedness; (2) that the training 

was worth the staff-hours invested; and, (3) that the training was useful, even for incidents that 

do not involve terrorism. Similar, and often slightly higher, ratings were given for the equipment 

provided by the 120 Cities program in terms of relevancy, improving readiness, and equipment 

usefulness.33 There were some exceptions: 

(1) State public health agencies and State OEMs were neutral about whether or not the 

training had improved their State’s readiness. 

(2) State OEMs and State EMS organizations were neutral about whether or not the 

equipment they received had improved their State’s readiness. 

(3) EMS organizations were neutral about whether the training had improved their 

organizations’ readiness and whether the training had been useful to their personnel 

(even for events not involving terrorism) and disagreed that the equipment had been 

relevant, adequate, or improved their readiness. 

(4) Fire departments were neutral about whether the equipment they received had 

improved their readiness and marginally negative about the high cost of maintaining 

the equipment and its adequacy. 

All types of State and local organizations reported that the program did not train an adequate 

number of personnel, with average ratings by responder group ranging from 1.8 to 2.4 (on a 1 to 

5 scale in which 3 is neutral and 1 is very inadequate). Similarly, most types of organizations 

found the equipment programs insufficient to equip an adequate number of personnel. 

Use of Other Federal Offices and Training and Equipment Programs 

Apart from the Domestic Preparedness Program, a number of Federal programs offered by the 

Department of Justice (DOJ), The Federal Emergency Management Agency (FEMA), and the 

Centers for Disease Control and Prevention (CDC) have attracted requests for support by most 

States and some local responders. Of local responders, OEMs reported requesting support from 

other Federal programs the most—30 percent from FEMA’s Emergency Management Institute 

(EMI) or Fire Academy and about the same from the DOJ or FBI, compared to just 9 percent 

 

32 All ratings were statistically significant except for law enforcement, which was statistically indistinguishable from 

“neutral.” 

33 See Tab 7 to Appendix G for a detailed breakdown of organizational ratings. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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who requested support from the Domestic Preparedness Program. Fire departments (15 percent) 

and responding EMS (6 percent) also requested support from FEMA’s EMI or Fire Academy. A 

small fraction of hospitals (4 percent) and local public health departments (7 percent) reported 

that they had requested support from CDC’s bioterrorism program, and a surprisingly small 

number of law enforcement organizations reported requesting support from any of these agencies 

(at most 3 percent, from FEMA’s EMI). 

In contrast, State-level agencies were far more likely to request Federal support. Nearly all State 

public health departments (98 percent) requested support from CDC’s bioterrorism program, but 

a considerable fraction (from about 20 to 40 percent) from DOJ or FEMA requested it as well. A 

strong majority of State OEMs reported looking to DOJ’s Office of State and Local Domestic 

Preparedness Support (95 percent) or FEMA (83 percent) for support, but also to other elements 

of DOJ (45 percent) and CDC (38 percent). State EMS offices were more likely to request 

support from CDC’s bioterrorism program (37 percent) than the others, but nearly half reported 

not seeking any support at all from any of the programs mentioned above. 

For radiological emergency training from DOE, local and State OEMs participate most often 

(eight and 48 percent, respectively), although a small number of State EMS agencies reported 

having participated as well (6 percent). State OEMs and EMS also report participating in U.S. 

Army programs, including the U.S. Army Chemical School, Medical Research Institute of 

Chemical Defense, and Research Institute of Infectious Diseases (from 5 to 17 percent), as do a 

small fraction of local public health departments (5 to 8 percent). 

As in the Domestic Preparedness Program, responders who received training from these 

programs generally agreed that participation yielded a significant improvement in their 

organization’s preparedness (3.2 to 3.7, depending on the responder group),34 and agreed even 

more strongly that the training was relevant to their needs (3.3 to 4.0); but all groups except local 

and State OEM felt that the number of personnel trained was not adequate for responding to 

terrorist incidents that might occur in the future (2.0 to 2.6). On this last point, local and State 

OEMs, which should be expected to have the broadest view of large-scale emergencies, were in 

fact neutral. All responder groups, on average, felt the time invested was worth the effort (3.5 to 

4.1) and that the programs would be useful, even for their day-to-day duties (3.5 to 3.9). 

Local and State views on equipment they received from Federal programs are much the same. 

However, law enforcement agencies were more critical than others. They did not agree that 

equipment they received significantly improved their preparedness, was relevant to their needs, 

was worth the cost of upkeep, or that the equipment would be useful (even for non-terrorist 

events). Other responder groups were more favorable. Fire departments and State OEMs (3.7) 

departed from the more negative views of others in their opinions that the equipment would be 

adequate for responding to future incidents. 

In their open-ended comments, however, some agencies expressed frustration with the targeting 

of funds and other support. The remarks below echo these thoughts—that targeting is neither 

equitable nor efficient. 

 

34 As before, a rating of 3 indicated neutrality, 5 indicated “strongly agree,” and 1 “strongly disagree.” The figures 

reported here are averages. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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“The Federal WMD funding is going to many non-state chem/emergency 

response/bomb] teams duplicating much of the current state response 

systems. States have been left out of the MMRS and 120 cities program 

making for a difficult response network with no one leading the effort... 

Many of the Federal training programs are the same thing with a 

different name, created by different contractors...state and local 

government have been left out of the process... We have asked for 

technical assistance and are yet to see any help!” 

A State OEM official 

“Our state is very densely populated and yet has had no Nunn-Lugar 

funding, has no NDMS, no HHS-MMRS, no full-time WMD-CST (NGB). 

As a result, we are years behind our neighbor states with respect to 

planning and resources for WMD preparedness. Doesn’t anyone at the 

Federal level care about our state?” 

A State public health official 

Exercises 

Organizations that have participated in exercises with Federal entities rate the exercises high in a 

number of ways. First, virtually all of the organizations tended to agree that their own 

participation helped make the exercise more realistic.35 Second, most organizations agreed that 

Federal involvement helped improve State and local capabilities more than would have been the 

case without Federal participation.36 Yet, Federal involvement does not imply an increase in the 

number of exercises. In particular, when asked whether the organizations would not have 

participated without Federal involvement, local organizations were statistically neutral and State 

organizations tended to disagree.37

In fact, more than 80 percent of each type of local response organization have not participated in 

exercises with the Federal government. Furthermore, either with or without Federal 

involvement, the majority of local organizations have not conducted exercises for moderately 

sized conventional explosives, chemical, biological, and radiological incidents.38 For example, 

fewer than half of most types of local response organizations have emergency response plans for 

a conventional explosives incident of approximately the size of Oklahoma City or for a chemical 

or radiological incident of similar size, and less than one-third have emergency response plans 

for a biological incident. Of the organizations with emergency response plans, only between 

one-third and two-thirds have exercised the plan within the last five years (with chemical 

incident exercises being conducted slightly more frequently). 

 

35 On a scale of 1 to 5, in which 3 is neutral and 5 is strongly agree, average responses ranged from 3.2 to 4.0. All 

were statistically significant except for fire departments and responding EMS organizations. (Hospitals were not 

asked this question.) 

36 On a scale of 1 to 5, in which 3 is neutral and 5 is strongly agree, average responses ranged from 3.1 to 3.8, with 

the exception of State OEMs, which averaged 2.9. All were statistically significant except for fire departments, law 

enforcement organizations, and responding EMS organizations. (Hospitals were not asked this question.) 

37 On a similar scale of 1 to 5, local organizations’ average responses ranged between 2.7 to 3.1, and none were 

statistically distinguishable from neutral, 3.0. State organizations’ average responses were between 2.5 and 2.6, and 

all were statistically significantly less than 3.0. 

38 See the scenarios in Section 4 of the sample survey in Tab 2 to Appendix G. These scenarios reflect incidents 

involving hundreds of casualties to be similar in magnitude to the Oklahoma City incident. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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In contrast, 71 percent of State EMS organizations, 76 percent of State public health 

organizations, and 92 percent of State OEMs have participated in exercises in which a Federal 

agency either helped organize or coordinate the exercise, provided funding to the participating 

organizations, or participated in the exercise itself. Furthermore, the majority of State 

organizations have emergency response plans for moderately sized conventional explosives, 

chemical, biological, and radiological incidents, and the majority of those with plans report 

exercising them in the last five years. 

Opinions on the Usefulness and Value of Federal Programs 

“Generally, numerous Federal efforts need to be consolidated and 

centrally coordinated.” 

A regional EMS official

Both State and local response organizations believe that Federal programs to improve responder 

preparedness are not well synchronized or organized. While law enforcement organizations, 

local EMS, and local public health organizations were statistically neutral in this regard, all other 

local response organizations (law enforcement, fire departments, hospitals) tended to be 

somewhat negative, and State organizations were the most negative. All organizations, whether 

local or State, tended to judge the programs to be inflexible, especially when they did not allow 

Federal funds and resources to be used to meet requirements identified at the State or local level. 

“A total lack of coordination and control exists at the Federal level.” 

A local OEM official 

All of the local response organizations also strongly felt that the programs should be better 

coordinated between the Federal government and State and local response organizations. On the 

other hand, State and local organizations tended to agree that the Federal programs were of use to 

their organizations, with State organizations most strongly agreeing.39

Factors Limiting Participation in Federal Programs 

Both State and local organizations indicate that the primary factor limiting their participation in 

Federally sponsored programs is lack of awareness of those programs. From 43 to 71 percent of 

local organizations, depending on the type of organization and type of program, reported lack of 

awareness of such programs. State organizations were less unaware, ranging from 38 percent of 

State public health organizations to 18 percent of State OEMs. This result holds for those 

organizations that participated in the Domestic Preparedness Program as well. Lack of 

awareness of Federal programs was reflected in survey respondents’ comments. 

 

39 On a scale of 1 to 5, where 1 is strongly disagree and 3 is neutral, local organizations’ average responses ranged 

from 2.3 to 2.7 and State organizations ranged from 2.1 to 2.4 for a question that said Federal programs “are of little 

use to our organization.” Hence, they agreed that the programs are of use, and the results were statistically 

significant for all organizational types. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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“The only WMD training I have heard about is from other local 

agencies. Let us know what is available.” 

A law enforcement official 

“We are unaware of most of the Federal programs you mention. 

Perhaps they are dealing with our state health department, or perhaps 

only with larger jurisdictions. At any rate, some outreach to inform us of 

their functions and resources would be helpful.” 

A local public health department official 

“Unaware of any of the programs mentioned [in the survey].” 

A hospital official 

 The next most common reasons for not taking advantage of these programs were excessive cost 

of participation, and excessive time commitment. A related charge, particularly strong among 

responders in volunteer organizations, is that training is generally not scheduled at times when 

they can participate. 

State public health organizations and State OEMs—those organizations that applied for and 

received Federal support most—also mildly, but statistically significantly, agreed with the 

statement that Federal programs for improving local responder preparedness are so numerous

that they have difficulty determining what is relevant to them.40

Application for and Receipt of Federal Preparedness Support 

All State public health departments and virtually all State offices of emergency management 

(OEMs)—98 percent—have applied to the Federal government for preparedness funding, 

training, equipment, or other support in the last five years. All State public health departments 

and State OEMs also report receiving some form of preparedness support from the Federal 

government. In contrast, about half of State EMS offices report applying for Federal support and 

63 percent—more than the number who applied—report receiving support either for their own 

organization or for other EMS organizations within their State. 

The majority of local organizations have not applied for Federal preparedness support. Only 40 

percent of local OEMs, and 16 percent or less of all other local response groups, have applied for 

such support. More local public health organizations (at the county level) and local OEMs report 

receiving Federal support than applying for it (55 percent of local OEMs and almost 27 percent 

of local public health organizations), perhaps benefiting from their State colleagues’ Federal 

contacts and activities. The percentage of other organizations—namely hospitals, responding 

EMS organizations, fire departments, and law enforcement agencies—reporting receiving such 

support is slightly less than or statistically indistinguishable from the percentage that applied. 

Types of Federal Preparedness Support Received 

Local responder organizations that receive support predominantly receive training, exercise, and 

reference materials. Between 4 and 14 percent of fire departments, hospitals, and local law 

enforcement organizations, responding (as opposed to regulatory) EMS organizations, and local 

public health agencies, and just over 40 percent of local OEMs receive these types of Federal 

 

40 On a 1 to 5 scale, where 5 is strongly agree and 3 is neutral, State OEMs’ average response was 3.5 and State 

public health averaged 3.2. Both were statistically significantly different from neutral (3.0). 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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support. On the other hand, law enforcement organizations, fire departments, hospitals, and 

EMS organizations rarely receive funding and equipment for preparedness (only approximately 1 

to 3 percent of each), while local public health organizations and local OEMs are more likely to 

receive Federal funding and equipment (14 and 26 percent, respectively). 

However, State organizations are far more likely to receive funding and equipment as well as 

other types of support. Virtually all State public health offices and State OEMs have received 

Federal preparedness funds.41 Slightly more than three-quarters of the State public health offices 

also received equipment, while only about one-third of the State OEMs received equipment. 

About half of the State EMS organizations received either funding or equipment. Most State 

offices also received training, exercise, and reference materials: 46 percent of State EMS offices, 

73 percent of State public health agencies, and 98 percent of State OEMs. 

Satisfaction with the Distribution of Federal Resources 

A majority of the State and local response organizations that receive Federal support share the 

resources they receive with other organizations. Fully 100 percent of State OEMs share their 

resources, as do 80 percent of local OEMs. Similarly, three-quarters of State public health 

organizations and between half and two-thirds of the other organizations share Federal resources. 

Whether it is distributed directly to local communities by the Federal government or through 

State governments, local organizations tend to be mildly dissatisfied with the distribution of 

funds. On a five-point scale where one is very negative, three is neutral, and five is very 

positive, each of the local response organizations’ average response tended to be negative. In 

particular, local organizations’ opinions of direct Federal distribution (to local organizations) 

ranged from 2.4 to 2.8, and for distribution by States from 2.3 to 2.9. All were statistically 

significant except for local public health organizations’ average score for State distribution, 

which, although negative, was not statistically distinguishable from “neutral.” 

State organizations view the performance of Federal agencies distributing funds to locals in 

much the same way: they are either neutral or equally mildly dissatisfied with direct Federal 

distribution of funds. They were more generous in their opinions of distribution of funds by 

State agencies: State EMS was mildly dissatisfied (2.8), State public health was mildly satisfied 

(3.2), and State OEMs were quite satisfied (4.0). 

Preferred Types of Federal Preparedness Support 

As shown in Table 2.2, financial support and training (or training aids) are the two most widely 

preferred ways that the Federal government can support the preparedness efforts of local 

organizations. Funds and training are followed by outreach to local organizations, equipment 

procurement, and exercise coordination and support. Table 2.3 shows that direct financial 

support is also the type of support most favored by State organizations, though many State 

OEMs want equipment procurement and some State EMS organizations want more Federal 

outreach or training. 

 

41 All State OEMs and 75 percent of State public health agencies indicated that they shared some part of Federal 

resources with other organizations within their State. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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What is the most important way Percent 

that the Federal Government 

can support the efforts of local 

organizations to improve 

WMD preparedness? 

Law Enforcement Fire department 

Local EMS Local OEM Local public health Hospitals 

Direct financial support 32 42 33 39 25 37 

Training or training aids 34 35 23 13 17 20 

Outreach to State and local organizations 8 11 10 12 12 17 

Equipment procurement 6 6 17 20 0 5 

Exercise coordination and support 7 1 7 4 7 3 

Other response 13 5 10 12 39 18 

Total: 100 100 100 100 100 100 

Table 2.2. Most Important Way Federal Government Can Support Local Response Organizations 

What is Percent the most important

way that the Federal Government 

can support the efforts of state 

organizations to improve 

WMD preparedness? 

State OEM State public health State EMS 

Direct financial support 49 61 38 

Training or training aids 3 5 14 

Outreach to state and local organizations 3 2 21 

Equipment procurement 27 0 7 

Exercise coordination and support 0 5 7 

Other response 18 27 13 

Total: 100 100 100 

Table 2.3. Most Important Way Federal Government Can Support State Organizations 

Looking more closely at the “Other response” category, Table 2.4 shows that only a small 

fraction of hospitals and local and State health departments ranked as most important Federally 

supported surveillance systems for detecting possibly terrorist-related disease outbreaks, 

communication systems between health agencies, and establishment of a national pharmaceutical 

stockpile. In fact, less than one in 10 members of each of these groups believe these efforts are 

the most important way the Federal government can support local and State responders to 

prepare for terrorist events. The table does not necessarily imply that enhancing surveillance 

systems, establishing health communication systems, and maintaining a pharmaceutical stockpile 

are not of any importance to the health and medical communities, only that when forced to 

choose, these organizations tended to rank direct funding and other items of immediate use to 

their organizations ahead of Federal help in specific areas. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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Percent 

What is the most important way that the Federal Government can . . . improve 

WMD preparedness? 

Hospitals Local public health State public health 

Enhance current surveillance systems to include detection and reporting of 

possible terrorist-related disease outbreaks or injuries 2 

 

5 10 

Establish a centralized communication system to rapidly notify health departments 

and other medical institutions regarding disease outbreaks related to bioterrorism 

and other emergency health information 1 16 0 

Maintain a national pharmaceutical stockpile of medical supplies, devices, and 

equipment for possible terrorist-caused illness or injury for local health department 

access 

3 6 0 

Table 2.4. Ways Federal Government Can Support Medical and Public Health Communities 

Consistent with all organizations nationwide, the smaller set of organizations that participated in 

the Domestic Preparedness Program (120 Cities) also predominantly ranked direct financial 

support as the most important way the Federal government can improve preparedness. Many of 

these organizations also chose equipment procurement, training and training aids, and outreach. 

In the only consistent difference from all response organizations nationwide, the 120 Cities 

program participants tended not to select exercise coordination and support, perhaps reflecting 

their recent participation in the 120 Cities program. 

Opinions of the Grant Application Process 

While State and local organizations were not directly asked about the Federal grant application 

process, some respondents provided written comments, and the comments they provided were 

generally critical. Some focused on the burden of the Federal grant process. 

“Presently, the Federal grant application process is laborious 

and cumbersome.” 

A fire department responder 

“Federal grant applications are usually complicated and too time 

consuming to complete, especially when the grants are generally 

awarded to much larger agencies...” 

A law enforcement official 

Some OEMs that have responsibility for managing the preparedness of other organizations in 

their jurisdiction focused on the lack of organization at the Federal level and said that Federal 

programs often bypass State organizations and are not well aligned with statewide priorities. 

“There appears to be an alphabet soup of Federal organizations that 

offer grants, each grant having different rules. We need one Federal 

agency to be in charge of all grants and they need to be funneled through 

the states.” 

A local OEM official 
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“The Equipment Procurement Grant has been too narrowly focused, 

again, ignoring the state’s attempts to develop a statewide response 

capability.” 

A State OEM official 

The survey did not delve into this topic in detail because the problems of the grants application 

process are well known. The National Domestic Preparedness Office (NDPO) was created in 

part to serve as a single focal point for State and local organizations. As described in a recent U. 

S. General Accounting Office (GAO) report, NDPO has not met its original expectations (GAO01-822, September 2001). While the NDPO was assigned the tasking of supporting State and 

local entities as a “one-stop shop,” it never fulfilled that mandate. This is not attributable to the 

individuals assigned to the office but is more directly related to the failure, over several years, of 

the Executive Branch and the Congress to fund that entity sufficiently. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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CHAPTER III. 

IMPROVING HEALTH AND MEDICAL CAPABILITIES 

While progress is being made in coordination, communication, and capabilities for combating 

terrorism in public health and medical care (public42 and private43), much remains to be done: 

A robust public health system is fundamental to a long-term solution for a variety of 

health issues, including terrorism. Improvements in public health infrastructure are now 

critical. Years of under-resourcing this vital national asset has increased our 

vulnerability. 

Improvements must be made in coordination and communications that span the complex 

interrelationships of all response entities, with special emphasis on effective pre-hospital 

emergency services and medical response in rural areas. 

Standards and protocols are lacking across most health and medical systems, especially in 

laboratory methods—detection, identification, surveillance, and forensics—and reporting. 

Much more is required in planning, training, and exercising among health and medical 

professionals and the broader emergency planning and response communities. While 

certain public health and medical personnel are now included in such activities, 

inconsistencies exist nationwide, and important personnel, such as psychologists, 

pathologists/ medical examiners, and veterinarians, are often overlooked. 

Preparation and mobilization for infrequent events, especially a large-scale acute event, 

and recognition of unannounced events, particularly those involving biological agents, 

present major challenges. Shortages in medical, public health and scientific research 

personnel exacerbate the problem. Incident management plans for such events are not 

well defined. Exercises focused on health and medical are needed to enhance response 

coordination and to identify areas that need further improvement. 

In addition to treating victims with physical injuries, medical and public health systems 

must be better prepared to deal with the “worried well” and patients suffering effects 

from stress.44 

Better focused and prioritized research is critical, especially detection, identification, 

prophylaxis, treatment, communications, epidemiology, and forensics. Development, 

production, and distribution of vaccines, drugs, and other medical supplies are required to 

respond to existing and emerging threats. Progress in biotechnology and increasing 

dissemination of information can improve the nation’s ability to prevent and respond but 

also increases the risks that terrorists will use this knowledge to cause great harm.45 

Current government and legal structures are ill equipped to handle quarantine, 

containment, isolation, mandatory vaccinations, and other issues of prescriptive activity. 

Public awareness and communications are important tools in combating terrorism. As 

illustrated by the public affairs and communications activities in the wake of the recent 

anthrax attacks, pre-event public education and awareness, and post-event public 

communications require greater attention and better planning. 

 

42 Those owned by local, State, and Federal government entities (including U.S. military and veterans hospitals). 

43 Both for-profit and not-for-profit institutions, including in the latter case those run by religious organizations. 

44 The lessons from the Aum Shinrikyo attack in 1995 are still instructive. See the panel’s First Annual Report, pp. 

40-50.

45 “Discovery sparks bio-warfare fears,” Stephen Brook, The Australian, January 12, 2001.
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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“While I am in complete agreement that we, as a nation, need to be 

prepared to deal with incidents of terrorism. I think we need to further 

exam[ine] the state of our emergency systems. This country’s 

Emergency Departments are unable to care for the current load of 

patients in an effective manner and even an epidemic of routine disease 

will overwhelm the system... ...there is a profound shortage of nurses as 

well as space” 

A hospital administrator 

“Our public health staff are overextended so it is difficult to train, 

prepare when staff resources are not available” 

A local public health official 

“Healthcare is being strangled by funding cutbacks while the 

expectations of us are increasing – we are lucky to still provide our 

traditional role of showing up for a heart attack” 

A local EMS responder 

“Hospitals are max’d out already. No ‘slack’ to plan, exercise, etc.” 

A state public health official 

In our survey, we asked local responders whether they thought hospitals and public health 

agencies “are well-integrated with other emergency response organizations” in their community 

in “planning and preparing” for terrorist incidents. Table 3.1 shows that, with the exception of 

law enforcement organizations’ opinion of hospital integration (and hospitals’ opinions of 

themselves) less than half of all types of local response organizations judge hospitals and public 

health agencies to be well-integrated in planning and preparations. 

Percent Agree 

“In your opinion, are _________ well-integrated 

 with other emergency response organizations 

in your community in planning and preparing 

for [WMD] incidents...?” 

Law Enforcement Fire department Local EMS Local OEM Local public health Hospitals 

 ...hospitals... 61 31 40 47 27 50 

 ...public health agencies... 42 24 29 41 25 33 

Table 3.1. Health and Medical Integration 

Improving Coordination, Communications, Standards, and Protocols 

“There is little to no coordination at the federal level & too much 

duplication.” 

A hospital official

In our survey of State and local health and medical organizations, all agreed that Federal 

preparedness programs should be better coordinated between the Federal government and State 

and local organizations. State public health and EMS organizations most strongly agreed, giving 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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average scores of 4.3 on a five-point scale in which 5 indicates “strongly agree.” Local public 

health departments, EMS organizations, and hospitals also agreed, with average scores of around 

4.0 for each group.46

In our second report, we recommended that a new office in the White House establish a national 

advisory board composed of Federal, State, and local public health officials and representatives 

of medical care providers, as an adjunct to that new office, to ensure that health and medical 

issues are an important part of the national strategy. To address medical system roles, we 

recommend that Federal, State, and local entities as well as affected private-sector medical 

organizations fully implement the American Medical Association (AMA) “Report and 

Recommendations on Medical Preparedness for Terrorism and Other Disasters.”47 The 

first principal recommendation of the AMA report begins to address our earlier recommendation 

by calling for the creation of a collaborative public-private entity at the national level to: 

Develop medical education on disaster medicine and the medical response to terrorism 

Develop information resources for the health and medical communities on terrorism and 

other disaster responses 

Coordinate with Federal and State entities, professional organizations, and the private 

sector to develop model plans for terrorism and other disaster response 

Address the issue of reliable, timely, and adequate reporting of dangerous diseases 

The Office of Homeland Security should establish such an advisory body for the development of 

strategies and programs. 

The second recommendation in the AMA report encourages State, local, and specialty entities of 

the Federation of Medicine48 to become more involved in terrorism and other disaster response 

planning, training, and education. That recommendation directly supports our emphasis on the 

need for closer coordination among all entities involved in combating terrorism. The 

implementation of this recommendation will facilitate the required relationships among medical 

providers, public health entities, emergency managers, and other emergency responders, through 

all-hazards joint planning, training, and exercises. As noted, a special focus on pre-hospital 

emergency medical services coordination is key. 

The third AMA recommendation is the same as one contained in our previous report49: That the 

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and state licensing 

authorities include, in their periodic accreditation and licensing processes, effective evaluations 

of hospital plans for terrorism and other disaster response.50 

 

46 All were statistically significant. See Appendix G for more detail. 

47 AMA Council on Scientific Affairs, January 2001, synopsis included at Appendix L. 

48 A term of art used by the AMA to describe all entities involved in public health and medical care. 

49 Second Annual Report, p. 35. 50 Plans for other disasters do undergo evaluation, but we question whether even those evaluations are sufficiently 

comprehensive. See further discussion of this topic in the section on standards and protocols. 
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“Conference/lectures have been very good about telling us . . . that we 

should be prepared and coordinated. What they lack are real nuts and 

bolts of ‘how to.’ How about sample protocols, etc...” 

A local public health official

We recommend that medical systems fully implement the JCAHO Revised Emergency 

Management Standard.51 That standard requires that accredited facilities establish and 

maintain a comprehensive plan for response to disasters and emergencies, including terrorism, 

within an all-hazards framework. Plans should address all aspects of response, including 

coordination with other response entities both public and private, reporting and other 

communications processes, and training of critical personnel, and the standard includes an annual 

evaluation of the plan. 

We recommend that the Congress provide sufficient resources to the U.S. Department of 

Health and Human Services (DHHS) for full implementation of related CDC and public 

health preparedness programs: 

Biological and Chemical Terrorism: Strategic Plan for Preparedness and Response—

This plan defines the critical steps to prepare the public health agencies for terrorist attacks, 

which include 

enhancing epidemiologic capacity to detect and respond; 

establishing surveillance for critical biological and chemical agents; 

enhancing training of public health professionals; 

enhancing communication and public education programs; and 

encouraging research. 

Laboratory Response Network for Bioterrorism52—This “collaborative partnership” of 

Federal agencies, State public health entities, professional associations, and academia is 

precisely the approach envisioned by this panel. The program involves 

developing critical laboratory capacity in public health laboratories; 

fostering appropriate linkage with clinical laboratories; and 

integrating these capacities into overall emergency preparedness. 

The goals of the program are rapid detection, analysis, and communication of the findings to 

appropriate health and medical entities nationwide. 

Secure and Rapid Communication Networks. The Health Alert Network is specifically 

designed to improve communications within the public health community, especially 

between CDC and local and State health departments and with other medical and emergency 

response entities (particularly law enforcement and emergency management agencies). It is 

also designed to support local efforts to track diseases, to train public health professionals, 

and to establish a nationwide information technology infrastructure. This and other systems, 

such as CDC’s Epi-X are beginning to provide encrypted Secure Data Networks for transfer 

of sensitive files between the CDC and State and local health departments, and secure 

communications between public health and other emergency response entities. These 

 

51 JCAHO Standard EC.1.4, can be found in Appendix M. 

52 For additional information, see the briefing provided by CDC to the panel on the panel’s website at 

www.rand.org/nsrd/terrpanel. 
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systems are only in the early stages of development and implementation, and need additional 

resources for further development, for coordination with affected entities nationwide, and for 

full implementation. 

We encourage the development and implementation of similar programs to enhance medical and 

public health preparedness and response for combating terrorism. 

Facilitating Planning, Training, and Exercises 

“WMD/HM training is very expensive. The information needs to be 

presented in an all hazards format to start.” 

A hospital official 

“We have participated in one full blown exercise [involving] hazardous 

materials (nerve gas). There is a critical need to develop a realistic 

table top drill for a biological weapon.” 

 A local public health official 

Additional standard medical and public health response models must be developed, and training 

and exercises on the use of those models should be embedded in Federal, State, and local 

activities. Those tools must be developed to enhance coordination and communications between 

medical and public health entities and with other response entities, with special recognition of 

the need to improve pre-hospital emergency medical services and the need to include rural 

communities all activities. We recommend that DHHS, in coordination with the Office of 

Homeland Security, develop standard models for health and medical responses to a variety 

of hazards for use at Federal, State, and local levels and in conjunction with the private 

sector. The planning tools should be community-based, tailorable to an individual jurisdiction’s 

unique requirements and capabilities,53 and focus on transportation, communications, and other 

coordination requirements that may span multiple hospitals and clinics, public health agencies, 

and numerous other emergency response entities. 

We recommend that the Secretary of HHS reestablish a pre-hospital Emergency Medical 

Services (EMS) program office. This is necessary to support state and local EMS organizations 

for professional development, evaluation, and planning processes and other issues of EMS 

systems and operations. No Federal office is now responsible for these issues. In addition, we 

recommend that the Secretary of Transportation direct the National Highway Traffic 

Safety Administration’s Office of Emergency Medical Service to revise the existing 

Emergency Medical Technician (EMT) and Paramedic National Standardized Training 

Curricula, and corresponding Refresher Curricula, to incorporate required educational 

modules to address 

EMS Response to Terrorism Incidents; 

EMS Response to Hazardous Materials Incidents; 

EMS Operations in Hazardous Environments; and 

EMS Disaster / Multiple Casualty Incident (MCI) Response and the Incident 

Management System for EMS. 

 

53 State response teams should be included in the model and planning template development. 
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More and better exercises are critical—to determine the adequacy of training; to test and improve 

the plans and capabilities of individual hospital facilities; to stress coordination between health 

and medical entities, and with the other emergency response agencies; and to span the range of 

response entities and threats, not just biological attacks. Nevertheless, exercises are especially 

important where biological agents are involved, because such attacks will necessitate new 

partnerships in communities and will demonstrate the need for better recognition of the critical 

role of medical and public health agencies. Exercises must be based on State and local input, to 

address the requirements of their jurisdictions. Equally important, exercises must include 

evaluations, after-action reports, and statements of lessons learned, to assist in decisions for 

resource allocation and to guide future training. Federal resources are required to support these 

initiatives. We recommend that the Congress increase Federal resources for exercises that 

are informed by and targeted at State and local health and medical entities. 

Improving Stockpiles 

“[We] need equipment and stockpiles.” 

A hospital administrator

The timely research, development, production, and distribution of certain critical vaccines and 

other medical supplies continue to be perplexing problems.54 Vaccines can cost hundreds of 

millions of dollars to develop, and commercial manufacturers may have little incentive to 

produce vaccines with a potentially small or variable market. Moreover, private industry has 

become more risk-averse where vaccines are concerned, because of the potentially huge liability 

that they may incur. In addition, vaccines and other pharmaceuticals must be licensed by the 

Food and Drug Administration (FDA) after meetings standards for both safety and efficacy. 

Human testing for efficacy is unethical, potentially unlawful, in the case of biological and 

chemical agents for which there is no known cure. FDA inspections are becoming increasingly 

stringent, making licensing even more challenging. 

We recommend the establishment of a government-owned, contractor-operated national 

facility for the research, development, and production of vaccines and therapeutics for 

specified infectious—especially contagious—diseases. The private-sector market is unlikely to 

be the answer to some of the more difficult vaccine issues. Direct government ownership is 

likely to be the only reasonable answer for certain bio-organisms—anthrax and smallpox being 

at the top of the list.55 This new laboratory could be seconded to DoD, perhaps as an adjunct to 

the U.S. Army Medical Research Institute on Infectious Diseases. We are not, however, 

proposing that the costs for such a laboratory be borne exclusively by DoD. Costs should be 

 

54 Recent experiences of the Department of Defense in the timely acquisition of reliable anthrax and adenovirus 

vaccines, as well as civilian shortages of influenza vaccines in 2000 and an ongoing tetanus toxoid shortage, 

highlight the magnitude of the problem. According to the American Society of Health System Pharmacists, supply 

problems for drug products have been increasing, stemming from challenges in all segments of the supply chain: 

raw material sources, pharmaceutical manufacturers, Federal regulators, wholesalers and other distributors, health 

care facilities, and pharmacies (accessed at http://www.ashp.org/shortage/ on October 12, 2001). In our Second 

Annual Report, we noted that the TOPOFF exercise, conducted in May 2000, highlighted existing problems in the 

delivery and distribution of vaccines, antidotes, and prophylaxes. Unfortunately, as of the writing of this document, 

the Department of Justice has not yet released the TOPOFF After-Action Report, which was due in November 2000. 

55 Such a laboratory could, among other things, conduct research into a recombinant anthrax vaccine that could 

reduce or eliminate the requirement for multiple vaccinations in order to take effect. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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apportioned among the various agencies that have responsibilities for the specific vaccine 

program. Significant research and development on vaccines of interest primarily to the military 

already exists. This research should be leveraged for the U.S. population as a whole. Limited 

production capabilities for small-market (i.e., military useful) vaccines are currently the largest 

hurdle facing DoD56 and civilian bioterrorism preparedness. 

“National pharmaceutical stockpile does not, in my opinion, 

address the needs of major cities at this time. Responses of C.D.C. 

stockpile personnel at our recent exercise clearly indicate a need 

to revise the program.” 

A local OEM official

“CDCs pharmaceutical stockpile program and release procedures are 

seriously FLAWED—will not work”. 

Another local OEM official

The availability of vaccines and other critical medical supplies, especially antidotes and 

prophylaxes—at the right place and the right time—is likely to make a dramatic difference in the 

level of casualties that result from an attack. The Department of Veterans Affairs (DVA) has 

certain responsibilities for stocking such supplies; the CDC and other DHHS entities have 

additional responsibilities. It is not clear that adequate coordination and comprehensive planning 

for the execution of those responsibilities have taken place, especially for point-of-distribution 

and other activities at the State and local level. Those responsibilities and implementation plans 

should be clarified, coordinated, and transparent to all affected response entities in the health, 

medical, and emergency response communities. The effect of transportation slowdowns, 

individual stockpiling, and other external factors should be considered in the design of 

stockpiles. We recommend that the Office of Homeland Security, with advice from its 

related national advisory board and in coordination with DHHS and DVA, review and 

recommend appropriate changes to plans for the stockpile of vaccines and other critical 

supplies. 57

 

56 A report to the Deputy Secretary of Defense by an independent panel of experts on “Department of Defense 

Acquisition of Vaccine Production (AV),” December 2000, found that, “DoD needs to consolidate and integrate its 

vaccine research, development, and acquisition programs for BW defense and endemic disease protection. Success 

requires a tailored acquisition model and infusion of technically qualified staff at all levels. A Joint Program Officer 

must have responsibility and authority for the program and report to a designated Vaccine Acquisition Executive 

reporting to the Undersecretary of Defense (Acquisition, Technology and Logistics).” Recommended resources 

were $3.2 billion for eight vaccines. 

57 In addition to these recommendations, the panel suggests that consideration be given to the creation of a National 

Vaccine Authority. See discussion on that topic in Chapter Seven, and in Appendix N. 
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Expanding Research and Development 

“Let’s get on the ball on development of vaccines and detection” 

A local law enforcement officer 

There are many challenges in the scope and coordination of the government’s research and 

development (R&D) programs as well as challenges in technology transfer and diffusion of 

technology innovations to the state and local levels. Many important areas of health and medical 

R&D require special attention, including, as noted previously, focused research in genetic 

modifications, mutations, and other areas, to keep pace with emerging research and technology. 

Surveillance is critical to mitigating the consequences of a terrorist attack, especially a biological 

one. R&D on effective surveillance systems is very important to the public health community’s 

ability to identify, investigate, and respond rapidly and effectively to terrorist threats and attacks. 

Because other surveillance methods often do not provide near real-time reporting, and because 

reporting can be critical for the prevention, recognition, and treatment of disease outbreaks, 

interest in early warnings through syndromic surveillance is growing. Syndromic surveillance 

relies on reports from pharmacies, hospitals, primary care medical providers, and others about 

syndromes or symptoms that may indicate an epidemic sooner than reports of specific 

diagnoses.58 There are some innovative ideas, including a prototype in New York City.59 As 

New York City itself has learned, however, syndromic surveillance systems must be 

complemented by good communications between medical and health entities.60

We emphasize the need for better detection and identification capabilities, especially for 

biological agents, and deployable, field monitoring capabilities for all agents.61 Quickly 

identifying those at risk of injury or infection from a terrorist attack, particularly one involving 

biological agents, is critical. That capability will facilitate a more effective response with 

antibiotics, antidotes, and prophylaxis for those truly exposed and provide reassurance to those 

who are not. 

Potential short- and long-term psychological problems may result from a terrorist attack. 

Surviving victims and the “worried well” may well suffer significantly from the terror of these 

attacks. Emergency responders, such as police, fire, and medical personnel, may suffer from 

 

58 Ann Marie Kimball, “Overview and Surveillance of Emerging Infections,” available at 

http://cer.hs.washington.edu/em_inf/emerging/emerg.html (accessed September 3, 2001). Kimball observes that 

syndromic surveillance is less specific than traditional disease surveillance and points to the danger that it may 

supersede laboratory-based surveillance. 

59 New York City has established a sentinel network of 11 hospitals that report daily to the New York City 

Department of Health on the number of hospital admissions via the emergency department. Health department 

officials also seek to track influenza by monitoring the numbers of seven types of 911 calls that were found to 

correlate with influenza outbreaks. The system tracks calls reporting difficulty breathing, respiratory distress, minor 

sickness, adult sickness, pediatric sickness, adult asthma, and pediatric asthma. Amy E. Smithson and Leslie-Anne 

Levy, Ataxia: The Chemical and Biological Terrorism Threat and U.S. Response, Henry L. Stimson Center, Report 

No. 35 (October 2000), p. 256. 

60 The West Nile virus was first recognized not by the excellent syndromic surveillance systems in place in New 

York but by an astute infectious disease physician who had recently met the public health epidemiologist and called 

her when she saw three unusual cases of encephalitis. 

61 Preferred qualities include low false-alarm rate, inexpensive, easy to operate with little training, lightweight, 

robust in the field, long shelf life, low power requirements, and environmental sampling capability. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

33 

“critical incident stress” that may affect performance and pose greater risk to themselves and to 

the public. Post-traumatic stress disorders can create longer-term treatment requirements for 

victims and responders alike. Even those who are indirect victims of an attack suffer 

psychological consequences, and research would likely improve the medical community’s ability 

to prevent, evaluate, and treat these conditions. Implications for entire communities, beyond just 

the medical aspects, also must be considered. 

We recommend that the Office of Homeland Security, on the advice of its related national 

advisory board, and in coordination with the responsible Federal agencies, develop a 

comprehensive plan for the full spectrum of medical and health research for terrorismrelated medical issues, including the psychological repercussions of terrorism and prehospital interventions. In developing such a research plan, we suggest the approach be, to the 

extent feasible, one of multi-purpose, broad-spectrum applications in concert with the private 

sector. 

Assessing Capabilities 

It has been more than five years since a comprehensive inventory of medical capacities under the 

National Disaster Medical System has been conducted. Information on available facilities and 

related capabilities will be crucial when an attack occurs. Moreover, there continue to be issues 

of structure, location, and capabilities of the Metropolitan Medical Strike Teams, organized 

under the Metropolitan Medical Response System (MMRS), and the Disaster Medical Assistance 

Teams, established under the National Disaster Medical System (NDMS). In addition, many 

systems depend on volunteers. We recommend that the Secretary of HHS, in conjunction 

with the Office of Homeland Security and its related advisory board, conduct a thorough 

review of the authorities, structures, and capabilities under MMRS and NDMS. 

Clarifying Authorities and Procedures for Health and Medical Response 

Policymakers and response entities are faced with thorny issues, such as quarantine, 

containment, isolation, mandatory vaccination and other prescriptive measures, and scope of 

practice and other legal issues. Significant civil rights and civil liberties issues are involved, 

such as privacy matters, arrest procedures, and search and seizure authority. These activities 

create the potential for conflicts between local, State, and Federal authorities. Some problems 

reflect a lack of knowledge about current law and regulation. Others arise from the disparity of 

the laws and the various procedures that may be required to implement them.62 We recommend 

that the Office of Homeland Security develop an information and education program on 

the legal and procedural problems involved in a health and medical response to terrorism, 

and in coordination with the Department of Justice and the American Bar Association, 

consider the efficacy of model laws or other programs to enhance future responses to such 

events.63 

 

62 We commend the American Bar Association (ABA) Standing Committee on Law and National Security for 

facilitating a variety of symposia on these issues in recent months. See “The Cantigny Conference on State 

Emergency Health Powers & the Bioterrorism Threat: Framework for Action,” set forth as Appendix O, which 

contains valuable insight into the problems as well as proposed solutions. 

63 A potential model is the “Model State Health Powers Act,” prepared by the Center for Law and the Public’s 

Health at Georgetown and Johns Hopkins Universities and the Centers for Disease Control and Prevention, in 

collaboration with the National Governors Association, the Association of State and Territorial Health Officials, the 

National Association of City and County Health Officers, and the National Association of Attorneys General, draft 

of October 23, 2001. A copy of the model act is available for download at www.rand.org/nsrd/terrpanel. 
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Developing Public Information Programs 

The attacks of September 11, the lessons from the recent anthrax attacks and subsequent 

investigation, and the meningitis outbreak in Ohio this spring64 highlight the importance of 

adequate preparation and effective execution of a public information strategy, especially in a 

biological emergency with humans or agricultural commodities (including livestock). 

Key to the role of public health is education and information for the public and for 

health professionals. Whether an epidemic is a naturally occurring one such as 

that involving West Nile virus, or whether produced by a terrorist, public health 

professionals and public health departments around the United States need timely, 

accurate, and reliable information . . . Within the Department of Health and 

Human Services, there must be a single credible medical/public health expert 

spokesperson that reports regularly, most likely daily, to the American people in 

regard to any outbreak with national significance. This is analogous to the 

situation in local communities where there is a need for such an individual to 

communicate on behalf of the local health department.65

We recommend that the Office of Homeland Security develop ongoing programs, as part of 

the implementation of the national strategy, for public education prior to terrorist events 

about the causes and effects of terrorism and for coordinating public pronouncements 

during and following an attack. Development of a public awareness program should include 

media representation. Such programs must also recognize the need to identify, in advance of an 

attack, credible medical and public health experts, who can assist in the dissemination of public 

information when an attack has occurred.66 Coordination of initial and continuing public 

announcements in the wake of an attack should include every affected response entity at all 

levels of government to avoid confusing or contradictory statements, which could increase public 

panic and anxiety. 

 

 

64 See Appendix P. 

65 Testimony of Kenneth I. Shine, M.D., President, Institute of Medicine, The National Academies, “Risk 

Communication: National Security and Public Health,” Subcommittee on National Security, Veterans Affairs, and 

International Relations, Committee on Government Reform, U.S. House of Representatives, November 29, 2001, 

pp. 3-4 (“Shine Testimony”). For that and other expert testimony on the subject before that hearing, see 

http://www.house.gov/reform/ns/statements_witness/nov_29.htm

66 See Harvard School of Public Health/Robert Wood Johnson Foundation “Survey Project on Americans’ Response 

to Biological Terrorism,” Tabulation Report, October 24-28, 2001, available on the panel’s webpage at 

www.rand.org/nsrd/terrpanel. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

35 

CHAPTER IV. 

STRENGTHENING IMMIGRATION AND BORDER CONTROLS 

The statutory mandate for the Advisory Panel requires it to “assess . . . the needs of maritime 

regions.”67 Immigration and other border security matters are all closely linked. This chapter 

will, therefore, address all avenues of entry into the United States—land, air, and sea—not just 

maritime. 

Issues of immigration enforcement and border security are especially important in developing a 

national strategy for combating terrorism to address the diverse activities of Federal, State and 

local entities. Some statistics emphasize the point68: 

Over 100,000 miles of national coastline 

Almost 2,000 miles of land border with Mexico, another 4,000 miles with Canada, 

most of it essentially open to transit 

Almost 500 million people cross our borders annually 

Over 127 million automobile crossings annually 

Over 11.5 million truck crossings annually 

Over 2.1 million rail cars annually 

Almost 1 million commercial and private aircraft enter annually 

Over 200,000 ships annually dock in maritime ports 

Over 5.8 million containers enter annually from maritime sources 

Of the latter category—maritime containers—less than 3 percent are adequately inspected. 

Outmoded regulations and processes compound the problem. For example, shippers are allowed 

a 30-day window, after a shipment arrives at our border, for filing with customs authorities the 

container bill of lading describing its contents. During that period, the vast majority of maritime 

containers transit ports and move well into the interior of the United States. That 30-day 

requirement is, moreover, easily extended. 

The movement of goods, people, and vehicles through our border facilities is characterized by 

vast transportation, logistics, and services systems that are extremely complex, essentially 

decentralized, and almost exclusively owned by the private sector. Despite efforts by the U.S. 

Customs Service, the U.S. Coast Guard, the U.S. Immigration and Naturalization Service 

(including the U.S. Border Patrol), the Federal Aviation Administration, and other Federal 

entities, as well as State and local enforcement authorities, the challenge is seemingly 

insurmountable. Those efforts are further hampered by a lack of interagency connectivity and 

information sharing. Establishing such capabilities could significantly improve enforcement 

activities without unduly hindering the flow of goods and people. 

The demand for the rapid movement of goods in commerce compounds enforcement difficulties. 

It is a simple matter to describe a number of scenarios in which terrorists might exploit such 

vulnerabilities. That situation permits significant smuggling of goods and people, creates the 

 

67 Section 1405 d.5., National Defense Authorization Act for Fiscal Year 1999, Pub. L. 105-261 (H.R. 3616, 105th 

Congress, 2nd Session) (October 17, 1998). 

68 Information for 2000, from multiple official U.S. government sources, including the Department of 

Transportation, the Department of Treasury, and the Department of Justice. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

36 

potential for the spread of infectious disease (naturally occurring or intentionally perpetrated), 

fosters fraudulent trade practices, and allows for violations of regulations governing the transit of 

controlled materials. 

Merely increasing enforcement of current laws and regulations through existing mechanisms 

may not be the answer. That activity could result in further delays at very busy ports of entry. 

The likely “domino” effect of further delays will be opposition from many U.S. commercial 

interests whose businesses depend on carefully timed delivery of goods, political pressure from 

states and localities whose job markets would likely be affected, potential retaliation from 

foreign countries that export goods to the United States, and increased complaints from the 

millions of business and tourist passengers transiting our border. 

Given the nature and complexity of the problem, the panel recognizes that we as a nation will not 

likely find the “100 percent solution” for our borders. The laws and traditions that create a free 

and open society in the United States also make us vulnerable to terrorist attacks. We should, 

nevertheless, search for ways to make it harder to exploit our borders for the purpose of doing 

harm—physical or economic—to our citizens. The confluence of these issues calls for 

innovative approaches that will strike an appropriate and more effective balance between valid 

enforcement activities, the interests of commerce, and civil liberties. 

Expanding Interagency Coordination 

The effectiveness of programs and activities of the Federal agencies with border responsibilities 

could be improved through a more effective allocation of resources within those agencies. 

There also must be better cooperation with State and local entities, with the commercial 

transportation and shipping industries, and with other private-sector organizations.69 

We recommend that the Office of Homeland Security create an intergovernmental border 

advisory group, with representatives of the responsible Federal agencies and with State, 

local, and private sector partners from jurisdictions with significant ports of entry.70 This 

advisory board could assist the director of the Office of Homeland Security in the development 

of related program and resource priorities as part of the national strategy, without causing 

upheavals in existing organizational structures. That entity could be modeled on the Border 

Interdiction Committee, formed in the late 1980s to address the problem of drug trafficking 

across U.S. borders. 

Moreover, existing structures and mechanisms do not allow for close coordination of 

enforcement activities on our borders. At the operational level, Federal, State and local agencies 

must act collectively and share critical information (including intelligence) on all aspects of 

immigration and border control. We recommend that the Office of Homeland Security 

facilitate the full integration of affected Federal, State and local entities, including U.S. 

Coast Guard “Captains of the Port,” representatives of airports of entry, and border-

 

69 Presidential Directive-2, “Combating Terrorism Through Immigration Policies,” is in Appendix Q. 

70 A Memorandum of Agreement Among the Department of Defense, the United States Coast Guard, the 

Immigration and Naturalization Service, and the Bureau of Consular Affairs, Department of State, Subject: Maritime 

Domain Awareness, dated January 12, 2001, establishes an “interagency sub-working group” known as the 

“National Security Maritime Coordinating Committee.” (See Appendix R.) That entity does not, however, include 

representation from the U.S. Customs Service, from the Intelligence Community, the Department of Commerce, 

DHHS, the Department of Agriculture, the Interstate Commerce Commission, or from related State or local entities. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

37 

crossing communities, into local or regional “port security committees,” as well as into any 

adjacent Joint Terrorism Task Force (coordinated by the FBI) or other interagency 

mechanisms. 

Improving Intelligence Collection and Analysis 

Our Second Annual Report discussed the importance of intelligence collection as part of an 

effective national strategy for combating terrorism. Relevant, timely intelligence is crucial in the 

campaign to combat terrorism, especially for immigration control and border security. We 

recommend that the Office of Homeland Security ensure that all agencies with border 

responsibilities are included as full partners in the intelligence collection, analysis, and 

dissemination process, as related to border issues.71 

This process is a “two-way street;” all entities involved must be willing to share information, 

horizontally and vertically. This will represent a departure from the current “culture” of many 

agencies to cloister information. We encourage the Office of Homeland Security to consider the 

structure and procedures in our second report for the establishment of intelligence oversight 

through an advisory board under that office and for the establishment of intelligence tasking, 

collection, analysis, and assessment capabilities in that office.72

Enhancing Information Sharing 

The full, timely analysis and dissemination of information among affected Federal, State, and 

local agencies may be critical in preventing the movement of foreign terrorists and their weapons 

across our borders. Some interagency agreements for border security do exist, notably the 

Memorandum of Agreement on Maritime Domain Awareness among the Department of 

Defense, the U.S. Coast Guard, the U.S. Immigration and Naturalization Service, and the 

Department of State.73 The Congress needs to revisit the funding for such programs; all affected 

agencies are not involved in a fully coordinated and integrated process. As acknowledged by 

several Federal agencies: 

[N]o single framework exists to effectively look at threats across the broad 

spectrum of issues. What is necessary is the establishment of an organization 

structure with the connectivity to create a virtual national data repository with the 

supporting analytical and communications capabilities to develop effective 

maritime awareness and coordinate appropriate response.74

We recommend that the Office of Homeland Security create a “Border Security 

Awareness” database system to collect and disseminate information about immigration and 

border control; and that the Congress mandate participation of relevant Federal agencies 

and provide adequate resources to fund it. The system could be modeled on the existing U.S. 

Coast Guard Maritime Domain Awareness program. That program could be expanded to create 

 

71 The Attorney General, in coordination with other Federal agencies, recently established the “Foreign Terrorist 

Tracking Task Force.” The purpose of the Task Force is to gather, coordinate, and disseminate information 

(including intelligence and other national security information) among law enforcement and other appropriate 

agencies (including the State Department) to enable them to have extensive, real-time information on potential 

terrorists and terrorist activities. 

72 Second Annual Report, p. 11. 73 See Appendix R. 

74 Ibid, p. R-2. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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an interactive and fully integrated database system for all border security matters.75 It should 

include participation from all relevant U.S. government agencies, and State and local partners. 

Strengthening Security Processes and Standards 

There are ways to strengthen our border security through compliance requirements and standards 

that will not adversely affect the movement of goods and people. The fundamental precept will 

be to provide incentives to those willing to cooperate in such processes. For example, only about 

10 percent of firms engaged in the shipment of cargo containers in international commerce 

handle more than 50 percent of such container shipments. If these firms voluntarily cooperate 

with stricter border security processes, then this reduces “suspect” container shipments by a 

similar percentage, allowing security officials to focus time and resources more effectively. 

As one step toward these stricter border security processes, we recommend that the Congress 

enact legislation requiring all shippers to submit cargo manifest information on any 

shipment transiting U.S. borders at a minimum simultaneous with the arrival of such goods 

at any U.S. port of entry, with the imposition of severe penalties for noncompliance. 

Allowing after-the-fact reporting and waivers of these requirements is no longer acceptable. In 

the “Information Age,” the vast majority of cargo manifests—outbound bills of lading and 

related documentation—are in electronic format and readily transmittable to authorities. 

Private-sector operators of international transportation and other logistics systems already 

maintain extensive information that could be helpful in the early identification of terrorist 

activities to move people or things into this country. There are ways to plumb such information 

in a manner advantageous to enforcement officials and private sector entities. We recommend 

that the President direct the establishment of “Trusted Shipper” programs within the 

relevant agencies of government. The philosophy behind such a program is classic “carrot and 

stick.” The underpinnings of the program should include incentives to entities in the 

transportation and logistics sector that are willing to cooperate with enforcement authorities. 

Such cooperative arrangements should include the implementation of industry self-policing 

procedures,76 the advance provision of cargo manifest data, the sharing of existing “in-transit 

visibility” data, and the use of improved “smart” technology, such as tagging devices and other 

enhanced “machine readable” capabilities. The Congress should provide authority and 

resources to Federal enforcement agencies for granting incentives to Trusted Shippers, in the 

form of facilitated shipping processes77 and financial assistance for using enhanced technology. 

The result of such an approach over time will be more effective concentration of investigative 

and enforcement activities on the relatively small number of transport and logistics entities who 

opt not to cooperate—the ones more likely to be engaged in criminal enterprises in the first 

place. Such efforts should enhance the capabilities of enforcement agencies to fuse that 

 

75 James Ziglar, Commissioner of the Immigration and Naturalization Service, announced on December 6 that INS 

will enter the names of more than 300,000 foreign nationals, who have remained in the country illegally after they 

were ordered deported, into the FBI’s National Crime Information Center database. Previously, the government did 

not pursue most people who ignored orders to leave the country. 

76 Models for such practices already exist, including the Technology Asset Protection Association, a cooperative 

organization of more than 75 high-tech companies, which implements a set of detailed security practices that must 

be followed by member companies and others who do business with them. 

77 As one leading expert on border security has described it: “E-Z Trade Lanes,” where cooperating shippers provide 

advance information and move quickly through an automated “lane” at ports. Flynn, Stephen E., “Beyond Border 

Control,” Foreign Affairs, November/December 2000, pp. 57-68. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

39 

information with other available information, providing better advance warning of the movement 

of terrorists or their devices. 

In the past five decades, the percentage of commercial U.S. “flagged” vessels—those registered 

with a U.S. home port designated—has continued to shrink as a percentage of the total number of 

commercial vessels in service worldwide. Nevertheless, U.S. persons own a significant number 

of additional commercial vessels—exclusively or in majority percentage of ownership—that are 

flagged by other countries. Currently, the U.S. Coast Guard has statutory authority to inspect in 

international waters only U.S. “flagged” vessels.78 We recommend that the Congress, in 

consultation with appropriate Executive Branch agencies,79 expand Coast Guard authority 

to include vessels that are owned in a majority percentage by U.S. persons. That authority 

may provide an additional measure of advance capability in the discovery of illicit cargo bound 

for our shores. 

Enhancing Sensor and Other Detection and Warning Systems 

Individual agencies have activities under way intended to enhance enforcement capabilities 

through the use of static or mobile sensors and other detection devices. The Customs Service, 

for example, uses several “non-intrusive” detection systems, such as radiographic methods, 

explosive vapor and particle inspection, and radiation detection. 

Valuable research and development is also underway in multiple agencies to extend such 

capabilities, especially in the area of non-intrusive inspection systems. There is, however, no 

comprehensive, prioritized plan among related agencies for critical aspects of such activities. 

Some agencies, like Customs, link requirements for combating terrorism to broader internal 

R&D agendas to get the most value out of resource funds. These processes, however, do not 

include a mechanism for prioritizing research and development funds for protecting our borders. 

Therefore, we recommend that the Office of Homeland Security develop a coordinated, fully 

resourced plan for R&D and for fielding and integration of sensor and other detection and 

warning systems. The advisory group, proposed in our previous recommendation, should be 

tasked to develop such a plan. In this way, feedback from the entities involved on technology 

would benefit the border security component of the overall national strategy for combating 

terrorism. 

 

78 14 U.S. Code, Section 89(a): “The Coast Guard may make inquiries, examinations, inspections, searches, seizures, 

and arrests upon the high seas and waters over which the United States has jurisdiction, for the prevention, detection, 

and suppression of violations of laws of the United States. For such purposes, commissioned, warrant, and petty 

officers may at any time go on board of any vessel subject to the jurisdiction, or to the operation of any law, of the 

United States, address inquiries to those on board, examine the ship's documents and papers, and examine, inspect, 

and search the vessel and use all necessary force to compel compliance. When from such inquiries, examination, 

inspection, or search it appears that a breach of the laws of the United States rendering a person liable to arrest is 

being, or has been committed, by any person, such person shall be arrested or, if escaping to shore, shall be 

immediately pursued and arrested on shore, or other lawful and appropriate action shall be taken; or, if it shall 

appear that a breach of the laws of the United States has been committed so as to render such vessel, or the 

merchandise, or any part thereof, on board of, or brought into the United States by, such vessel, liable to forfeiture, 

or so as to render such vessel liable to a fine or penalty and if necessary to secure such fine or penalty, such vessel or 

such merchandise, or both, shall be seized.” 

79 Including the Departments of Justice, State, Transportation, and Commerce. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

40 

Increasing Resources for the U.S. Coast Guard 

Coast Guard resources to perform its ordinary missions have been reduced in recent budget 

cycles, with no concomitant reduction in missions. Those missions cross a broad spectrum from 

vessel safety inspections, marine search and rescue, environmental protection, to navigable 

waters and port safety and security. 

With the increased requirement for enhanced homeland security, the Coast Guard must be 

provided adequate resources by the Congress to accomplish these critical tasks. For example, the 

Coast Guard has insufficient funds to conduct port vulnerability assessments at the more than 

350 U.S. ports. We recommend that the Congress increase resources for the U.S. Coast 

Guard for homeland security missions. 

Expanding Cooperation with Our Border Neighbors 

Canada has been a base of operations for terrorists or would-be terrorists for planning attacks 

against the United States. Unfortunately, the laws of Canada do not explicitly make terrorist 

activities a crime per se. As a result, Canada has been unable to take action against certain 

individuals who may, for example, be conspiring to perpetrate a terrorist attack against the 

United States. The illegal movement of people and drugs across our border with Mexico 

indicates the ease with which terrorists could cross into our country from the south. We 

recommend that the U.S. government negotiate more comprehensive treaties and 

agreements for combating terrorism with Canada and Mexico. Some agreements and 

protocols with both countries already exist, but more needs to be done. Country-to-country 

negotiations with both Canada and Mexico should be designed to strengthen laws and processes 

that will enhance our collective ability to deter, prevent, and respond to terrorist activities, to 

exchange information on terrorist activities, and to assist in the apprehension of known terrorists 

before they can strike.80

 

80 On December 3, U.S. Attorney General John Ashcroft, Minister of Citizenship and Immigration of Canada, Elinor 

Caplan, and the Solicitor General of Canada, Lawrence MacAulay, announced a Joint Statement of Cooperation on 

Border Security and Regional Migration Issues that will directly support Prime Minister Chrétien and President 

Bush's emerging public security and border strategy. These actions focus on deterrence, detection, and prosecution 

of security threats, the disruption of illegal migration and the efficient management of legitimate travel. The two 

governments agreed to expand cooperation and collaboration in a number of immigration matters. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

41 

CHAPTER V. 

ENHANCING CYBER SECURITY 

Cyber attacks, regardless of origin, can be a means for disruption, destruction, even death. 

Whether perpetrated as the single mode of attack or in conjunction with another weapon, the 

effects could be substantial, even exponential. This is an exceptionally complex topic, one that 

spans national security, law enforcement, civil rights, and commercial and other private-sector 

interests. It is one for which there are no easy solutions and little historical precedent. 

Civil rights considerations will be critical, as government grapples with the best means to 

provide adequate protections from cyber intrusions and other forms of criminal activity, at the 

same time attempting to safeguard individual and corporate privacy, due process requirements, 

and other private interests. More than 80 percent of all information systems in this country are 

owned by the private sector. Any solutions for improving cyber security will require an 

unprecedented partnership between government and private entities. 

Rapid technological advances compound the problem. The imminent “convergence” of video 

communications (cable and satellite), telephone communications (wire and wireless), the Internet 

and its related systems, and other day-to-day convenience systems such as Automated Teller 

Machines, will increase the risk of simultaneously disrupting multiple networks and systems 

with a carefully engineered cyber attack. 

FUNCTIONS: Prepare Deter Detect Prevent Warn Investigate Prosecute Retaliate Mitigate Recover

INTELLIGENCE

Structure and 

Coordination

THREAT/RISK/VULNERABILITYASSESSMENTS

STRATEGY

INFORMATION SHARING

RESEARCH, DEVELOPMENT, TEST & EVALUATION 

PLANNING, TRAINING, EXERCISES

ENFORCEMENT

NATIONAL DEFENSE

CIVIL LIBERTIES (INCLUDING PRIVACY ACT RESTRICTIONS)

INVESTIGATIVE AUTHORITIES

OUTDATED LAWS (COMMUNICATIONS ACT; DEFENSE PRODUCTION ACT)

Legal Issues and 

Law Enforcement

FREEDOM OF INFORMATION

PROPRIETARY/INTELLECTUAL PROPERTY

ANTI-TRUST

LIABILITY AND INSURANCE

JUDICIAL PROCEDURE 

INTELLIGENCE/INFORMATION SHARING

Federal, State, Local, Private Federal Federal, State, Local, Private, International Federal, State, Local, International

Figure 5.1. Cyber Functional Interrelationships 
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42 

As Figure 5.1 attempts to illustrate, the functions are diffuse and the issues cross many 

jurisdictional lines. Moreover, significant resource issues need to be addressed, including 

insurance coverage, appropriate levels of investment in security measures, both public and 

private-sector research, development, testing, and evaluation, and the availability of the 

necessary technically-skilled people to make all of it work. Consideration should be given to 

creating incentives from government to the private sector to implement necessary safeguards. 

Improving National Coordination 

The White House recently announced new cyber security initiatives, including the creation of a 

Federal interagency critical infrastructure protection board.81 That advisory panel apparently will 

only be the representatives of 25 Federal agencies. Any such effort should include significant 

representation from State and local governments and from the private sector.82 We recommend 

that the President direct that the interagency policymaking panel on critical infrastructure 

include representatives from State and local governments, as well as the private sector. 

That forum can serve as a basis for providing recommendations for the development of a broad 

and comprehensive strategy for cyber security and other critical infrastructure, which is informed 

by the interests of all “stakeholders.” It should have broad representation from the private sector 

and from the three levels of government, including a wide range of disciplines with relevant 

responsibilities for addressing prevention and response activities.

In addition, we recommend that the Congress create an independent commission, tasked to 

evaluate programs designed to promote cyber security, to identify areas where 

requirements are not being met, to recommend strategies for better security, and to report 

its findings to the President and the Congress. Such a Federal advisory body can assist 

materially in the development of strategies, policies, and priorities by providing an independent, 

objective assessment of Federal programs. That commission should be modeled on our advisory 

panel. 

Enhancing Detection, Alert, Warning, and Response 

Federal agencies, State and local governments, and numerous private-sector entities all have 

substantial interests in knowing that a cyber attack may occur or may already have commenced. 

There are major national security implications where foreign adversaries are concerned, 

significant law enforcement considerations where criminal conduct—including terrorist 

attacks—are indicated, and issues for other public and private-sector entities unrelated to either 

national security or law enforcement. Given the interdependency of most systems and the 

pervasive reliance on the Internet as a primary mechanism for the transmission of electronic 

communications, these varied interests will almost certainly converge if a broad-spectrum attack 

is launched. 

 

81 Executive Order on Critical Infrastructure Protection, The White House, October 16, 2001. See Appendix S. 82 The Executive Order only provides for “outreach to and consultation with the private sector . . . [and] outreach to 

State and local governments, as well as communities and representatives from academia and other relevant elements 

of society, ” not representation on the board. A separate State, local, and private sector advisory board—the 

National Infrastructure Advisory Council—is being formed, but it is not clear whether that board can truly influence 

the policymaking process. See Section 10 of the Executive Order in Appendix S. 
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43 

In our Second Annual Report, we identified concerns about the effectiveness of the National 

Infrastructure Protection Center (NIPC) at the FBI, in executing certain responsibilities for 

critical infrastructure alert, warning, and response coordination, including cyber attacks by 

terrorists. We do not question the dedication or good faith efforts by the NIPC to execute its 

mission; there may simply be too many obstacles that inhibit its ability to do so. Since our 

second report, others have expressed similar concerns—most notably the GAO. In both a formal 

report83 and in testimony before the Congress,84 the GAO has noted several factors limiting the 

effectiveness of the NIPC to date: 

No generally accepted methodology exists for analyzing strategic cyber-based threats. 

The NIPC has sustained prolonged leadership vacancies and does not have adequate 

staff expertise, in part because other participating Federal agencies have not detailed 

the originally anticipated number of Personnel. 

The NIPC lacks industry-specific data on such factors as critical system components, 

known vulnerabilities, and interdependencies.85

We would add at least two other factors: 

Private-sector entities and other government agencies resist providing information, 

some of which may be sensitive for a number of otherwise legitimate purposes, to 

what is perceived to be a law enforcement agency. 

Many feel that the NIPC is more interested in receiving information for law 

enforcement purposes than it is in sharing information that has come to its attention. 

We recommend that the President establish a government-funded, not-for-profit entity that 

can represent the interests of all stakeholders, public and private—national security, law 

enforcement, other government functions, and business and industry concerns—to provide 

cyber detection, alert, and warning functions. That entity would serve as a “fusion center” 

and clearinghouse, at or near real-time, for information on impending or actual cyber attacks. 

That entity should be a not-for-profit organization or a consortium of not-for-profit entities with 

recognized expertise in the field. Graphically depicted, flow of information in and out of such an 

entity would resemble the following: 

 

83 “Critical Infrastructure Protection, Significant Challenges in Developing National Capabilities,” United States 

General Accounting Office, GAO-01-323, April 2001. For access to the comprehensive set of GAO reports and 

testimony on combating terrorism, bioterrorism, and critical infrastructure protection, visit the GAO website at 

www.gao.gov. 84 See, for example, GAO testimony before the Subcommittee on Technology, Terrorism, and Government 

Information, Committee on the Judiciary, U.S. Senate, July 25, 2001. 

85 Ibid., at pp. 4-5. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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NATIONAL SECURITY

PRIVATE TO PUBLIC

FUSION 

CENTER

“Detect, Prevent, Warn”

LAW ENFORCEMEN

F

T

ILTERS

FILTERS

FILTERS

FILTERS

FILTERS

Raw Input

Fused Output

CYBER TRIANGLE

“Filtered” Data

Figure 5.2. Cyber Triangle 

LEGEND: The “Private to Public” category includes the broad private sector, as well as Federal, State, or local government entities 

not involved in law enforcement or national security activities. Public, private, or combination public-private entities, designated by 

respective end users, would perform the "filter" functions. “Fused output” would be provided to stakeholders as indicated by the 

nature of the information. 

Improving Legal and Law Enforcement Processes 

The law has not kept pace with rapid changes in information technology and systems, or the need 

for effective response against those who would exploit them. Changes are needed to such 

outdated legislation as the Communications Act of 1934, the Defense Production Act, the federal 

criminal statutes, the Freedom of Information Act, as well as others. Several Members of 

Congress have developed an understanding of the issues and have introduced legislation to 

address these issues. Progress has, however, been slow. 

We recommend that the Congress and the Executive Branch convene a “summit” to 

address, on an urgent basis, necessary changes to a wide range of federal statutes, in order 

to provide necessary protection and incentives for enhancing cyber assurance. We envision 

Members of Congress and senior Executive Branch representatives meeting over a period of 

several days to craft legislative remedies. That summit should include representatives from State 

and local government and the private sector. On the Executive Branch side, it should involve 

principals from those agencies with responsibilities for executing the Federal portions of a 

national plan. Each committee of Congress with authorization, oversight, budget, and 

appropriations jurisdiction should similarly be represented. The goal of the summit should be to 

agree in principal, and in as much detail as feasible, the required changes to Federal law and 

regulation. It should also focus on the civil liberties considerations that permeate cyber security. 

Federal criminal law and procedure is one specific area that requires urgent attention. Federal 

prosecutors and investigators are often impeded in their activities because of the lack of effective 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

45 

procedures for obtaining court authority to conduct certain investigative activities where criminal 

cyber conduct is involved. Authority to use investigative tools for “tapping” criminal electronic 

transmissions or tracing electronic signatures often comes too late or not at all. There is a lack of 

complete understanding among many in the judiciary at large of the nature and urgency of cyber 

security. We recommend that the Congress create a special “Cyber Court” patterned after 

the court established in the Foreign Intelligence Surveillance Act (FISA).

86 A court 

dedicated to criminal cyber conduct can develop the expertise to recognize the issues and act 

more quickly in approving or disapproving special authority for investigative activities. Such a 

court is more likely to ensure that civil rights and civil liberties are fully protected. At the same 

time, it can more likely respond quickly enough to authorize time-sensitive actions. We envision 

an electronic, real-time, on-line, secure method for U.S. Attorneys anywhere in the country to 

contact a cyber judge on very short notice, subject to a prior, on-line expedited review (using a 

similar process to FISA applications) by the Department of Justice. 

Fostering an Effective Research and Development Agenda 

Enhanced R&D is critical to cyber security. Technology is changing so rapidly that additional 

near- and long-term research is required. Many Federal agencies are engaged in research, 

development, test, and evaluation (RDT&E) in the cyber realm. However, no single 

comprehensive research agenda now exists that establishes priorities, prevents unnecessary 

duplication, and identifies gaps in current research. 

The President’s Committee of Advisors on Science and Technology (PCAST) recommended in 

1998 that the President direct the establishment of a national laboratory for focused R&D in the 

area of security of the nation’s information infrastructure. While recognizing the special 

challenges in this arena, the President declined to implement the PCAST proposal and ordered 

further review. 

Recent attacks on information systems87 indicate the need for urgency. We recommend that 

the Office of Homeland Security develop and implement a comprehensive plan for RDT&E 

to enhance cyber security. We envision a government-funded consortium of not-for-profit 

entities with expertise in the field.88 That entity can serve as the fulcrum for leveraging RDT&E 

resources in a manner consistent with national priorities for cyber security. 

The Congress has given The Institute for Security Technology Studies (ISTS) at Dartmouth 

College resources to form the basis for establishing such an entity, including formal discussions 

with experts about the structure of such an organization; a comprehensive national needs 

assessment developed from a survey of stakeholders in government (Federal, State, and local), 

academia, and the private sector; and the development of a definitive near- and long-term agenda 

for RDT&E for cyber security. That institute may be the logical nucleus around which the 

proposed entity could be formed. 

 

86 50 U.S. Code, Sections 1801–1863. 87 The “Code Red,” “SirCAM,” and “Badtrans” attacks are examples. 

88 This recommendation is consistent with the comprehensive analysis, conclusions, and recommendations contained 

in the report, “A National R&D Institute for Information Infrastructure Protection,” Institute for Defense Analysis, 

April 2000. 
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46 

 CHAPTER VI. 

CLARIFYING THE ROLES AND MISSIONS OF THE MILITARY 

The Armed Forces of the United States have enormous capabilities and resources that can 

support our nation’s efforts to combat terrorism, including activities inside our own borders. It 

can be a critical asset for both prevention and response. As the panel has noted in prior reports, 

the Armed Forces has unequaled command and control capabilities, organizations trained for 

operations under emergency conditions, and a highly professional military leadership structure. 

Notwithstanding these inherent strengths, the roles, missions, and organization of the U.S. 

Armed Forces to deter, prevent, or respond to a terrorist threat inside the borders of the United 

States remain ambiguous. The command and control of U.S. military forces for operations 

inside the United States is not well established. There remains a lack of detailed plans for use of 

forces to combat terrorism, especially inside the United States. Sufficient forces are not fully 

trained and are, as a result, able to provide only modest support in terrorist response situations. 

Until recently, there has not been a comprehensive effort on the part of our leaders to map 

requirements against capabilities, or to organize and train forces to meet anticipated 

requirements. No clear definition of “homeland security” and no precise definition of the 

military role in that activity have even been established. 

The Department of Defense, in close coordination with the newly appointed Assistant to the 

President for Homeland Security, is now initiating many positive steps for better use of the 

military inside our borders. That close working relationship will be important in the weeks and 

months ahead. 

The current problems exist, in part, because of an inadequate understanding of the sequence of 

commitment of local, State, and Federal response. State and local agencies are, moreover, not 

well informed about the capabilities that the Armed Forces can contribute to emergency 

responses, and the Armed Forces do not fully understand the capabilities and roles of State and 

local response entities. 

“The level of clarity and coordination among Federal agencies is 

appalling, and very dysfunctional to planning at the local level. 

For example, it is unclear what roles the military... and others 

would take; it is also unclear whether or how they would 

cooperate with local authorities. Federal agencies have put a lot 

of informal ‘signals’ out in the communication environment, but 

have not explicitly defined their roles or proposed actions.” 

A local public health agency 

Basic principles should guide any consideration for using the military to combat terrorism inside 

the United States. These principles have guided our recommendations in this report: 

Establish clear lines of responsibility, authority and accountability. 

Ensure protection of civil liberties. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

47 

Identify required and appropriate military capabilities that can be developed and used if 

necessary. 

Develop detailed plans, train military units and leaders, and exercise them to obtain the 

required capabilities. 

Establish a reasonable budget balance that recognizes the important missions of our 

armed forces and requirements to provide civil support in emergency situations. 

Designating a Federal Civilian Lead Agency 

In the Second Annual Report, we made a categorical recommendation on the use of the military: 

“We recommend that the President always designate a Federal civilian agency 

other than the Department of Defense (DoD) as the Lead Federal Agency.” 

The panel understands that the Armed Forces are always under civilian control, as established in 

the United States Constitution and our laws and regulations. The President is Commander in 

Chief, and the Secretary of Defense and service secretaries provide immediate and continuous 

control of the Armed Forces. Nonetheless, the panel reaffirms the foregoing recommendation. 

Our rationale is simple—despite that civilian leadership, the perception will likely be that “the 

military” is in the lead if DoD is designated as the Lead Federal Agency. 

Major issues are at stake. There are critical civil liberties implications. Coordination and prior 

planning are required among Federal, State, and local response agencies, including how and 

under what circumstances the military may be engaged. There is the simple proposition that 

military commanders and their subordinates should not be called on—potentially in extremis—

without a clear understanding of response plans and without sufficient training and exercises 

prior to the application of military capabilities in connection with a threat or attack inside our 

borders, for roles and missions that may be very non-traditional for military organizations. 

In this Third Annual Report, we delve into the intricacies of what form “civilian control” should 

take, and how to provide the mechanism for the military to become a more effective asset for 

responding to terrorism inside our borders. A fundamental precept to our considering this issue 

is that the military not be viewed as a primary resource for deterrence, prevention, or response 

activities inside the United States. Conditions that may exist at the time of such an attack, 

including one that may involve significant elements of our armed forces having been deployed to 

foreign soil, may limit the availability of military resources. Although State governors may 

employ the National Guard for combating terrorism, the Guard is also subject to Federal 

activation. Nevertheless, contingency plans, covering the full spectrum of the potential use of 

the military—to deter, prevent, and respond—must be developed, in full coordination with other 

agencies at the Federal, State, and local levels. 

In our survey of State and local agencies, we asked the organizations what they thought the 

appropriate role of the military should be during a response to a terrorist incident inside the 

United States. Consistently, across all types of local (city and county) and state response 

agencies, the general consensus was that the military should perform supporting roles. 

Specifically, only 10 percent of the survey respondents indicated that the military should 

“assume the role of lead agency in a unified command.” Local law enforcement and local public 

health departments were more likely to agree with the military’s assuming a lead role; local 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

48 

emergency management officials and state organizations, particularly state public health entities, 

were least likely to agree. 

The following table shows the substantial support for the military to perform such roles as 

maintaining order and providing security, providing personnel and equipment, and setting up 

kitchens, clinics, and mass care facilities. In contrast, very few stated that the military should not 

perform any role.89

City and County State 

What roles do you feel would be 

appropriate for the U.S. military to 

play during a response to a domestic 

WMD incident?90

 Fire  Law  OEM  Public  Health  EMS  OEM  Public  Health  EMS 

Perform one or more supporting roles 96.6 

(1.6) 

94.9 

(2.4) 

94.2 

(2.1) 

93.9 

(2.6) 

93.8 

(2.5) 

92.5 

(2.0) 

100.0 

(0.0) 

90.6 

(3.2) 

Assume the role of the lead agency in a 

unified command 

10.3 

(3.9) 

15.6 

(3.8) 

6.2 

(2.6) 

16.0 

(3.9) 

11.5 

(3.3) 

2.5 

(1.1) 

0.0 

(0.0) 

6.3 

(2.7) 

Do not perform any role 0.8 

(0.8) 

2.7 

(1.9) 

1.3 

(0.8) 

0.4 

(0.4) 

4.2 

(2.1) 

2.5 

(1.1) 

0.0 

(0.0) 

3.1 

(1.9) 

Table 6-1. Opinions on Military Roles 

Understanding the Sequence of Commitment 

The panel recognizes that all terrorist incidents are local, or at least will start that way. It is 

inherent in that concept that the initial response to an attack will come from local response 

entities. It is only after local capabilities are exhausted or after the incident spreads that 

resources from the State and then perhaps Federal level may be required. Multiple entities at the 

local, State, and Federal level may each have a role in combating terrorism. Sometimes these 

roles play out simultaneously and sometimes they are sequential, depending on the type, extent, 

and location of the incident. Understanding this “sequence of commitment” concept will help to 

place the use of the Armed Forces in perspective and may help to inform the specific capabilities 

that they may be expected to bring to the response effort. 

When an incident occurs, local response entities will always be engaged. These “local 

responders” might include fire services, law enforcement, emergency medical technicians, 

doctors, nurses, the public health community, and non-governmental organizations within the 

community, such as the American Red Cross. 

Second, depending on the extent of the attack and the ability of local responders (including those 

from supporting communities) to handle the situation, state authorities and capabilities may be 

engaged, including use of the National Guard under the control of a governor (its Title 32 status). 

At that point, state and local authorities will share responsibilities for response consistent with 

their authorities and capabilities. The overall management of the state’s response is normally 

through the state office of emergency management or similar organization. 

 

89 This survey question did not distinguish between the National Guard and the Federal military (active duty and the 

Title 10 Reserve). Hence, these estimates provide a broad assessment of the role of the military. 

90 With the exception of local emergency medical service organizations, these percentages have been adjusted to 

represent the U.S. population of each type of organization. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

49 

Third, should a state not be able to cope fully with the crisis, state authorities may exercise 

agreements contained in mutual assistance compacts for support from member states. 

Fourth, either simultaneous or sequentially with support from other states, a state may also ask 

for Federal support, from FEMA under the Federal Response Plan, from the Justice Department 

and its agencies, and from other Federal agencies 

A commitment of the Federal Armed Forces (in Title 10 status), including the use of the Federal 

Reserve Component,91 will likely occur only when all other capabilities have been or are 

expected to be exceeded. A request for use of the military could come from a governor, or the 

National Command Authority could direct its use.92 The application of military capability could 

take several forms. It could be limited to small, skilled reaction teams, or it could constitute a 

commitment of larger structures and capabilities, including medical, transportation, supply, 

security, engineers, or public affairs. Nevertheless, the panel views the use of the military inside 

our borders, in most cases, as one of last resort. 

Establishing Command Authority and Structures 

Given the underlying complexities of responding to a terrorist attack, the organizational 

structures, the “chains of command,” and the lines of communication between responders must 

be clear. FEMA has been designated as the Lead Federal Agency for “Consequence 

Management”; the FBI for “Crisis Management.” However those terms may be defined in actual 

execution, the DoD chain of command must have positive coordination links into those agencies. 

In addition to these interagency links, responsibilities, authorities, and accountability must be 

clearly established within the defense structure—both the civilian and the military pieces—to 

ensure that the Armed Forces respond appropriately and effectively. 

Section 901 of the National Defense Authorization Act for Fiscal Year 2001 (NDAA FY01),93

required the Secretary of Defense to designate an Assistant Secretary of Defense as the senior 

civilian with responsibility for “the overall supervision of the Department’s combating terrorism 

activities.” That designation was made in a directive issued on March 29, 2001—the Assistant 

Secretary of Defense for Special Operations/Low Intensity Conflict (ASD-SO/LIC).94 That 

office is being reorganized to address the expanded responsibilities. Nevertheless, on October 3, 

the Secretary of Defense designated the Secretary of the Army to be the interim focal point for 

“homeland defense” activities of DoD. An attempt to obtain congressional relief from the 

Section 901 requirement, in order to make that designation permanent, was reportedly not 

favorably received by the authorizing committees. In an extraordinary move,95 the President has 

designated the Secretary of the Army as the Acting ASD-SO/LIC. 

Concurrent with these events, the Secretary of Defense also has asked the Congress to authorize 

a new under secretary and three new assistant secretaries—presumably for “homeland security,” 

 

91 For example, 70 percent of the U.S. Army’s deployable medical capability is in the U.S. Army Reserve—the 

Army’s Title 10 Reserve Component. 

92 A subsequent section addresses the legal authorities for use of Federal Armed Forces inside the United States, 

including the “federalization” of the National Guard. 

93 HR 4205, Pub. L. 106–398. See discussion in Conference Report to accompany NDAA FY01, p. 833.

94 Memorandum of the Deputy Secretary of Defense, Subject: Combating Terrorism, March 29, 2001. 

95 Although not entirely without precedent. 
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but that is not clear from the request. We are, at present, not certain of the status of that request. 

The panel believes, however, that the issues are so important that an under secretary position is 

justified. A position at the undersecretary level will foster stronger relations with the Office of 

Homeland Security and strengthen coordination with the military departments and the Joint 

Chiefs of Staff. Therefore, we recommend that the Secretary of Defense seek and that the 

Congress approve the authority to establish a new under secretary position for homeland 

security. This recommendation is consistent with our support of the congressional intent to 

centralize the policy oversight of DoD activities responsible for combating terrorism. That 

centralization will help alleviate much of the previous fragmentation at the senior levels within 

the Department of Defense and provide a single DoD “lead” with which other Federal and State 

agencies can work. 

Additional progress has been made within the Joint Staff. The Joint Staff has recently 

implemented some organizational changes, specifically under the Director of Operations, J-3, to 

address the issues of combating terrorism. The Chairman, Joint Chiefs of Staff, has published 

OPLAN 0500, which fully implements the Joint Task Force-Civil Support (JTF-CS) concept, 

but limits its responsibilities to those involved in domestic consequence management. 

Despite this progress, there are continuing issues in the uniformed military structure. In 1999, 

the DoD established a new headquarters for planning efforts, as well as for the command and 

control of subordinate military elements that provide “consequence management” support to 

domestic civil authorities. The Joint Task Force-Civil Support (JTF-CS) is a major subordinate 

command of the U.S. Joint Forces Command headquartered at Norfolk Naval Base, Virginia. 

But JTF-CS is limited to missions associated with “consequence management.” Prior to the 

creation of JTF-CS, military activities to support civil authorities in most types of emergency 

response had previously been coordinated through the U.S. Army’s Director of Military Support 

(DOMS)— acting as “Executive Agent” for all of the Department of Defense for such 

purposes—especially any military assistance for response to a natural disaster under provisions 

of the Stafford Act. Under the new structure, JTF-CS will direct consequence management 

support for terrorism, but DOMS retains its current emergency response functions. This creates 

two or more separate systems for providing military assistance to civil authorities. Additional 

military organizations may be called on to support other agencies, including the Department of 

Justice, in assisting with so-called “crisis management” activities. One is the Joint Special 

Operations Task Force under the U.S. Special Operations Command. 

Therefore, even though the DoD has resources and capabilities for command, control, 

communications, intelligence, transportation and other logistics, and engineering and medical 

support that can and likely will be utilized to respond to terrorist attacks, the problem continues 

to be the lack of comprehensive, carefully coordinated, well-understood plans and programs for 

how that response might occur. Moreover, the structure and internal processes for 

accomplishing a DoD integrated response is still fragmented and unclear. To ensure that the full 

capability of the Department of Defense can be mobilized to act within a clear chain of command 

in the event of a terrorist attack, we recommend that the National Command Authority 

establish a single, unified command and control structure to execute all functions for 

providing military support or assistance to civil authorities. Such a structure could be used 

for support for natural disasters, counterdrug activities, combating terrorism, or civil 

disturbances. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

51 

Preparing the Armed Forces for Homeland Missions 

U.S. Armed Forces are currently designed, equipped, and trained for combat operations, not for a 

response to a terrorist attack. The structure, training, and extensive operational experience of 

leaders at every level have prepared them and the military units they command to integrate fully 

all aspects of command, control, communications, and intelligence activities and to coordinate 

numerous supporting organizations in the performance of joint operations. This is a valued, 

innate capability that military formations bring to a disaster environment. Their integration and 

coordination experience, however, has been with similar military units rather than State and local 

responders. Therefore, the headquarters and units that may be called on to provide such 

responses in the future must plan, train, and conduct exercises accordingly. 

We as a nation cannot afford to respond to terrorist attacks on our soil on an ad hoc basis after an 

attack has commenced. All interests—Federal, State, and local—must have planned, trained, 

and exercised together across a broad spectrum of scenarios. We recommend that the 

Secretary of Defense direct the development of more detailed plans for the use of the 

military domestically across the spectrum of potential activities, and coordinate with State 

and other Federal agencies in the creation of more State- or regional-specific plans. We 

further recommend that the secretary direct the military departments to institute specific 

training in military units most likely to be involved in military support to civil authorities 

and to expand military involvement in related exercises with Federal, State, and local 

agencies. All exercises must include comprehensive evaluations and capture lessons learned. 

The Joint Staff is the logical place for planning and coordinating a military response of this 

nature. Giving the responsibility for these activities to the Joint Staff will provide consistency in 

planning, training, exercises, and, if necessary, execution of such missions. 

With a unified structure; clear lines of responsibility, authority and accountability; and sound 

planning, realistic training, and practical exercises, the Armed Forces can provide a significant 

capability to the nation’s efforts to combat terrorism—but this force must only be committed 

under the lead of a recognized Federal civilian agency. 

Expanding the Role of the National Guard

The National Guard is a logical “bridge” between the military and civil authorities in responding 

to terrorists incidents. The National Guard, in its Title 32 or “State” status, is subject to the 

control of the governors. That allows the Guard to be used for purely State missions, including 

in some cases being free of certain limitations imposed on “Federal” military personnel. Many 

States have agreed to provide National Guard resources to other States in the event of an 

emergency, through the adoption of emergency management assistance compacts, without the 

requirement to “federalize” those Guard elements. National Guard units, however, may need to 

be reconfigured into something quite different and better suited for “homeland security” 

missions. 

Because the National Guard is readily available to State leaders, it can provide a “near 

immediate” impact in meeting State support requirements in cases of various types of 

emergencies. Nevertheless, the National Guard generally is organized and trained for traditional 

combat missions. Moreover, certain support capabilities that needed to respond to terrorism 

inside the United States are not in the National Guard. More than two-thirds of the Army’s 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

52 

medical capabilities are in the Army Reserve. Military police, transportation, and 

communications units are disproportionately in the Title 10 Reserve versus the National Guard. 

Although the National Guard can be made immediately available for State use, units are 

frequently not appropriately organized, trained, or equipped for such missions. Given the critical 

nature of homeland security missions, the Department of Defense and State governors should 

discuss more effective ways to configure Guard units for conducting both combat and homeland 

security missions. 

Military leaders must pay special attention to the effects of mobilizing Reserve Component units 

frequently. Despite laws that require job protection, many Reserve members continue to 

experience employment problems after release from mobilization. Moreover, frequent periods of 

mobilization have also affected recruiting and retention in the Reserve. 

We recommend that the Secretary of Defense direct specific mission areas for the use of the 

National Guard for providing support to civil authorities for combating terrorism. 

Further, we recommend that the Secretary: 

In coordination with State governors, assess National Guard force structure, define 

appropriate roles and missions, and establish units with specific capabilities for 

homeland security missions. 

Increase the percentage of full-time personnel in Guard units designated for 

homeland security missions and ensure that pay and benefits parallel those of 

active-duty service members. 

Direct which National Guard units will be assigned homeland security missions as 

their primary missions with combat missions outside the United States as secondary 

missions and provide resources consistent with the designated priority of their 

homeland missions. 

Direct that National Guard units with priority homeland security missions plan, 

train, and exercise with State and local agencies. 

Understanding Legal Authorities

There continues to be considerable misunderstanding about the legal bases for military activities 

inside the United States. Some believe that the provisions of the Posse Comitatus Act96 create a 

significant bar to many potential activities for which the Armed Forces could be employed to 

combat terrorism inside our borders. There is, however, ample authority for using the military 

inside our borders for responding to a variety of emergencies, many of which are explicit 

exceptions to the strictures of the Posse Comitatus Act. 

The National Guard, when serving under the control of a State governor, is generally thought to 

be exempt from the Posse Comitatus Act. Statutes and regulations in certain States, however, 

prohibit the use of the Guard for law enforcement activities. Guard units currently providing 

security at many of the nation’s airports remain in their “State” or Title 32 status, perhaps in the 

belief that Posse Comitatus will universally not apply to their activities. But many States, 

 

96 18 U. S. Code, Section 1385 — “Use of Army and Air Force as a posse comitatus. Whoever, except in cases and 

under circumstances expressly authorized by the Constitution or Act of Congress, willfully uses any part of the 

Army or the Air Force as a posse comitatus or otherwise to execute the laws shall be fined under this title or 

imprisoned not more than two years, or both.” 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

53 

including some that do not generally prohibit the Guard from performing a law enforcement role, 

have specifically prohibited them from performing those functions in their current airport 

missions. 

As we noted in our Second Annual Report, several statutes provide for the use of the military for 

assistance to civil authorities in a variety of emergencies.97 The Stafford Act98 provides broad 

authority and has been invoked frequently for using the military domestically for responses to 

floods, earthquakes, hurricanes, wildfires, and other natural disasters. Provisions of the Stafford 

Act also apply to intentional acts, such as terrorism. 

The Congress has also created significant authority for use of the military to suppress domestic 

insurrections, rebellions, and unlawful combinations and conspiracies in the various states. The 

Insurrection Statutes are an extension of the Constitutional mandate to protect the states against 

domestic violence.99 Provisions of those statutes have been used as the basis for engaging the 

military to integrate schools and to respond to riots in major U.S. cities. Those statutes form a 

legal basis for using the military to respond to certain acts of terrorism. 

Beginning in 1981, the Congress has created statutory authority for use of the military in various 

counterdrug operations, both inside the United States and extraterritorially.100 Those activities 

include the use of military equipment and facilities and the maintenance and operations of a vast 

array of equipment—owned at the Federal, State, and local level. In 1988, the Congress added to 

this series of provisions authority for the military to operate equipment in the conduct of counterterrorism operations domestically.101 

Most significantly in the terrorism context, the Congress has also provided the authority for use 

of the military domestically to assist in combating biological and chemical terrorist incidents, 

which may, under certain exceptional circumstances, include direct involvement in arrests, 

searches, seizures, and the collection of specific intelligence102; and authority to provide 

assistance in nuclear terrorism cases, which may also include participation in arrest, search, and 

seizure activities.103 Under each of these statutes, it only requires an agreement between the 

Attorney General and the Secretary of Defense to engage the military. 

It is important that these authorities and the limitations on their use are well understood by 

Federal, State, and local entities that may be involved in combating terrorism, and by the 

uniformed military as well. For this reason, we recommend that the Secretary of Defense 

publish a compendium, in layman’s terms, of the statutory authorities for using the 

military domestically to combat terrorism, with detailed explanations about the procedures 

for implementing those authorities. That knowledge should be embedded in military training 

and exercise, and in exercises with other Federal as well as State and local agencies. 

 

97 See Second Annual Report, Appendix R. 

98 42 U.S. Code, Sections 5121, et seq. 

99 10 U.S. Code, Sections 331, et seq.

100 10 U.S. Code, Section 124, and Sections 371, et seq. 101 10 U.S. Code, Section 374. 102 10 U.S. Code, Section 382. 103 18 U.S. Code, Section 831. 
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Fostering Better Coordination with Other Agencies 

The Department of Defense has long-standing relationships with the Department of Justice and 

FEMA for the coordination of military support for a variety of contingencies, including natural 

and manmade disasters. In the area of combating terrorism, the relationships with State and 

local response entities is spotty. More-direct relationships can overcome misunderstandings 

about the potential domestic roles and missions of the military and can assist materially in better 

planning, training, and exercises for response operations. 

Although the Department of Defense now has liaison offices in the various FEMA regions, they 

have not been fully effective in coordinating response plans, training, and exercises with State 

and local emergency management agencies. Those liaison elements—known as Emergency 

Preparedness Liaison Offices—can assist in the necessary planning and coordination with State 

emergency authorities and through those authorities with local jurisdictions, including the 

development of fully integrated training and exercises to validate and improve response plans. 

However, they must be fully resourced to do so.104 We recommend that the Secretary of 

Defense improve the full-time liaison elements located in the 10 FEMA regions and assign 

those elements expanded missions to enhance coordination with State and local agencies in 

planning, training, and exercising emergency response missions. The coordination of plans, 

training, and exercise should not be limited to “consequence management” functions but should 

include the full spectrum of potential military activities. The panel suggests that the military 

liaison elements be staffed with a combination of active-duty and Title 10 Reserve personnel and 

National Guard personnel in a Title 32 status. 

 

104 We suggest that even better coordination would result if all Federal agencies with homeland security missions 

create or strengthen liaison elements in the FEMA regional offices. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

55 

CHAPTER VII. 

PERSPECTIVES ON SEPTEMBER 11 AND ITS AFTERMATH

The vast majority of the recommendations in the previous chapters were approved prior to the 

attacks of September 11. Numerous lessons can, however, be learned from those attacks and 

from the anthrax attacks that followed. 

Some of the issues addressed in this chapter are confirmatory of previous conclusions and 

recommendations we have made. Others will require further discussion and deliberation. They 

should not, therefore, be taken as definitive conclusions or recommendations but simply as initial 

reactions based on our training, experience, and collective views. 

State and Local Capabilities 

Local and state-level intra- and interstate mutual assistance is critical. Nevertheless, more can be 

done to plan for the integration of that assistance into resources of the jurisdiction actually 

attacked, especially procedures for deploying to the scene of the attack support personnel and 

equipment from other jurisdictions. 

It is imperative that Congress and the Administration recognize the need to enhance existing 

capabilities of State and local emergency management entities. Those agencies have the primary 

responsibility to provide for the implementation of emergency management functions. The 

emergency management system will be more effective if those capabilities are enhanced. 

Our previous recommendations for equipment standardization and interoperability—especially in 

communications— resonate with greater force following the experiences of recent weeks. This is 

especially important between non-traditional partners such as law enforcement agencies and the 

public health medical communities. 

More planning is required for the effective integration of non-governmental and private 

volunteer organizations (NGOs and PVOs). 

Additional “light” Urban Search and Rescue capabilities—type 2 and 3 units—are indicated. 

Assistance in protecting critical infrastructure at the State and local level is required. State and 

local emergency response budgets cannot exclusively absorb the costs to provide sustained 

protection and security at those facilities. 

Health and Medical 

Following the September attacks on the World Trade Center, the health and medical 

communities in New York City mobilized quickly, initiating emergency procedures, freeing bed 

space for victims, calling in additional staff. More than 4,000 people received medical treatment 

of some type. Care must be taken, however, not to use the result of the attacks in New York City 

as the nationwide rule of thumb for future preparations. First, New York City is as well prepared 

as any city in the country—better prepared than most—to handle this type of disaster. Second, 

the relatively small number of people who required medical attention for major trauma or burns 

could well be an aberration as a result of the specific type of attack. A different type of weapon 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

56 

could well have resulted in medical response capabilities being overwhelmed. More effort is 

required nationwide to develop “surge” capabilities for bed space in hospitals and clinics or 

alternate sites, additional burn treatment units, decontamination facilities, and isolation units. 

The anthrax attacks have highlighted the resource limitations at the Federal, State, and local 

levels for responding to biological incidents. Additional investment will be required for 

enhanced epidemiological and laboratory capabilities—forensics, diagnostics, investigation, and 

surveillance—and in the development and availability of diagnostic tools (such as those needed 

to identify those exposed to biological agents), vaccines, antitoxins, and additional prophylaxes. 

Significant coordination problems continue to exist between public health and law enforcement. 

As important as the law enforcement aspect of such attacks may be, public health issues must 

take relative priority over law enforcement issues when the two are in direct conflict. 

Additional resources are required for improvement in health and medical communications, 

horizontally among entities at the local level and vertically from localities to States to Federal 

entities and the reverse. CDC and State and local public health telephone system and Website 

capabilities were jammed following the attacks, especially those involving anthrax. More 

resources are required to ensure that robust information systems are available in a crisis. 

There are major personnel issues in the health and medical professions. A recruitment and 

retention problem of significant proportion affects public health professionals, such as 

epidemiologists and laboratorians, as well as traditional medical staff, including emergency 

medical technicians, paramedics, registered nurses, and allied health professionals. A large-scale 

emergency, which will require around-the-clock multiple-shift capability, would quickly 

overwhelm existing resources. Consideration should be given to programs, similar to those for 

law enforcement, to address these issues.105

The need for improvements in public awareness before an attack, and in the appropriate 

dissemination of information following an attack, is especially acute in the health and medical 

arena. Better advance public awareness of the causes and effects of infectious agents, such as 

anthrax, will lessen public overreaction that manifests itself in the form of personal stockpiles of 

antibiotics, the run on gas masks—which would be ineffective against many agents—and 

increased anxiety. 

As we noted in Chapter Three, “Improving Health and Medical Capabilities,” more is required to 

understand and deal with the psychological impact of terrorism. The anthrax attacks have 

highlighted the importance of procedures to identify and respond to public fear and anxiety—

both rational and irrational. 

Better preparation for and management of the dissemination of information and media 

coordination following an attack is also indicated. Public officials, who are experts in various 

 

105 Expanding the CDC’s Epidemic Intelligence Service (the public health training program for bioterrorism), with 

more officers serving at the State and national level, could greatly increase our ability to respond to biological 

incidents. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

57 

fields and seen by the public to be credible,106 should be identified and prepared in advance. The 

media would also be well advised to confirm the credentials of so-called (perhaps selfdesignated) experts on terrorism, especially bioterrorism.107

The reaction to the potential for a smallpox attack is exemplary, and deserves special comment. 

The Smallpox Issue 

Members of this panel are well versed in the risks posed by smallpox. Those risks—though real 

but, according to most experts in the field, admittedly of extremely low probability—do not 

justify the current reaction. A dispassionate approach is in order. 

In the view of experts on our panel and others with whom we have consulted,108 it is not 

necessary and may not be advisable to vaccinate the entire U.S. population before an outbreak. 

The strategy of “circling” or “ringing” cases with vaccination for the adjacent population was the 

basis for the global eradication of smallpox and is a logical basis for responding to a biological 

attack. A smallpox vaccine produces virtually complete immunity after a single inoculation and 

is effective even when given two to three days after exposure. 

Sounds arguments can be made for vaccinating “emergency responders” in communities across 

the country, as a preemptive measure. There are currently, however, statistically significant risks 

in vaccinating millions of Americans before an outbreak. While the percentage risk is small, 

vaccinating 300 million people would likely result in a 300 to 600 deaths just from reaction to 

the vaccine. That figure does not take into account those who may be at risk from 

immunodeficiencies, such as victims of HIV. More research is required to develop a vaccine 

without adverse side effects. 

Deliberate planning is required for the potential vaccination of large segments of our population 

if an outbreak does occur, including prudent increases in the stockpile of vaccines, storage and 

distribution, the physical aspects of vaccinating vast numbers of people, and related legal 

authorities.109 Such plans, when developed, must be exercised. 

Intelligence and Information Sharing 

While we do not adhere to the view that there was a “total intelligence failure” leading up to 

September 11, there were major shortcomings, especially for intelligence collection and fusion, 

for many of which we have already recommended solutions. Additional effort is also required 

to ensure effective two-way sharing with State and local entities, and for better cooperation with 

the private sector, especially those in transportation, energy, finance, and communications. 

We have made specific recommendations to enhance immigration and border controls. 

Improvements at the borders should be quickly followed by further integration of immigration 

and other border data with additional internal aspects of homeland security. 

 

106 See Harvard School of Public Health/Robert Wood Johnson Foundation “Survey Project on Americans’ 

Response to Biological Terrorism,” Tabulation Report, October 24-28, 2001, available on the panel’s website at 

www.rand.org/nsrd/terrpanel. 107 One such “expert” called anthrax a “virus.” It is bacteria and non-contagious. See Shine Testimony, p. 4. 108 Including Dr. William Foege, who helped eradicate smallpox. 

109 See draft Executive Summary for CDC Interim Smallpox Response Plan and Guidelines, at Appendix T. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

58 

Use of the Military 

We trust that the current use of National Guard personnel for duty at the nation’s airports will 

only be, as has been stated, a temporary measure. Authorities and responsibilities for this 

activity are not consistent nationwide. If similar activities are envisioned for the Guard or other 

military elements in the long term, our recommendations for better plans, training, and exercises 

merit increased attention. 

In any event, pay and benefits for National Guard members—including strict application and 

enforcement of employment protections—must apply whether Guard personnel are serving in 

Federal (Title 10) or State (Title 32) status. 

General 

We must continue to seek innovative ways to use our superior technological capability to our 

advantage and to deny its use to potential adversaries. Better use of technology for positive 

identification and for knowledge management should be at the top of the list. 

Recent events have indicated that FEMA may not have the capability to conduct several 

emergency operations simultaneously. That capability is critical. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

59 

CHAPTER VIII. 

THE ROAD AHEAD 

On December 13, 2001, the U.S. House of Representatives and the United States Senate 

completed action on S. 1438, the National Defense Authorization Act for Fiscal Year 2002. The 

President is expected to sign that bill into law. Section 1514 of that Act provides for a two-year 

extension of the Advisory Panel. Panel members are considering several areas for future 

research and analysis, and subsequent conclusions and policy recommendations. Those areas 

include but may not be limited to the following. 

State, Local, and Private 

Standards. We will consider in more detail the progress that has been made in establishing 

national standards for equipment performance and compatibility, especially the work of the 

Interagency Board for Equipment Standardization and Interoperability and the National Personal 

Protection Technology Institute. 

Continuity of government and continuity of operations. The attacks in recent weeks have 

shown that these issues require more in-depth consideration, especially for programs that require 

coordination with or assistance to the private sector. 

 

Establishing partnerships with non-governmental entities. We will consider ways for better 

integration of the private sector—business, industry, and other non-governmental and private 

volunteer organizations (NGOs and PVOs)--with governmental entities in emergency 

preparations and response, including better coordination, planning, training and combined 

exercises. 

Government protection of private-sector critical infrastructure. Issues in this area that 

require further attention include both the appropriate levels of government support to the private 

sector and methods for delivery of Federal assistance. 

Information sharing from government to the private sector. In this report, we recommended 

areas in which the private sector could assist by providing more information already at their 

disposal to government entities. We now must explore the reverse of that equation, especially in 

the transportation, energy, finance, and communications sectors. 

Direct appropriations to States. To provide appropriate Federal resources to States more 

effectively, the panel will consider ways and means of providing direct authorization and 

appropriations to the States, without the burdensome process of Federal grants. 

 Health and Medical 

Long-term mental health and psychological issues. We have noted, both in the 

recommendations in the substantive chapters and in the chapter on “perspectives,” our concern 

about these issues. We are especially concerned about the impact of such attacks, and the threat 

of future ones, on our children, as well as better methods for dealing with the “worried well.” 

We will consider various coping strategies and will likely conduct case studies on systems in 

Israel and the United Kingdom. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

60 

Vaccines. We will consider in more detail the recommendation to create a government-owned, 

contractor-operated vaccine research, development, and production capability. We will also 

explore other areas involving vaccines for both humans and livestock. We will consider 

especially the prospect for the creation of a National Vaccine Authority.110

Agriculture and the food and water supply. We have repeatedly raised concerns about threats 

to agriculture. More consideration of those issues is required, and for possible threats to our food 

and water supplies. 

Medical examiners. Too little attention has been focused on the important roles of government 

medical examiners and other pathologists. We will consider the need for improvements in 

forensics and reporting requirements and capabilities in this arena. 

Public health reserve corps. We will consider the potential benefits and requirements of 

establishing a robust reserve of medical and health professionals that can be mobilized to 

respond to health and medical crises. 

Use of the Military 

Roles and Missions. We will continue our assessment of progress in defining and clarifying the 

activities of our Armed Forces inside our borders, especially the roles and missions of the 

National Guard. 

Coordination and Other Security Issues 

Positive identification. Potential systems could include a form of universal identification card, 

such electronic methods as palm or eye scans, or other technological capabilities. 

Financial tracking. “Following the money” is an important way of discovering and preventing 

potential terrorist activities. Much is being done in this area following September 11 but the 

panel will consider other potential measures. 

Strategic communications planning. We will explore potential models for providing better 

information to the public before, during, and after a terrorist incident—threats, hoaxes, and 

actual attacks. 

Airline and airport security measures. The panel may undertake an assessment of the 

effectiveness of the measures currently being implemented as well as others that may be 

implemented in the future. 

 

 

110 See Appendix N for more information on this latter topic. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

61 

TABLE OF APPENDICES 

Appendix A—Enabling Legislation ........................................................................................... A-1 

Appendix B—Panel Chair and Members ....................................................................................B-1 

Appendix C—Persons Interviewed..............................................................................................C-1

Appendix D—Executive Order Establishing the Office of Homeland Security ........................ D-1 

Appendix E—Citizen Preparedness in War on Terrorism Executive Order ...............................E-1 

Appendix F—Homeland Security Presidential Directive-1, Organization and Operation of the 

 Homeland Security Council....................................................................................................F-1 

Appendix G—Survey Information ............................................................................................. G-1 

 Tab 1—The Survey Instrument .....................................................................................G-1-1

 Tab 2—Fire Department Survey....................................................................................G-2-1

 Tab 3—Fielding Procedures ..........................................................................................G-3-1 

 Tab 4—Sample Design and Respondent Selection .......................................................G-4-1 

 Tab 5—Response Rates .................................................................................................G-5-1 

 Tab 6—Constructing the Survey Weights .....................................................................G-6-1 

 Tab 7—Section 5 Tabulations .......................................................................................G-7-1 

 Tab 8—Survey Comments.............................................................................................G-8-1 

Appendix H—Harvard Executive Session Memorandum, “Intergovernmental Dimensions of 

 Domestic Preparedness” ........................................................................................................ H-1 

Appendix I—National Emergency Management Association White Paper on Domestic 

 Preparedness ............................................................................................................................I-1 

Appendix J—The President’s Emergency Supplemental Funds for Combating Terrorism.........J-1 

Appendix K—The Immediate Needs of America’s Fire Service ............................................... K-1 

Appendix L—AMA Report and Recommendations....................................................................L-1 

Appendix M—JCAHO Standard ................................................................................................M-1 

Appendix N—Statement on Vaccine Development ................................................................... N-1 

Appendix O—Cantigny Conference on State Health Powers and Bioterrorism ........................ O-1 

Appendix P—Media and Health Communication – The Ohio Meningitis Incident ...................P-1 

Appendix Q—Homeland Security Presidential Directive-2, Combating Terrorism Through 

 Immigration Policies.............................................................................................................. Q-1 

Appendix R—Maritime Domain Awareness...............................................................................R-1 

Appendix S—Executive Order on Critical Infrastructure Protection ..........................................S-1 

Appendix T—Executive Summary of CDC Draft Smallpox Plan ..............................................T-1 

Appendix U—Panel Activities – Calendar Year 2001 ............................................................... U-1 

Appendix V—RAND Staff Providing Support to the Advisory Panel....................................... V-1
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

A-1 

APPENDIX A--ENABLING LEGISLATION 

Following is an extract of the legislation, sponsored by Representative Curt Weldon of 

Pennsylvania, which created the Advisory Panel and provided its mandate. 

 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 

An Extract of PUBLIC LAW 105-261 (H.R. 3616, 105th Congress, 2nd Session) (October 17, 1998) 

An Act 

To authorize appropriations for fiscal year 1999 for military activities of the Department of Defense, for military 

construction, and for defense activities of the Department of Energy, to prescribe personnel strengths for such fiscal year 

for the Armed Forces, and for other purposes. 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 

SECTION 1. SHORT TITLE; FINDINGS. 

a. SHORT TITLE-This Act may be cited as the “Strom Thurmond National Defense Authorization Act for Fiscal Year 

1999.” 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 

SEC. 1405. ADVISORY PANEL TO ASSESS DOMESTIC RESPONSE CAPABILITIES FOR TERRORISM 

INVOLVING WEAPONS OF MASS DESTRUCTION. 

a. REQUIREMENT FOR PANEL- The Secretary of Defense, in consultation with the Attorney General, the Secretary of 

Energy, the Secretary of Health and Human Services, and the Director of the Federal Emergency Management Agency, 

shall enter into a contract with a federally funded research and development center to establish a panel to assess the 

capabilities for domestic response to terrorism involving weapons of mass destruction. 

b. COMPOSITION OF PANEL; SELECTION- (1) The panel shall be composed of members who shall be private 

citizens of the United States with knowledge and expertise in emergency response matters. (2) Members of the panel shall 

be selected by the federally funded research and development center in accordance with the terms of the contract 

established pursuant to subsection (a). 

c. PROCEDURES FOR PANEL- The federally funded research and development center shall be responsible for 

establishing appropriate procedures for the panel, including procedures for selection of a panel chairman. 

d. DUTIES OF PANEL- The panel shall-- 

1. assess Federal agency efforts to enhance domestic preparedness for incidents involving weapons of mass destruction; 

2. assess the progress of Federal training programs for local emergency responses to incidents involving weapons of mass 

destruction; 

3. assess deficiencies in programs for response to incidents involving weapons of mass destruction, including a review of 

unfunded communications, equipment, and planning requirements, and the needs of maritime regions; 

4. recommend strategies for ensuring effective coordination with respect to Federal agency weapons of mass destruction 

response efforts, and for ensuring fully effective local response capabilities for weapons of mass destruction incidents; 

and 

5. assess the appropriate roles of State and local government in funding effective local response capabilities. 

e. DEADLINE TO ENTER INTO CONTRACT- The Secretary of Defense shall enter into the contract required 

under subsection (a) not later than 60 days after the date of the enactment of this Act. 

f. DEADLINE FOR SELECTION OF PANEL MEMBERS- Selection of panel members shall be made not later 

than 30 days after the date on which the Secretary enters into the contract required by subsection (a). 

g. INITIAL MEETING OF THE PANEL- The panel shall conduct its first meeting not later than 30 days after the 

date that all the selections to the panel have been made. 

h. REPORTS- (1) Not later than 6 months after the date of the first meeting of the panel, the panel shall submit to the 

President and to Congress an initial report setting forth its findings, conclusions, and recommendations for improving 

Federal, State, and local domestic emergency preparedness to respond to incidents involving weapons of mass 

destruction. (2) Not later than December 15 of each year, beginning in 1999 and ending in 2001, the panel shall 

submit to the President and to the Congress a report setting forth its findings, conclusions, and recommendations for 

improving Federal, State, and local domestic emergency preparedness to respond to incidents involving weapons of 

mass destruction. 

i. COOPERATION OF OTHER AGENCIES- (1) The panel may secure directly from the Department of Defense, 

the Department of Energy, the Department of Health and Human Services, the Department of Justice, and the Federal 

Emergency Management Agency, or any other Federal department or agency information that the panel considers 

necessary for the panel to carry out its duties. (2) The Attorney General, the Secretary of Defense, the Secretary of 

Energy, the Secretary of Health and Human Services, the Director of the Federal Emergency Management Agency, 

and any other official of the United States shall provide the panel with full and timely cooperation in carrying out its 

duties under this section. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

B-2 

APPENDIX B--PANEL CHAIR AND MEMBERS 

NAME AND AFFILIATION EXPERTISE 

The Honorable James S. Gilmore, III, Governor of the 

Commonwealth of Virginia, Chair

State government

L. Paul Bremer, Corporate Executive, and Former Ambassadorat-Large for Counter-Terrorism, U.S. Department of StateTerrorism, counter-terrorism

Raymond Downey, Commander, Special Operations, City of 

New York Fire Department

Emergency response—local

George Foresman, Deputy State Coordinator, Department of 

Emergency Management, Commonwealth of Virginia

Emergency response—State

William Garrison (Major General, U.S. Army, Retired), Private 

Consultant, and Former Commander, U.S. Army Special 

Operations Command's Delta Force

Military special operations

Ellen M. Gordon, Administrator, Emergency Management 

Division, Department of Public Defense, State of Iowa, and 

President, National Emergency Management Association 

Emergency response—State

James Greenleaf, Private Consultant, and Former Associate 

Deputy for Administration, Federal Bureau of Investigation

Law enforcement—Federal

Dr. William Jenaway, Private Consultant, and Chief of Fire and 

Rescue Services, King of Prussia, Pennsylvania

Emergency response—local

William Dallas Jones, Director, Office of Emergency Services, 

State of California

Emergency response—State

Paul M. Maniscalco, Past President, National Association of 

Emergency Medical Technicians, and Deputy Chief/Paramedic, 

City of New York Fire Department, EMSC

Emergency response—local

John O. Marsh, Jr., Attorney at Law, former Secretary of the 

Army, and former Member of Congress

Government structure, interagency 

coordination, cyber, and legal 

Kathleen O'Brien, City Coordinator, City of Minneapolis, 

Minnesota

Municipal government

M. Patricia Quinlisk, M.D., Medical Director/State 

Epidemiologist, Department of Public Health, State of Iowa

Health—State
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

B-3 

Patrick Ralston, Executive Director, Indiana State Emergency 

Management Agency; Executive Director, Department of Fire 

and Building Services; and Executive Director, Public Safety 

Training Institute, State of Indiana

Emergency response—State

William Reno (Lieutenant General, U.S. Army, Retired), 

former Senior Vice President of Operations, American Red 

Cross

Non-governmental organizations

Joseph Samuels, Jr., Chief of Police, Richmond, California, and 

Third Vice President, International Association of Chief of 

Police

Law enforcement—local, 

terrorism preparedness

Kenneth Shine, M.D., President, Institute of Medicine, The 

National Academies

Health—Federal

Hubert Williams, President, The Police Foundation Law enforcement/civil liberties

NON-VOTING PARTICIPANTS 

Ellen Embrey, U.S. Department of Defense Representative 

Michael A. Wermuth, Senior Policy Analyst, RAND, Executive

Project Director

FORMER MEMBERS 

The Honorable Donald Rumsfeld, Secretary of Defense 

James R. Clapper, Jr. (Lieutenant General, U.S. Air Force, 

Retired), Director, National Imagery and Mapping 

Administration; former Director, Defense Intelligence Agency, 

and former panel Vice Chair 

James Q. Wilson, Ph.D., former Harvard and UCLA professor; 

Member, board of trustees, American Enterprise Institute; 

former member, President’s Foreign Intelligence Advisory 

Board 

Richard Falkenrath, Office of Homeland Security; former 

Associate Professor, John F. Kennedy School of Government, 

Harvard University 

Ronald S. Neubauer, Chief of Police, St. Peters, Missouri, and 

Past President, International Association of Chiefs of Police 

 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

 C-1

APPENDIX C--PERSONS INTERVIEWED 

An “interview,” for the purpose of this list, includes a formal presentation to members of the 

Advisory Panel, a formal interview by a panel member or support staff, the written submission or 

exchange of information, or discussions about the issues addressed in this report with a panel 

member or support staff. 

Steve Abbot (Admiral, U.S. Navy, Ret.) 

Office of the Vice President 

Lawrence Adams 

Critical Incident Analysis Group 

University of Virginia 

David S. Addington 

Office of the Vice President 

Michael Alexander 

Office of Senator Joseph Lieberman 

Kenneth Alibek 

Hadron, Inc. 

Graham Allison, Ph.D. 

Harvard University 

Richard Andrews 

EQE International 

Larry Ankrom 

Federal Bureau of Investigation 

Odyssias Anthansiou 

City of Portsmouth, New Hampshire 

Donna Barbisch, DPH, MPH 

Brigadier General, U.S. Army Reserve 

Office of the Secretary of the Army 

Eileen Barker, Ph.D., OBE, FBA 

London School of Economics 

Michael Barkun 

Syracuse University 

John Barth 

Office of Senator Jon Kyl 

Donald Bassett 

Federal Bureau of Investigation 

Ann Beauchesne 

National Governors Association 

Peter Beering, J.D. 

Indianapolis, Indiana 

Richard Behrenhausen 

McCormick Tribune Foundation 

Charles R. Bell 

Marine Corps Systems Command 

Pamela Berkowsky 

Assistant to the Secretary of Defense 

Thomas Bevan, Ph.D. 

Georgia Tech 

Carolyn Bird, M.D., M.P.H. 

County Health Division 

Oakland County, Michigan 

Ronald Blanck, D.O. (LTG, USA, Ret.) 

University of North Texas 

Major Adrian Bogart 

InterAgency Board for Equipment 

 Standardization and Interoperability 

The Honorable Robert Bonner 

Commissioner of U.S. Customs 

Diana Bontá, RN, DrPH 

California Department of Health Services 

David Bowen 

Office of U.S. Senator Edward Kennedy 

Eugene Bowman, J.D., LL.M. 

Federal Bureau of Investigation 

Sam Brinkley 

Department of State 

Kathy Cahill, MPH 

Centers for Disease Control and Prevention 

Department of Health and Human Services 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

 C-2

Stephen L. Caldwell 

General Accounting Office 

Daniel Callahan 

Office of the Attorney General 

State of Illinois 

Seth Carus, Ph.D. 

National Defense University 

Julie Ann Casani 

Department of Health and Mental Hygiene 

State of Maryland 

Kwai-Cheung Chan 

General Accounting Office 

John Chapin 

Department of Health 

State of Wisconsin 

Lewis M. Chapman 

Federal Bureau of InvestigationJoni Charme 

Captain, U.S. Army 

Joint Task Force-Civil Support 

Frank Cilluffo 

Center for Strategic and International Studies 

Tim Clancy 

Committee on Science 

U.S. House of Representatives 

Christine Clark 

Office of Senator Jon Kyl 

Richard Clarke 

National Security Council 

Paul Cobb, Jr., J.D. 

Jenner & Block 

Rudy Cohen 

Office of the Secretary of Defense 

Deborah Colantonio 

General Accounting Office 

Joseph J. Collins, Ph.D. 

Center for Strategic and International Studies 

Charles Cragin 

Office of the Secretary of Defense 

Michael Cronin 

Immigration and Naturalization Service 

Cabell Cropper 

National Criminal Justice Association 

Terry Cross 

Rear Admiral, U.S. Coast Guard 

Dean D’Amore 

Office of Representative Sherwood Boehlert 

Pamela D’Angelo 

Yvette Daniels, J.D. 

Department of Human Resources 

State of Georgia 

 

Ruth David, Ph.D. 

ANSER Corporation 

 Frederick Davidson 

Critical Infrastructure Assurance Office 

Department of Commerce 

Raymond Decker 

General Accounting Office 

Scott Deitchman, M.D. 

American Medical Association 

Armand DeKeyser 

Office of Senator Jeff Sessions 

Mark DeMier 

ANSER Corporation 

Rebecca Denlinger 

Cobb County Fire Department 

Georgia 

Wilton Dillon, Ph.D. 

Smithsonian Institution 

Dan Donohue 

National Guard Bureau 

Stephen M. Duncan 

Southeastern Computer Consultants, Inc. 

Eric Edelman 

Office of the Vice President 

Edward Edens 

Committee on Armed Services 

United States Senate 

William W. Ellis 

Congressional Research Service 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

 C-3

Gerald Epstein 

Office of Science and Technology Policy 

The White House 

Mark Esper 

Committee on Foreign Relations 

United States Senate 

Dan Estrem 

National Domestic Preparedness Office 

Steven Etter 

Federal Bureau of Investigation 

George S. Everly, Jr., Ph.D., FAPM, CTS 

International Critical Incident Stress Foundation 

Jack Fenimore 

Major General, U.S. Army (Ret.) 

John Fenzel 

Office of the Vice President 

David Fidler, J.D., LL.M. 

Indiana University School of Law 

Stephen Flynn, Ph.D. 

Commander, U.S. Coast Guard and 

 Fellow, Council on Foreign Relations 

Woodbury P. Fogg 

New Hampshire Office of Emergency 

Management 

John Frank 

InterAgency Board for Equipment 

 Standardization and Interoperability 

Richard Friedman, J.D. 

National Strategy Forum 

Archie Galloway 

Office of Senator Jeff Sessions 

Jorge Garcia 

Federal Bureau of Investigation 

Richard Goodman 

Centers for Disease Control and Prevention 

Department of Health and Human Services 

Lisa Gordon-Hagerty 

National Security Council 

Lawrence Gostin, J.D., LL.D (Hon.) 

Georgetown University 

Alfred Gray (GEN, USMC, Ret.) 

Garber International Associates 

John Gustafson 

U.S. National Response Team 

Environmental Protection Agency 

Don Hamilton 

Memorial Institute for the Prevention of 

 Terrorism 

John Hamre 

Center for Strategic and International Studies 

Francis Hartmann 

Harvard University 

William Haynes, II, J.D. 

Jenner & Block 

Carl E. Hildebrand 

Office of Science and Technology Policy 

The White House 

Bill Hilsman 

Booz Allen &Hamilton, Inc. 

James Hodge, Jr., J.D., LL.M. 

Johns Hopkins University 

Krister Holladay 

Office of Representative Saxby Chambliss 

Arnold Howitt, Ph.D. 

Harvard University 

John Hoyt, Ph.D. 

Office of Justice Programs 

Department of Justice 

Kenneth Huffer 

United States Secret Service 

Holly Idelson 

Office of Senator Joseph Lieberman 

Jay Jakub 

House Permanent Select Committee on 

 Intelligence 

U.S. House of Representatives 

David Jarrell 

U.S. General Services Administration 

Dan Kaniewski 

Office of Congressman Curt Weldon 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

 C-4

Juliette Kayyem, J.D. 

Harvard University 

Terrence Kelly 

Critical Infrastructure Assurance Office 

Department of Commerce 

Dennis Kenneally 

Brigadier General 

California National Guard 

Thomas Kinnally 

National Domestic Preparedness Office 

Carol Kuntz 

Office of the Vice President 

Colonel Timothy Lampe 

Defense Threat Reduction Agency 

John Landry 

National Intelligence Council 

Tom Lane 

Office of the Secretary of Defense 

Peter LaPorte 

Emergency Management Agency 

District of Columbia 

Randall Larsen 

ANSER Corporation 

Major General Bruce M. Lawlor 

Joint Task Force-Civil Support 

Scott Layne, M.D. 

University of California at Los Angeles 

Marcelle Layton, M.D. 

New York City Department of Health 

Mary Lou Leary 

Department of Justice 

Howard Levitin, M.D. 

I. Lewis Libby, Jr. 

Office of the Vice President 

Scott Lillibridge, M.D. 

Centers for Disease Control and Prevention 

Department of Health and Human Services 

Wilfredo Lopez 

Department of Health 

City of New York 

Donald Lumpkins 

Maryland Emergency Management Agency 

Stephen Marshall, M.S. 

Division of Public Health 

State of Wisconsin 

Barbara Martinez 

Federal Bureau of Investigation 

Gene Matthews, J.D. 

Centers for Disease Control and Prevention 

Department of Health and Human Services 

Tom Matthews, COL, U.S. Army 

The Joint Staff 

Gary McConnell 

Georgia Emergency Management Agency 

Alan McCurry 

Office of Senator Pat Roberts 

Sallie McDonald 

U.S. General Services Administration 

John McGowan 

U.S. Customs Service 

Stanley M. McKinney 

Emergency Preparedness Division 

State of South Carolina 

Peter Menk, COL, U.S. Army 

U.S. Army War College 

Richard Metzler 

National Personal Protective Technology 

 Laboratory 

Thomas Milne 

National Association of County and 

City Health Officials 

Andy Mitchell 

Office of State and Local Domestic 

 Preparedness Support 

Department of Justice 

V. Alan Mode, Ph.D. 

Lawrence Livermore National Laboratory 

Paul Monroe, Jr. 

Major General 

California National Guard 

Barbara Monseu 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

 C-5

Jonathan Moreno, Ph.D. 

University of Virginia 

Lisa Moreno-Hix 

Oklahoma City National Memorial Institute 

 for the Prevention of Terrorism 

 

D’Arcy Morgan 

Office of Justice Programs 

Department of Justice 

Darrell Morgeson 

Los Alamos National Laboratory 

James Morhard 

Subcommittee on Commerce, Justice, State, 

 and the Judiciary Appropriations 

United States Senate 

Randall Murch 

Defense Threat Reduction Agency 

William Navas 

Robert Newberry 

Office of the Secretary of Defense 

Gary Noesner 

Federal Bureau of Investigation 

Phillip Oates 

Major General 

Alaska National Guard 

Terry O’Brien, J.D. 

Frank Ochberg, MD 

Michigan State University, 

 and Dart Foundation 

Paula Olsiewski, Ph.D. 

Alfred P. Sloan Foundation 

Michael Pace 

Kroll Associates 

R. Nicholas Palarino, 

Subcommittee on National Security 

 Veterans Affairs, and International 

 Relations 

U.S. House of Representatives 

Pamela Parizek, J.D. 

Kroll Associates 

Marcus Peacock, P.E. 

Subcommittee on Oversight, Investigations, 

 and Emergency Management 

U.S. House of Representatives 

Tony D. Perez 

Centers for Disease Control and Prevention 

Raphael F. Perl 

Congressional Research Service 

Ann Petersen, J.D. 

Joseph Pilat 

Los Alamos National Laboratory 

J.D. Piposvar, MPH 

Allegheny County Health Department 

State of Pennsylvania 

Ed Plaugher 

Arlington County Fire Department 

William Pollack 

Department of Energy 

Stephen Prior, Ph.D. 

The Potomac Institute 

Charles Ramsey 

Metropolitan Police Department 

Washington, DC 

Dennis Reimer 

National Memorial Institute 

 for the Prevention of Terrorism 

Sue Reingold 

Center for Strategic and International Studies 

Gary Richter 

Sandia National Laboratory 

Elizabeth Rindskopf, J.D. 

University of Wisconsin 

Joe Robinson, COL, U.S. Army 

Office of Director of Military Support 

Department of the Army 

John Rood 

Office of Senator Jon Kyl 

Ford Rowan 

Rowan & Blewitt, Inc. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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Gary Rowen 

National Domestic Preparedness Office 

Dwight D. Rowland 

General Accounting Office 

Gregory Saathof, MD 

University of Virginia 

Joshua Sinai, Ph.D. 

ANSER 

Patricia Sari-Spear 

U.S. General Accounting Office 

Richard Scribner 

Institute for Security Technology Studies 

Dartmouth College 

Kimberly Seay 

U.S. General Accounting Office 

The Honorable Jeff Session 

United States Senate 

Tania Shand 

Committee on Government Reform 

U.S. House of Representatives 

The Honorable Michael Sheehan 

Department of State 

Brendan Shields 

Office of Representative J.C. Watts 

Henry J. Siegelson, MD, FACEP 

Emory University School of Medicine 

David Siegrist 

The Potomac Institute 

Roger Simpson, Ph.D. 

University of Washington 

Roman Sloniewsky 

Critical Infrastructure Assurance Office 

Department of Commerce 

Jill Snowden, Ph.D. 

Institute of Food Technologies 

Suzanne Spaulding, J.D. 

James R. Stanton, M.S.W. 

Maryland Institute for Emergency Medical 

 Services Systems 

University of Maryland 

Leslee Stein-Spencer 

Illinois Department of Public Health 

Dan Stier, J.D. 

Department of Health 

State of Wisconsin 

Lorelei St. James 

U.S. General Accounting Office 

C.H. Straub II 

Office for State and Local Domestic 

 Preparedness Support 

Department of Justice 

John Sullivan 

Los Angeles Sheriff's Department 

Patrick J. Sullivan 

Arapahoe County (CO) Sheriff’s Department 

Robert Sullivan, J.D. 

City of Portsmouth, New Hampshire 

Vigdor Teplitz 

Office of Science and Technology Policy 

The White House 

The Honorable George Terwilliger, III, J.D. 

White and Case 

Fenton Thomas, COL, U.S. Army 

Federal Emergency Management Agency 

Kathleen Toomey, MD, MPH 

Department of Human Resources 

State of Georgia 

David Trachtenberg 

Committee on Armed Service 

U.S. House of Representatives 

John Tritak 

Critical Infrastructure Assurance Office 

Department of Commerce 

David Tubbs 

Utah Olympics Public Safety Command 

Bert Tussing 

U.S. Army War College 

Victor Utgoff 

Institute for Defense Analysis 
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Margaret Van Ameringe 

Joint Commission on Accreditation of 

 Healthcare Organizations 

Michelle Van Cleave 

Office of the Secretary of Defense 

Michael Vatis 

Institute for Security Technology Studies 

Dartmouth College 

Peter Verga 

Office of the Secretary of Defense 

A.D. Vickery 

Seattle Fire Department 

Martin Walker 

United Press International 

Charles Ward 

National Ground Intelligence Center 

Samuel J. Watson 

BioMedical Security Institute 

University of Pittsburgh 

William H. Webster 

Attorney at Law 

Captain Robert West, USN 

Joint Task Force-Computer Network 

 Operations 

Richard M. Wheeler, Ph.D. 

Department of Energy 

Michelle E. White 

Subcommittee on Oversight, Investigations 

 and Emergency Management 

U.S. House of Representatives 

John Allen Williams, Ph.D. 

Loyola University Chicago 

Michael A. Williams 

Department of State 

Frances Winslow 

Office of Emergency Services 

San Jose, California 

Robert Wise, M.D. 

Joint Commission on Accreditation of 

 Healthcare Organizations 

Leslie Wiser 

National Infrastructure Protection Center 

James Woolsey 

Attorney at Law 

Lee Zeichner 

LegalNetWorks 

The Honorable James Ziglar 

Commissioner 

Immigration and Naturalization Service 

Keith Yamanaka 

Department of Human Resources 

State of California
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APPENDIX D--EXECUTIVE ORDER ESTABLISHING OFFICE OF HOMELAND 

SECURITY 

For Immediate Release 

Office of the Press Secretary 

October 8, 2001

Executive Order Establishing Office of Homeland Security 

Executive Order 

Establishing the Office of Homeland Security and the Homeland Security Council 

 By the authority vested in me as President by the Constitution and the laws of the 

United States of America, it is hereby ordered as follows: 

 Section 1. Establishment. I hereby establish within the Executive Office of the President 

an Office of Homeland Security (the "Office") to be headed by the Assistant to the President 

for Homeland Security. 

 Sec. 2. Mission. The mission of the Office shall be to develop and coordinate the 

implementation of a comprehensive national strategy to secure the United States from 

terrorist threats or attacks. The Office shall perform the functions necessary to carry out 

this mission, including the functions specified in section 3 of this order. 

 Sec. 3. Functions. The functions of the Office shall be to coordinate the executive 

branch's efforts to detect, prepare for, prevent, protect against, respond to, and recover 

from terrorist attacks within the United States. 

 (a) National Strategy. The Office shall work with executive departments and agencies, 

State and local governments, and private entities to ensure the adequacy of the national 

strategy for detecting, preparing for, preventing, protecting against, responding to, and 

recovering from terrorist threats or attacks within the United States and shall periodically 

review and coordinate revisions to that strategy as necessary. 

 (b) Detection. The Office shall identify priorities and coordinate efforts for collection 

and analysis of information within the United States regarding threats of terrorism against 

the United States and activities of terrorists or terrorist groups within the United States. 

 The Office also shall identify, in coordination with the Assistant to the President for National 

Security Affairs, priorities for collection of intelligence outside the United States regarding 

threats of terrorism within the United States. 

 (i) In performing these functions, the Office shall work with Federal, State, and local 

agencies, as appropriate, to: 

 (A) facilitate collection from State and local governments and private entities of 

information pertaining to terrorist threats or activities within the United States; 

 (B) coordinate and prioritize the requirements for foreign intelligence relating to 

terrorism within the United States of executive departments and agencies responsible for 
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homeland security and provide these requirements and priorities to the Director of Central 

Intelligence and other agencies responsible collection of foreign intelligence; 

 (C) coordinate efforts to ensure that all executive departments and agencies that 

have intel-ligence collection responsibilities have sufficient technological capabilities and 

resources to collect intelligence and data relating to terrorist activities or possible terrorist 

acts within the United States, working with the Assistant to the President for National 

Security Affairs, as appropriate; 

 (D) coordinate development of monitoring protocols and equipment for use in 

detecting the release of biological, chemical, and radiological hazards; and 

 (E) ensure that, to the extent permitted by law, all appropriate and necessary 

intelligence and law enforcement information relating to homeland security is disseminated 

to and exchanged among appropriate executive departments and agencies responsible for 

homeland security and, where appropriate for reasons of homeland security, promote 

exchange of such information with and among State and local governments and private 

entities. 

 (ii) Executive departments and agencies shall, to the extent permitted by law, make 

available to the Office all information relating to terrorist threats and activities within the 

United States. 

 (c) Preparedness. The Office of Homeland Security shall coordinate national efforts to 

prepare for and mitigate the consequences of terrorist threats or attacks within the United 

States. In performing this function, the Office shall work with Federal, State, and local 

agencies, and private entities, as appropriate, to: 

 (i) review and assess the adequacy of the portions of all Federal emergency 

response plans that pertain to terrorist threats or attacks within the United States; 

 (ii) coordinate domestic exercises and simulations designed to assess and practice 

systems that would be called upon to respond to a terrorist threat or attack within the 

United States and coordinate programs and activities for training Federal, State, and local 

employees who would be called upon to respond to such a threat or attack; 

 (iii) coordinate national efforts to ensure public health preparedness for a terrorist 

attack, including reviewing vaccination policies and reviewing the adequacy of and, if 

necessary, increasing vaccine and pharmaceutical stockpiles and hospital capacity; 

 (iv) coordinate Federal assistance to State and local authorities and 

nongovernmental organizations to prepare for and respond to terrorist threats or attacks 

within the United States; 

 (v) ensure that national preparedness programs and activities for terrorist threats or 

attacks are developed and are regularly evaluated under appropriate standards and that 

resources are allocated to improving and sustaining preparedness based on such 

evaluations; and 

 (vi) ensure the readiness and coordinated deployment of Federal response teams to 

respond to terrorist threats or attacks, working with the Assistant to the President for 

National Security Affairs, when appropriate. 
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 (d) Prevention. The Office shall coordinate efforts to prevent terrorist attacks within the 

United States. In performing this function, the Office shall work with Federal, State, and 

local agencies, and private entities, as appropriate, to: 

 (i) facilitate the exchange of information among such agencies relating to 

immigration and visa matters and shipments of cargo; and, working with the Assistant to 

the President for National Security Affairs, ensure coordination among such agencies to 

prevent the entry of terrorists and terrorist materials and supplies into the United States 

and facilitate removal of such terrorists from the United States, when appropriate; 

 (ii) coordinate efforts to investigate terrorist threats and attacks within the United 

States; and 

 (iii) coordinate efforts to improve the security of United States borders, territorial 

waters, and airspace in order to prevent acts of terrorism within the United States, working 

with the Assistant to the President for National Security Affairs, when appropriate. 

 (e) Protection. The Office shall coordinate efforts to protect the United States and its 

critical infrastructure from the consequences of terrorist attacks. In performing this 

function, the Office shall work with Federal, State, and local agencies, and private entities, 

as appropriate, to: 

 (i) strengthen measures for protecting energy production, transmission, and 

distribution services and critical facilities; other utilities; telecommunications; facilities that 

produce, use, store, or dispose of nuclear material; and other critical infrastructure services 

and critical facilities within the United States from terrorist attack; 

 (ii) coordinate efforts to protect critical public and privately owned information 

systems within the United States from terrorist attack; 

 (iii) develop criteria for reviewing whether appropriate security measures are in 

place at major public and privately owned facilities within the United States; 

 (iv) coordinate domestic efforts to ensure that special events determined by 

appropriate senior officials to have national significance are protected from terrorist attack; 

 (v) coordinate efforts to protect transportation systems within the United States, 

including railways, highways, shipping, ports and waterways, and airports and civilian 

aircraft, from terrorist attack; 

 (vi) coordinate efforts to protect United States livestock, agriculture, and systems 

for the provision of water and food for human use and consumption from terrorist attack; 

and 

 (vii) coordinate efforts to prevent unauthorized access to, development of, and 

unlawful importation into the United States of, chemical, biological, radiological, nuclear, 

explosive, or other related materials that have the potential to be used in terrorist attacks. 

 (f) Response and Recovery. The Office shall coordinate efforts to respond to and 

promote recovery from terrorist threats or attacks within the United States. In performing 

this function, the Office shall work with Federal, State, and local agencies, and private 

entities, as appropriate, to: 
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 (i) coordinate efforts to ensure rapid restoration of transportation systems, energy 

production, transmission, and distribution systems; telecommunications; other utilities; and 

other critical infrastructure facilities after disruption by a terrorist threat or attack; 

 (ii) coordinate efforts to ensure rapid restoration of public and private critical 

information systems after disruption by a terrorist threat or attack; 

 (iii) work with the National Economic Council to coordinate efforts to stabilize United 

States financial markets after a terrorist threat or attack and manage the immediate 

economic and financial consequences of the incident; 

 (iv) coordinate Federal plans and programs to provide medical, financial, and other 

assistance to victims of terrorist attacks and their families; and 

 (v) coordinate containment and removal of biological, chemical, radiological, 

explosive, or other hazardous materials in the event of a terrorist threat or attack involving 

such hazards and coordinate efforts to mitigate the effects of such an attack. 

 (g) Incident Management. The Assistant to the President for Homeland Security shall 

be the individual primarily respon-sible for coordinating the domestic response efforts of all 

departments and agencies in the event of an imminent terrorist threat and during and in the 

immediate aftermath of a terrorist attack within the United States and shall be the principal 

point of contact for and to the President with respect to coordination of such efforts. The 

Assistant to the President for Homeland Security shall coordinate with the Assistant to the 

President for National Security Affairs, as appropriate. 

 (h) Continuity of Government. The Assistant to the President for Homeland Security, in 

coordination with the Assistant to the President for National Security Affairs, shall review 

plans and preparations for ensuring the continuity of the Federal Government in the event 

of a terrorist attack that threatens the safety and security of the United States Government 

or its leadership. 

 (i) Public Affairs. The Office, subject to the direction of the White House Office of 

Communications, shall coordinate the strategy of the executive branch for communicating 

with the public in the event of a terrorist threat or attack within the United States. The 

Office also shall coordinate the develop-ment of programs for educating the public about the 

nature of terrorist threats and appropriate precautions and responses. 

 (j) Cooperation with State and Local Governments and Private Entities. The Office shall 

encourage and invite the participation of State and local governments and private entities, 

as appropriate, in carrying out the Office's functions. 

 (k) Review of Legal Authorities and Development of Legislative Proposals. The Office 

shall coordinate a periodic review and assessment of the legal authorities available to 

executive departments and agencies to permit them to perform the functions described in 

this order. When the Office determines that such legal authorities are inadequate, the 

Office shall develop, in consultation with executive departments and agencies, proposals for 

presidential action and legislative proposals for submission to the Office of Management and 

Budget to enhance the ability of executive departments and agencies to perform those 

functions. The Office shall work with State and local govern-ments in assessing the 

adequacy of their legal authorities to permit them to detect, prepare for, prevent, protect 

against, and recover from terrorist threats and attacks. 
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 (l) Budget Review. The Assistant to the President for Homeland Security, in 

consultation with the Director of the Office of Management and Budget (the "Director") and 

the heads of executive departments and agencies, shall identify programs that contribute to 

the Administration's strategy for homeland security and, in the development of the 

President's annual budget submission, shall review and provide advice to the heads of 

departments and agencies for such programs. The Assistant to the President for Homeland 

Security shall provide advice to the Director on the level and use of funding in departments 

and agencies for homeland security-related activities and, prior to the Director's forwarding 

of the proposed annual budget submission to the President for transmittal to the Congress, 

shall certify to the Director the funding levels that the Assistant to the President for 

Homeland Security believes are necessary and appropriate for the homeland securityrelated activities of the executive branch. 

 Sec. 4. Administration. 

 (a) The Office of Homeland Security shall be directed by the Assistant to the President 

for Homeland Security. 

 (b) The Office of Administration within the Executive Office of the President shall 

provide the Office of Homeland Security with such personnel, funding, and administrative 

support, to the extent permitted by law and subject to the availability of appropriations, as 

directed by the Chief of Staff to carry out the provisions of this order. 

 (c) Heads of executive departments and agencies are authorized, to the extent 

permitted by law, to detail or assign personnel of such departments and agencies to the 

Office of Homeland Security upon request of the Assistant to the President for Homeland 

Security, subject to the approval of the Chief of Staff. 

 Sec. 5. Establishment of Homeland Security Council. 

 (a) I hereby establish a Homeland Security Council (the "Council"), which shall be 

responsible for advising and assisting the President with respect to all aspects of homeland 

security. The Council shall serve as the mechanism for ensuring coordina-tion of homeland 

security-related activities of executive departments and agencies and effective development 

and implementation of homeland security policies. 

 (b) The Council shall have as its members the President, the Vice President, the 

Secretary of the Treasury, the Secretary of Defense, the Attorney General, the Secretary of 

Health and Human Services, the Secretary of Transportation, the Director of the Federal 

Emergency Management Agency, the Director of the Federal Bureau of Investigation, the 

Director of Central Intelligence, the Assistant to the President for Homeland Security, and 

such other officers of the executive branch as the President may from time to time 

designate. The Chief of Staff, the Chief of Staff to the Vice President, the Assistant to the 

President for National Security Affairs, the Counsel to the President, and the Director of the 

Office of Management and Budget also are invited to attend any Council meeting. The 

Secretary of State, the Secretary of Agriculture, the Secretary of the Interior, the Secretary 

of Energy, the Secretary of Labor, the Secretary of Commerce, the Secretary of Veterans 

Affairs, the Administrator of the Environmental Protection Agency, the Assistant to the 

President for Economic Policy, and the Assistant to the President for Domestic Policy shall be 

invited to attend meetings pertaining to their responsibilities. The heads of other executive 

departments and agencies and other senior officials shall be invited to attend Council 

meetings when appropriate. 
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 (c) The Council shall meet at the President's direction. When the President is absent 

from a meeting of the Council, at the President's direction the Vice President may preside. 

 The Assistant to the President for Homeland Security shall be responsible, at the 

President's direction, for determining the agenda, ensuring that necessary papers are 

prepared, and recording Council actions and Presidential decisions. 

 Sec. 6. Original Classification Authority. I hereby delegate the authority to classify 

information originally as Top Secret, in accordance with Executive Order 12958 or any 

successor Executive Order, to the Assistant to the President for Homeland Security. 

 Sec. 7. Continuing Authorities. This order does not alter the existing authorities of 

United States Government departments and agencies. All executive departments and 

agencies are directed to assist the Council and the Assistant to the President for Homeland 

Security in carrying out the purposes of this order. 

 Sec. 8. General Provisions. 

 (a) This order does not create any right or benefit, substantive or procedural, 

enforceable at law or equity by a party against the United States, its departments, agencies 

or instrumentalities, its officers or employees, or any other person. 

 (b) References in this order to State and local governments shall be construed to 

include tribal governments and United States territories and other possessions. 

 (c) References to the "United States" shall be construed to include United States 

territories and possessions. 

 Sec. 9. Amendments to Executive Order 12656. Executive Order 12656 of November 

18, 1988, as amended, is hereby further amended as follows: 

 (a) Section 101(a) is amended by adding at the end of the fourth sentence: ", except 

that the Homeland Security Council shall be responsible for administering such policy with 

respect to terrorist threats and attacks within the United States." 

 (b) Section 104(a) is amended by adding at the end: ", except that the Homeland 

Security Council is the principal forum for consideration of policy relating to terrorist threats 

and attacks within the United States." 

 (c) Section 104(b) is amended by inserting the words "and the Homeland Security 

Council" after the words "National Security Council." 

 (d) The first sentence of section 104(c) is amended by inserting the words "and the 

Homeland Security Council" after the words "National Security Council." 

 (e) The second sentence of section 104(c) is replaced with the following two sentences: 

 "Pursuant to such procedures for the organization and management of the National 

Security Council and Homeland Security Council processes as the President may establish, 

the Director of the Federal Emergency Management Agency also shall assist in the 

implementation of and management of those processes as the President may establish. The 

Director of the Federal Emergency Management Agency also shall assist in the 

implementation of national security emergency preparedness policy by coordinating with the 

other Federal departments and agencies and with State and local governments, and by 
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providing periodic reports to the National Security Council and the Homeland Security 

Council on implementation of national security emergency preparedness policy." 

 (f) Section 201(7) is amended by inserting the words "and the Homeland Security 

Council" after the words "National Security Council." 

 (g) Section 206 is amended by inserting the words "and the Homeland Security Council" 

after the words "National Security Council." 

 (h) Section 208 is amended by inserting the words "or the Homeland Security Council" 

after the words "National Security Council." 

GEORGE W. BUSH 

THE WHITE HOUSE, 

October 8, 2001. 
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APPENDIX E—CITIZEN PREPAREDNESS IN WAR ON TERRORISM EXECUTIVE 

ORDER 

For Immediate Release 

Office of the Press Secretary 

November 9, 2001

Citizen Preparedness in War on Terrorism Executive Order 

Presidential Task Force on Citizen Preparedness in the War on Terrorism Executive Order 

By the authority vested in me as President by the Constitution and the laws of the United 

States of America, and in order to support and enhance the efforts of the American public 

with respect to preparedness and volunteerism in the war on terrorism, it is hereby ordered 

as follows: 

Section 1. Establishment. There is hereby established the "Presidential Task Force on 

Citizen Preparedness in the War On Terrorism" (Task Force). 

Sec. 2. Membership. (a) The Task Force shall be composed of the heads of the following 

executive branch entities, who may designate representatives from within their respective 

entities to assist them in their duties in connection with the Task Force: the Office of the 

Vice President, the Office of Homeland Security, the Domestic Policy Council, the Office of 

Science and Technology Policy, the Office of Management and Budget, the Department of 

the Treasury, the Department of Justice, the Department of Labor, the Department of 

Health and Human Services, the Department of Housing and Urban Development, the 

Department of Transportation, the Department of Energy, the Department of Veterans 

Affairs, the Environmental Protection Agency, the Federal Emergency Management Agency, 

and the Corporation for National and Community Service. The heads of other executive 

branch departments and agencies and other senior executive branch officials may 

participate in the work of the Task Force upon the invitation of the Co-Chairs. 

(b) The heads of the Office of Homeland Security and the Domestic Policy Council, or their 

designated representatives, shall serve as Co-Chairs of the Task Force. 

Sec. 3. Mission. The Task Force shall identify, review, and recommend appropriate means 

by which the American public can: 

(a) prepare in their homes, neighborhoods, schools, places of worship, workplaces, and 

public places for the potential consequences of any possible terrorist attacks within the 

United States; and 

(b) volunteer to assist or otherwise support State and local public health and safety officials 

and others engaged in the effort to prevent, prepare for, and respond to any possible 

terrorist attacks within the United States. 

Sec. 4. Reporting Requirement. The Task Force shall submit its recommendations to the 

President within 40 days from the date of this order. 

Sec. 5. Termination of Task Force. The Task Force shall terminate 30 days after submitting 

its report to the President. 

GEORGE W. BUSH 

THE WHITE HOUSE, 

November 9, 2001. 
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APPENDIX F—HOMELAND SECURITY PRESIDENTIAL DIRECTIVE-1, 

ORGANIZATION AND OPERATION OF THE HOMELAND SECURITY COUNCIL 

For Immediate Release 

Office of the Press Secretary 

October 30, 2001 

Homeland Security Presidential Directive-1 

October 29, 2001 

SUBJECT: Organization and Operation of the Homeland Security Council 

This is the first in a series of Homeland Security Presidential Directives that shall record and 

communicate presidential decisions about the homeland security policies of the United 

States. 

A. Homeland Security Council 

Securing Americans from terrorist threats or attacks is a critical national security 

function. It requires extensive coordination across a broad spectrum of Federal, State, and 

local agencies to reduce the potential for terrorist attacks and to mitigate damage should 

such an attack occur. The Homeland Security Council (HSC) shall ensure coordination of all 

homeland security-related activities among executive departments and agencies and 

promote the effective development and implementation of all homeland security policies. 

B. The Homeland Security Council Principals Committee 

The HSC Principals Committee (HSC/PC) shall be the senior interagency forum under the 

HSC for homeland security issues. The HSC/PC is composed of the following members: the 

Secretary of the Treasury; the Secretary of Defense; the Attorney General; the Secretary of 

Health and Human Services; the Secretary of Transportation; the Director of the Office of 

Management and Budget; the Assistant to the President for Homeland Security (who serves 

as Chairman); the Assistant to the President and Chief of Staff; the Director of Central 

Intelligence; the Director of the Federal Bureau of Investigation; the Director of the Federal 

Emergency Management Agency; and the Assistant to the President and Chief of Staff to the 

Vice President. The Assistant to the President for National Security Affairs shall be invited to 

attend all meetings of the HSC/PC. The following people shall be invited to HSC/PC 

meetings when issues pertaining to their responsibilities and expertise are discussed: the 

Secretary of State; the Secretary of the Interior; the Secretary of Agriculture; the Secretary 

of Commerce; the Secretary of Labor; the Secretary of Energy; the Secretary of Veterans 

Affairs; the Administrator of the Environmental Protection Agency; and the Deputy National 

Security Advisor for Combating Terrorism. The Counsel to the President shall be consulted 

regarding the agenda of HSC/PC meetings and shall attend any meeting when, in 

consultation with the Assistant to the President for Homeland Security, the Counsel deems it 

appropriate. The Deputy Director of the Office of Homeland Security shall serve as 

Executive Secretary of the HSC/PC. Other heads of departments and agencies and senior 

officials shall be invited, when appropriate. 
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The HSC/PC shall meet at the call of the Assistant to the President for Homeland Security, in 

consultation with the regular attendees of the HSC/PC. The Assistant to the President for 

Homeland Security shall determine the agenda, in consultation with the regular attendees, 

and shall ensure that all necessary papers are prepared. When global terrorism with 

domestic implications is on the agenda of the HSC/PC, the Assistant to the President for 

Homeland Security and the Assistant to the President for National Security Affairs shall 

perform these tasks in concert. 

C. Homeland Security Council Deputies Committee 

The HSC Deputies Committee (HSC/DC) shall serve as the senior sub-Cabinet interagency 

forum for consideration of policy issues affecting homeland security. The HSC/DC can task 

and review the work of the HSC interagency groups discussed below. The HSC/DC shall 

help ensure that issues brought before the HSC/PC or the HSC have been properly analyzed 

and prepared for action. The HSC/DC shall have the following as its regular members: the 

Deputy Secretary of the Treasury; the Deputy Secretary of Defense; the Deputy Attorney 

General; the Deputy Secretary of Health and Human Services; the Deputy Secretary of 

Transportation; the Deputy Director of the Office of Homeland Security (who serves as 

Chairman); the Deputy Director of Central Intelligence; the Deputy Director of the Federal 

Bureau of Investigation; the Deputy Director of the Federal Emergency Management 

Agency; the Deputy Director of the Office of Management and Budget; and the Assistant to 

the President and Chief of Staff to the Vice President. The Assistant to the President and 

Deputy National Security Advisor shall be invited to attend all meetings of the HSC/DC. The 

following people shall be invited to attend when issues pertaining to their responsibilities 

and expertise are to be discussed: the Deputy Secretary of State; the Deputy Secretary of 

the Interior; the Deputy Secretary of Agriculture; the Deputy Secretary of Commerce; the 

Deputy Secretary of Labor; the Deputy Secretary of Energy; the Deputy Secretary of 

Veterans Affairs; the Deputy Administrator of the Environmental Protection Agency; the 

Deputy National Security Advisor for Combating Terrorism; and the Special Advisor to the 

President for Cyberspace Security. The Executive Secretary of the Office of Homeland 

Security shall serve as Executive Secretary of the HSC/DC. Other senior officials shall be 

invited, when appropriate. 

The HSC/DC shall meet at the call of its Chairman. Any regular member of the HSC/DC 

may request a meeting of the HSC/DC for prompt crisis management. For all meetings, the 

Chairman shall determine the agenda, in consultation with the regular members, and shall 

ensure that necessary papers are prepared. 

D. Homeland Security Council Policy Coordination Committees 

HSC Policy Coordination Committees (HSC/PCCs) shall coordinate the development and 

implementation of homeland security policies by multiple departments and agencies 

throughout the Federal government, and shall coordinate those policies with State and local 

government. The HSC/PCCs shall be the main day-to-day fora for interagency coordination 

of homeland security policy. They shall provide policy analysis for consideration by the 

more senior committees of the HSC system and ensure timely responses to decisions made 

by the President. Each HSC/PCC shall include representatives from the executive 

departments, offices, and agencies represented in the HSC/DC. 
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Eleven HSC/PCCs are hereby established for the following functional areas, each to be 

chaired by the designated Senior Director from the Office of Homeland Security: 

1. Detection, Surveillance, and Intelligence (by the Senior Director, Intelligence and 

Detection); 

2. Plans, Training, Exercises, and Evaluation (by the Senior Director, Policy and Plans); 

3. Law Enforcement and Investigation (by the Senior Director, Intelligence and Detection); 

4. Weapons of Mass Destruction (WMD) Consequence Management (by the Senior 

Director, Response and Recovery); 

5. Key Asset, Border, Territorial Waters, and Airspace Security (by the Senior Director, 

Protection and Prevention); 

6. Domestic Transportation Security (by the Senior Director, Protection and Prevention); 

7. Research and Development (by the Senior Director, Research and Development); 

8. Medical and Public Health Preparedness (by the Senior Director, Protection and 

Prevention); 

9. Domestic Threat Response and Incident Management (by the Senior Director, Response 

and Recovery); 

10. Economic Consequences (by the Senior Director, Response and Recovery); 

and 

11. Public Affairs (by the Senior Director, Communications). 

Each HSC/PCC shall also have an Executive Secretary to be designated by the Assistant to 

the President for Homeland Security (from the staff of the HSC). The Executive Secretary of 

each HSC/PCC shall assist his or her Chair in scheduling the meetings of the HSC/PCC, 

determining the agenda, recording the actions taken and tasks assigned, and ensuring 

timely responses to the central policy-making committees of the HSC system. The 

Chairman of each HSC/PCC, in consultation with its Executive Secretary, may invite 

representatives of other executive departments and agencies to attend meetings of the 

HSC/PCC, when appropriate. 

The Assistant to the President for Homeland Security, at the direction of the President and 

in consultation with the Vice President, the Attorney General, the Secretary of Defense, the 

Secretary of Health and Human Services, the Secretary of Transportation, and the Director 

of the Federal Emergency Management Agency, may establish additional HSC/PCCs, as 

appropriate. 

The Chairman of each HSC/PCC, with the agreement of its Executive Secretary, may 

establish subordinate working groups to assist the PCC in the performance of its duties. 

The Vice President may attend any and all meetings of any entity established by or under 

this directive. 

This directive shall be construed in a manner consistent with Executive Order 13228. 

GEORGE W. BUSH 
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APPENDIX G—SURVEY INFORMATION 

The tabs to the appendix contain detailed information on all aspects of the State and Local 

Responder Survey. 

 TAB 1— THE SURVEY INSTRUMENT 

 TAB 2— FIRE DEPARTMENT SURVEY 

 TAB 3— FIELDING PROCEDURES 

 TAB 4— SAMPLE DESIGN & RESPONDENT SELECTION 

 TAB 5— RESPONSE RATES 

 TAB 6—CONSTRUCTING THE SURVEY WEIGHTS 

 TAB 7— SECTION 5 TABULATIONS 

 TAB 8—SURVEY COMMENTS 
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TAB 1 TO APPENDIX G (Survey Information)—THE SURVEY INSTRUMENT 

This appendix contains a description of the Federal Weapons of Mass Destruction Preparedness 

Programs Survey (FWMDPPS) instrument and an example of one particular variant of the 

instrument. 

Instrument Format 

The information collected across the various local response organizations followed a common 

format, as shown in the survey outline in Figure G-1-1. The survey questions were organized 

into five sections (1) Organizational Information, (2) Organizational Experience and Perceptions, 

(3) Emergency Response Planning Activities, (4) Responding to Specific WMD Terrorist 

Incidents, and (5) Assessment of Federal Programs. The survey’s main objective was to elicit 

local and State responders’ assessments of Federal WMD preparedness programs. 

Survey variations were primarily limited to differences in question phrasing and specific 

response sets (e.g., lists of relevant Federal programs) specific to the respondent group. For 

example, when referring to a responder organization’s area of responsibility, the word “State” 

was used for State organizations, “region” or “jurisdiction” for most local organizations, and 

“service area” for hospitals. More significant differences were introduced in the surveys for 

OEM and State-level organizations for questions about training or equipment received from the 

Federal government. For these organizations, additional questions were either added or the 

existing wording was changed to distinguish between training and equipment received for use by 

the organization completing the survey versus another organization within their jurisdiction. 

Also, hospital and public health surveys contained questions and response sets unique to each of 

these communities, though every effort was made to keep the various survey versions as 

compatible as possible. 

Section Descriptions 

Section 1 of the FWMDPPS included questions regarding information on the respondent’s 

organization, including size, special capabilities or functions, personnel assignments by field, 

type of jurisdiction served, size of the population served, service by a 911 system, and 

participation in area mutual aid agreements. 

Section 2 covered organizational experience and perceptions related to terrorism and incidents 

requiring similar scales of response (e.g., natural disasters). Respondents were asked to give 

their opinion regarding the likelihood of different types of terrorist incidents occurring within the 

United States and in their jurisdiction or region within the next five years. They also were asked 

to rate the likelihood of a significant natural disaster occurring within the same time period. 

Actual incidents of terrorism and their related hoaxes within a respondent’s jurisdiction in the 

past five years were also recorded. 

Section 3 focused on an agency’s emergency response planning activities. This section surveyed 

the following: whether or not the agency had individuals specially assigned to management or 

response training, including WMD management and response; participation in Superfund 

Amendments and Reauthorization Act (SARA) Title 3 groups or other interagency 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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Section 1: Organizational Information 

Relevant organizational demographics 

Section 2: Organizational Experience and Threat Perceptions 

Expectation of a terrorist incident: 

Within the U.S. in the next five years 

Within their jurisdiction in the next five years 

Organizational experience with actual incidents and hoaxes 

Section 3: Emergency Response Planning Activities 

Organizational participation in emergency response planning 

Existence of emergency response plans 

Relevant training 

Section 4: Responding to Specific Terrorist Incidents 

Measures of preparedness for incidents: 

Conventional explosives 

Chemical 

Biological 

Radiological 

Specific questions for the scenario above deemed most important by each respondent 

Section 5: Assessment of Federal Programs 

Application and/or receipt of Federal support 

Evaluation of Federally sponsored exercises 

Assessment of various aspects of Federal programs 

Use of the military and cyber-terrorism 

Figure G-1-1. Survey Instrument Outline 

 

disaster preparedness committees in their area; existence, depth, and integration of the agency’s 

written emergency response plan; participation in joint preparedness activities; percentage of 

personnel trained in particular areas of emergency response; access to special equipment for use 

in response to WMD incidents; and information related to any special units trained to respond to 

WMD incidents. 

Section 4 contained a narrated scenario section,111 where nearly identical questions were asked 

of the respondent about two to four different hypothetical WMD scenarios (conventional 

explosives, chemical, biological, radiological). This device was used to evaluate the 

thoroughness of an agency’s written emergency plan in relation to specific potential terrorist 

incidents in addition to their ability to respond to such an event, on their own and in conjunction 

with other agencies. The narrative portion was created to give respondents a specific image 

against which to compare their policies and response capabilities, while employing a storytelling tool to engage the respondents and raise interest in the topic (and the survey) through 

realistic portrayals of casualties, damage, and media concerns. Agencies were also given an 

opportunity to rate their perceived level of readiness to respond to the type of WMD incident 

they perceived to be most important for their organization to prepare for. 

 

Section 5 was designed as an assessment of Federal preparedness assistance programs. 

Respondents were questioned about Federal and non-Federal funding, training equipment, and/or 

support they had applied for; use of resources they may have received; and opinions regarding 

the value of programs in which they had participated. Data were also collected on factors 

limiting agencies’ ability to participate in federally sponsored programs, and agencies’ opinions 

 

111 See Scenarios section for an in-depth discussion regarding the construction of this piece of the instrument. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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regarding the role of government in this area. Additional questions specifically addressed issues 

pertaining to cyber-terrorism. 

In addition to these, a final section collected information on the individual completing the survey 

(as opposed to the organizational information collected in Section 1), and provided an 

opportunity for the respondent to share additional, open-ended comments and suggestions 

regarding Federal programs and/or any other comments the respondent wished to provide. 

Scenarios 

The narrative scenarios of Section 4 of the survey were designed to measure respondents' 

objective and self-assessed preparedness for a variety of WMD terrorist incident scenarios: 

conventional explosives, chemical, biological, and radiological (not all survey versions contained 

all four scenarios—see “Survey Variant Differences” to follow). A narrative was presented at 

the beginning of each subsection to introduce and describe the hypothetical WMD incident in 

some detail. The specificity in each narrative assured - to the extent possible in a mail survey—

that all respondents shared a common notion of the scale and nature of what was meant by 

"WMD terrorist incident," both in the questions that followed in Section 4 and for the evaluation 

of Federal preparedness programs in Section 5. Although definitions and terms were spelled out 

on the inside cover of the survey, the scenarios helped to fix ideas and establish a baseline 

against which respondents' claims of preparedness could be interpreted and compared. 

Because the scenarios are well defined, the survey subsequently restricts the respondent's point 

of view, and hence measures preparedness, to a finite subset of possible incidents. However, the 

specific scenarios provide a concrete definition of what that subset is. Without them, the 

potential for damage, loss of life, and the scale of the required response in a given WMD 

incident would all be left to the respondents' potentially divergent views as to what each type of 

incident might entail, thereby making their responses incomparable. A challenge in designing 

the scenarios was balancing the need to present all respondents with identical scenarios while 

ensuring that respondents (e.g., urban and rural locales, large metropolitan areas versus smaller 

communities) would not be over- or underwhelmed by the requisite response. The approach 

utilized was to calibrate the scale of the response according to an incident in the recent past that 

could have occurred anywhere: the bombing of the Murrah Federal building in Oklahoma City. 

To determine the content of the scenarios, researchers reviewed recent WMD scenarios from a 

variety of sources: chemical, biological, and radiological (CBR) scenarios used by the DOJ's 

Office for State and Local Domestic Preparedness Support (OSLDPS) in its 1999 survey of first 

responders112; chemical, biological, radiological, and nuclear (CBRN) scenarios used by FEMA's 

Emergency Management Institute to train first responders; and scenarios culled from on-line 

sources and the academic literature.113 The Emergency Management Institute's scenarios proved 

the most comprehensive but unfortunately too lengthy to include in whole form in the survey. In 

addition, some of these scenarios were not as current as others put forth in the academic 

 

112 DOJ, Responding to Incidents of Domestic Terrorism: Assessing the Needs of the State and Local Jurisdictions, Phase II 

Report, 1999. 113 For example, “Smallpox: An Attack Scenario” in: Emerging Infectious Diseases 5(4), 1999, CDC.
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literature. Thus, elements from more recent publications such as the Journal of the American 

Medical Association114 were also incorporated into the scenario. 

The scenarios were then iteratively revised with input from various subject matter experts to 

arrive at concise incident descriptions that provided enough information to: 

Set the scale of the incident (number of casualties, property loss, etc.); 

Mention key factors specific to the given agent that would distinguish it from an 

"everyday," non-WMD, non-terrorist event (e.g., secondary explosives in the 

conventional explosives incident, cross-contamination in the biological incident); 

Highlight the "key actors" likely to be involved (i.e., the interagency and multijurisdictional nature of the response, and the role that they would potentially play 

in these incidents). 

 

Thus, the scenarios were specifically written so that the different types of responder groups 

would be able to identify how their organization might fit into the response. 

Survey Variant Differences 

As was noted above, public health departments were asked to consider chemical, 

biological, and radiological incidents, but not conventional explosives. Because public 

health is less likely to have a role in the event of a conventional explosives incident, this 

scenario was omitted from the surveys to local and State public health departments and so 

these agencies were only presented with three of the scenarios (chemical, biological, 

radiological). 

Also as previously mentioned, hospitals were questioned about biological and chemical 

incidents in their narrative scenario section but not about chemical and radiological 

incidents, in order to keep the hospital surveys as short as possible to encourage response 

rates in this group. 

Public health departments were additionally questioned about in-house laboratory 

capabilities and their capacity to distribute information to other responder groups.

Perceived level of readiness questions were not asked of State EMS, because virtually all 

are regulatory agencies rather than response coordination agencies. 

Local OEM, State OEM, and State EMS agencies were questioned about whether their 

jurisdiction as a whole received training or equipment from the Domestic Preparedness 

Program (120 Cities Program) in addition to whether their individual organizations did 

so. Follow-up questions for these agencies delved into the respondent’s opinion of the 

support provided to their jurisdiction as a whole, rather than support provided specifically 

to their agency. 

State OEM and EMS agencies were asked to evaluate any role they may have played in 

administering support provided by federally sponsored programs, rather than about 

specific training or equipment their specific organization might have received. 

 

114 JAMA, May 12, 1999, Vol. 281, No. 18, consensus statements on the medical and public health management of such 

biological weapons as anthrax and smallpox. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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Pretesting The Survey Instrument 

Pretesting of the survey instrument was primarily conducted with selected experts. The 

appropriate questionnaire was mailed to each participating field expert with instructions to take 

the survey as a responder would, start-to-finish, timing their completion of each section. 

Pretesting was used to pinpoint and fix instrument problems, streamline questions, adjust 

wording to match appropriate vocabulary for each responder group, test and expand organization 

lists, and reduce the survey length. 

Each version of the survey was tested on two to four subject matter experts. The comments of 

each pre-tester were incorporated into discussions with subsequent pre-testers to allow for the 

possibility of agreement or disagreement between pretesters on their suggestions. In each case, 

pretesters comments were found to be crucial to the development of the survey. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction 

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 CARD 01 5-6/ 

 

BAR CODE LABEL 1-4/

SURVEY OF FEDERAL WEAPONS 

OF MASS DESTRUCTION (WMD)

PREPAREDNESS PROGRAMS 

Conducted by 

R 

on behalf of 

The Advisory Panel to Assess Domestic Response Capabilities 

for Terrorism Involving Weapons of Mass Destruction 

INSTRUCTIONS 

1. Please use a dark colored pen to fill out the survey. 

2. Mark only one box or circle one number per item, unless otherwise instructed. 

3. As the designated representative of your organization, please fill out all questions, 

to the best of your ability, from the perspective of your organization as a whole. 

FORM: 4 7/ 

BATCH: 8-11/

 2001 R
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Acronyms Used in this Survey

CDC Centers for Disease Control and Prevention, Department of Health and Human Services 

DHHS Department of Health and Human Services 

DMAT Disaster Medical Assistance Team 

DoD Department of Defense 

DOE Department of Energy 

DOJ Department of Justice 

DOT Department of Transportation 

EMS Emergency Medical Services 

EPA Environmental Protection Agency 

ER Emergency Room 

ERTP Emergency Response Training Program, Environmental Protection Agency 

FBI Federal Bureau of Investigation, Department of Justice 

FEMA Federal Emergency Management Agency 

HAZMAT Hazardous Materials 

HHS Department of Health and Human Services 

ICS Incident Command System 

LEPC Local Emergency Planning Committee or Commission 

NDMS National Disaster Medical System 

NDPO National Domestic Preparedness Office, Federal Bureau of Investigation 

NEIC National Enforcement Investigation Center, Environmental Protection Agency 

OEP Office of Emergency Preparedness, Department of Health and Human Services 

OJP Office of Justice Programs, Department of Justice 

OSLDPS Office for State and Local Domestic Preparedness Support, Office of Justice Programs, 

Department of Justice 

SARA Superfund Amendments and Reauthorization Act passed by the U.S. Congress in 1986; 

also known as the Emergency Planning and Community Right-to-Know Act (EPCRA) 

SBCCOM U.S. Army Soldier and Biological Chemical Command 

SOP Standard Operating Procedure 

USPHS United States Public Health Service 

WMD Weapons of Mass Destruction 

2-PAM Pralidoxime chloride 

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Section 1: 

ORGANIZATIONAL INFORMATION 

1. Which of the following categories best describes your agency?

(Mark One)

1 ❒ Volunteer department only 12/

2 ❒ Paid department only 

3 ❒ Combination department (both volunteer and paid personnel) 

2. Does your organization specialize in any of the following functions, in addition to its 

core firefighting role? 

(Mark All That Apply) 

1 ❒ Hazardous materials containment and/or clean-up (HAZMAT) 13/

2 ❒ Emergency Medical Services (EMS) 14/

0 ❒ None of the above ➨Skip to Question 3 15/

2a. Which of the following services does your organization provide regionally or to another 

jurisdiction as part of a mutual aid agreement? 

(Mark All That Apply) 

1 ❒ Hazardous materials containment and/or clean-up (HAZMAT) 16/

2 ❒ Emergency Medical Services (EMS) 17/

0 ❒ None of the above 18/

3. Is there another organization that provides HAZMAT services for your area? 

1 ❒ Yes 19/

2 ❒ No 

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4. Is there another organization that normally provides Emergency Medical Services (EMS) 

for your area? 

1 ❒ Yes 20/

2 ❒ No 

5. What is the size of your fire department? (Please give your best estimate) 

Total number of response personnel: ........................  21-25/

Number of paid firefighter personnel: .........................  26-30/

Number of volunteer firefighter personnel: .................  31-35/

Number of HAZMAT personnel: ......................................  36-39/

Number of EMS personnel: ............................................  40-43/

Number of total calls responded to 

(not including false alarms) in the last year: ........  44-49/

6. Is your jurisdiction served by a 911 emergency dispatch system? 

1 ❒ Yes ➨ Continue to Question 6a 55/

2 ❒ No ➨ Skip to Question 7

6a. Is it a consolidated 911 system? 

1 ❒ Yes 56/

2 ❒ No 

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7. What type of jurisdiction does your organization serve? 

(Mark One) 

1 ❒ City 57/

2 ❒ City / County 

3 ❒ County 

4 ❒ Multi-county or regional (within your state) 

5 ❒ State 

6 ❒ Other (specify):_________________________________________________ 58/

8. What is the size of the population your organization serves? 

(Mark One)

1 ❒ 1 – 15,000 59/

2 ❒ 15,001 – 30,000 

3 ❒ 30,001 – 65,000 

4 ❒ 65,001 – 250,000 

5 ❒ 250,001 – 1,000,000 

6 ❒ 1,000,001 + 

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DEFINITIONS

For the purposes of this study, we ask you to keep the following definitions and their scope in mind 

when answering the remainder of the survey. 

 Weapon of Mass Destruction (WMD) – A weapon of mass destruction is typically defined as a 

chemical, biological, radiological, or nuclear device. However, as used in this survey, it may also 

be any device capable of producing large-scale physical destruction, widespread disruption and / 

or mass casualties. Thus, a weapon of mass destruction may also be:

 A conventional explosive device of sufficient magnitude to inflict massive damage 

or casualties, such as with the Murrah Federal Building in Oklahoma City

 A device capable of disrupting critical societal infrastructure (for example, 

contaminating drinking water or agricultural products, or destroying or manipulating 

fuel or power distribution systems)

 An attack on an industrial facility (not necessarily involving an actual explosive device) 

where the purpose is to engineer the hazardous release of a toxic substance to kill and 

injure surrounding populations. 

Terrorism – A criminal act of violence, or threat of violence, designed to create an atmosphere 

of fear and alarm and to achieve maximum publicity in order to coerce others into actions they 

otherwise would not undertake, or into refraining from actions that they desire to take. Terrorists 

are motivated by political aims, may be either lone actors or members of a group, and seek to 

produce effects beyond the immediate physical damage that they cause. 

Cyber-Terrorism – A criminal act involving computer systems or networks designed to cause 

massive disruption of physical or electronic services in order to intimidate or coerce others. 

Examples of cyber-terrorism include:

 An attack against an industrial facility’s communications or control systems, resulting 

 in the release of a toxic substance

 An attack against local responder communications and other computer systems that 

 impairs response, in coordination with a conventional weapons attack

 Infiltration or corruption of critical data systems (at a hospital or bank, for example) 

in order to impair normal operations resulting in a lack of public confidence and societal 

disruption.

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Section 2: 

ORGANIZATIONAL EXPERIENCE AND PERCEPTIONS

Throughout the rest of the questionnaire, the acronym WMD is used as shorthand for “weapons of 

mass destruction." The previous page of definitions explains all that we are including in this category 

for the purposes of this study. 

Also, please keep in mind that in the following questions, “cyber-terrorism” is defined as the disruption 

of critical infrastructure or key information systems for more than one day. 

9. How would you rate the likelihood of the following types of major terrorism incidents (e.g., 

more than 30 individuals with serious injuries) occurring within the United States in the 

next 5 years? 

(Mark One Box on Each Row)

Very Somewhat Somewhat Very 

 Unlikely Unlikely Likely Likely

a. WMD chemical incident .......................... 1 ❒ 2 ❒ 3 ❒ 4 ❒ 60/

b. WMD biological incident ......................... 1 ❒ 2 ❒ 3 ❒ 4 ❒ 61/

c. WMD radiological incident ...................... 1 ❒ 2 ❒ 3 ❒ 4 ❒ 62/

d. Conventional explosives terrorism 

 incident .................................................. 1 ❒ 2 ❒ 3 ❒ 4 ❒ 63/

e. Cyber-terrorism incident ......................... 1 ❒ 2 ❒ 3 ❒ 4 ❒ 64/

 f. Terrorism incident involving the use 

 of military-grade weapons ..................... 1 ❒ 2 ❒ 3 ❒ 4 ❒ 65/

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10. How would you rate the likelihood of the following types of major terrorism incidents (e.g., 

more than 30 individuals with serious injuries) occurring within your jurisdiction or region in 

the next 5 years? 

(Mark One Box on Each Row)

Very Somewhat Somewhat Very 

 Unlikely Unlikely Likely Likely

a. WMD chemical incident ....................... 1 ❒ 2 ❒ 3 ❒ 4 ❒ 66/

b. WMD biological incident ...................... 1 ❒ 2 ❒ 3 ❒ 4 ❒ 67/

c. WMD radiological incident ................... 1 ❒ 2 ❒ 3 ❒ 4 ❒ 68/

d. Conventional explosives terrorism 

 incident ............................................... 1 ❒ 2 ❒ 3 ❒ 4 ❒ 69/

e. Cyber-terrorism incident ...................... 1 ❒ 2 ❒ 3 ❒ 4 ❒ 70/

 f. Terrorism incident involving the use 

 of military-grade weapons .................. 1 ❒ 2 ❒ 3 ❒ 4 ❒ 71/

11. How would you rate the likelihood of a significant natural disaster (e.g., earthquake, 

hurricane, tornado, flood, etc.) occurring within your jurisdiction or region in the next 

5 years?

Very Somewhat Somewhat Very 

 Unlikely Unlikely Likely Likely

1 ❒ 2 ❒ 3 ❒ 4 ❒ 72/

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12. Have any incidents of terrorism (including hoaxes) occurred, been attempted, or 

threatened within your jurisdiction or region in the past 5 years that required a response 

by your organization?

1 ❒ Yes (briefly describe): ______________________________________________ 73/ 

________________________________________________ 

________________________________________________ 74/

2 ❒ No ➨Skip to Section 3, next page

12a. Did any of these incidents involve the use (or threat of use) of any of the following?

(Mark All That Apply) 

1 ❒ Chemical, biological, or radiological weapons 75/

2 ❒ Conventional explosives 76/

3 ❒ Cyber-terrorism 77/

4 ❒ Military-grade weapons 78/ 

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Section 3: 

EMERGENCY RESPONSE PLANNING ACTIVITIES

13. Does your organization have any individuals specifically assigned (full-time or part-time) 

to do emergency management or response planning? 

1 ❒ Yes 79/

2 ❒ No 

14. Does your organization have any individuals specifically assigned (full-time or part-time) 

to do planning for WMD incidents?

1 ❒ Yes 80/

2 ❒ No 

15. Does your organization participate in a SARA Title 3 Emergency Planning Committee or 

Commission (LEPC) in your area?

1 ❒ Yes 81/

2 ❒ No 

16. Does an interagency disaster preparedness committee, task force, or working group (not 

including an LEPC) exist in your jurisdiction or region (whether or not your agency is a 

participant in it)? 

1 ❒ Yes  Continue to Question 16a 82/

2 ❒ No  Skip to Question 17

16a. Does your organization participate in this group?

1 ❒ Yes 83/

2 ❒ No 

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16b. Please indicate which organizations in your region regularly participate in this 

interagency disaster preparedness committee, task force, or working group: 

(Mark All That Apply)

Local Organizations (city or county)

01 ❒ Board of supervisors or other elected government officials 7-8/

02 ❒ Law enforcement organizations 9-10/

03 ❒ Other fire departments 11-12/

04 ❒ Free-standing HAZMAT organizations 13-14/

05 ❒ Local hospitals or other medical institutions 15-16/

06 ❒ EMS (3rd-service, hospital-based, fire department-based, or private ambulances) 17-18/

07 ❒ Local health departments 19-20/

08 ❒ Public or private utilities (e.g., water and power) 21-22/

09 ❒ Public or private transportation organizations 23-24/

10 ❒ Office of emergency management or preparedness 25-26/

11 ❒ Surrounding mutual aid response organizations 27-28/

12 ❒ Other (please specify): ___________________________________________ 29-30/

31/

State Organizations

13 ❒ State office of emergency management 32-33/

14 ❒ State office of emergency medical services 34-35/

15 ❒ State law enforcement organizations 36-37/

16 ❒ State public health department 38-39/

17 ❒ State office of fire control 40-41/

18 ❒ National Guard 42-43/

19 ❒ Other (please specify): ___________________________________________ 44-45/

46/

Federal Organizations

20 ❒ Federal Emergency Management Agency (FEMA) 47-48/

21 ❒ Federal Bureau of Investigation (FBI) 49-50/

22 ❒ Other (please specify): ___________________________________________ 51-52/

53/

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G-2-12 

16c. Does this interagency disaster preparedness committee, task force, or working group 

address planning for WMD incidents specifically? 

1 ❒ Yes 54/

2 ❒ No 

17. Does your organization have mutual aid agreements with other city, county, state, or 

regional organizations for disaster and emergency response? 

(Mark All That Apply)

1 ❒ Yes, for disaster and emergency response in general 55/

2 ❒ Yes, for WMD incidents specifically 56/

3 ❒ No 57/

18. Does your organization have a written emergency response plan?

1 ❒ Yes ➨ Continue with Question 19 58/

2 ❒ No ➨ Skip to Question 20 on next page

19. Does your organization’s written emergency response plan . . . 

(Please Mark One Box per Question)

a. Address operational areas and jurisdictional 

 boundaries? ............................................................. 1 ❒ Yes 2 ❒ No 59/

b. Include mutual aid agreements to 

provide additional resources? ................................... 1 ❒ Yes 2 ❒ No 60/

c. Include a response plan for handling the media? ...... 1 ❒ Yes 2 ❒ No 61/

19d. Is your organization’s written emergency response plan integrated with other local, state, 

and federal response plans?

1 ❒ Yes 62/

2 ❒ No 

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20. In the table below, please mark the appropriate boxes to indicate whether your 

organization participates in joint preparedness activities for natural disasters and / or 

WMD incidents with each of the organizations listed. 

Our organization participates, at least once a year, in joint preparedness activities for . . .

(Please Mark All That Apply)

 Natural 

disasters and 

emergencies 

with: 

WMD 

incident 

response

with: 

A. Law enforcement organizations 1 ❒ 2 ❒ 63-64/

B. Other fire departments 1 ❒ 2 ❒ 65-66/

C. Free-standing HAZMAT organizations 1 ❒ 2 ❒ 67-68/

D. Local hospitals or other medical institutions 1 ❒ 2 ❒ 69-70/

E. Emergency Medical Services (EMS) 1 ❒ 2 ❒ 71-72/

F. Local health departments 1 ❒ 2 ❒ 73-74/

G. Public or private utilities (e.g., water, power) 1 ❒ 2 ❒ 75-76/

H. Public or private transportation organizations 1 ❒ 2 ❒ 77-78/

I. Office of emergency management 

 or preparedness 1 ❒ 2 ❒ 79-80/

J. Surrounding mutual aid organizations 1 ❒ 2 ❒ 81-82/

21. What formal protocol for command and control does your organization use for 

 large-scale incidents? 

1 ❒ Incident Command System (ICS) 83/

2 ❒ Other standardized incident command and control or management system 

0 ❒ Neither of the above 

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22. What percentage of your response personnel are trained in the following areas? 

 (Please give your best estimate)

Percent of Response 

Personnel Trained 

a. Incident Command or Incident Management  7-9/

b. Personal Protective Equipment Levels A or B  10-12/

c. Personal Protective Equipment Level C  13-15/

d. Hazardous Materials Technician / Specialist  16-18/

e. WMD Awareness or Response  19-21/

23. Does your organization stock or have access to any of the following types of equipment 

for WMD incidents? 

(Mark All That Apply)

1 ❒ Monitoring and detection equipment for chemical agents 22/

2 ❒ Monitoring and detection equipment for biological agents 23/

3 ❒ Monitoring and detection equipment for radiological agents 24/

4 ❒ Personal Protective Equipment (PPE) Levels A or B 25/

5 ❒ Personal Protective Equipment (PPE) Level C 26/

6 ❒ Medical caches and/ or antidotes for chemical agents 27/

(e.g., atropine sulfate autoinjectors, 2-PAM, cyanide antidote kits) 

7 ❒ Medical caches and/ or antidotes for WMD biological agents 28/

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24. Does your organization have any unit(s) specially trained and equipped to respond to 

WMD incidents?

1 ❒ Yes ➨ Continue with Question 24a 29/

2 ❒ No ➨ Skip to Section 4, next page

24a. What types of WMD incidents are they trained to respond to?

(Mark All That Apply)

1 ❒ Chemical 30/

2 ❒ Biological 31/

3 ❒ Radiological 32/

4 ❒ Cyber-terrorism 33/

5 ❒ Large-scale conventional explosives 34/

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Section 4: 

RESPONDING TO SPECIFIC WMD TERRORIST INCIDENTS

The following section presents 4 different WMD scenarios involving the use of conventional explosives and 

chemical, biological, and radiological weapons. Please respond to the questions that follow each scenario 

regarding your organization’s readiness and support needs. 

SCENARIO 1: CONVENTIONAL EXPLOSIVES INCIDENT

One weekday morning, a major explosion occurs in a large office building downtown, with 

hundreds of people reportedly inside at the time of the blast. First responders report the 

following: 

The blast caused major structural damage to the office building, with some floors 

collapsed in upon each other 

Firefighters, police, and emergency medical personnel find dozens of people 

stumbling from the building with mild to severe physical injuries 

Buildings as far as a 5-block radius suffered blown-out windows 

Within an hour, 337 individuals require transport for medical treatment, with an 

unknown number still inside 

Hundreds of lookers-on, family, co-workers, and media personnel have congregated 

in the area, awaiting information. 

As local responders attempt to enter, they find evidence of other explosive devices in the 

building, forcing them to exit and fall back from the scene. As the full magnitude of the 

incident becomes known, first State, and then Federal agencies are called on to assist in 

the response. As a suspected act of terrorism, collecting and preserving evidence from 

the scene immediately becomes a major concern. 

Please answer each of the questions below as it pertains to the above conventional explosives scenario. 

25. Does your organization’s written emergency plan or standard operating procedure (SOP) 

address response to a conventional explosives incident similar to this scenario? 

1 ❒ Yes ➨ Continue to Question 25a 7/

2 ❒ No ➨Skip to Scenario 2

FIRE DEPT – 4 CARD 04 5-6/

RAND 1-4/

CARD 04 - 14 - 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-17 

25a. Does this emergency response plan or SOP address . . . 

(Mark All That Apply)

1 ❒ how your organization would communicate with other law enforcement, fire, 8/

 and HAZMAT organizations within your jurisdiction? 

2 ❒ how your organization would communicate with other hospitals and 9/

 public health agencies within your jurisdiction? 

3 ❒ how your organization would execute a response, given the threat of a 10/

 secondary explosive device? 

4 ❒ how your organization would coordinate with other agencies outside of your jurisdiction? 11/

0 ❒ None of the above 12/

26. When was this plan exercised for a conventional explosives incident? 

1 ❒ Within the last 12 months 13/

2 ❒ Between 1-2 years ago 

3 ❒ 2 or more years ago ➨ Skip to Scenario 2, next page

0 ❒ This plan has never been exercised 

 for a conventional explosives incident ➨ Skip to Scenario 2, next page 

27. Did this exercise for responding to a conventional explosives incident similar to this 

scenario test your organization’s capability to . . . 

(Mark All That Apply)

1 ❒ communicate with other law enforcement, fire, and HAZMAT organizations 14/

 within your jurisdiction? 

2 ❒ communicate with other hospitals and public health agencies 15/

 within your jurisdiction? 

3 ❒ execute a response, given the threat of a secondary explosive device? 16/

4 ❒ coordinate with other agencies outside of your jurisdiction? 17/ 

0 ❒ None of the above 18/

- 15 - CARD 04

FIRE DEPT – 4 RAND 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-18 

SCENARIO 2: CHEMICAL INCIDENT

An explosion in a building with 200 people inside results in numerous injuries and some 

fatalities, but minimal structural damage. As first responders arrive on the scene, they observe 

the following: 

Twenty-five individuals have been killed by the blast 

There are more casualties than would be expected for an explosion alone 

Unlikely symptoms among the survivors include sweating, disorientation, muscle tremors, 

convulsions and eye pain exhibited by 145 individuals. 

Soon, some of the responders also start to experience similar symptoms. A highly toxic and 

persistent chemical agent is suspected of having been released by the explosion. Both state 

and Federal emergency management officials are immediately notified. Cross-contamination 

becomes a major concern as victims find their way to local hospitals and responders operate 

in an area potentially covered with an active chemical agent. As the media quickly picks up on 

the story, panic begins to spread among the large crowd that has formed outside the building 

and in the nearby vicinity. 

Please answer each of the questions below as it pertains to the above chemical scenario. 

28. Does your organization’s written emergency plan or standard operating procedure (SOP) 

address response to a chemical incident similar to this scenario? 

1 ❒ Yes ➨ Continue to Question 28a 19/

2 ❒ No ➨ Skip to Scenario 3

28a. Does this emergency response plan or SOP address . . . 

(Mark All That Apply)

1 ❒ how your organization would communicate with other law enforcement, fire, 20/

 and HAZMAT organizations within your jurisdiction? 

2 ❒ how your organization would communicate with other hospitals and 21/

 public health agencies within your jurisdiction? 

3 ❒ procedures for mass decontamination, specifically for a large-scale chemical incident? 22/

4 ❒ how your organization would coordinate with other agencies outside of your jurisdiction? 23/

0 ❒ None of the above 24/

CARD 04 - 16 - 

FIRE DEPT – 4 RAND 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-19 

29. When was this plan last exercised for a chemical incident? 

1 ❒ Within the last 12 months 25/

2 ❒ Between 1-2 years ago 

3 ❒ 2 or more years ago ➨ Skip to Scenario 3, next page

0 ❒ This plan has never been exercised for a chemical incident ➨ Skip to Scenario 3, 

next page

30. Did this exercise for responding to a chemical incident similar to this scenario 

test your organization’s capability to . . . 

 (Mark All That Apply)

1 ❒ communicate with other law enforcement, fire, and HAZMAT organizations 26/

 within your jurisdiction? 

2 ❒ communicate with other hospitals and public health agencies 27/

 within your jurisdiction? 

3 ❒ decontaminate victims, specifically for a large-scale chemical incident? 28/

4 ❒ coordinate with other agencies outside of your jurisdiction? 29/

0 ❒ None of the above 30/

- 17 - CARD 04

FIRE DEPT – 4 RAND 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-20 

SCENARIO 3: BIOLOGICAL INCIDENT

During a three-day period in July, 20 individuals present to a local hospital’s emergency room 

complaining of fever, night sweats, headaches, coughing and joint pains. Initially, an untimely 

flu epidemic is suspected. However, after the third day, concern grows more acute: 

Additional patients are admitted with more severe symptoms 

Laboratory personnel who analyzed patient blood samples begin reporting 

similar symptoms 

Several days later, ERs and physicians have seen enough cases to alert local and state public 

health authorities, who immediately undertake large-scale surveillance and dispatch an 

investigation team. The state health department also notifies the CDC at which point other 

Federal agencies are also alerted. It is quickly determined that all patients had visited a 

regional airport in the past 10 days. The Governor orders the airport closed and quarantined. 

Fire and HAZMAT teams report to the scene to investigate and determine if there is a 

continuing threat. The National Guard is called to assist police with airport closure and crowd 

control. 

Days later, 7 of those affected die. 

All victims’ blood specimens test positive for brucellosis. 

A statewide and international alert is activated urging anyone who passed through the airport 

to contact their local health department. News agencies report that brucellosis can be fatal, 

creating panic. Local ERs are flooded with patients complaining of flu-like symptoms.

Please answer each of the questions below as it pertains to the above biological scenario. 

31. Does your organization’s written emergency plan or standard operating procedure (SOP) 

address response to a biological incident similar to this scenario? 

1 ❒ Yes ➨ Continue to Question 31a 31/

2 ❒ No ➨ Skip to Question 34

31a. Does this emergency response plan or SOP address . . . 

(Mark All That Apply)

1 ❒ how your organization would communicate with other law enforcement, fire, 32/

and HAZMAT organizations within your jurisdiction? 

2 ❒ how your organization would communicate with other hospitals and 33/

 public health agencies within your jurisdiction? 

3 ❒ procedures for mass decontamination, specifically for a large-scale biological incident? 34/

4 ❒ how your organization would coordinate with other agencies outside of your jurisdiction? 35/

5 ❒ the role of the Public Health department in your jurisdiction? 36/

0 ❒ None of the above 37/

CARD 04 - 18 -

FIRE DEPT – 4 RAND 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-21 

32. When was this plan last exercised for a biological incident? 

1 ❒ Within the last 12 months 38/

2 ❒ Between 1-2 years ago 

3 ❒ 2 or more years ago ➨ Skip to Question 34 

0 ❒ This plan has never been exercised for a biological incident ➨ Skip to Question 34

33. Did this exercise for responding to a biological incident similar to this scenario 

test your organization’s capability to . . . 

 (Mark All That Apply)

1 ❒ communicate with other law enforcement, fire, and HAZMAT organizations 39/

 within your jurisdiction? 

2 ❒ communicate with other hospitals and public health agencies 40/

 within your jurisdiction? 

3 ❒ decontaminate victims, specifically for a large-scale biological incident? 41/

4 ❒ coordinate with other agencies outside of your jurisdiction? 42/

5 ❒ coordinate with the Public Health department in your jurisdiction? 43/ 

0 ❒ None of the above 44/

34. Does your organization have procedures in place for reporting possible disease outbreaks 

to public health authorities in your area? 

1 ❒ Yes 45/

2 ❒ No 

35. Does your organization have access to laboratory capabilities to identify a suspected 

biological weapon based on samples taken from individuals or those collected at the 

scene of an incident? 

1 ❒ Yes 46/

2 ❒ No 

FIRE DEPT – 4 RAND 

- 19- CARD 04
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-22 

SCENARIO 4: RADIOLOGICAL INCIDENT

An explosion downtown on the top of a multi-storied building causes significant structural 

damage and starts a major fire on the upper levels. Fire and EMS personnel arrive and 

attempt to suppress the fire, rescue people trapped inside, and treat and transport the 

injured. Ambulances carry the first victims to local hospitals, while police cordon off the 

area. 

Hundreds were reportedly in the building at the time of the blast 

A local radio station receives a call claiming responsibility on behalf of a terrorist group, 

stating that the bomb released radioactive materials 

A HAZMAT team with detection capability is dispatched and confirms the bomb was 

a radioactive dispersion device. 

Police begin to evacuate a 10-block radius around the incident site, asking residents in 

adjacent areas to remain indoors. News agencies quickly pick up on the story. People in 

and around downtown panic and flee, causing traffic gridlock and a mass exodus from the 

town. Since initial responders transported the first rescued victims directly to hospitals, 

spread of radioactive contaminants becomes a serious concern. 

Please answer each of the questions below as it pertains to the above radiological scenario. 

36. Does your organization’s written emergency plan or standard operating procedure (SOP) 

address response to a radiological incident similar to this scenario? 

1 ❒ Yes ➨ Continue to Question 36a 47/

2 ❒ No ➨ Skip to Question 39

36a. Does this emergency response plan or SOP address . . . 

(Mark All That Apply)

1 ❒ how your organization would communicate with other law enforcement, fire, 48/

 and HAZMAT organizations within your jurisdiction? 

2 ❒ how your organization would communicate with other hospitals and 49/

 public health agencies within your jurisdiction? 

3 ❒ procedures for mass decontamination, specifically for a large-scale radiological incident? 50/

4 ❒ how your organization would coordinate with other agencies outside of your jurisdiction?51/

0 ❒ None of the above 52/

 

FIRE DEPT – 4 RAND 

CARD 04 - 20 - 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-23 

37. When was this plan last exercised for a radiological incident? 

1 ❒ Within the last 12 months 53/

2 ❒ Between 1-2 years ago 

3 ❒ 2 or more years ago ➨ Skip to Question 39 

0 ❒ This plan has never been exercised for a radiological incident ➨ Skip to Question 39

38. Did this exercise for responding to a radiological incident similar to this scenario 

test your organization’s capability to . . . 

(Mark All That Apply)

1 ❒ communicate with other law enforcement, fire, and HAZMAT organizations 54/

 within your jurisdiction? 

2 ❒ communicate with other hospitals and public health agencies 55/

 within your jurisdiction? 

3 ❒ decontaminate victims, specifically for a large-scale radiological incident? 56/

4 ❒ coordinate with other agencies outside of your jurisdiction? 57/ 

0 ❒ None of the above 58/

39. Which of these four types of WMD incidents is most important for your organization 

to prepare for? 

(Mark One Box Only) 

1 ❑ Biological 59/

2 ❑ Chemical 

3 ❑ Conventional explosives 

4 ❑ Radiological 

40. How high a priority is it for your organization to spend resources preparing for the type 

of WMD incident you selected in Question 39? 

1 ❒ High priority 60/

2 ❒ Somewhat of a priority 

3 ❒ Low priority 

0 ❒ Not at all a priority 

- 21- CARD 04

FIRE DEPT – 4 RAND 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-24 

Considering the type of WMD incident you selected in Question 39, please rate your organization’s 

level of readiness on a scale of 1 to 5, with 1 being INADEQUATE and 5 being EXCELLENT. 

Please circle one number for each question on the 5-point scale given below. 

41. Your organization’s written emergency plan to be used during a response to an event similar to the 

one selected above is: 

INADEQUATE EXCELLENT 

1 2 3 4 5 61/

42. Your organization’s knowledge and expertise about response to this type of event are: 

INADEQUATE EXCELLENT 

1 2 3 4 5 62/

43. Your organization’s equipment to respond to this type of event is: 

INADEQUATE EXCELLENT 

1 2 3 4 5 63/

44. Your organization’s training to prepare for this type of event is: 

INADEQUATE EXCELLENT 

1 2 3 4 5 64/

45. Your organization’s ability to communicate and coordinate with other organizations likely to 

 be involved in a response to this type of event is: 

INADEQUATE EXCELLENT 

1 2 3 4 5 65/

46. How would you rank your organization’s overall preparedness to respond to this type of event?

INADEQUATE EXCELLENT 

1 2 3 4 5 66/

CARD 04 -22- 

FIRE DEPT – 4 RAND 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-25 

47. Again, for the type of WMD incident you selected in Question 39, which of your response 

capabilities do you think are the weakest? 

(Mark All That Apply)

01 ❑ Hazard ID and detection 67-68/

02 ❑ Protection of response personnel from exposure to harmful agents 69-70/

03 ❑ Medical treatment of victims 71-72/

04 ❑ Mass care (e.g., bulk distribution of food, shelter, and basic necessities) 73-74/

05 ❑ Decontamination of victims 75-76/

06 ❑ Communication / coordination with local response organizations 77-78/

07 ❑ Communication / coordination with state and Federal agencies 79-80/

08 ❑ Media and information management 81-82/

09 ❑ Crowd control 83-84/

10 ❑ Basic operations during this kind of incident 85-86/

00 ❑ None of the above ➨ Skip to Question 49 87-88/

48. What item(s) would be most helpful to strengthen the response capabilities you 

 indicated as weaknesses in Question 47? 

(Please Mark All That Apply)

1 ❑ New or more up-to-date equipment 89/

2 ❑ Training courses for personnel (including “train the trainers”) 90/

3 ❑ Exercises 91/

4 ❑ Better integration of preparedness activities with local response organizations 92/

5 ❑ Better integration of preparedness activities with state and Federal agencies 93/

6 ❑ Information and reference materials about responding to this kind of incident 94/

7 ❑ Other (please specify): 95/

______________________________________________________________________________ 

______________________________________________________________________________ 96/

Fire Dept – 4 RAND

-23- CARD 04
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-26 

49. In your opinion, which of the following relationships between local, State, and Federal 

organizations would provide the most effective unified command structure for operations 

during the type of WMD incident you chose in Question 39? 

(Mark ONE Box Only) 

1 ❒ Federal agencies assume the lead role, managing and directing all local, State, and 

Federal assets 97/

2 ❒ State agencies assume the lead role, managing and directing local and State assets, 

and any Federal resources provided 

3 ❒ State agencies assume the lead role once local capability is overwhelmed, but relinquish 

 the lead to Federal agencies once State capability is overwhelmed 

4 ❒ Local organizations retain the lead role throughout the response, supported by additional 

resources provided by State and Federal agencies 

5 ❒ Local, State, and Federal organizations conduct their responses independently and do not 

coordinate under a unified command structure 

50. In your opinion, are hospitals well-integrated with other emergency response organizations 

in your community in planning and preparing for incidents similar to the type of WMD incident 

you chose in Question 39?

1 ❒ Yes 98/

2 ❒ No 

51. In your opinion, are Public Health agencies well-integrated with other emergency response 

organizations in your community in planning and preparing for incidents similar to the type 

of WMD incident you chose in Question 39?

1 ❒ Yes 99/

2 ❒ No 

Fire Dept – 4 RAND

CARD 04 -24- 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-27 

FIRE DEPT – 5 CARD 05 5-6/

RAND 1-4/ 

Section 5: 

ASSESSMENT OF FEDERAL PROGRAMS 

52. Since 1996, has your organization applied for funding, training, equipment, or other WMD 

preparedness support available from the Federal government, regardless of whether or not 

you received it? 

1 ❒ Yes ➨ Continue with Question 53 7/

2 ❒ No ➨ Skip to Question 54

53. How satisfied was your organization with the speed and efficiency of the application process 

for Federal WMD preparedness programs?

Not at All Moderately Very 

 Satisfied Satisfied Satisfied

1 ❒ 2 ❒ 3 ❒ 4 ❒ 5 ❒ 8/

54. Since 1996, has your organization received any support for funding, training, equipment, 

or other WMD preparedness from the Federal government?

1 ❒ Yes ➨ Continue with Question 55 9/

2 ❒ No ➨ Skip to Question 58

55. Please indicate below the types of Federal support your organization has received. 

(Mark All That Apply)

1 ❒ Funding 10/

2 ❒ Equipment 11/

3 ❒ Organization-wide training or exercises 12/

4 ❒ Individual study materials or videos 13/

5 ❒ Handbooks or reference materials 14/

6 ❒ Other (please specify): ________________________________________ 15/

16/

-25- CARD 05
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-28 

56. How were the Federal WMD resources you received used?

1 ❒ Shared with other organizations in our region 17/

2 ❒ Used only by our organization 

57. Has your organization’s participation in Federal WMD programs hindered your ability to 

obtain additional State support for WMD or any other type of emergency preparedness?

1 ❒ Yes 18/

2 ❒ No 

8 ❒ Don’t know 

58. Since 1996, has your organization applied to any of the non-Federal sources below for 

funding, training, equipment, or other support to improve your preparedness for WMD 

incidents?

(Mark All That Apply) 

1 ❒ State government agencies 19/

2 ❒ Local government agencies 20/

3 ❒ Private sector organizations 21/

0 ❒ We have not applied to any of the above for WMD preparedness support 22/

59. Since 1996, has your office requested WMD preparedness assistance or support from 

any of the following Federal programs or offices? If so, please indicate which ones.

(Mark All That Apply)

1 ❒ FBI National Domestic Preparedness Office (NDPO) 23/

2 ❒ DOJ Office for State and Local Domestic Preparedness Support (OSLDPS) 24/

3 ❒ FEMA Emergency Management Institute or Fire Academy 25/

4 ❒ CDC Bioterrorism Preparedness and Response Program 26/

5 ❒ Domestic Preparedness Program (also known as the “120 Cities” Program) 27/

6 ❒ Other (please specify): _________________________________________________ 28/

 29/ 

0 ❒ We have not requested WMD preparedness support from these Federal 

 programs or offices 30/

CARD 05 -26- 

Fire Dept – 5 RAND
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-29 

60. Has your organization received any training or equipment from the Domestic Preparedness 

Program (“120 Cities Program”)?

1 ❒ Yes ➨ Continue to Question 61 31/

2 ❒ No ➨ Skip to Question 63

61. Please indicate how much you agree or disagree with the following statements about 

the training your organization received from the Domestic Preparedness Program. 32/

0 ❒ We did not receive any training from the Domestic Preparedness Program ➨ Skip to Question 

62. 

(Circle One Choice for Each Line)

 Neither

Strongly Agree Nor Strongly

Disagree Disagree Agree

a. The training significantly improved our 

 organization’s preparedness. ............................ 1 2 3 4 5 33/

b. The number of personnel trained was adequate 

for responding to future WMD incidents. ............ 1 2 3 4 5 34/

c. The content of the training was relevant 

 to our organization’s WMD needs. .................... 1 2 3 4 5 35/

d. The staff-hours we invested in participation 

 were worth what our organization gained. ......... 1 2 3 4 5 36/

e. The training was well-aligned with our 

 community’s local WMD preparedness strategy. 1 2 3 4 5 37/

 f. The training will be useful to our personnel, 

 even for incidents that do not involve WMD. ..... 1 2 3 4 5 38/

-27- CARD 05

Fire Dept – 5 RAND
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-30 

62. Please indicate how much you agree or disagree with the following statements about the 

equipment your organization received from the Domestic Preparedness Program. 

39/

0 ❒ We did not receive any equipment from the Domestic Preparedness Program ➨ Skip to 

Question 63 

(Circle One Choice for Each Line)

 Neither

Strongly Agree Nor Strongly

Disagree Disagree Agree

a. The equipment significantly improved our 

 organization’s preparedness. ........................... 1 2 3 4 5 40/

b. The equipment we received was relevant 

 to our organization’s WMD needs. ................... 1 2 3 4 5 41/

c. We received enough to equip an adequate 

number of personnel for responding to 

future WMD incidents. ...................................... 1 2 3 4 5 42/

d. The cost of maintaining the equipment we 

 received is a worthwhile use of our resources. . 1 2 3 4 5 43/

e. The equipment will be useful to our personnel, 

 even for incidents that do not involve WMD. .... 1 2 3 4 5 44/

CARD 05 -28- 

Fire Dept – 5 RAND
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-31 

63. Since 1996, has your organization participated in any other Federally-sponsored programs 

for funding, equipment, training, or other WMD preparedness support? If so, please indicate 

which ones: 

(Mark All That Apply)

01 ❒ OJP First Responder Equipment Acquisition Program 45-46/

02 ❒ OJP Municipal Fire and EMS Equipment and Training Program 47-48/

03 ❒ NDPO Equipment Research and Development Program 49-50/

04 ❒ OJP Anti-Terrorism State and Local Training Grants 51-52/

05 ❒ OSLDPS training (DOJ-sponsored) 53-54/

06 ❒ FEMA Emergency Management Institute course(s) (WMD-related only) 55-56/

07 ❒ National Fire Academy Emergency Response to Terrorism course(s) 57-58/

08 ❒ U.S. Army Chemical School (USACLMS) Training Program 59-60/

09 ❒ DOE Training for Radiological Emergencies 61-62/

10 ❒ New Mexico Tech’s Incident Response to Terrorist Bombings course 63-64/

11 ❒ EPA Emergency Response Training Program (ERTP) 65-66/

12 ❒ Other (specify) : ____________________________________________________ 67-68/ 

69/

00 ❒ None of the above ➨ Skip to Question 67 70-71/

64. Which of the programs listed above did your organization most recently participate in? (If 

you cannot determine which program you participated in most recently, please choose any 

one of the programs you selected above.) Please write the name of this program in the 

space below. 

Name of program: __________________________________________________ 72-73/

Fire Dept – 5 RAND

-29- CARD 05
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-32 

65. If your organization received training from the program you listed in Question 64, please 

indicate how much you agree or disagree with the following statements about this training: 

0 ❒ We did not receive any training from this program ➨ Skip to Question 66 74/

(Circle One Choice for Each Line)

 Neither

Strongly Agree Nor Strongly

Disagree Disagree Agree

a. The training significantly improved our 

 organization’s preparedness. ............................... 1 2 3 4 5 75/

b. The number of personnel trained was adequate 

 for responding to future WMD incidents. .............. 1 2 3 4 5 76/

c. The content of the training was relevant 

 to our organization’s WMD needs. ....................... 1 2 3 4 5 77/

d. The investment of staff-hours due to participation 

 was worth what our organization gained. ............. 1 2 3 4 5 78/

e. The training was well-aligned with our 

 community’s local WMD preparedness strategy. . 1 2 3 4 5 79/

f. The training will be useful to our personnel, 

 even for incidents that do not involve WMD. ........ 1 2 3 4 5 80/

Fire Dept – 5 RAND

CARD 05 -30- 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-33 

66. If your organization received any equipment from the program you listed in Question 64, 

please indicate how much you agree or disagree with the following statements about that 

equipment: 

0 ❒ We did not receive any equipment from this program ➨ Skip to Question 67 81/

(Circle One Choice for Each Line)

 Neither

Strongly Agree Nor Strongly

Disagree Disagree Agree

a. The equipment significantly improved our 

 organization’s preparedness. ........................... 1 2 3 4 5 82/

b. The equipment is relevant to our 

 organization’s WMD needs. ............................. 1 2 3 4 5 83/

c. We received enough to equip an adequate 

number of personnel for responding to 

future WMD incidents. ...................................... 1 2 3 4 5 84/

d. The cost of maintaining the equipment is 

 worth the investment. . ..................................... 1 2 3 4 5 85/

e. The equipment will be useful to our personnel, 

 even for incidents that do not involve WMD. .... 1 2 3 4 5 86/

67. In general, what factors limit your organization’s ability to participate in Federally-sponsored 

training programs?

(Mark All That Apply)

1 ❒ Not eligible to participate in these programs 87/

2 ❒ Unaware of Federal training programs 88/

3 ❒ Content is not relevant to our organization’s needs 89/

4 ❒ Time commitment is excessive 90/

5 ❒ Training is not scheduled during times when our personnel can attend 91/

6 ❒ Programs are poorly organized and / or difficult to understand 92/

7 ❒ Cost of participating is excessive 93/

8 ❒ Our organization’s preparedness would not be improved through participation 94/

9 ❒ We have other more important emergency preparedness responsibilities to worry about 95/

0 ❒ None of the above 96/

Fire Dept – 5 RAND

-31- CARD 05
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-34 

FIRE DEPT – 5 CARD 06 5-6/

RAND 1-4/ 

68. In general, what factors limit your organization’s ability to participate in Federally-sponsored 

equipment programs?

(Mark All That Apply)

1 ❒ Not eligible to participate in these programs 7/

2 ❒ Unaware of Federal equipment programs 8/

3 ❒ The equipment made available is not relevant to our organization’s needs 9/

4 ❒ Programs are poorly organized and / or difficult to understand 10/

5 ❒ Application process is too involved 11/

6 ❒ Cost of participating is excessive 12/

7 ❒ Our organization’s preparedness would not be improved through participation 13/

8 ❒ We have other more important emergency preparedness responsibilities to worry about 14/

0 ❒ None of the above 15/

69. Since 1996, has your organization participated in or conducted any exercises for WMD 

response in which a Federal agency:

(Mark All That Apply)

1 ❒ helped organize or coordinate the exercise? 16/

2 ❒ provided funding to the participating organization(s)? 17/

3 ❒ participated in the actual exercise? 18/

0 ❒ None of the above ➨ Skip to Question 71 19/

70. Please indicate how much you agree or disagree with the following statements about 

exercises your organization participated in or conducted in which a Federal agency or 

organization was involved. 

(Circle One Choice for Each Line)

Strongly Neither Agree Strongly

Disagree Nor Disagree Agree

a. Federal participation helped make 

 the exercise more realistic. ............................... 1 2 3 4 5 20/

b. Without Federal participation we probably 

 would not have participated in the exercise. ..... 1 2 3 4 5 21/

c. Federal involvement helped us test 

and / or improve our capabilities more 

 than we would have otherwise .......................... 1 2 3 4 5 22/

CARD 06 -32- 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-35 

71. Since 1996, has your organization used or obtained information or technical assistance for 

WMD preparedness or response from any of the following Federally-sponsored resources?

(Mark All That Apply)

01 ❒ Chemical Weapons Improved Response Program (CW IRP) 23-24/

02 ❒ Biological Weapons Improved Response Program (BW IRP) 25-26/

03 ❒ CDC’s Health Alert Network (HAN) 27-28/

04 ❒ FBI’s National Domestic Preparedness Office (NDPO) 29-30/

05 ❒ FEMA Rapid Response Information System (RRIS) 31-32/

06 ❒ Chemical and Biological (CB) Hotline 33-34/

07 ❒ DOT Emergency Response Guidebook 35-36/

08 ❒ DoD Chemical and Biological Information Analysis Center (CBIAC) 37-38/

09 ❒ DoD Consequence Management Interoperability Services (CMI) 39-40/

10 ❒ OSLDPS Technical Assistance Program (DOJ-sponsored) 41-42/

11 ❒ Other (specify):____________________________________________________ 43-44/

 45/ 

00 ❒ We have not used or obtained information or technical assistance 

from any of the above 46-47/

 

-33- CARD 06

Fire Dept – 5 RAND
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-36 

72. Does your organization have formal procedures in place to coordinate with any of the 

following Federally-sponsored special units in the event of a WMD incident? If so, please 

indicate which ones:

(Mark All That Apply)

01 ❒ HHS Metropolitan Medical Strike System 48-49/

02 ❒ National Guard Weapons of Mass Destruction Civil Support Teams 50-51/

03 ❒ EPA’s Environmental Response Team 52-53/

04 ❒ EPA’s Radiological Response Team 54-55/

05 ❒ DoD U.S. Marine Corps Chemical Biological Incident Response Force (CBIRF) 56-57/

06 ❒ NDMS National Medical Response Team – Weapons of Mass Destruction (NDMS NMRT)58-59/

07 ❒ DOE Nuclear Emergency Search Team (NEST) 60-61/

08 ❒ DOE Nuclear Incident Team 62-63/

09 ❒ DOE Nuclear / Radiological Advisory Team 64-65/

10 ❒ U.S. Army Chemical / Biological Rapid Response Team (C/B – RRT) 66-67/

11 ❒ Other (specify): _____________________________________________________ 68-69/

 70/ 

00 ❒ We do not have any formal procedures in place for coordinating with 

these special units 71-72/ 

Please indicate how much you agree or disagree with the following statements: 

73. Federal WMD preparedness funding that is being distributed through state governments

is reaching local organizations and communities with the greatest need.

 Neither

Strongly Agree Nor Strongly 

 Disagree Disagree Disagree Agree Agree

1 ❒ 2 ❒ 3 ❒ 4 ❒ 5 ❒ 73/

74. WMD preparedness funding being distributed by the Federal government directly to local 

communities and local responders is reaching the organizations and communities with the 

greatest need.

 Neither

Strongly Agree Nor Strongly 

 Disagree Disagree Disagree Agree Agree

1 ❒ 2 ❒ 3 ❒ 4 ❒ 5 ❒ 74/

CARD 06 -34- 

Fire Dept – 5 RAND
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-37 

75. Federal Government programs for improving local responder WMD preparedness . . . 

(Circle One Choice for Each Line)

Strongly Neither Agree Strongly

Disagree Nor Disagree Agree

a. are carefully coordinated and well-organized ...... 1 2 3 4 5 75/

b. are flexible enough to allow our organization to 

 use Federal funding and resources as we see fit 1 2 3 4 5 76/

c. are taking funding and resources away 

from more important priorities ............................. 1 2 3 4 5 77/

d. are focused on highly unlikely scenarios 

 at the expense of more likely scenarios .............. 1 2 3 4 5 78/

e. should provide threat and risk assessment 

 information to local response organizations ....... 1 2 3 4 5 79/

 f. are so numerous that we have difficulty in 

figuring out what is relevant to our organization .. 1 2 3 4 5 80/

g. are of little use to our organization ...................... 1 2 3 4 5 81/

h. fit well with our community’s local 

 preparedness strategy ....................................... 1 2 3 4 5 82/

 i. should involve dedicated Federal assets 

so that local response organizations can 

concentrate on their primary mission ................... 1 2 3 4 5 83/

 j. should provide intelligence about terrorist 

 activities to local response organizations ........... 1 2 3 4 5 84/

k. should promote research and development of 

 new technologies to combat terrorism................. 1 2 3 4 5 85/

 l. should involve better coordination between the 

 Federal Government and local responders ........ 1 2 3 4 5 86/

m. should help our organization strengthen 

 the security of our computer systems 

 against cyber-terrorist attacks ........................... 1 2 3 4 5 87/

Fire Dept – 5 RAND

-35- CARD 06
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-38 

76. What is the single most important way that the Federal government can support the efforts 

of local organizations like yours to improve their WMD preparedness? 

(Mark ONE Box Only) 88/

1 ❒ Direct financial support 

2 ❒ Equipment procurement 

3 ❒ Training or training aids 

4 ❒ Exercise coordination and support 

5 ❒ Distribution of WMD technical information 

6 ❒ Research and development on WMD preparedness and response 

7 ❒ Outreach to state and local organizations 

8 ❒ Dissemination of intelligence data 

9 ❒ No improvement needed 

0 ❒ Other (specify):_________________________________________________________ 89/

77. What roles do you feel would be appropriate for the U.S. military to play during a

response to a domestic WMD incident?

(Mark All That Apply)

1 ❒ Maintain order and / or provide security 90/

2 ❒ Advise other response organizations on technical and / or logistical matters 91/

3 ❒ Conduct needs assessments to determine what kind of response is required 92/

4 ❒ Provide personnel and equipment to support local, State, and / or Federal agencies 93/

5 ❒ Set up kitchens, clinics, and mass care facilities for victims and relief workers 94/

6 ❒ Assume the role of lead agency in a unified command 95/

7 ❒ No form of participation by the military would be appropriate 96/

8 ❒ Other (specify):_________________________________________________________ 97/ 

98/

Fire Dept – 5 RAND

CARD 06 -36- 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-39 

FIRE DEPT – 5 CARD 07 5-6/

RAND 1-4/ 

The following questions deal with responding to incidents of cyber-terrorism. For the purposes of 

this study, a cyber-terrorism incident is defined as involving the disruption of critical infrastructure 

or key information systems for more than 1 day. 

78. Do any of your organization’s critical response functions (e.g., command, control, 

communications, dispatch) depend on computer systems? 

1 ❒ Yes ➨ Continue to Question 79 7/

2 ❒ No ➨ Skip to Question 80

79. Have any of these critical computer systems ever been the target of a criminal attempt to:

(Mark All That Apply)

1 ❒ gain unauthorized access? 8/

2 ❒ damage or impair system functioning or operability? 9/

3 ❒ Other (please specify): ______________________________________________________ 10/

 11/

0 ❒ Our computer systems have not been targeted in this way, to our knowledge. 12/

80. Has your organization ever requested assistance from the FBI, including the FBI’s Regional 

Computer Crime Squads, for any of the following:

(Mark All That Apply) 

1 ❒ to report, investigate, or seek assistance after a computer crime was committed 13/

 against your organization? 

2 ❒ to request assistance in order to strengthen the security of your organization’s 14/

 computer systems? 

0 ❒ None of the above 15/

-37- CARD 07
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-40 

ADDITIONAL COMMENTS 

81. Do you personally serve a specific WMD role within your organization? 

1 ❒ Yes (briefly describe) : ___________________________________________________ 16/

___________________________________________________ 17/

2 ❒ No 

Thank you for taking the time to complete this survey. If this questionnaire did not address all 

of the WMD-related issues of importance to your organization, please use this space or attach 

additional pages to add comments or clarifications. 

Does your organization have other suggestions for changes or improvements in Federal 

programs for WMD preparedness that this survey has not covered? 

_____________________________________________________________________________ 18/

_____________________________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

Has your organization’s experiences or challenges in preparing for domestic terrorism 

incidents involving Weapons of Mass Destruction resulted in other lessons learned about 

specific Federal government WMD programs or agencies not addressed in this survey? 

_____________________________________________________________________________ 19/

_____________________________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

 

 

CARD 07 -38- 

Fire Dept – 6 RAND
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-2-41 

POINT OF CONTACT FOR MATTERS RELATED TO THIS SURVEY: 

Your Name: ______________________________________________________________________ 

Position Title: ______________________________________________________________________ 

Title of organization: ________________________________________________________________ 

Address: _________________________________________________________________________ 

Street 

_________________________________________________________________________ 

City State Zip Code

E-Mail: _________________________________________________________________________ 

Phone: ( ________ ) __________- _______________ 

Fax: ( ________ ) __________- _______________ 

Thank you for completing this important survey. Please return your completed survey in the 

business reply envelope provided. If you have any questions regarding this study, please call 

Dr. Ron Fricker or Dr. Lois Davis at R, tel. 888-767-4758, or feel free to e-mail us at 

(Ron_Fricker@rand.org; or Lois_Davis@rand.org). 

-39- CARD 07

Fire Dept – 6 RAND
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-3-1 

TAB 3 TO APPENDIX G (Survey Information)—FIELDING PROCEDURES 

FIELDING PROCEDURES 

This appendix describes the procedures used to pretest and field the Federal Weapons of Mass 

Destruction Preparedness Programs Survey (FWMDPPS). An outline of the major fielding steps 

that were implemented includes the following: a letter sent one week in advance of the survey 

mailing; inclusion of a motivating cover letter and appropriate incentive with the survey mailing; 

telephone follow-up to assure arrival of the survey and emphasize the importance of the study; 

establishing a toll-free 800 number to field respondent questions; follow-up postcard reminders 

post survey mailing; the mailing of a second, replacement survey; and lastly, a final telephone 

follow-up. 

To further improve respondent identification and increase response rates, because many of these 

groups (e.g., law enforcement) have been over surveyed, the following additional procedures 

were implemented: a mailing three months prior to the commencement of the survey fielding 

period in an effort to have survey respondents designated in advance by the heads of their 

agencies, and informed of the nature and purpose of the survey; a broadcast fax follow-up to 

respondents who did not respond initially; extended telephone follow-up; and a third survey 

mailing sent via Federal Express to the two most challenging respondent populations, hospitals 

and state EMS. 

Survey research has shown that incentive gifts mailed along with a survey instrument can 

increase response rates by elevating the perceived importance of the study and conveying both 

appreciation and recognition of the respondent’s time.115 In recognition of the gravity and 

importance of the survey subject matter, an incentive was commissioned that could also be easily 

mailed in the same envelope with the survey: a three-inch diameter, copper-colored, two-sided 

commemorative coin, which was imprinted with the title of the survey and an American flag on 

one side and the name of the panel and the Great Seal of the United States on the other side. 

These commemorative coins were included in each packet sent in the initial survey mailing. 

Advance Notification 

Data collection for this survey was primarily conducted between March and July 2001.116 For 

most groups, letters were mailed out to respondents in January 2001 describing the survey that 

was to arrive in March or April and encouraging participation. In the letter, the agencies were 

asked to designate a survey respondent within their organization who would be the most 

knowledgeable about terrorism preparedness and provide that person’s contact information on a 

postage-paid return postcard included in the mailing. This advance notice was used to heighten 

the awareness and importance of the survey among the contacted organizations, while increasing 

response rates by focusing future mail and telephone efforts on individuals specifically 

designated at the outset as the proper survey respondents by agency heads. For those 

organizations not returning postcards, follow-up calls were made to the original contact on 

 

115 Fowler, F. Jr. Survey Research Methods (2nd ed.), Newbury Park, CA, Sage Publications, 1993. 116 Additional follow-up efforts via FedEx were conducted between August and September 2001 with two of the most 

challenging and lowest response sub-groups, state EMS and hospitals. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-3-2 

record in an effort to have a specific, knowledgeable respondent assigned in advance of the 

actual survey mailing. 

Survey Mailing 

To better manage the fielding process, the nine types of organizations were divided into groups, 

or “waves.” The data collection schedule for each was staggered by 10 days to allow the 

telephone survey staff adequate time to contact each respondent during the various phases of 

telephone follow-up. Each survey wave opened with an advance letter to the respondent 

indicating the importance of the survey and alerting them to its imminent arrival. Advance 

letters were printed on RAND stationary and signed by the RAND study director. For those 

agencies not contacted in January (hospitals, local EMS, local OEM, local public health), the 

advance letter gave the addressee the option of assigning a knowledgeable survey designee if 

they deemed it appropriate. Seven days following the advance letter mailing, the survey was 

sent out with a cover letter and commemorative coin. Cover letters were printed on panel 

stationary and were signed by Panel Chairman James S. Gilmore, III, Governor of Virginia. The 

survey itself was bound in a brightly colored cover designed to attract attention on a respondent’s 

desk once out of its envelope. 

Instructions To Respondents 

In the survey cover letter, respondents were asked to complete the survey and return it to RAND 

in an enclosed postage-paid, business reply envelope. They were told that the survey would take 

about one-half hour to complete. On the cover of the survey, the following additional instruction 

was printed: “As the designated representative of your organization, please fill out all questions, 

to the best of your ability, from the perspective of your organization as a whole.” Respondents 

were also given specific definitions for “weapons of mass destruction,” “terrorism,” and “cyber 

terrorism” in the body of the survey, and were asked to keep these definitions and their scope in 

mind when answering each question. 

Phone Contact 

Concurrent with the arrival of the survey packet, the first round of telephone follow-up began. 

This wave of calling was conducted by RAND Survey Research Group (SRG) telephone 

interviewers working from a centralized telephone interviewing facility in RAND’s Santa 

Monica, California office. 

In all rounds of telephone follow-up, interviewers spoke either to the person to whom the packet 

was mailed or, in cases where that was impossible, to that person’s assistant or secretary. The 

purpose of the first round of calling was to verify that the packet had been received, to reiterate 

the importance of the respondent’s participation in the study, and to answer any questions or 

concerns that the respondent might have. Eliminating questions and encouraging participation 

makes survey response more likely, as the respondent feels more accountable to the study after 

the call than if verbal contact is not conducted. First-round calling continued for 10 days for 

each sample wave, with state public health and hospital first-round calling extended to 14 days. 

Follow-Up 

Seven days following the survey mailing, reminder postcards were sent out to all survey 

recipients. The postcard thanked respondents if they had already filled out and returned the 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-3-3 

survey, but also prodded those to complete the survey if who had not already done so, again 

citing the importance of the study and their participation in it. 

Approximately four weeks following the initial mailing of the survey packet, a replacement 

survey was mailed to all candidates for whom a returned survey was not on file. As an added 

measure for samples with fax numbers on file (police, fire, and EMS), a broadcast fax was sent 

concurrent with the second survey mailing, encouraging them to watch for the replacement 

survey and to complete and return it. 

One week following this second survey mailing, second-round telephone follow-up began, with 

interviewers stepping up attempts to convert potential survey refusals. For the samples with 

higher response rates at this stage, the second round calling lasted from 4 to 12 days; for those 

with the lowest response rates, follow-up calls continued for longer periods to allow the 

interviewers to thoroughly work through the samples. In particular, this period of telephone 

follow-up was most intensive and lengthy for the EMS and hospital samples, as their response 

rates were substantially lower than for the other groups (as expected because of the sampling 

difficulties experienced in determining the proper respondent for these populations). Hospital 

and EMS respondents also proved to be the most difficult to reach by telephone, stemming from 

the nature of their occupations. 

While the final response rate for the majority of the groups was higher than 70 percent, response 

rates for EMS and hospital respondents remained low at the end of the second calling period, 

even after the extended effort undertaken to follow-up with these two groups. In a final effort to 

improve their response rates, one additional survey mailing was sent—this time, via Federal 

Express. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-4-1 

TAB 4 TO APPENDIX G (Survey Information)—SAMPLE DESIGN & RESPONDENT 

SELECTION 

SAMPLE DESIGN & RESPONDENT SELECTION 

The Federal Weapons of Mass Destruction Preparedness Programs Survey (FWMDPPS) was 

designed to allow inference to the nationwide community of state and local emergency response 

and health organizations. The sample consisted of three tiers of respondents—county, regional, 

and state—as shown in Table G.4.1 below, with sampling strategies tailored to each. Surveys 

were sent directly to the individual in each organization most familiar with the organization’s 

participation in Federal program and WMD preparedness activities, or, if no such individual 

could be identified, to the individual responsible for emergency response planning. The names 

and contact information for these individuals were requested from the head of each 

organization—for example, the chief of a fire or police department, or the ER or medical director 

of a hospital. In many cases, the organizational heads elected to complete the survey themselves. 

In all, surveys were sent to 1,687 organizations, including 150 at the state level and 1,526 at the 

local and regional levels.117 

Local (city/county) Regional 

Law enforcement EMS 

Fire departments 

 (paid, volunteer, combination) 

Hospitals State 

Emergency Medical Services (EMS) EMS 

Offices of Emergency Management 

(OEM) 

OEM 

Public health departments Public health departments 

Table G-4-1. Organizations Included in the Survey 

Sampling County-level Organizations 

The survey followed a multi level cluster design for local and regional response organizations, 

first sampling counties and then sampling local and regional organizations that serve the sampled 

counties. Two factors motivated the decision to sample by county. First, lack of comprehensive 

nationwide registries for some of the organizations listed in Table G-4-1, “Organizations 

Included in the Survey,” makes it cost-effective to first choose counties and then identify all 

response organizations within the subset of counties selected. Second, from a substantive 

perspective, counties provide the most consistent unit of geographic organization for emergency 

response services throughout the United States, particularly when both urban and rural areas are 

the object of study. Service areas and jurisdictions for response organizations tend to follow 

political boundaries, with counties playing a central role between local or city areas and the state. 

Of course, counties are not always the most relevant units of emergency response. Service 

catchment areas for hospitals and EMS organizations, for example, do not always respect county 

boundaries, as is true for the formal emergency response regions established by many states. 

 

117 Washington, D.C. was also sent all three state-level surveys, and state-level OEM and public health surveys were 

sent to the U.S. territories of Puerto Rico, Guam, Virgin Islands, and Northern Marianas Islands. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-4-2 

Nonetheless, clustering by county provided the most cost-effective and consistent geographic 

unit for obtaining a nationwide sample of local organizations. 

Ensuring the Inclusion of “Sensitized” Counties 

In addition to the randomly sampled of counties, 10 counties were hand picked for inclusion 

based on past WMD terrorist incidents or upcoming events that might have heightened their 

sensitivity to WMD terrorism (e.g., the Olympics).118 The most prominent of each type of 

response organization in each of these counties was then selected to receive a survey. This 

allowed comparisons between “average” U.S. counties and those most likely to have invested in 

preparedness efforts or sought federal support to do so. 

Selecting the County-Level Sample 

The county sample followed a two-stage design that used counties as the primary sampling unit 

and then type of response organization as the secondary sampling unit. In the first stage, 200 

counties out of the 3,105 counties in the contiguous United States, Alaska, and Hawaii were 

selected with a probability proportional to the size of their 1998 population, as estimated in the 

DHHS 2000 Area Resource File. The choice to give more populous counties a greater chance of 

selection was based on the following factors: urban areas have been the foremost recipients of 

federal preparedness support; they are perceived to be more likely targets for terrorism; and, as 

Table G-4-2 illustrates, without such a selection scheme it is that rural counties would have 

likely constituted nearly half of the sample simply because about half of U.S. counties are rural. 

However, rural organizations are not excluded altogether. Though the probability of selection is 

based on county population, the sampling scheme ensures that a sufficient number of rural 

counties are also included in the sample, so that rural views on federal assistance enter into the 

analysis. Weighting proportional to population provides the balance required to ensure an 

adequate selection of urban counties without sacrificing the ability to give rural counties a voice 

in the Panel’s deliberations. Figure G-4-1 (below) displays the geographic distribution across the 

continental United States of the counties selected into the sample. 

 

118 The selection of sensitized counties was made prior to the attacks on New York City and Washington D.C., on 

September 11th of this year. They are Cook County, Illinois; Dade County, Florida; Fulton County, Georgia; King 

County, Washington; Los Angeles County, California; Multnomah County, Oregon; New York County, New York; 

Oklahoma County, Oklahoma; Salt Lake County, Utah; and San Francisco County, California. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-4-3 

Figure G-4-1. Location of the 200 Randomly Sampled Counties*

Selecting Organizations Within Counties 

Within each county, one organization from each of the respondent groups listed in Table G-4-1 

(local law enforcement; paid, volunteer, and combination fire departments; hospitals; EMS 

organizations; OEMs; public health departments; and regional EMS organizations) was 

randomly selected to receive a survey. When no organizations within a county from a particular 

respondent group could be identified, it was determined which surrounding organizations served 

the county, and the sampling was done from these. 

 All U.S. Counties 

(N=3,105) 

 Sampled 

Counties 

(N=200) 

N % N % 

Northeast 217 7 31 16 

Midwest 1,055 34 60 30 

West 442 14 33 17 

South 1,391 45 76 38 

Rural 1,410 45 43 22 

COMPARISON BY POPULATION

 All U.S. Counties Sampled 

Counties 

 Mean Median Mean Median 

Population 87,053 24,080 398,037 65,745 

Table G-4-2. Comparison of Sampled Counties and All Counties in the United States 

*Note: Some counties are too small to see. Alaska and 

Hawaii are not shown. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-4-4 

Sampling Regional Organizations 

Often, emergency response or health organizations are located apart from the counties they 

serve. For example, a public health department may reside in one county but have a number of 

neighboring counties under its jurisdiction, especially in sparsely populated or rural areas. The 

term “regional” as used here refers to such organizations, whose jurisdiction or service area falls 

between the county and state level. In each county, the sample was drawn first from local 

organizations residing within the county; if no local organizations were found to serve the 

county, regional organizations serving the county, but residing elsewhere, were searched for and 

sampled. This “first local, then regional” rule guaranteed that the most local relevant provider of 

services to a county was properly identified and surveyed, even when that provider resides 

outside the county. 

Regional EMS organizations, in particular, are unique in that they often serve a county 

population already served by a local EMS provider. That is, a number of counties are served by 

both local EMS organizations based within the county and regional EMS organizations based 

outside the county. To ensure that the perspectives of both local and regional EMS organizations 

on federal programs and WMD awareness were captured in the survey, both local and regional 

EMS organizations were sampled for each county. 

Census of State-level Organizations 

In addition to local and regional responders, state-level EMS, OEM, and public health 

departments in each of the 50 states, Washington, D.C., and the U.S. territories of Puerto Rico, 

the Virgin Islands, Marianas Islands, and Guam were also surveyed. “State-level” signifies the 

single focal point, coordinating, or administrative body in each state for a particular response 

community (e.g., public health) that has the state as its jurisdictional mandate. These state-level 

entities are important for their statewide response and policymaking activity but also as 

intermediaries between Federal agencies and local response organizations. 

Sample Size Calculations 

Sample size calculations were used to determine the number of required respondents to achieve a 

desired accuracy in the final survey results. The calculations for the survey were based on a 

desired eight percent margin of error for each type of county-level responder organization and an 

assumed 70 to 80 percent survey response rate. Based on a dichotomous (i.e., yes/no) question, 

an initial sample of 200 of each type of responder organization will yield approximately 140 

responses, which will result in the desired margin of error under the additional conservative 

assumption that 50 percent of the population would answer yes to the question. 

Planning the sample size for such a relatively large margin of error reflected the intended use of 

the survey as a means of checking and evaluating the general conclusions of the Advisory Panel 

and as a way of ensuring that a wide cross section of the local response community had input 

into the Advisory Panel’s deliberative process. 

For the census of State-level organizations, calculation of the margin of error, under the 

assumption that not all organizations replied to the survey, is still relevant. With a dichotomous 

question and an assumed 70 to 80 percent response rate, and correcting for the finite size of the 

population (there are only 50 states), the resulting margin of error is very similar to that of the 

county-level organizations’—between 7 and 10 percent. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-5-1 

TAB 5 TO APPENDIX G (Survey Information)—RESPONSE RATES

RESPONSE RATES 

This appendix presents the number of surveys sent, the number of surveys returned, and the 

resulting response rate for all respondent groups, including local, regional and State respondents, 

and separately for respondents in “sensitized” counties119 (counties that likely have heightened 

sensitivity to terrorism based on past WMD terrorist incidents or upcoming events). 

Overall, the final sample of FWMDPPS respondents is representative of local and State 

responders both geographically (with surveys returned by every State and the District of 

Columbia) and across the different emergency response and health disciplines. The strong 

response from most groups, with the exception of hospitals and EMS organizations, met or 

exceeded the original goal of achieving a 70 percent response rate for each group, corresponding 

to a desired margin of error of plus and minus 8 percent (based on a conservative estimate of half 

of the respondent population answering yes to a given question).120 

Table G-5-1 shows the response rate for each group: first for local and regional respondents in all 

sample counties (excluding sensitized counties), then for local and regional respondents in 

sensitized counties, and finally, for all State-level respondents. State agencies, as a group, had a 

higher response rate than local and regional organizations, at 76 percent; State public health 

agencies responded at the highest rate (apart from the sensitized organizations) at 82 percent. 

The FWMDPPS also achieved higher rates of response from respondents in counties designated 

as “sensitized.” However, one should be cautious when drawing conclusions about differences 

between the non sensitized and sensitized figures in Table G-5-1 and elsewhere, as counties 

designated as “sensitized” all contain major urban centers. Thus, these differences may simply 

reflect urban-rural differences, rather than a heightened focus on terrorism within the county. 

The sample is also geographically diverse. Table G-5-2 shows response rates for respondents in 

the northeastern, southern, midwestern, and western United States, respectively.121 For example, 

52 percent of fire departments in the northeast in the sample responded (37 surveys were 

received from this group). The FWMDPPS achieved a response rate of 55 percent or greater in 

all regions among local and regional organizations, and 71 percent or greater among state-level 

agencies. 

 

119 The selection of sensitized counties was made prior to the attacks on New York City and the Capital on 

September 11th of this year. They are Cook County, Illinois; Dade County, Florida; Fulton County, Georgia; King 

County, Washington; Los Angeles County, California; Multnomah County, Oregon; New York County, New York; 

Oklahoma County, Oklahoma; Salt Lake County, Utah; and San Francisco County, California. 

120 The motivation for this desired margin of error is discussed in Appendix G-4. 121 The regions are Northeast (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, 

Pennsylvania, Rhode Island, and Vermont); South (Alabama, Arkansas, Delaware, District of Columbia, Florida, 

Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, 

Texas, Virginia, and West Virginia); Midwest (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, 

Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin); and West (Alaska, Arizona, California, Colorado, 

Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming). 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-5-2 

Type of Organization 

Surveys 

Sent 

Surveys 

Returned 

Response 

Rate (%) 

Local/Regional 

(“Non Sensitized” Counties) 

 

 Fire 423 283 67 

 Law Enforcement 194 135 70 

 EMS 113 54 48 

 EMS, regional 103 49 48 

 Hospital 194 95 49 

 Public Health 187 138 74 

 OEM 192 137 71 

Local/Regional “Non Sensitized” Total 1406 891 63 

Local/Regional 

(“Sensitized” Counties) 

 

 Fire 20 17 85 

 Law Enforcement 14 12 86 

 EMS 6 5 83 

 EMS, regional 8 3 38 

 Hospital 14 10 71 

 Public Health 12 9 75 

 OEM 10 5 50 

Local/Regional “Sensitized” Total 84 61 73 

State 

 EMS 51 35 69 

 OEM 51 40 78 

 Public Health 51 42 82 

State Total 153 117 76 

All Respondents 1643 1069 65 

Table G-5-1. Response Rates by Type of Organization 

Although respondents in the west and midwest responded at the highest rates, the largest number 

of surveys was sent to and received from respondents in the south, simply because sampling was 

conducted by county and relatively more U.S. counties are in southern states (primarily in 

Texas). Despite these regional differences in response, none of the four regions comprises less 

than 15 percent of the final sample. As previously mentioned, surveys were received from every 

state and the District of Columbia, and state-wide response rates were never less than 33 percent. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-5-3 

Type of Organization Region 

Northeast South Midwest West 

N† RR N RR N RR N RR 

Local/Regional 

 Fire 37 52 107 66 90 68 66 84 

 Law Enforcement 15 48 57 72 42 69 33 89 

 EMS 10 45 14 45 20 49 15 60 

 EMS, regional 16 62 20 50 8 32 8 40 

 Hospital 13 42 38 48 32 52 22 59 

 Public Health 17 61 53 68 48 81 29 85 

 OEM 23 79 49 63 46 77 24 69 

Local/Regional Total: 131 55 338 62 286 65 197 74 

State 

 EMS 6 67 11 65 9 75 9 69 

 OEM 8 89 13 76 11 92 8 62 

 Public Health 8 89 12 71 11 92 11 85 

State Total: 22 81 36 71 31 86 28 72 

All Respondents: 153 58 374 63 317 67 225 74 

Table G-5-2. Response Rates by Region 

† The first column, N, shows the number of surveys received in the region. The second column, RR, shows the response rate in the

region. For example, 37 (52%) of fire departments in the northeast responded to the survey. The number of surveys sent, not 

shown in the table, is N/RR. 

Table G-5-2 also shows that the trends from Table G-5-1 are generally consistent across regions: 

public health departments had strong rates of response in all regions at both the local and State 

level (from 61 to 92 percent), while local and regional EMS organizations, and hospitals were 

much less likely to respond (from 32 to 62 percent) in all regions but the northeast. Rates for the 

remaining local groups were generally closer to the 70 percent range, with low points occurring 

in the northeast, and State agencies as a group responding more strongly than locals in all regions 

(best in the northeast and midwest). 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-6-1 

TAB 6 TO APPENDIX G (Survey Information)—CONSTRUCTING THE SURVEY 

WEIGHTS

CONSTRUCTING THE SURVEY WEIGHTS 

Survey weights account for differential probability of being sampled among strata and for 

nonresponse. These statistical adjustments allow the analysis to properly infer back to the 

correct local response population. 

The overall survey weight applied to any respondent can be expressed as 

igj

igj P

W

1  , where 

Pigj is the probability that respondent i in group g (e.g., hospitals) in county j was selected and 

completed the survey. Because organizations were selected from within counties, this overall 

probability is really threefold: it depends on (1) the probability county j was selected in the first 

stage; (2) the probability organization i was selected from among the eligibles in group g in the 

second stage, given county j was selected in the first stage; and (3) the probability organization i 

completed and returned the survey, given organization i was selected. If one calls these 

probabilities πj , πigj , and R πigj , respectively, then the overall probability of response, which is 

all that is needed to calculate a particular respondent’s survey weight, is just their product: 

R Pigj  πj * πigj * πigj (1) 

The first terms above, πj , πigj , are referred to as the “probabilities of selection” and their 

derivation depends only on the sampling methodology employed for each group of respondents. 

The final term, R πigj , has a different meaning: it is an adjustment to account for the fact that 

some organizations who were asked to complete the survey were more likely than others to 

actually complete and return it. The last term in equation (1), R πigj , is referred to as the 

“probability of response”; it accounts for observed patterns of response that can only be 

determined after all surveys have been returned and processed. For example, hospitals in rural 

counties were less likely to complete and return the survey than their urban counterparts. In this 

case, the adjustment is necessary to ensure that rural hospitals’ views are not underemphasized—

simply because of differences in response rates—when results from both urban and rural 

hospitals are aggregated. 

The next sections derive the right-hand side probabilities in equation (1) separately for each 

respondent group. The separate derivations are necessary because differences in organizational 

structure between groups and in the data available to construct sampling frames necessitated 

different sampling rules. The impact of these differences on each term in equation (1) is 

summarized in Table G.6.1., below. 

Weights were not constructed for EMS respondents, since the sample of EMS organizations is a 

convenience sample. Hence, care must be taken when generalizing the local and regional EMS 

samples to any larger EMS population. Weights also have not been constructed for State-level 

respondents, since the State surveys are censuses, rather than randomly selected samples, and 

because State respondents exhibited no observable patterns of nonresponse. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-6-2 

Probability of Selection for Counties 

The sample of n = 200 counties was drawn without replacement from the N = 3,105 counties in 

the contiguous United States, Alaska, and Hawaii, with probabilities of selection proportional to 

the square root of each county’s population.122 Label county j’s population j, then the 

probability of selection for the jth county was 

∑

N

k

k

j

j

ρ

n ρ

π

1

 (2) 

Probability of Selection for Organizations 

Apart from the exceptions described in the next section and in Tab 5 to Appendix G, only one 

representative from each group was selected per county. Therefore, the probability of selection 

for any organization i in group g and county j, given county j was selected in the first stage, was 

just 

gj

igj N

π

1 = (3) 

where Ngj is the number of organizations from group g eligible for sampling within county j. 

Note that later sections will describe adjustments to the j required for public health, OEM, and 

hospital respondents. Also, fire departments were selected using a more complicated method to 

ensure sufficient HAZMAT organizations were selected—see below. 

Sampling Fire Departments 

One of two schemes were followed in each county for selecting fire departments into the sample, 

depending on the distribution of departments with HAZMAT capability across the departments’ 

organizational strata: all volunteer, all paid, and combination. From here on, department stratum 

refers to this classification. Which scheme was used will affect how the weights are computed in 

the county. 

Let Nc be the total number of fire departments in county c. For each department i ∈ 1..Nc in 

county c, define: 

vic = 1 if department is volunteer, else 0 

pic = 1 if department is paid, else 0 

cic = 1 if department is combination, else 0 

hic = 1 if department has HAZMAT capability, else 0. 

Then the number of HAZMAT departments in each stratum, volunteer, paid, and combination, 

respectively, in county c is: 

 

122 Population estimates were taken from the February, 2000 release of the DHHS’s Area Resource File. Sampling 

was carried out using SAS’s SURVEYSELECT procedure. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-6-3 

 ∑

Nc

i

HVc vichic

= 1

= 

 ∑

Nc

i

HPc pichic

=1

= 

 ∑

Nc

i

HCc cichic

=1

= 

Now, the number of strata of departments in county c with HAZMAT capability is: 

HTc = min(1, HVc) + min(1, HPc) + min(1, HCc) 

The sampling scheme, Sc ∈{1,2}, was chosen for county c according to: 

 { 2

< 2

2

1 = c ≥

c

HT

HT

if

if

Sc

A few more definitions before writing down the expressions for weighting under each scheme in 

each county c: 

∑Nc

i Vc vic =1 = # of volunteer departments 

∑Nc

i Pc pic =1 = # of paid departments 

∑Nc

i Cc cic =1 = # of combination departments 

Hc = HVc + HPc + HCc # of HAZMAT departments 

Sampling Scheme One 

This scheme was used if out of the three department strata in a county, at most one had any fire 

departments with HAZMAT capability. In this case, volunteer, paid, and combination 

departments were considered separately and randomly selected one respondent from each group, 

so that the probability of selection, πifc ,

123 for a department just depends on its stratum. 

So, for a county with Sc = 1, 

= 1

= 1

= 1

=

1

1

1

ic

ic

ic

C

P

V

ifc

c

p

v

if

if

if

π

c

c

c

or just 

ic c ic c c ic

ifc

p P v V C c

π

+ +

1 =

 

123 πifc , for a fire department i in a county c. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-6-4 

Sampling Scheme Two 

Here there were two stages. First, one department was selected randomly from all HAZMAT 

departments, irrespective of its stratum. It was then noted the stratum of the department selected 

and ruled this stratum out from further sampling in the county. This left one or two strata of 

departments, depending on the county. In the second stage, one department was randomly 

selected from each of the remaining strata. 

For HAZMAT departments, then, πifc is determined by the chance of getting selected in the 

first round, Hc

1 , plus the likelihood of getting selected in a subsequent round given i’s stratum 

was not the same as the department chosen in the first round. For example, for a volunteer 

department i, the chance i’s stratum was not chosen in the first round is c

c

H

HV 1 . That is one 

minus the chance a HAZMAT of i’s stratum, volunteer, was selected from among all 

HAZMATs. 

So, if Sc = 2 and hic = 1: 

= 1

= 1

= 1

(1 )

(1 )

(1 )

+

+

+

=

1

1

1

1

1

1

ic

ic

ic

H C HC

H P HP

H V HV

H

H

H

ifc

c

p

v

if

if

if

π

c c

c

c c

c

c c

c

c

c

c

-

-

-

 

The last case is if hic = 0, a non-HAZMAT department in a county using the second sampling 

scheme. Here, there is no chance of selection in the first round, but the chance of selection in a 

subsequent round is the same. 

So, if Sc = 2 and hic = 0: 

= 1

= 1

= 1

(1 )

(1 )

(1 )

=

1

1

1

ic

ic

ic

H C HC

H P HP

H V HV

ifc

c

p

v

if

if

if

π

c c

c

c c

c

c c

c

-

-

-

Adjustment for OEMs and Public Health Respondents 

A number of public health departments and OEMs have jurisdiction over neighboring counties 

that have no such organizations within their borders. For these “regional” organizations, the 

county probability of selection given in equation (2) must be augmented to account for the fact 

that if any county under their jurisdiction had been selected in the first stage sample of counties, 

the regional organization in question would have been selected into the sample in the second 

stage. Let πR ’ be the adjusted probability of selection for a public health department or OEM in 

county R (for “regional”) that has NR>1 counties under its jurisdiction. Then, 

′ ∑

NR

c

πR πR πc

1

 (4) 

where the right-hand side π ’s are just the πj ’s from equation (2). 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-6-5 

Adjustment for Hospitals 

Hospitals with trauma centers were over sampled to ensure selection of an adequate number of 

hospitals involved in emergency response. In each county, a sampling procedure was 

constructed to ensure a 70 per cent or greater chance of selecting a hospital with a trauma 

center.124 Essentially, the list of trauma center hospitals was replicated an integer Z number of 

times until trauma center hospitals comprised at least 70 percent of all hospitals. Let Tj and NTj

be the number of hospitals with and without trauma centers, respectively, in county j. Then Z is

ceil(0.7NTj/0.3Tj), where the ceil operator rounds its argument to the next highest integer. This 

procedure results in a probability of selection for each trauma center hospital t in county j of 

j j j

j

t hj Z T NT

Z

π * + , = (5) 

and for each hospital nt, that does not have a trauma center, of 

j j j

nt hj Z T NT

π * +

1 , = (6) 

where h in the subscripts indicates the hospital respondent group. The equations above replace 

equation (3) for hospitals in the calculation of survey weights. 

One final adjustment to the hospital weights is necessary to account for the “nearest neighbor” 

selection rule employed when no hospital could be identified within a county. The adjustment, 

described below, results in an expression similar to the regional adjustment for public health 

departments and OEMs in equation (4) in the sense that it does not affect the adjustments given 

in (5) and (6) above, but instead replaces the hospitals’ county probabilities of selection given in 

equation (2). 

When no hospital could be identified within a county c, a hospital from the county nearest to c

was selected at random. Consequently, hospitals in the sample could have been selected either 

because they were located within a sample county, or because they were in a county, call it R, 

that did have a hospital within its borders and happened to be the county closest to c. Thus, an 

adjustment to each hospital’s probability of selection is required. In this case, it is more 

straightforward to make the adjustment to each hospital’s county probability of selection, πj , 

than to the organizational probability of selection,πihj . Let NR be the number of counties 

surrounding c that contain no hospital and for which R is the nearest county that does contain a 

hospital. If R and NR are interpreted in this manner, equation (4) gives the correctly adjusted πj

for hospitals. 

 

124 In counties where no trauma center hospital was present, the usual selection mechanism was employed: one 

hospital was selected at random from all of the eligible hospitals (eligibility was discussed in Section 3). 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-6-6 

Summary 

Table G-6-1 below summarizes the above discussion. For each respondent group, it lists the 

number of the equation used to form the county probability of selection and the organizational 

probability of selection, respectively. These give the correct inputs to equation (1), adjusted as 

necessary for the different sampling rules required for each group. The derivation of survey 

weights for fire departments is more involved and is described in further detail later in this 

appendix. 

Respondent group g πj πigj Reason for weighting adjustment 

Law enforcement (2) (3) No adjustment necessary

Fire (2) See narrative Stratification by HAZMAT; paid, volunteer, 

combination departments 

EMS (2) πigj =1 Convenience sample 

Public health (4) (3) Regional, multi-county jurisdictions 

OEM (4) (3) Regional, multi-county jurisdictions 

Hospitals (4) (5)/(6) Over-sampling of trauma centers; nearest neighbor 

rule 

Table G-6-1. Equation References for Adjusted Probabilities of Selection due to Special Weighting 

Considerations 

Probability of Nonresponse 

Nonresponse was accounted for using the propensity score method of Little and Rubin125 to 

determine the probability, R πigj from equation (1), that organization i in group g in county j

responded given that organization i was sampled. This probability was calculated by fitting a 

separate logistic regression model for each respondent group of the form 

1 + exp( + + )

exp( + + ) = g i j

R g i j

igj β

β

π

X Y

X Y

 (7) 

where g is the intercept coefficient for the respondent group (e.g., hospitals), and Xg, and Yj are 

vectors of organization-specific and county-specific characteristics, respectively. 

At both the county and organization level, covariates were candidates for inclusion in the model 

if (1) they were strongly predictive of observed patterns of nonresponse or, (2) if they were 

weakly predictive (p-values up to 25% were acceptable), but had a reasonable theoretical 

justification for influencing a respondent’s interest in WMD or willingness to respond (e.g., 

urban degree of the respondent’s county). 

 

125 Little, R.J.A. and Rubin, D.B. (1987) Statistical Analysis with Missing Data. John Wiley and Sons. New York, 

New York. 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-1 

TAB 7 TO APPENDIX G (Survey Information)—SECTION 5 TABULATIONS 

SURVEY SECTION 5, “ASSESSMENT OF FEDERAL PROGRAMS,” TABULATIONS 

These tables have been statistically adjusted to account for oversampling and nonresponse. As 

such, they provide the best estimate of how a question would have been answered if every 

organization in the population had been surveyed. Some notes to keep in mind when reading the 

tables: 

These tables are designed to be read with the survey instrument available for reference. 

That is, the reader must refer to the actual survey for information about response scales, the 

exact question and response set wording, etc. Please see Tab 2 to Appendix G for a copy 

of the Fire Department Survey. 

Questions may have varied slightly between responder groups. To minimize space, 

questions that were similar in intent, but may have differed in particular wording, were 

combined in a single table. Again, please refer to the survey instrument for actual question 

wording. 

Similarly, some tables contain abbreviations for the various survey responses. Referral to 

the possible responses to each question in the survey will make the meaning of the 

abbreviations clear. 

Answering some questions was appropriate only if the respondent appropriately answered 

a previous question. This is indicated in the wording of each table’s title, e.g., “Of those 

who...” etc. 

A dot (i.e., “.”) in a table cell indicates that response was not offered for that particular 

group. 

Larger tables may be continued on another page. This is indicated by “(continued)” in the 

bottom left corner of the table. 

The cells of the tables contain the percentage of organizations that chose each response by 

type of organization. Abbreviations for the type of organization are listed in Table G-7-1. 

Type of Organization Abbreviation 

Number of Surveys 

Returned 

Fire Department Fire 300 

Law Enforcement Law 147 

Office of Emergency 

Management (OEM) OEM 142 

Public Health PubHlth 147 

Hospital Hosp 105 

Emergency Medical Services 

(EMS) EMS 68 

State EMS St EMS 35 

State OEM St OEM 40 

State Public Health St PH 42 

Table G-7-1. Number of Responding Organizations 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-2 

 SINCE 1996 HAS YOUR ORGANIZATION APPLIED FOR FUNDING, TRAINING, EQUIPMENT, OR OTHER WMD PREPAREDNESS 

 SUPPORT AVAILABLE FROM THE FEDERAL GOVERNMENT, REGARDLESS OF WHETHER OR NOT YOU RECEIVED IT? 

 GROUP % YES % NO 

 Fire 15.5 84.5 

 Hosp 13.7 86.3 

 Law 5.6 94.4 

 OEM 39.7 60.3 

 PubHlth 13.3 86.7 

 EMS 11.9 88.1 

 St EMS 54.3 45.7 

 St OEM 97.5 2.5 

 St PH 100.0 0.0 

 AVG SCORE FOR THOSE RESPONDENTS WHO APPLIED FOR FEDERAL GOVT SUPPORT (SEE PREVIOUS QUESTION): 

 HOW SATISFIED WAS YOUR ORGANIZATION WITH THE SPEED AND EFFECIENCY OF THE APPLICATION 

 PROCESS FOR FEDERAL WMD PREPAREDNESS PROGRAMS? 

 

 AVG 

 GROUP SCORE 

 Fire 2.0 

 Law 2.7 

 OEM 3.1 

 PubHlth 3.5 

 EMS 3.3 

 St EMS 3.2 

 St OEM 2.9 

 St PH 3.5 

 NOTE: HOSPITALS NOT ASKED THIS QUESTION 

 SINCE 1996, HAS YOUR ORGANIZATION RECEIVED ANY SUPPORT FOR FUNDING, TRAINING, 

 EQUIPMENT, OR OTHER WMD PREPAREDNESS FROM THE FEDERAL GOVERNMENT? 

 

 GROUP % YES % NO 

 Fire 17.9 82.1 

 Hosp 12.4 87.6 

 Law 7.2 92.8 

 PubHlth 26.5 73.5 

 EMS 11.8 88.2 

 St PH 100.0 0.0 

 NOTE: LOCAL/STATE OEM AND STATE EMS NOT ASKED THIS FORM OF THE QUESTION 

 SINCE 1996, HAS YOUR ORGANIZATION RECEIVED ANY SUPPORT FOR WMD PREPAREDNESS 

 FROM THE FEDERAL GOVERNMENT INTENDED FOR: 

 

 --------------------------------------------- 

 | | TYPE OF | 

 | | ORGANIZATION | 

 | |-----------------| 

 | | | St | St | 

 | | OEM | EMS | OEM | 

 | |-----+-----+-----| 

 | | % | % | % | 

 |-------------------------+-----+-----+-----| 

 |YOUR ORGANIZATION'S | | | | 

 |PERSONNEL OR STAFF? | 47% | 57% | 98% | 

 |-------------------------+-----+-----+-----| 

 |OTHER ORGANIZATIONS IN | | | | 

 |YOUR JURISDICTION? | 30% | 49% | 93% | 

 |-------------------------+-----+-----+-----| 

 |NONE OF THE ABOVE | 45% | 37% | 0% | 

 --------------------------------------------- 

 NOTE: ONLY LOCAL/STATE OEM AND STATE EMS ASKED THIS FORM OF THE QUESTION 

 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-3 

FOR THOSE THAT RECEIVED FEDERAL SUPPORT (SEE PREVIOUS QUESTION): 

 PLEASE INDICATE THE TYPES OF FEDERAL SUPPORT YOUR ORGANIZATION HAS RECEIVED 

 

 ------------------------------------------------------------------------------------------ 

 | | TYPE OF ORGANIZATION | 

 | |--------------------------------------------------------------| 

 | | | | | |PubHl-| | | | | 

 | | Fire | Hosp | Law | OEM | th | EMS |St EMS|St OEM|St PH | 

 | |------+------+------+------+------+------+------+------+------| 

 | | % | % | % | % | % | % | % | % | % | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |FUNDING | 3% | 3% | 19% | 48% | 27% | 13% | 77% | 98% | 100% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |EQUIPMENT | 7% | 9% | 22% | 18% | 38% | 25% | 36% | 33% | 78% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |ORGANIZATION-WIDE | | | | | | | | | | 

 |TRAINING/EXERCISES | 27% | 60% | 48% | 42% | 30% | 38% | 45% | 60% | 34% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |INDIV STUDY | | | | | | | | | | 

 |MATERIALS/VIDEOS | 25% | 58% | 32% | 50% | 26% | 50% | 50% | 78% | 46% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |HANDBOOKS OR REFERENCE | | | | | | | | | | 

 |MATERIALS | 50% | 64% | 50% | 49% | 27% | 50% | 68% | 80% | 66% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |SUPPORT TO | | | | | | | | | | 

 |ATTEND/ORGANIZE | | | | | | | | | | 

 |CONFERENCES/LECTURES | .| 68% | .| 57% | 38% | .| 77% | 65% | 85% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |ANNOUNCEMENTS/BULLETINS | | | | | | | | | | 

 |CITING ADVANCES... | .| .| .| .| 35% | .| .| .| 51% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |OTHER | 41% | 36% | 31% | 7% | 9% | 38% | 9% | 8% | 7% | 

 ------------------------------------------------------------------------------------------ 

 NOTE: DIFFERENT RESPONSE SET FOR EACH GROUP 

 FOR THOSE THAT RECEIVED FEDERAL SUPPORT: 

 HOW WERE THE FEDERAL WMD RESOURCES YOU RECEIVED USED? 

 

 % % ONLY_ 

 GROUP SHARED OUR_ORG 

 Fire 58.8 41.2 

 Law 50.8 49.2 

 OEM 79.7 20.3 

 PubHlth 56.3 43.7 

 EMS 66.7 33.3 

 St EMS 65.0 35.0 

 St OEM 100.0 0.0 

 St PH 75.0 25.0 

 NOTE: HOSPITALS NOT ASKED THIS QUESTION 

 FOR THOSE THAT RECEIVED FEDERAL SUPPORT: 

 HAS YOUR ORGANIZATION'S PARTICIPATION IN FEDERAL WMD PROGRAMS HINDERED YOUR ABILITY 

 TO OBTAIN ADDITIONAL STATE SUPPORT FOR WMD OR ANY OTHER TYPE OF EMERGENCY PREPAREDNESS? 

 

 GROUP % YES % NO % DK 

 Fire 0.3 30.4 69.2 

 Law 2.2 40.6 57.2 

 OEM 1.7 49.7 48.6 

 PubHlth 2.7 60.4 36.9 

 EMS 8.3 41.7 50.0 

 St EMS 0.0 72.7 27.3 

 St OEM 0.0 70.0 30.0 

 St PH 7.1 59.5 33.3 

 NOTE: HOSPITALS NOT ASKED THIS QUESTION 

 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-4 

SINCE 1996, HAS YOUR ORGANIZATION APPLIED TO ANY OF THE NON-FEDERAL SOURCES BELOW FOR FUNDING, TRAINING, 

 EQUIPMENT, OR OTHER SUPPORT TO IMPROVE YOUR ORGANIZATION'S (JURISDICTION'S) PREPAREDNESS FOR WMD INCIDENTS? 

 

 ------------------------------------------------------------------------------------------ 

 | | TYPE OF ORGANIZATION | 

 | |--------------------------------------------------------------| 

 | | | | | |PubHl-| | | | | 

 | | Fire | Hosp | Law | OEM | th | EMS |St EMS|St OEM|St PH | 

 | |------+------+------+------+------+------+------+------+------| 

 | | % | % | % | % | % | % | % | % | % | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |STATE GOVT AGENCIES | 7% | 10% | 8% | 30% | 21% | 16% | 31% | 20% | .| 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |LOCAL GOVT AGENCIES | 4% | 5% | 4% | 6% | 2% | 7% | .| .| .| 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |PRIVATE SECTOR | | | | | | | | | | 

 |ORGANIZATIONS | 1% | 0% | 2% | 1% | 0% | 3% | 3% | 5% | 2% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |FOUNDATIONS | .| 1% | .| .| 0% | .| .| .| 0% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |OTHER | .| 2% | .| .| 1% | .| .| .| 5% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |WE HAVE NOT APPLIED TO | | | | | | | | | | 

 |ANY OF THE ABOVE... | 79% | 76% | 87% | 66% | 74% | 75% | 69% | 75% | 90% | 

 ------------------------------------------------------------------------------------------ 

 NOTE: DIFFERENT RESPONSE SET FOR EACH GROUP 

 SINCE 1996, HAS YOUR OFFICE REQUESTED WMD PREPAREDNESS ASSISTANCE 

 OR SUPPORT FROM ANY OF THE FOLLOWING FEDERAL PROGRAMS OR OFFICES? 

 

 ------------------------------------------------------------------------------------------ 

 | | TYPE OF ORGANIZATION | 

 | |--------------------------------------------------------------| 

 | | | | | |PubHl-| | | | | 

 | | Fire | Hosp | Law | OEM | th | EMS |St EMS|St OEM|St PH | 

 | |------+------+------+------+------+------+------+------+------| 

 | | % | % | % | % | % | % | % | % | % | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |FBI NATIONAL DOMESTIC | | | | | | | | | | 

 |PREPAREDNESS OFFICE | 1% | 1% | 1% | 9% | 0% | 1% | 11% | 45% | 17% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |DOJ OFFICE FOR STATE & | | | | | | | | | | 

 |LOCAL DOMESTIC | | | | | | | | | | 

 |PREPAREDNESS SUPPORT | 4% | 1% | 1% | 19% | 4% | 4% | 23% | 95% | 40% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |FEMA EMERGENCY MANAGEMENT| | | | | | | | | | 

 |INSTITUTE OR FIRE ACADEMY| 15% | 2% | 3% | 30% | 3% | 6% | 14% | 83% | 19% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |CDC BIOTERRORISM | | | | | | | | | | 

 |PREPAREDNESS & RESPONSE | | | | | | | | | | 

 |PROGRAM | 0% | 3% | 0% | 3% | 7% | 0% | 37% | 38% | 98% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |DOMESTIC PREPAREDNESS | | | | | | | | | | 

 |PROGRAM ('120 CITIES' | | | | | | | | | | 

 |PROGRAM) | 1% | 4% | 1% | 9% | 1% | 4% | 26% | 55% | 19% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |OTHER | 1% | 2% | 3% | 2% | 2% | 1% | 3% | 15% | 10% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |WE HAVE NOT REQUESTED WMD| | | | | | | | | | 

 |PREPAREDNESS SUPPORT... | 72% | 71% | 92% | 59% | 83% | 85% | 46% | 3% | 2% | 

 ------------------------------------------------------------------------------------------ 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-5 

 HAS YOUR ORGANIZATION RECEIVED ANY TRAINING OR EQUIPMENT FROM THE 

 DOMESTIC PREPAREDNESS PROGRAM ('120 CITIES PROGRAM')? 

 

 GROUP % YES % NO 

 Fire 4.9 95.1 

 Hosp 12.2 87.8 

 Law 3.4 96.6 

 OEM 12.5 87.5 

 PubHlth 14.7 85.3 

 EMS 11.9 88.1 

 St EMS 36.4 63.6 

 St OEM 50.0 50.0 

 St PH 38.1 61.9 

 HAS YOUR JURISDICTION RECEIVED ANY TRAINING OR EQUIPMENT FROM THE 

 DOMESTIC PREPAREDNESS PROGRAM ('120 CITIES PROGRAM')? 

 GROUP % YES % NO % DK 

 OEM 9.7 73.6 16.7 

 STATE EMS: HAVE OTHER EMS ORGS IN YOUR STATE RECEIVED ANY TRAINING OR EQUIPMENT FROM THE 

 DOMESTIC PREPAREDNESS PROGRAM ('120 CITIES PROGRAM')? 

 GROUP % YES % NO % DK 

 St EMS 59.1 27.3 13.6 

 STATE OEM: HAS YOUR STATE RECEIVED ANY TRAINING OR EQUIPMENT FROM THE 

 DOMESTIC PREPAREDNESS PROGRAM ('120 CITIES PROGRAM')? 

 GROUP % YES % NO % DK 

 St OEM 77.5 20.0 2.5 

 AVERAGE SCORE FOR THOSE THAT RECEIVED TRAINING FROM THE DOMESTIC PREPAREDNESS PROGRAM: 

 HOW MUCH DO YOU DISAGREE OR AGREE WITH THE FOLLOWING STATEMENTS ABOUT THE 

 TRAINING YOUR ORGANIZATION/JURISDICTION/STATE RECEIVED FROM THE DOMESTIC PREPAREDNESS PROGRAM? 

 GROUP Trn_Impr Trn_Adeq Trn_Relv Trn_Hrs Trn_Loc Trn_Use Trn_Appr Trn_St Trn_Know 

 Fire 3.6 1.8 3.9 4.2 3.0 4.3 . . . 

 Law 3.4 2.3 3.9 3.9 3.8 4.7 . . . 

 OEM 3.8 2.3 3.8 . 3.6 3.8 4.0 . 3.2 

 PubHlth 3.5 2.2 3.6 3.6 3.4 3.7 . . . 

 EMS 3.0 2.3 3.9 3.6 3.1 3.1 . . . 

 St EMS 3.6 2.3 3.9 . . 3.9 3.2 3.3 3.6 

 St OEM 3.0 2.3 3.4 . . 3.3 2.8 2.8 4.1 

 St PH 3.1 2.4 3.6 3.5 . 3.7 . 3.7 . 

 NOTES: HOSPITALS NOT ASKED THIS QUESTION; DIFFERENT RESPONSE SET FOR EACH GROUP 

 AVERAGE SCORE FOR THOSE THAT RECEIVED EQUIPMENT FROM THE DOMESTIC PREPAREDNESS PROGRAM: 

 HOW MUCH DO YOU DISAGREE OR AGREE WITH THE FOLLOWING STATEMENTS ABOUT THE 

 EQUIPMENT YOUR ORGANIZATION/JURISDICTION/STATE RECEIVED FROM THE DOMESTIC PREPAREDNESS PROGRAM? 

 GROUP Eqp_Impr Eqp_Relv Eqp_Adeq Eqp_Cost Eqp_Use Eqp_Appr Eqp_Know 

 Fire 3.1 3.3 2.7 2.9 3.2 . . 

 Law 5.0 4.0 2.0 4.0 4.0 . . 

 OEM 4.0 4.0 3.0 . 4.0 4.0 3.2 

 PubHlth 4.3 4.3 4.0 4.3 4.3 . . 

 EMS 2.0 2.0 1.0 1.0 1.0 . . 

 St EMS 3.0 3.3 2.3 . 3.7 3.4 3.5 

 St OEM 3.1 3.3 2.2 . 3.4 2.6 4.1 

 NOTES: HOSPITALS NOT ASKED THIS QUESTION; DIFFERENT RESPONSE SET FOR EACH GROUP 

 AVERAGE SCORE FOR THOSE THAT RECEIVED TRAINING OR EQUIPMENT FROM THE DOMESTIC PREPAREDNESS PROGRAM: 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-6 

 HOW MUCH DO YOU DISAGREE OR AGREE WITH THE FOLLOWING STATEMENTS ABOUT THE 

 TRAINING/EQUIPMENT YOUR ORGANIZATION/JURISDICTION/STATE RECEIVED FROM THE DOMESTIC PREPAREDNESS PROGRAM? 

 TE_Impr TE_Adeq TE_Relv TE_Hrs TE_Loc TE_Use 

 3.5 2.6 4.0 3.8 3.5 4.0 

 NOTE: ONLY HOSPITALS ASKED THIS VERSION OF THE QUESTION 

 SINCE 1996, HAS YOUR ORGANIZATION PARTICIPATED IN ANY OTHER FEDERALLY-SPONSORED PROGRAMS 

 FOR FUNDING, EQUIPMENT, TRAINING, OR OTHER WMD PREPAREDNESS SUPPORT? 

 ------------------------------------------------------------------------------------------ 

 | | | | | |PubHl-| | | | | 

 | | Fire | Hosp | Law | OEM | th | EMS |St EMS|St OEM|St PH | 

 | |------+------+------+------+------+------+------+------+------| 

 | | % | % | % | % | % | % | % | % | % | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |OJP FIRST RESPONDER EQUIP| | | | | | | | | | 

 |ACQUISITION PROG | 2% | .| 1% | 9% | .| 0% | 17% | 43% | .| 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |OJP MUNICIPAL FIRE & EMS | | | | | | | | | | 

 |EQUIP & TRNG PROG | 0% | .| 0% | 0% | .| 0% | 6% | 10% | .| 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |NDPO EQUIP RESEARCH & | | | | | | | | | | 

 |DEVELOPMENT PROG | 0% | .| 0% | 0% | .| 1% | 0% | 8% | .| 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |OJP ANTI-TERRORISM STATE | | | | | | | | | | 

 |& LOCAL TRNG GRANTS | 1% | .| 0% | 3% | 4% | 3% | 20% | 33% | 19% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |OSLDPS TRAINING (DOJ- | | | | | | | | | | 

 |SPONSORED) | 8% | .| 1% | 9% | .| 0% | 34% | 70% | .| 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |FEMA EMERGENCY MANAGEMENT| | | | | | | | | | 

 |ISTITUTE COURSE (WMD | | | | | | | | | | 

 |RELATED) | 5% | 8% | 8% | 19% | 6% | 4% | 26% | 68% | 31% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |NATIONAL FIRE ACADEMY | | | | | | | | | | 

 |EMERGENCY RESPONSE TO | | | | | | | | | | 

 |TERRORISM COURSE | 21% | .| 1% | 19% | .| 9% | 31% | 63% | .| 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |U.S. ARY CHEMICAL SCHOOL | | | | | | | | | | 

 |(USACLMS) TRAINING PROG | 0% | .| 1% | 2% | 0% | 0% | 3% | 10% | 5% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |DOE TRAINING FOR | | | | | | | | | | 

 |RADIOLOGICAL EMERGENCIES | 1% | .| 0% | 8% | .| 0% | 6% | 48% | .| 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |NEW MEXICO TECH'S | | | | | | | | | | 

 |INCIDENT RESPONSE TO | | | | | | | | | | 

 |TERRORIST BOMBING COURSE | 0% | .| 1% | .| .| .| .| .| .| 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |EPA EMERGENCY RESP TRNG | | | | | | | | | | 

 |PROG (ERTP) | 1% | .| 0% | 5% | .| 0% | 3% | 13% | .| 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |FBI HAZARDOUS DEVICES | | | | | | | | | | 

 |SCHOOL | .| .| 2% | 3% | .| .| .| 5% | .| 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |OAK RIDGE INSTITUTE... | .| .| .| 1% | 0% | 1% | 6% | 15% | 5% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |U.S. ARMY MEDICAL | | | | | | | | | | 

 |RESEARCH INSTITUTE OF | | | | | | | | | | 

 |INFECTIOUS DISEASES | .| .| .| 2% | 8% | 0% | 17% | 10% | 55% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |U.S. ARMY MEDICAL | | | | | | | | | | 

 |RESEARCH INSTITUTE OF | | | | | | | | | | 

 |CHEMICAL DEFENSE | .| .| .| 1% | 5% | 0% | 17% | 5% | 29% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |MEDICAL MANAGEMENT OF | | | | | | | | | | 

 |BIOLOGICAL CASUALTIES | | | | | | | | | | 

 |COURSE... | .| 8% | .| 1% | 13% | 3% | 34% | 5% | 74% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |OTHER CDC BIOTERRORISM | | | | | | | | | | 

 |COURSES | .| 8% | .| .| 12% | .| .| .| 86% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |U.S. PUBLIC HEALTH | | | | | | | | | | 

 |SERVICE NOBLE TRNG CENTER| .| .| .| 2% | 1% | 0% | 6% | 13% | 14% | 

 ------------------------------------------------------------------------------------------ 

 (Continued) 

 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-7 

 SINCE 1996, HAS YOUR ORGANIZATION PARTICIPATED IN ANY OTHER FEDERALLY-SPONSORED PROGRAMS 

 FOR FUNDING, EQUIPMENT, TRAINING, OR OTHER WMD PREPAREDNESS SUPPORT? 

 ------------------------------------------------------------------------------------------ 

 | | | | | |PubHl-| | | | | 

 | | Fire | Hosp | Law | OEM | th | EMS |St EMS|St OEM|St PH | 

 | |------+------+------+------+------+------+------+------+------| 

 | | % | % | % | % | % | % | % | % | % | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |1ST OR 2ND NATIONAL | | | | | | | | | | 

 |SYMPOSIA ON MEDICAL & PUB| | | | | | | | | | 

 |HEALTH... | .| 0% | .| .| 5% | .| .| .| 71% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |OTHER FEDERALLY-SPONSORED| | | | | | | | | | 

 |CONFERENCES... | .| .| .| .| 8% | .| .| .| 62% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |OTHER | 6% | 6% | 3% | 6% | 4% | 3% | 11% | 8% | 10% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |NONE OF THE ABOVE | 66% | 73% | 84% | 57% | 65% | 85% | 34% | 5% | 0% | 

 ------------------------------------------------------------------------------------------ 

 NOTE: DIFFERENT RESPONSE SET FOR EACH GROUP 

 WHICH OF THE PROGRAMS DID YOUR ORGANIZATION MOST RECENTLY PARTICIPATE IN? 

 THOSE RESPONDENTS WHO DID NOT ANSWER 'NONE OF THE ABOVE' TO PREVIOUS QUESTION 

 Loc Law Loc St St 

 Most Recently Participated EMS OEM Enf Hosp Fire PH StPH OEM EMS 

 (%) (%) (%) (%) (%) (%) (%) (%) (%) 

 1ST/2ND NATIONAL SYMPOSIA ON MEDICAL & PUB HEALTH... 0 0 0 0 0 7 26 0 0 

 DOE TRAINING FOR RADIOLOGICAL EMERGENCIES 0 3 1 0 1 0 0 0 0 

 EPA EMERGENCY RESP TRNG PROG (ERTP) 0 4 0 0 1 0 0 0 0 

 FBI HAZARDOUS DEVICES SCHOOL 0 4 7 0 0 0 0 0 0 

 FEMA EMERG MANAGEMENT ISTITUTE COURSE (WMD RELATED) 0 15 35 11 3 8 7 5 22 

 MEDICAL MANAGEMENT OF BIOLOGICAL CASUALTIES COURSE.. 0 0 0 2 0 12 19 0 4 

 MISSING 36 17 17 55 27 15 2 13 9 

 NAT FIRE ACADEMY EMERG RESPONSE TO TERRORISM COURSE 36 17 0 0 32 0 0 8 22 

 NM TECH'S INCIDENT RESP TO TERRORIST BOMBING CRSE 0 0 3 0 0 0 0 0 0 

 NONE OF THE ABOVE 0 2 13 0 2 0 0 0 0 

 OAK RIDGE INSTITUTE... 9 0 0 0 0 0 0 0 0 

 OJP ANTI-TERRORISM STATE & LOCAL TRNG GRANTS 9 1 2 0 1 10 5 3 0 

 OJP FIRST RESPONDER EQUIP ACQUISITION PROG 0 7 4 0 5 2 2 26 13 

 OJP MUNICIPAL FIRE & EMS EQUIP & TRNG PROG 0 0 0 0 0 0 0 3 4 

 OSLDPS TRAINING (DOJ-SPONSORED) 0 7 3 0 24 0 0 39 13 

 OTHER 9 18 13 30 4 7 5 3 9 

 OTHER CDC BIOTERRORISM COURSES 0 0 0 1 0 7 14 0 0 

 OTHER FEDERALLY-SPONSORED CONFERENCES... 0 0 0 0 0 13 5 0 0 

 U.S. ARMY MED RSRCH INSTITUTE OF CHEMICAL DEFENSE 0 0 0 0 0 11 5 0 0 

 U.S. ARMY MED RSRCH INSTITUTE OF INFECTIOUS DISEASES 0 0 0 0 0 7 7 0 0 

 U.S. ARY CHEMICAL SCHOOL (USACLMS) TRAINING PROG 0 0 2 0 0 0 0 0 0 

 U.S. PUBLIC HEALTH SERVICE NOBLE TRNG CENTER 0 5 0 0 0 1 2 0 4 

 NOTE: DIFFERENT RESPONSE SET FOR EACH GROUP 

 AVERAGE SCORE FOR THOSE THAT PARTICIPATED IN OTHER FED-SPONSORED PROGRAMS (TRAINING): 

 HOW MUCH DO YOU DISAGREE OR AGREE WITH THE FOLLOWING STATEMENTS ABOUT THE TRAINING? 

 GROUP MRT_Impr MRT_Adeq MRT_Relv MRT_Hrs MRT_Loc MRT_St MRT_Use 

 Fire 3.2 2.0 3.3 3.5 2.7 . 3.1 

 Law 3.3 2.2 3.7 3.8 3.4 . 3.9 

 PubHlth 3.5 2.2 3.6 3.8 3.2 . 3.6 

 EMS 3.6 2.0 4.0 3.4 3.6 . 3.9 

 St PH 3.6 2.6 4.0 4.1 . 3.8 3.5 

 NOTE: FIRE, LAW, LOCAL AND REGIONAL EMS, LOCAL AND STATE PUBLIC HEALTH 

 IF THE PROGRAM FROM WHICH YOU MOST RECENTLY RECEIVED TRAINING 

 PROVIDED SUPPORT TO IMROVE THE OPERATIONS/PREPAREDNESS OF YOUR OWN ORG 

 AVERAGE SCORE: HOW MUCH DO YOU DISAGREE OR AGREE WITH THE FOLLOWING STATEMENTS ABOUT THE TRAINING? 

 

 GROUP Sup_Impr Sup_Adeq Sup_Relv Sup_Hrs Sup_Loc Sup_St Sup_Use 

 OEM 3.6 3.0 3.3 3.6 3.4 . 3.6 

 St EMS 3.3 2.5 3.8 3.9 . 3.5 3.6 

 St OEM 3.7 3.1 3.6 3.5 . 3.3 3.8 

 NOTE: LOCAL AND STATE OEM AND STATE EMS 

 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-8 

FOR THE FED-SPONSORED PGM MOST RECENTLY PARTICIPATED IN 

 AVERAGE SCORE: HOW MUCH DO YOU DISAGREE OR AGREE WITH THE FOLLOWING STATEMENTS ABOUT THE TRAINING? 

 

 MRTh_ MRTh_ 

 Impr MRTh_Hrs Relv MRTh_Use 

 3.8 4.4 4.3 3.9 

 NOTE: HOSPITALS ONLY 

 AVERAGE SCORE FOR THOSE THAT PARTICIPATED IN OTHER FED-SPONSORED PROGRAMS (EQUIPMENT): 

 HOW MUCH DO YOU DISAGREE OR AGREE WITH THE FOLLOWING STATEMENTS ABOUT THE EQUIPMENT? 

 GROUP MRE_Impr MRE_Relv MRE_Adeq MRE_Cost MRE_Use 

 Fire 3.7 4.0 3.7 4.1 3.7 

 Law 2.7 2.7 2.9 2.7 2.7 

 PubHlth 3.9 3.7 2.7 4.2 4.4 

 EMS . . . . . 

 St PH . . . . . 

 IF YOUR ORGANIZATION PLAYED A ROLE IN ADMINISTERING SUPPORT PROVIDED BY 

 THE PROGRAM FROM WHICH YOU MOST RECENTLY RECEIVED EQUIPMENT 

 AVERAGE SCORE: HOW MUCH DO YOU DISAGREE OR AGREE WITH THE FOLLOWING STATEMENTS ABOUT THE EQUIPMENT? 

 GROUP Adm_Impr Adm_Info Adm_Adeq Adm_Flex Adm_Use Adm_Know 

 OEM 3.4 3.3 3.0 3.2 3.7 3.1 

 St EMS 3.3 3.1 2.6 2.9 3.9 3.1 

 St OEM 3.3 3.5 3.0 3.4 3.8 3.4 

 NOTE: LOCAL AND STATE OEM AND STATE EMS 

 WHAT FACTORS LIMIT YOUR ORGANIZATION'S ABILILTY TO PARTICIPATE IN FED-SPONSORED TRAINING PROGRAMS? 

-------------------------------------------------------------- 

| | | |PubHl-| | | 

| | Fire | Law | th | EMS |St PH | 

| |------+------+------+------+------| 

| | % | % | % | % | % | 

|-------------------------+------+------+------+------+------| 

|NOT ELIGIBLE | 9% | 7% | 3% | 9% | 10% | 

|-------------------------+------+------+------+------+------| 

|UNAWARE | 61% | 68% | 59% | 71% | 38% | 

|-------------------------+------+------+------+------+------| 

|CONTENT NOT RELEVANT | 17% | 7% | 14% | 7% | 17% | 

|-------------------------+------+------+------+------+------| 

|TIME COMMITMENT EXCESSIVE| 28% | 30% | 34% | 35% | 36% | 

|-------------------------+------+------+------+------+------| 

|NOT SCHEDULED AT TIMES WE| | | | | | 

|CAN ATTEND | 34% | 10% | 6% | 29% | 7% | 

|-------------------------+------+------+------+------+------| 

|POORLY ORGANIZED | 10% | 3% | 3% | 4% | 12% | 

|-------------------------+------+------+------+------+------| 

|COST IS EXCESSIVE | 39% | 38% | 40% | 40% | 33% | 

|-------------------------+------+------+------+------+------| 

|PREPAREDNESS WOULD NOT BE| | | | | | 

|IMPROVED | 1% | 4% | 2% | 3% | 5% | 

|-------------------------+------+------+------+------+------| 

|MORE IMPORTANT | | | | | | 

|RESPONSIBILITIES | 10% | 8% | 7% | 13% | 14% | 

|-------------------------+------+------+------+------+------| 

|NONE OF THE ABOVE | 8% | 8% | 16% | 6% | 29% | 

--------------------------------------------------------------

NOTE: NOT ASKED OF LOCAL/STATE OEM, STATE EMS OR HOSPITAL 

 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-9 

WHAT FACTORS LIMIT YOUR ORGANIZATION'S ABILITY TO PARTICIPATE IN FED-SPONSORED WMD PREPAREDNESS PROGRAMS? 

 ------------------------------------------------------- 

 | | Hosp | OEM |St EMS|St OEM| 

 | |------+------+------+------| 

 | | % | % | % | % | 

 |-------------------------+------+------+------+------| 

 |NOT ELIGIBLE | 2% | 9% | 17% | 5% | 

 |-------------------------+------+------+------+------| 

 |UNAWARE | 62% | 43% | 37% | 18% | 

 |-------------------------+------+------+------+------| 

 |EQUIPMENT NOT RELEVANT | 4% | 8% | 14% | 15% | 

 |-------------------------+------+------+------+------| 

 |TIME COMMITMENT IS | | | | | 

 |EXCESSIVE | 19% | 38% | 31% | 35% | 

 |-------------------------+------+------+------+------| 

 |POORLY ORGANIZED | 6% | 4% | 3% | 23% | 

 |-------------------------+------+------+------+------| 

 |APPLICATION PROCESS TOO | | | | | 

 |INVOLVED | 3% | 12% | 6% | 15% | 

 |-------------------------+------+------+------+------| 

 |COST IS EXCESSIVE | 21% | 32% | 26% | 8% | 

 |-------------------------+------+------+------+------| 

 |PREPAREDNESS WOULD NOT BE| | | | | 

 |IMPROVED | 2% | 2% | 3% | 5% | 

 |-------------------------+------+------+------+------| 

 |MORE IMPORTANT | | | | | 

 |RESPONSIBILITIES | 12% | 17% | 14% | 13% | 

 |-------------------------+------+------+------+------| 

 |NOT SCHEDULED AT TIMES WE| | | | | 

 |CAN ATTEND | .| 36% | 17% | 13% | 

 |-------------------------+------+------+------+------| 

 |NONE ARE RELEVANT TO | | | | | 

 |HOSPITALS | 6% | .| .| .| 

 |-------------------------+------+------+------+------| 

 |NONE OF THE ABOVE | 19% | 17% | 20% | 35% | 

 ------------------------------------------------------- 

 NOTE: ONLY ASKED OF LOCAL/STATE OEM, STATE EMS AND HOSPITALS 

 WHAT FACTORS LIMIT YOUR ORGANIZATION'S ABILILTY TO PARTICIPATE IN FED-SPONSORED EQUIPMENT PROGRAMS? 

-------------------------------------------------------------- 

| | | |PubHl-| | | 

| | Fire | Law | th | EMS |St PH | 

| |------+------+------+------+------| 

| | % | % | % | % | % | 

|-------------------------+------+------+------+------+------| 

|NOT ELIGIBLE | 11% | 6% | 7% | 18% | 38% | 

|-------------------------+------+------+------+------+------| 

|UNAWARE | 72% | 60% | 69% | 71% | 36% | 

|-------------------------+------+------+------+------+------| 

|EQUIPMENT NOT RELEVANT | 17% | 9% | 13% | 6% | 33% | 

|-------------------------+------+------+------+------+------| 

|POORLY ORGANIZED | 4% | 4% | 1% | 6% | 10% | 

|-------------------------+------+------+------+------+------| 

|APPLICATION PROCESS TOO | | | | | | 

|INVOLVED | 14% | 17% | 4% | 9% | 2% | 

|-------------------------+------+------+------+------+------| 

|COST IS EXCESSIVE | 34% | 30% | 20% | 21% | 2% | 

|-------------------------+------+------+------+------+------| 

|PREPAREDNESS WOULD NOT BE| | | | | | 

|IMPROVED | 1% | 6% | 2% | 3% | 5% | 

|-------------------------+------+------+------+------+------| 

|MORE IMPORTANT | | | | | | 

|RESPONSIBILITIES | 7% | 4% | 3% | 7% | 0% | 

|-------------------------+------+------+------+------+------| 

|OTHER (PUB HEALTH) | .| .| 14% | .| 14% | 

|-------------------------+------+------+------+------+------| 

|NONE ARE RELEVANT TO | | | | | | 

|PUBLIC HEALTH | .| .| 1% | .| 24% | 

|-------------------------+------+------+------+------+------| 

|NONE OF THE ABOVE | 6% | 14% | 9% | 4% | 14% | 

-------------------------------------------------------------- 

 NOTES: NOT ASKED OF LOCAL/STATE OEM, STATE EMS OR HOSPITAL; DIFFERENT RESPONSE SET FOR PUBLIC HEALTH 

 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-10 

WHAT FACTORS LIMIT YOUR ABILILTY TO ADMINISTER SUPPORT PROVIDED BY FED-SPONSORED WMD PREPAREDNESS? 

 ------------------------------------------------ 

 | | OEM |St EMS|St OEM| 

 | |------+------+------| 

 | | % | % | % | 

 |-------------------------+------+------+------| 

 |NOT ELIGIBLE | 9% | 20% | 0% | 

 |-------------------------+------+------+------| 

 |UNAWARE | 44% | 20% | 5% | 

 |-------------------------+------+------+------| 

 |REPORTING PROCESS TOO | | | | 

 |BURDENSOME | 12% | 0% | 23% | 

 |-------------------------+------+------+------| 

 |COST IS EXCESSIVE | 31% | 20% | 20% | 

 |-------------------------+------+------+------| 

 |ORGANIZATIONS WOULD NOT | | | | 

 |BENEFIT | 1% | 0% | 3% | 

 |-------------------------+------+------+------| 

 |MORE IMPORTANT | | | | 

 |RESPONSIBILITIES | 14% | 14% | 5% | 

 |-------------------------+------+------+------| 

 |WE DO NOT HAVE NECESSARY | | | | 

 |EXPERTISE | 20% | 9% | 5% | 

 |-------------------------+------+------+------| 

 |NOT FLEXIBLE ENOUGH | 9% | 9% | 33% | 

 |-------------------------+------+------+------| 

 |OTHER | 7% | 31% | 23% | 

 |-------------------------+------+------+------| 

 |NONE OF THE ABOVE | 21% | 17% | 28% | 

 ------------------------------------------------ 

 NOTE: ONLY ASKED OF LOCAL/STATE OEM AND STATE EMS 

 SINCE 1996, HAS YOUR ORG PARTICIPATED IN OR CONDUCTED ANY EXERCISES 

 FOR WMD RESPONSE IN WHICH A FEDERAL AGENCY: 

 ----------------------------------------------------------------------------------- 

 | | | | |PubHl-| | | | | 

 | | Fire | Law | OEM | th | EMS |St EMS|St OEM|St PH | 

 | |------+------+------+------+------+------+------+------| 

 | | % | % | % | % | % | % | % | % | 

 |-------------------------+------+------+------+------+------+------+------+------| 

 |HELPED ORGANIZE OR | | | | | | | | | 

 |COORDINATE THE EXERCISE | 1% | 4% | 12% | 8% | 10% | 54% | 78% | 52% | 

 |-------------------------+------+------+------+------+------+------+------+------| 

 |PROVIDED FUNDING TO THE | | | | | | | | | 

 |PARTICIPATING ORG(S) | 1% | 1% | 5% | 7% | 1% | 34% | 70% | 50% | 

 |-------------------------+------+------+------+------+------+------+------+------| 

 |PARTICIPATED IN THE | | | | | | | | | 

 |ACTUAL EXERCISE | 2% | 3% | 13% | 14% | 13% | 54% | 75% | 71% | 

 |-------------------------+------+------+------+------+------+------+------+------| 

 |NONE OF THE ABOVE | 93% | 94% | 84% | 86% | 82% | 29% | 8% | 24% | 

 ----------------------------------------------------------------------------------- 

 NOTE : NOT ASKED OF HOSPITALS 

 HOW MUCH TO YOU AGREE OR DISAGREE WITH THE FOLLOWING STATEMENTS ABOUT EXERCISES YOUR 

 ORGANIZATION PARTICIPATED IN/CONDUCTED IN WHICH A FED AGENCY/ORG WAS INVOLVED: 

 FED PARTICIPATION HELPED MAKE THE EXERCISE MORE REALISTIC 

 

 Percent Percent 

 Strong Percent Percent Percent Strong AVG_ 

 GROUP Disagree Disagree Neither Agree Agree SCORE 

 Fire 3.6 1.1 8.3 12.8 1.6 3.3 

 Law 0.0 15.8 9.2 46.7 12.1 3.7 

 OEM 4.1 3.2 34.8 32.0 15.9 3.6 

 PubHlth 5.2 2.2 18.4 33.8 36.0 4.0 

 EMS 8.3 0.0 41.7 33.3 0.0 3.2 

 St EMS 4.0 12.0 40.0 24.0 16.0 3.4 

 St OEM 8.1 8.1 37.8 37.8 8.1 3.3 

 St PH 9.4 6.3 9.4 46.9 25.0 3.7 

 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-11 

 NOTE: FOR THOSE WHO DID NOT ANSWER 'NONE' TO THE PREVIOUS QUESTION (NOT ASKED OF HOSPITALS) 

 HOW MUCH TO YOU AGREE OR DISAGREE WITH THE FOLLOWING STATEMENTS ABOUT EXERCISES YOUR 

 ORGANIZATION PARTICIPATED IN/CONDUCTED IN WHICH A FED AGENCY/ORG WAS INVOLVED: 

 W/O FED PARTICIPATION WE PROBABLY WOULD NOT HAVE PARTICIPATED 

 Percent Percent 

 Strong Percent Percent Percent Strong AVG_ 

 Fire 2.8 7.3 7.3 7.1 2.9 3.0 

 Law 13.7 6.4 41.6 16.5 5.5 2.9 

 OEM 30.0 9.9 11.4 30.5 8.3 2.7 

 PubHlth 23.0 15.5 10.5 26.7 19.9 3.1 

 EMS 16.7 16.7 16.7 16.7 16.7 3.0 

 St EMS 24.0 32.0 16.0 8.0 16.0 2.6 

 St OEM 37.8 13.5 27.0 8.1 13.5 2.5 

 St PH 25.0 31.3 21.9 6.3 12.5 2.5 

 NOTE: FOR THOSE WHO DID NOT ANSWER 'NONE' TO THE PREVIOUS QUESTION (NOT ASKED OF HOSPITALS) 

 HOW MUCH TO YOU AGREE OR DISAGREE WITH THE FOLLOWING STATEMENTS ABOUT EXERCISES YOUR 

 ORGANIZATION PARTICIPATED IN/CONDUCTED IN WHICH A FED AGENCY/ORG WAS INVOLVED: 

 FED INVOLVEMENT HELPED US TEST/IMPROVE OUR CAPABILITIES MORE THAN WE WOULD HAVE OTHERWISE 

 Percent Percent 

 Strong Percent Percent Percent Strong AVG_ 

 GROUP Disagree Disagree Neither Agree Agree SCORE 

 Fire 3.7 1.2 9.9 11.7 1.9 3.2 

 Law 9.5 6.2 46.0 7.9 14.1 3.1 

 OEM 11.8 4.0 13.8 41.2 19.4 3.6 

 PubHlth 0.0 6.4 32.4 29.2 27.6 3.8 

 EMS 0.0 8.3 33.3 50.0 0.0 3.5 

 St EMS 16.0 4.0 20.0 40.0 16.0 3.4 

 St OEM 8.1 32.4 29.7 18.9 10.8 2.9 

 St PH 6.3 12.5 28.1 31.3 15.6 3.4 

 NOTE: FOR THOSE WHO DID NOT ANSWER 'NONE' TO THE PREVIOUS QUESTION (NOT ASKED OF HOSPITALS) 

 SINCE 1996, HAS YOUR ORG USED/OBTAINED INFO OR TECH ASSISTANCE FOR WMD PREPAREDNESS 

 OR RESPONSE FROM ANY OF THE FOLLOWING FED-SPONSORED RESOURCES? 

------------------------------------------------------------------------------------------ 

| | | | | |PubHl-| | | | | 

| | Fire | Hosp | Law | OEM | th | EMS |St EMS|St OEM|St PH | 

| |------+------+------+------+------+------+------+------+------| 

| | % | % | % | % | % | % | % | % | % | 

|-------------------------+------+------+------+------+------+------+------+------+------| 

|CHEMICAL WEAPONS IMPROVED| | | | | | | | | | 

|RESPONSE PROGRAM | 0% | 5% | 1% | 1% | 0% | 1% | 11% | 13% | 7% | 

|-------------------------+------+------+------+------+------+------+------+------+------| 

|BIOLOGICAL WEAPONS | | | | | | | | | | 

|IMPROVED RESPONSE PROGRAM| 0% | 5% | 0% | 1% | 3% | 1% | 11% | 18% | 24% | 

|-------------------------+------+------+------+------+------+------+------+------+------| 

|CDC's HEALTH ALERT | | | | | | | | | | 

|NETWORK | 0% | 3% | 0% | 4% | 24% | 3% | 54% | 30% | 83% | 

|-------------------------+------+------+------+------+------+------+------+------+------| 

|FBI's NATIONAL DOMESTIC | | | | | | | | | | 

|PREPAREDNESS OFFICE | 2% | 4% | 2% | 14% | 5% | 4% | 51% | 63% | 57% | 

|-------------------------+------+------+------+------+------+------+------+------+------| 

|FEMA RAPID RESPONSE INFO | | | | | | | | | | 

|SYSTEM | 3% | 3% | 9% | 9% | 5% | 1% | 11% | 33% | 10% | 

|-------------------------+------+------+------+------+------+------+------+------+------| 

|CHEMICAL AND BIOLOGICAL | | | | | | | | | | 

|(CB) HOTLINE | 0% | 0% | 0% | 1% | 1% | 1% | 6% | 38% | 12% | 

|-------------------------+------+------+------+------+------+------+------+------+------| 

|DOT EMERGENCY RESPONSE | | | | | | | | | | 

|GUIDEBOOK | 33% | .| 13% | 53% | 7% | 38% | 66% | 78% | 24% | 

|-------------------------+------+------+------+------+------+------+------+------+------| 

|DoD CHEM & BIO INFO | | | | | | | | | | 

|ANALYSIS CENTER | 0% | 1% | 0% | 0% | 1% | 0% | 14% | 3% | 7% | 

|-------------------------+------+------+------+------+------+------+------+------+------| 

|DoD CONSEQUENCE | | | | | | | | | | 

|MANAGEMENT | | | | | | | | | | 

|INTEROPERABILITY SERVICES| 0% | 0% | 0% | 0% | 1% | 0% | 3% | 3% | 0% | 

|-------------------------+------+------+------+------+------+------+------+------+------| 

|OSLDPS TECHNICAL | | | | | | | | | | 

|ASSISTANCE PROGRAM | 1% | 1% | 0% | 8% | 3% | 1% | 11% | 80% | 33% | 

|-------------------------+------+------+------+------+------+------+------+------+------| 

|CDC BIOTERRORISM RESPONSE| | | | | | | | | | 

|AND PREPAREDNESS PROGRAM | .| 14% | .| .| 23% | .| .| .| 90% | 

|-------------------------+------+------+------+------+------+------+------+------+------| 

|OTHER | 0% | 2% | 4% | 3% | 7% | 3% | 14% | 18% | 10% | 

|-------------------------+------+------+------+------+------+------+------+------+------| 

|NONE OF THE ABOVE | 59% | 64% | 75% | 33% | 52% | 59% | 20% | 0% | 0% | 

------------------------------------------------------------------------------------------

 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-12 

 DOES YOUR ORG HAVE FORMAL PROCEDURES IN PLACE TO COORDINATE W/ ANY OF THE FOLLOWING 

 FED-SPONSORED SPECIAL UNITS IN THE EVENT OF A WMD INCIDENT? 

 --------------------------------------------------------------------- 

 | | | | | | | | 

 | | Fire | Law | OEM | EMS |St EMS|St OEM| 

 | |------+------+------+------+------+------| 

 | | % | % | % | % | % | % | 

 |-------------------------+------+------+------+------+------+------| 

 |HHS METROPOLITAN MEDICAL | | | | | | | 

 |STRIKE SYSTEM | 1% | 1% | 4% | 4% | 26% | 23% | 

 |-------------------------+------+------+------+------+------+------| 

 |NATIONAL GUARD WMD CIVIL | | | | | | | 

 |SUPPORT TEAMS | 1% | 4% | 20% | 3% | 34% | 73% | 

 |-------------------------+------+------+------+------+------+------| 

 |EPA's ENVIRONMENTAL | | | | | | | 

 |RESPONSE TEAM | 6% | 6% | 14% | 4% | 14% | 35% | 

 |-------------------------+------+------+------+------+------+------| 

 |EPA's RADIOLOGICAL | | | | | | | 

 |RESPONSE TEAM | 1% | 5% | 6% | 4% | 11% | 35% | 

 |-------------------------+------+------+------+------+------+------| 

 |DoD US MARINE CORPS CHEM | | | | | | | 

 |BIO INCIDENT RESPONSE | | | | | | | 

 |FORCE | 0% | 1% | 3% | 1% | 6% | 13% | 

 |-------------------------+------+------+------+------+------+------| 

 |NDMS NATIONAL MEDICAL | | | | | | | 

 |RESPONSE TEAM - WMD | 1% | 1% | 6% | 6% | 26% | 13% | 

 |-------------------------+------+------+------+------+------+------| 

 |DOE NUCLEAR EMERGENCY | | | | | | | 

 |SEARCH TESAM | 1% | 0% | 2% | 0% | 9% | 20% | 

 |-------------------------+------+------+------+------+------+------| 

 |DOE NUCLEAR INCIDENT TEAM| 1% | 1% | 5% | 1% | 9% | 18% | 

 |-------------------------+------+------+------+------+------+------| 

 |DOE NUCLEAR/RADIOLOGICAL | | | | | | | 

 |ADVISORY TEAM | 1% | 0% | 5% | 0% | 11% | 20% | 

 |-------------------------+------+------+------+------+------+------| 

 |US ARMY CHEM/BIO RAPID | | | | | | | 

 |RESPONSE TEAM | 0% | 2% | 6% | 1% | 6% | 10% | 

 |-------------------------+------+------+------+------+------+------| 

 |OTHER | 12% | 2% | 2% | 3% | 9% | 3% | 

 |-------------------------+------+------+------+------+------+------| 

 |NONE | 87% | 90% | 66% | 82% | 60% | 18% | 

 --------------------------------------------------------------------- 

 NOTES: NOT INCLUDING LOCAL/STATE PUBLIC HEALTH; NOT ASKED OF HOSPITALS 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-13 

 DOES YOUR ORG HAVE FORMAL OR INFORMAL PROCEDURES IN PLACE TO COORDINATE W/ ANY 

 OF THE FOLLOWING FED-SPONSORED SPECIAL UNITS IN THE EVENT OF A WMD INCIDENT? 

 ----------------------------------------- 

 | |PubHl-| | 

 | | th |St PH | 

 | |------+------| 

 | | % | % | 

 |-------------------------+------+------| 

 |NDMS DISASTER MEDICAL | | | 

 |ASSISTANCE TEAMS | 5% | 52% | 

 |-------------------------+------+------| 

 |HHS METROPOLITAN MEDICAL | | | 

 |STRIKE SYSTEM | 3% | 33% | 

 |-------------------------+------+------| 

 |NATIONAL GUARD WMD CIVIL | | | 

 |SUPPORT TEAMS | 7% | 57% | 

 |-------------------------+------+------| 

 |EPA's ENVIRONMENTAL | | | 

 |RESPONSE TEAM | 10% | 36% | 

 |-------------------------+------+------| 

 |EPA's RADIOLOGICAL | | | 

 |RESPONSE TEAM | 4% | 38% | 

 |-------------------------+------+------| 

 |DoD US MARINE CORPS CHEM | | | 

 |BIO INCIDENT RESPONSE | | | 

 |FORCE | 2% | 10% | 

 |-------------------------+------+------| 

 |NDMS NATIONAL MEDICAL | | | 

 |RESPONSE TEAM - WMD | 2% | 29% | 

 |-------------------------+------+------| 

 |DOE NUCLEAR EMERGENCY | | | 

 |SEARCH TESAM | 1% | 24% | 

 |-------------------------+------+------| 

 |DOE NUCLEAR INCIDENT TEAM| 1% | 29% | 

 |-------------------------+------+------| 

 |DOE NUCLEAR/RADIOLOGICAL | | | 

 |ADVISORY TEAM | 1% | 26% | 

 |-------------------------+------+------| 

 |US ARMY CHEM/BIO RAPID | | | 

 |RESPONSE TEAM | 3% | 10% | 

 |-------------------------+------+------| 

 |OTHER | 7% | 7% | 

 |-------------------------+------+------| 

 |NONE | 76% | 14% | 

 ----------------------------------------- 

 NOTE: LOCAL AND STATE PUBLIC HEALTH ONLY; 

 NOT ASKED OF HOSPITALS 

 FED WMD PREPAREDNESS FUNDING THAT IS BEING DISTRIBUTED THROUGH STATE GOVTS IS 

 REACHING LOCAL ORGANIZATIONS AND COMMUNITIES WITH THE GREATEST NEED. 

 Percent Percent 

 Strong Percent Percent Percent Strong AVG_ 

 GROUP Disagree Disagree Neither Agree Agree SCORE 

 Fire 21.0 26.7 41.2 6.3 0.0 2.3 

 Hosp 12.3 19.0 52.5 12.7 0.9 2.7 

 Law 7.0 27.0 52.9 10.0 1.9 2.7 

 OEM 13.2 16.6 43.4 16.9 2.6 2.8 

 PubHlth 5.2 16.5 60.0 14.2 2.0 2.9 

 EMS 20.6 20.6 51.5 5.9 0.0 2.4 

 St EMS 8.6 25.7 40.0 25.7 0.0 2.8 

 St OEM 2.5 5.0 17.5 37.5 32.5 4.0 

 St PH 7.1 14.3 35.7 35.7 4.8 3.2 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-14 

 WMD FUNDING BEING DISTRIBUTED BY THE FED GOVT DIRECTLY TO LOCAL COMMUNITIES AND LOCAL 

 RESPONDERS IS REACHING LOCAL ORGANIZATIONS AND COMMUNITIES WITH THE GREATEST NEED. 

 

 Percent Percent 

 Strong Percent Percent Percent Strong AVG_ 

 GROUP Disagree Disagree Neither Agree Agree SCORE 

 Fire 20.9 18.2 42.5 13.7 0.1 2.5 

 Hosp 11.8 22.7 51.8 8.9 2.2 2.7 

 Law 7.1 24.0 56.3 7.4 4.2 2.8 

 OEM 13.0 24.8 40.8 11.9 2.2 2.6 

 PubHlth 7.9 13.7 65.7 10.7 0.4 2.8 

 EMS 19.1 25.0 47.1 5.9 1.5 2.4 

 St EMS 5.7 22.9 37.1 34.3 0.0 3.0 

 St OEM 15.0 22.5 37.5 17.5 7.5 2.8 

 St PH 9.5 14.3 45.2 23.8 2.4 3.0 

 FEDERAL GOVT PROGRAMS FOR IMPROVING LOCAL RESPONDER WMD PREPAREDNESS... 

 AVERAGE SCORE: AGREE OR DISAGREE 

 F F F F F F F F 

 e e e e e F F F F e e F e 

 d d d d d e e e e d d e F d 

 G _ _ _ _ _ d d d d _ _ d e _ 

 R C F F U A _ _ _ _ I P _ d C 

 O o l u n s N U F D n r L _ y 

 U o e n l e u s i e t o o S b 

 P r x d k s m e t d l m c t r 

 Fire 2.5 2.5 2.9 3.3 4.0 3.0 2.6 2.6 3.3 3.8 4.0 4.1 . 3.6 

 Hosp 2.5 2.6 2.8 2.7 3.8 2.9 2.6 3.0 3.5 3.7 3.8 3.9 . 3.8 

 Law 2.9 2.7 3.0 3.0 3.7 3.1 2.8 3.0 3.4 3.9 4.0 4.0 . 3.9 

 OEM 2.7 2.7 2.9 3.1 3.8 3.1 2.7 2.9 3.3 3.8 3.9 3.9 . 3.7 

 PubHlth 2.9 2.7 2.8 2.9 3.9 3.2 2.6 3.0 3.5 3.5 3.8 4.0 . 3.7 

 EMS 2.8 2.5 2.9 3.1 3.8 3.2 2.6 3.1 3.4 3.7 3.7 4.1 . 3.6 

 St EMS 2.5 2.5 2.7 2.9 4.0 3.1 2.4 3.2 3.0 3.7 4.2 . 4.3 3.9 

 St OEM 2.1 2.4 2.5 3.2 4.1 3.5 2.2 3.2 2.9 4.1 4.2 . 4.6 4.1 

 St PH 2.2 2.5 2.5 3.1 3.8 3.2 2.1 3.3 3.1 3.9 3.8 . 4.3 3.9 

 NOTE: SLIGHTLY DIFFERENT RESPONSE SET FOR LOCAL ORGS AND STATE ORGS 

 WHAT IS THE SINGLE MOST IMPORTANT WAY THAT THE FED GOVT CAN SUPPORT THE EFFORTS OF LOCAL 

 ORGANIZATIONS LIKE YOURS TO IMPROVE THEIR WMD PREPAREDNESS? 

 Loc Law Loc St St 

 MostImportantWay EMS OEM Enf Hosp Fire PH StPH OEM EMS 

 (%) (%) (%) (%) (%) (%) (%) (%) (%) 

 OTHER 0 5 4 5 1 6 10 11 10 

 DIRECT FINANCIAL SUPPORT 22 39 32 37 42 25 61 49 38 

 EQUIPMENT PROCUREMENT 12 20 6 5 6 0 0 27 7 

 TRAINING OR TRAINING AIDS 37 13 34 20 35 17 5 3 14 

 EXERCISE COORDINATION AND SUPPORT 6 4 7 3 1 7 5 0 7 

 DISTRIBUTION OF WMD TECHNICAL INFORMATION 4 1 3 1 1 1 2 0 0 

 RESEARCH & DEVELOPMENT ON WMD PREPAREDNESS & RESPONSE 0 4 3 1 2 3 2 8 3 

 OUTREACH TO STATE & LOCAL ORGS 18 12 8 17 11 12 2 0 21 

 DISSEMINATION OF INTELLIGENCE DATA 0 2 3 5 2 1 2 3 0 

 NO IMPROVEMENT NEEDED 2 0 0 0 0 1 0 0 0 

 ENHANCE CURRENT SURVEILLANCE SYSTEMS... 0 0 0 2 0 5 10 0 0 

 MAINTAIN A NATIONAL PHARMACEUTICAL STOCKPILE... 0 0 0 3 0 6 0 0 0 

 ESTABLISH A CENTRALIZED COMMUNICATION SYSTEM... 0 0 0 1 0 16 0 0 0 

 ESTABLISH A RAPID-RESP & ADVANCED TECH LAB... 0 0 0 1 0 0 0 0 0 

 NOTE: DIFFERENT RESPONSE SETS FOR EACH GROUP 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-15 

 WHICH OF THE FOLLOWING AREAS OF WMD PREPAREDNESS DO YOU FEEL THE FED GOVT COULD IMPROVE ITS SUPPORT? 

 --------------------------------------------- 

 | | | St | St | 

 | | OEM | EMS | OEM | 

 | |-----+-----+-----| 

 | | % | % | % | 

 |-------------------------+-----+-----+-----| 

 |CONDUCTING ASSESSMENTS OF| | | | 

 |PREPAREDNESS NEEDS... | 54% | 54% | 28% | 

 |-------------------------+-----+-----+-----| 

 |PREPARING TO COORDINATE | | | | 

 |AND MANAGE... | 35% | 17% | 33% | 

 |-------------------------+-----+-----+-----| 

 |DESIGNING WMD RESPONSE | | | | 

 |PLANS... | 52% | 46% | 50% | 

 |-------------------------+-----+-----+-----| 

 |DEVELOPING FRAMEWORKS FOR| | | | 

 |MUTUAL AID W/IN OUR | | | | 

 |JURISDICTION | 17% | 23% | 13% | 

 |-------------------------+-----+-----+-----| 

 |DEVELOPING FRAMEWORKS FOR| | | | 

 |MUTUAL AID W/ OTHER | | | | 

 |REGIONS | 24% | 43% | 23% | 

 |-------------------------+-----+-----+-----| 

 |IMPROVING COMMUNICATIONS | | | | 

 |CAPABILITY... | 42% | 54% | 50% | 

 |-------------------------+-----+-----+-----| 

 |ESTABLISHING/CONDUCTING | | | | 

 |REGIONAL WORKING | | | | 

 |GROUPS... | 52% | 54% | 48% | 

 |-------------------------+-----+-----+-----| 

 |OTHER | 3% | 17% | 20% | 

 --------------------------------------------- 

 NOTE: ONLY ASKED OF LOCAL/STATE OEM AND STATE EMS 

 WHAT ROLE DO YOU FEEL WOULD BE APPORPRIATE FOR THE U.S. MILITARY TO PLAY 

 DURING A RESPONSE TO A DOMESTIC WMD INCIDENT? 

 --------------------------------------------------------------------------- 

 | | TYPE OF ORGANIZATION | 

 | |-----------------------------------------------| 

 | | | | |PubH-| | St | St | | 

 | |Fire | Law | OEM | lth | EMS | EMS | OEM |St PH| 

 | |-----+-----+-----+-----+-----+-----+-----+-----| 

 | | % | % | % | % | % | % | % | % | 

 |-------------------------+-----+-----+-----+-----+-----+-----+-----+-----| 

 |MAINTAIN ORDER/PROV | | | | | | | | | 

 |SECURITY | 71% | 65% | 64% | 79% | 66% | 66% | 33% | 69% | 

 |-------------------------+-----+-----+-----+-----+-----+-----+-----+-----| 

 |ADVISE OTH RESP ORGS... | 56% | 56% | 64% | 51% | 57% | 69% | 50% | 79% | 

 |-------------------------+-----+-----+-----+-----+-----+-----+-----+-----| 

 |CONDUCT NEEDS ASSESS... | 48% | 43% | 37% | 28% | 38% | 20% | 15% | 24% | 

 |-------------------------+-----+-----+-----+-----+-----+-----+-----+-----| 

 |PROV PERSONNEL & EQUIP...| 87% | 88% | 90% | 84% | 78% | 77% | 83% | 86% | 

 |-------------------------+-----+-----+-----+-----+-----+-----+-----+-----| 

 |SET UP KITCHENS... | 61% | 66% | 67% | 52% | 49% | 54% | 50% | 57% | 

 |-------------------------+-----+-----+-----+-----+-----+-----+-----+-----| 

 |ASSUME ROLE OF LEAD | | | | | | | | | 

 |AGENCY... | 10% | 16% | 6% | 16% | 15% | 6% | 3% | 0% | 

 |-------------------------+-----+-----+-----+-----+-----+-----+-----+-----| 

 |NO FORM OF | | | | | | | | | 

 |PARTICIPATION... | 1% | 3% | 1% | 0% | 6% | 3% | 3% | 0% | 

 |-------------------------+-----+-----+-----+-----+-----+-----+-----+-----| 

 |OTHER (specify) | 0% | 2% | 1% | 1% | 1% | 9% | 20% | 0% | 

 --------------------------------------------------------------------------- 

 NOTE: HOSPITALS NOT ASKED THIS QUESTION 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-7-16 

 DO ANY OF YOUR ORGANIZATION'S CRITICAL RESPONSE FUNCTIONS (e.g., COMMAND, 

 CONTROL, COMMUNICATIONS, DISPATCH) DEPEND ON COMPUTER SYSTEMS? 

 GROUP % YES % NO 

 Fire 74.5 25.5 

 Hosp 95.7 4.3 

 Law 65.8 34.2 

 OEM 79.0 21.0 

 PubHlth 69.3 30.7 

 EMS 67.6 32.4 

 St EMS 67.6 32.4 

 St OEM 85.0 15.0 

 St PH 97.6 2.4 

 FOR THOSE RESPONDENTS WHO ANSWERED 'YES' TO THE PREVIOUS QUESTION: 

 HAVE ANY OF THESE CRITICAL COMPUTER SYSTEMS EVER BEEN THE TARGET OF A CRIMINAL ATTEMPT TO: 

 --------------------------------------------------------------------------------- 

 | | | | | |PubH-| | St | St | | 

 | |Fire |Hosp | Law | OEM | lth | EMS | EMS | OEM |St PH| 

 | |-----+-----+-----+-----+-----+-----+-----+-----+-----| 

 | | % | % | % | % | % | % | % | % | % | 

 |-------------------------+-----+-----+-----+-----+-----+-----+-----+-----+-----| 

 |GAIN UNAUTHORIZED ACCESS?| 1% | 10% | 5% | 9% | 7% | 0% | 26% | 26% | 20% | 

 |-------------------------+-----+-----+-----+-----+-----+-----+-----+-----+-----| 

 |DAMAGE OR IMPAIR SYSTEM | | | | | | | | | | 

 |FUNCTIONING OR | | | | | | | | | | 

 |OPERABILITY? | 1% | 8% | 1% | 7% | 12% | 2% | 13% | 26% | 20% | 

 |-------------------------+-----+-----+-----+-----+-----+-----+-----+-----+-----| 

 |OTHER (PLEASE SPECIFY) | 0% | 7% | 0% | 0% | 5% | 0% | 4% | 3% | 5% | 

 |-------------------------+-----+-----+-----+-----+-----+-----+-----+-----+-----| 

 |OUR COMPUTER SYSTEMS HAVE| | | | | | | | | | 

 |NOT BEEN TARGETED IN THIS| | | | | | | | | | 

 |WAY, TO OUR KNOWLEDGE | 97% | 90% | 94% | 87% | 84% | 96% | 70% | 62% | 61% | 

 --------------------------------------------------------------------------------- 

 HAS YOUR ORGANIZATION EVER REQUESTED ASSISTANCE FROM THE FBI, INCLUDING 

 THE FBI'S REGIONAL COMPUTER CRIME SQUADS, FOR ANY OF THE FOLLOWING: 

 ------------------------------------------------------------------------------------------ 

 | | TYPE OF ORGANIZATION | 

 | |--------------------------------------------------------------| 

 | | | | | |PubHl-| | | | | 

 | | Fire | Hosp | Law | OEM | th | EMS |St EMS|St OEM|St PH | 

 | |------+------+------+------+------+------+------+------+------| 

 | | % | % | % | % | % | % | % | % | % | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |TO REPORT, INVESTIGATE, | | | | | | | | | | 

 |OR SEEK ASSISTANCE... | 0% | 6% | 5% | 3% | 0% | 0% | 3% | 3% | 0% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |TO REQUEST ASSISTANCE IN | | | | | | | | | | 

 |ORDER TO STRENGTHEN... | 0% | 5% | 0% | 1% | 0% | 0% | 3% | 5% | 7% | 

 |-------------------------+------+------+------+------+------+------+------+------+------| 

 |NONE OF THE ABOVE | 96% | 93% | 94% | 90% | 97% | 99% | 80% | 90% | 88% | 

 ------------------------------------------------------------------------------------------ 

 DO YOU PERSONALLY SERVE A SPECIFIC WMD ROLE WITHIN YOUR ORGANIZATION? 

 GROUP % YES % NO 

 Fire 42.3 57.7 

 Hosp 40.9 59.1 

 Law 37.8 62.2 

 OEM 68.0 32.0 

 PubHlth 56.9 43.1 

 EMS 30.9 69.1 

 St EMS 76.5 23.5 

 St OEM 92.3 7.7 

 St PH 92.9 7.1 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-8-1 

TAB 8 TO APPENDIX G (Survey Information)—SURVEY COMMENTS 

SURVEY COMMENTS 

The following were excerpted from the comments provided by the survey respondents. 

Fire Departments 

“Being from a small town I feel lost on a lot of issues 

concerning WMD.” 

 “Train the trainer courses we attend [sic] 18 months 

ago have to date not been followed up with course 

material, training aids or monitoring equipment needed 

to train other responders. Local gov’t agencies do not 

have financial resources to cover these costs.” 

“Need to focus funding on more realistic scenario areas 

(such as explosives) and spread over a larger number of 

communities.” 

“It is good to learn the proper procedures for 

identification of an incident, but it is disheartening to 

not have the funding or equipment to implement any 

action or measures to control the situation other than 

evacuation and wait for the ‘government’ to show up. 

We are the first responders – help us help you.” 

“Information about WMD risks and programs 

developed to assist 1st responders gets lost at regional 

and state levels. The Federal Gov’t, if it’s going to 

really support those who will [be] ‘on scene’ first, must 

get by all the upper-level agencies who want to make 

claim to resources, and get information directly to local 

fire and police units.” 

“Process and paperwork is to much to ask of a volunteer 

Chief.” “No time for this. Pay people if you want this 

done. Too many other things to focus on.” 

“We need funds to trickle down to local HAZ MAT 

teams. Most municipalities do not believe it is a 

problem that they will face. We must educate the 

political powers that be. 

“I feel that some local governments do not fully 

comprehend the potential – they feel it won’t happen to 

them.” 

“We need recommendations on the risk our area is in for 

WMD.” 

“Our department covers a very rural area...we need 

programs that provide us with training and scenarios 

that we see as a realistic threat to our community.” 

“Current Federal grant/coordination are real confusing.” 

“Doesn’t seem [that] WMD effort[s] are coordinated 

across [the] Nation.” 

“I filled out a state WMD response need questionnaire 

with <<redacted>>. I have heard nothing from them 

since is was returned in approximately November 

2000.” 

“There needs to be a special program at low/no cost to 

local volunteer response groups for training, exercises 

and equipment done at a local level.” 

“Presently, the Federal grant application process is 

laborious and cumbersome.” 

“One of the largest challenges was providing adequate 

training for all first responders in mass decontamination. 

The need for this training exposed the fact that this type 

of training was non-existant [sic] or unavailable from 

any Federal WMD program.” 

“A large amount of money, training and effort has been 

directed at the 120 largest cities in America. From my 

perspective it appears that there is either no thought or 

very little thought given to the fact that other areas of 

our country can be vulnerable to terrorist attack.” 

“...you should follow the recommendations as noted in 

the ‘America’s Achilles Heel’ by Richard A. 

Falkenrath, Robert D. Newman, and Bradley A. Thayer 

instead of reinventing the wheel.” 

“The Federal government has pumped millions of 

dollars into Civil Support Teams that most likely will 

never use the hazardous materials technician training 

that they have received. Yet the <<redacted>>’s 

Hazardous Materials Team and others like us around the 

nation, annually respond to incidents and we must beg, 

borrow and scrape to get funding, training and 

equipment. Something is drastically wrong with this 

scenario.” 

“Let programs be known.” 

“WMD program is an ill conceived top down 

approach.” 

“The military is great to work with but would 

overwhelm most initial incident management teams.” 

“If these threat[s] are as real as they appear to be we 

need a lot of work and quickly.” 

“The organizations all need to be brought together and 

teach off the same page. It seems each government 

branch has some type of WMD training that is unique to 

them, when in reality it is all the same.” 

“[Send] sustainment funding directly to local 

jurisdictions who have operational capability.” 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-8-2 

“DOJ has consistently supported the local first 

responder – the others just talk about support.” 

“In a city of our size the response resources to a WMD 

[incident] would be out stripped instantly... What we 

need to know is what we can do to help ourselves before 

State and Federal assistance arrives.” 

“Small departments like ours do not have the resources 

or the money available.” 

“More training and assistance to more rural dept’s. 

People and equipment are short in rural areas. Training 

is limited.” 

“Needs to be coordination with local community 

programs, especially those close to major population 

areas or military facilities” 

“The rural and smaller areas of the state have seen little 

to no support. This includes resources, equipment and 

training. It never seems to get past the agencies that 

need it the least!” 

“The President needs to appoint an individual to a 

cabinet level position with an adequate staff to develop 

a clear plan for the Country’s defense against WMD 

events. Using this plan, direct each Federal Agency to 

develop their tasked capabilities in a coordinated 

manner that will assist State assets in supporting local 

responders who will assume the primary responsibility 

of responding to and commanding a WMD event.” 

“Every Federal agency involved in WMD defense see 

the available funding as a means of increasing their own 

agency programs and needs and too often cannot or do 

not see the “national” picture. Local responders too 

often are not included in the planning stages and usually 

are the last level of government to see funding when it 

is clear to most people that locals will be the first on the 

scene and responsible [for] short term mitigation and 

long term recovery.” 

“It appears that a lot of WMD programs and 

information don’t reach the local levels. Federal 

programs an[d] information relating to WMD should be 

sent directly to all first responder agencies.” 

“Offer training on the weekends (regionally) so paid call 

and volunteer personnel can attend.” 

“We need to know what potential exposure we have in 

our area. We have no idea if we should be preparing for 

these incidents or not.” 

“National policy focus. Mass care capability is lacking 

(critical need!!!)” 

“Need to identify federal resources and how to access 

these resources.” 

“We need a lot more funding in order to do it right! 

Funding should not be based on population alone.” 

“The WMD money went to the large cities that could 

already afford the equipment.” 

“The federal government should require joint exercises 

involving fire, police, EMS, and state/federal 

government. Occasionally. All those organizations that 

would respond to a WMD incident should attend. This 

could be done on a semi-annual basis.” 

“Being volunteer it is difficult for Federal programs to 

get down to us. Federal programs could be handled 

through the county EMA or better through the county 

vol[unteer] firemens associations.” 

“Our community is relatively small—our biggest 

concern would be the transportation of WMD and/or 

terrorist action on the Interstate Highway that goes 

through our community.” 

“Publish a catalogue with all the resources available to a 

local agency.... need more and better training material.” 

“Previous funds to responders were wasted. The 

direction is not focused, roles not defined, no clear plan 

(that we can see), duplicate systems being developed.” 

“We are a small department. WMD-related issues are 

not that important to me but should be to a bigger 

department.” 

“Need for... sophisticated equipment to get into the right 

hands on a regional, county level; assistance in 

planning, conducting and financing realistic, scenario 

based training exercises on a regional basis; strong 

military support. Direct financing of fire and police 

agencies—except the major metro. cities—would be a 

mistake.” 

“Funding would help. Training provided free to local 

agencies, here or near here, would help... we are 

financially unprepared for any disaster.” 

“I represent a small rural district with a response force 

of virtually all volunteers. I am sure there are many 

federal resources available, relative to WMD, 

unfortunately stay[ing] prepared for the common crisis 

seems to keep us busy enough.” 

“...small departments as ours are spread way too thin as 

it is... I wish funding was there to broaden [our view], 

but it is not.” 

“Allow the people who may be in harm’s way initially 

[to] have input in the planning process to develop a 

national response system that makes sense and is not 

driven by politics... When large sums of money are 

available to improve a local situation the usual federal 

and state politics make fair distribution impossible. 

Regulatory agencies made up of responsible local 

responders should be the ones to decide where and how 

monetary or national aid is dispersed.... politicians 

should have no say.” 

“We are a resort community of 40,000 to 50,000 in the 

summer that changes weekly. I feel this makes us 

vulnerable for attack especially biological which could 

be spread as vacationers go home each week.” 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-8-3 

“Military reluctance to provide mapping and (JCIT) 

inter-operable radio for the coordination of consequence 

management activities.” 

“Please bring training & equipment & access down to 

the bottom of the list. Small rural areas need this as 

much as anyone else. Don’t keep everything at such a 

high level that we don’t know about it! ‘Volunteers’ 

have to be able to be incorporated.” 

“Just like most federal projects, the assistance goes to 

major cities and key (political) communities. Most of 

us in the outback receive very little assistance. Some of 

us have major potential problems and are told don’t 

worry it will never happen to you anyway...” 

Law Enforcement 

“Much of the money has been siphoned off to State and 

other entities (like consultants). If there is not enough 

money, give it all to local first responders.” 

“Give more info. and assistance (funds, training, 

equipment) to small budgeted local departments.” 

“A greater effort to make Federal resources available 

and known to local agencies.” 

“The grants being made available through OES are a 

great source for WMD type equipment.” 

“Federal Government should reach out to local police 

agencies to provide information, training and equipment 

procurement data on WMD programs to aid in planning 

and preparing for incidents.” 

“Federal programs often overlook township 

governments. We usually hear of programs after they 

are over.” 

Our organization is very inadequate in training, 

planning, and responding to any WMD incident. It is, 

however, a source of concern for me as there are two (2) 

nuclear facilities within close proximity... As the 

facilities are in rural areas, I would imagine a terrorist 

feeling these ... to be easy targets.” 

“It would be nice to get some training and possibly 

updates.” 

“Federal grant applications are usually complicated and 

too time consuming to complete, especially when the 

grants are generally awarded to much larger 

agencies...” 

“Too many reporting requirements, which is very time 

consuming for smaller agencies with limited staffing 

and resources.” 

“Generally, there are too many ‘strings’ attached to 

Federal grants.” 

“...this is a topic that should be given high priority 

nationwide in both information materials and training.” 

“Being a very small rural police department we feel 

WMD should be in the hands of the military or state 

police agencies or the FBI. Most departments under 25 

members do not have the budget or manpower.” 

“The only WMD training I have heard about is from 

other local agencies. Let us know what is available.” 

“Small communities have very limited resources and 

funding.” 

“The flow of information and communication about 

WMD seems lacking.” 

“Let’s have a focal point for coordination – ” 

“Let’s get on the ball on development of vaccines and 

detection.” 

“Small cities such as this have neither manpower or 

equipment...” 

“Tabletop and field exercises should be done by Federal 

programs like Operation ‘Topoff” at least yearly for al 

MMRS cities.” 

“Federal programs should include local responders in a 

bottom-up/operations focused ‘concept of operations’ 

development process. Local responders need to help 

build training programs and capabilities.” 

“My main schooling and contact Federally to date has 

been with FEMA and their Emmittsburg facility. The 

experience was super. The training was top notch, and I 

strongly support it being continued.” 

Hospitals 

“There is little to no coordination at the federal level & 

too much duplication.” 

“WMD/HM training is very expensive. The 

information needs to be presented in an all hazards 

format to start.” 

“Hospitals often lack the technical resources needed for 

WMD response – especially with civilian incidents.” 

“Information/suggestions need to be sent to all hospitals 

for inclusion in local disaster plans.” 

“I believe it is only a matter of time before a major 

population center is targeted by one of these wackos.” 

“We are a 59 bed, primary hospital... We do not have 

the resources – human and other – to mount aggressive 

programs.” 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-8-4 

“Need to do a better job of disseminating information to 

our hospital on the availability of funding for training, 

equipment and other needs.” 

“Need equipment and stockpiles.” 

“Very few people in local hospitals will ever pay any 

serious attention to WMD issues – other than to request 

financial support that they can divert to other local 

projects... So, WMD is not even a priority when it is 

much more likely that we’ll be hit by a hurricane.” 

“Don’t just offer training to the top 100 cities.” 

“Our hospital does not have the resources and capacity 

to care for our patients on a day to day basis, much less 

prepare for a WMD incident. Get real!” 

“Unaware of any of the programs mentioned [in the 

survey].” 

“While I am in complete agreement that we, as a nation, 

need to be prepared to deal with incidents of terrorism I 

think we need to further exam[ine] the state of our 

emergency systems. This country’s Emergency 

Departments are unable to care for the current load of 

patients in an effective manner and even an epidemic of 

routine disease will overwhelm the system... ...there is 

a profound shortage of nurses as well as space.” 

“A long-term solution should include bolstering of this 

nations emergency systems to integrate preparedness for 

WMD and other events ... of national importance. This 

includes natural epidemics as well as natural disasters.” 

“Need more resources for training and PPE, etc.” 

“We need info – practical, user-friendly.” 

“What programs???”

Local Public Health 

“WMD preparedness is a huge challenge. Capacity of 

local health jurisdiction to respond in a rapid, effective 

fashion will take a major investment in staffing, 

training, and communication systems. This capacity 

can also be used to respond to non-WMD 

communicable disease and environmental toxic effects.” 

“We are a small public health nursing agency. We 

provide nursing care to individuals in their homes and 

various public health programs and activities. We 

recognize that bioterrorism and WMD are issues that 

should involve public health. We would work with 

other county entities should an incident occur. We 

would probably not be the lead.” 

“Our State Health Department HIN and HAN staff and 

web site has been very helpful with linkages to 

resources on WMD bioterrorism, etc. They are my 

connection to everyone else.” 

“Screening tool designed for local health departments. 

Ours is a regional state health department. Our response 

should reflect that.” 

“We have been the beneficiaries of much attention due 

to <<redacted>>, but all exercises and funding have 

either been directed to <<redacted>> City or the State 

agencies. Our valley has 15 cities, all [unreadable] 

dept., so exercises or resources that are not locally 

driven will not meet our needs. We have had numerous

exercises, none of which really tested the total system.” 

“You really need to do more to assure broad local 

involvement and integration.” We recently had a BIG 

FEMMA exercise which was very extensive and 

probably expensive, but it was of little help to us as it 

was not focused on local issues.” 

“Need to develop a family of plans (local, state, 

national) with well developed/clear command and 

control ‘triggers’. Central web site (interactive) with 

funding sources/requirements.” 

“We need to get moving on Smallpox issue.” 

“Small rural counties feel left out. There is no specific 

funding for WMD at the county level. Many local 

agencies see the WMD possibilities as remote. There is 

no state reimbursement for WMD programs.” 

“Our biggest problem is lack of local funding to access 

or send staff to training outside of [our state], and even 

to some courses or exercises within [our state]. 

“Why was this survey geared to health departments? In 

small cities police/fire responsible for this area of 

concern. Our ‘health’ department had no idea what you 

were talking about.” 

“As a county health jurisdiction, the only funding we 

have for WMD is a tiny grant from the state level health 

department for bioterrorism planning, but we have 

major responsibilities in the MMRS planning.” 

“Need more involvement from USDA and Interior (nets, 

lab teams, etc.). Need more web-based training.” 

“Some duplication of programs exists—maintain single 

point of contact for requests re: training, equipment, 

assistance, etc... The culture of public health agencies is 

quite different from the culture of most emergency 

response, WMD agencies. The DOJ training was useful 

in understanding the other culture and recognizing that 

we will have to learn to communicate in their language 

because it will not be their priority to learn our language 

and methods.” 

“Hospitals have been totally forgotten and have not 

received any money for planning or preparedness. They 

are the cornerstone of response to these events. Without 

them the government agencies can’t do anything.” 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-8-5 

“WMD training and equipment are not yet at the local 

level. Supporting public health infrastructure on a 

sustained basis for the 3,000+ counties is the best way 

to help with this potential situation.” 

“Current Federal support is poor—multiple programs 

w/conflicting eligibility factors, differing funding 

streams, poor coordination at the local level. Many 

programs assume that traditional emergency responders 

(e.g., fire departments) will be in the lead on WMD 

events—this is a poor/invalid approach that leads to 

poor planning, local conflicts, and poor resource 

allocation. The real need is to develop general local 

[unreadable] capacity w/flexibility in roles and 

leadership based on the event and its requirements.” 

“The level of clarity and coordination among Federal 

agencies is appalling, and very dysfunctional to 

planning at the local level. For example, it is unclear 

what roles the military, FBI, USPHS, CDC and others 

would take; it is also unclear whether or how they 

would cooperate w/local authorities. Federal agencies 

have put a lot of informal ‘signals’ out in the 

communication environment, but have not explicitly 

defined their roles or proposed actions.” 

“We are unaware of most of the Federal programs you 

mention. Perhaps they are dealing with our state health 

department, or perhaps only with larger jurisdictions. 

At any rate, some outreach to inform us of their 

functions and resources would be helpful.” 

“Our greatest challenge is fulfilling our routine, day-today responsibilities to achieve our basic mission and 

objectives in public health. We do not have enough 

time or staff to do everything we are expected to do. 

This explains the delay in returning the survey. It also 

means we do not have staff with time to devote to 

extensive preparations for a remote possibility, when we 

are overworked trying to cope with reality. We need 

someone to prepare a cookie-cutter, fill-in-the-blanks 

manual, if we are to deal with WMD. Thank you.” 

“Federal programs should support local health 

departments directly for surveillance. Additional 

funding necessary for hospitals/ERs to augment medical 

capacity. Current CDC priorities/budget omits support 

for these critical responders.” 

“We are a small health department, but I think we need 

to think about this potential problem and prepare.” 

“Programs and monies need to be targeted to population 

centers—not arbitrarily to ‘cities’. This has created a 

fragmented less efficient effort in <<redacted>> County 

(pop. ~2 million). <<redacted>> [county] has 40 

municipalities—including <<redacted>> and 

<<redacted>>. Half of the population is left out and the 

funds are not as efficiently expended—the MMRS 

grants from HRSS-USPHS DHHS should have been 

consolidated and funneled at the county level here!” 

“Local health department resources are inadequate to 

perform at the level expected or necessary. CDC 

funding is only barely adequate to provide a statewide 

effort and does not cover any additional resources 

required by local health departments. As far as I know, 

no DOJ funds have been awarded to the state or local 

health departments and I doubt if those who control 

these funds are likely to approve any for that purpose. 

While the potential for bioterrorism may or may not be 

great in this country, the consequences of being 

unprepared are very great. Too many people still look 

on a bioterrorism event as being a variant of a 

HAZMAT one; bioterrorism events will likely be very 

different.” 

“It seems as though funding for these activities could 

help strengthen local health department infrastructure—

so please make funding flexible—and available to 

integrate with other health department activities. We do 

not have the staff or capacity to devote a lot of time or 

staff to this effort.” 

“Our public health staff are overextended so it is 

difficult to train, prepare when staff resources are not 

available.” 

“All available training should be collaborative with 

public health, hospital, EMS primary providers and 

presented as field exercises by FEMA/SEMO.” 

“Turnover of staff who attended training has affected us 

adversely.” 

“WMD training requirements for basic curricula all

levels of health providers—EMT, paramedic, RN, MD; 

requirements for HCFA reimbursement programs, e.g., 

medicare, that all health facilities have WMD 

contingency plans and exercises; JCAHO requirements, 

too; fund excess capacity in the health care system—

somewhere—conus military hospitals? VA hospitals? 

Teaching hospitals? community hospitals?; Improve 

FEMA reimbursement to health institutions for care of 

disaster victims. This would revive NDMS and make 

more potential capacity to care for WMD victims.” 

“Need resources for implementation.” 

“Need the involvement of medical agencies, schools of 

medicine, large hospitals. Physicians are the most 

difficult category of professional to engage in this 

process. They think they are ‘in the know’ but will be 

scrambling when an event occurs. p.s. I am an M.D.!” 

“Need better delineation of responsibility and 

coordination at federal level. Also need to redefine 

programs so that resources go to front line health care 

providers. Current federal policies re: health do not 

direct resources to front (e.g., local) lines. CDC funds 

to states, at least in <<state redacted>>, do not appear to 

have strengthened capacity.” 

“We have attended a number of trainings on first 

responders through local LEPC and the state. The 

training has helped in preparing the local authorities on
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-8-6 

risk and response. These agencies likely have had 

federal or other group sponsors which are not always 

highly credited for their support. We are grateful at the 

local level for training and educational resources. We 

would always welcome funding or financial support to 

advance local preparedness.” 

“Look—we are poorly funded, understaffed, 

overworked, undergoing reorganization and layoffs. 

We have a hard time doing our normal job. I believe in 

WMD terrorism and the like but when we go to training 

we can’t do our normal job. It is very difficult for us. 

You should develop special units within the military to 

deal with the problem and not rely on us to do it for 

you.” 

“We have participated in one full blown exercise at 

<<redacted>>. This exercise involved hazardous 

materials (nerve gas). There is a critical need to 

develop a realistic table top drill for a biological 

weapon.” 

“Much of the district are is rural, low population 

density. There are neither funds nor personnel to 

undertake WMD functions. Staffing is limited as it is 

due to financial constraints; there are few local 

resources available.” 

“Utilize public health’s well established relationship 

with the CDC and funnel all WMD-related activities 

through the CDC rather than having multiple federal 

agencies reaching out to (and confusing) local and state 

public health agencies. The CDC does a great job!” 

“Perceived and real security needs limit the ability of 

Federal agencies and facilities located in <<state 

redacted>> to fully and effectively partner with public 

health entities. The expected wrangling over who’s in 

control looms as a likely problem if an incident occurs.” 

“Because we are small rural health department, we do 

not have resources to provide all needs in time of 

disaster. We rely on taking care of the first 2 hours until 

additional support, advice, expertise, and equipment can 

arrive. We are committed to the safety and well-being 

of our community with the information and equipment 

we have.” 

“Need education for bio terrorism, plans for quarantine 

and mass burial, surveillance system for bio terrorism 

detection of index cases, and epidemiological training 

for outbreak investigation.” 

“The non-bio preparation is very distracting to bio 

preparedness. Bio required epidemiologist not first 

responder activities. I assume bio attack will be covert. 

Our preparedness for bio attack comes from routine 

communicable outbreak investigations (TB, measles, 

pertusiss). We need training and support that bio attack 

will be similar but on a massive/lethal scale. The key is 

that bio and to some extent chemical (VX nerve agent) 

is communicable and may require quarantine. Since 

anthrax is not communicable, please stop using this as 

an example of a bio attack. Plague or virulent flu is 

better.” 

“Conference/lectures have been very good about telling 

us what WMD are and that we should be prepared and 

coordinated. What they lack are real nuts and bolts of 

‘how to.’ How about sample protocols, etc, list of 

needed equipment and list of potential resources.” 

“The next generation of attention should include 

expansion and refinement of informatic networks 

locally, statewide and nationally. Telemedicine 

capabilities should be additionally included as a 

component of future planning. Pursuing technological 

development at the behest of Federal funding to 

facilitate rapid identification of threat agents...could 

serve to save lives.” 

“The roles and value of including Federal agencies, 

such as FBI, DOD, and CDC in support of locally based 

leadership has become more clearly defined as WMD 

scenarios have been exercised in a spirit of multilevel 

cooperation.” 

State Public Health 

“Federal programs need to address the reality that most 

BT-assigned health department personnel are tasked 

with other jobs. So there is a conflict between planning, 

training, and drilling for a contingency (e.g., BT attack) 

and maintaining/improving ‘bread and butter’ public 

health programs that address prevalent existing 

problems (e.g., hypertension.”)” 

“If first responder funds during the last five years had 

been spent on state and local health infrastructure the 

nation would now be better prepared to respond to 

WMD incidents.” 

“Absolute need to target states (such as ours) that have 

been completely left out of Nunn-Lugar-Domenici 

funding.” 

“Our state is very densely populated and yet has had no 

Nunn-Lugar funding, has no NDMS, no HHS-MMSS, 

no full-time WMD-CST (NGB). As a result, we are 

years behind our neighbor states with respect to 

planning and resources for WMD preparedness. 

Doesn’t anyone at the federal level care about our 

state?” 

“The biggest problem is the CDC and other programs, 

not working with the established emergency 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-8-7 

management systems. We use the Federal Response 

Plan as our model in developing our state plan.” 

“Feds need to coordinate themselves!!” 

 “The missing element within the CDC program is the 

low priority placed on planning and preparedness 

capacity for WMD at the State level. We are already 

stretched thin for natural and existing man-made 

disaster. Working on WMD issues requires more staff 

time and resources in putting together a NEW program. 

CDC has only strengthened existing programs, i.e., EPI, 

HAN, LABS, and not supported integration and 

coordination for state agencies and myriad of private 

entities.” 

“We have learned that certain lobby groups are good at 

getting money (esp. fire and law enforcement) resulting 

in a disproportion of asset allocation in communities. 

The end result of a terrorist event is that people get hurt, 

become ill or are going to be chronically affected and 

under current conditions will receive inadequate 

medical and health care.” 

“Only a small percentage of federal aid currently is 

directed at health agencies, mostly going to 

police/fire/HAZMAT. The health department role is 

larger than the funding available.” 

“Model plans would be helpful; model information for 

public information needed; more emphasis on 

empowering the citizen to mitigate spread, damage, etc.; 

more consideration of distribution of meds rapidly than 

remove traditional ‘gatekeeper’ who will slow 

distribution.” 

“Hospitals are max’d out already. No ‘slack’ to plan, 

exercise, etc. Regional groups hold promise for 

especially large states like <<state redacted>>. Many 

exercise participants assume much greater medical 

military assets than presently exist. VA system is not 

well integrated into state plans (states’ responsibility to 

do this). Need to address psych/mob/panic issues.” 

“Better coordination between Federal programs would 

ultimately lead to better coordination of state and local 

level. A clear declaration of mission, goals and 

objectives communicated between Federal programs 

and directed and communicated to State agencies would 

help to synchronize the programs.” 

“While those of us studying and working in the field of 

terrorism preparedness and response understand the risk 

and place a respectable priority on planning, many 

public health and health system administrators do not. 

Federal leaders must stress the importance of 

reasonable, common sense planning for each 

community.” 

“The National Guard CST is of very limited use for our 

needs. The money spent could be better used for 

state/local support. These response teams will not be 

timely or helpful.” 

“Supplying each state health department with 

[unreadable] protective equipment and monitoring 

devices would be helpful. Supplying data and material 

for the collection and shipping of samples to 

laboratories would be of assistance.” 

“Coordinated clearinghouse for support (funding, etc); 

One number to call up agencies for response (~911); 

limit funding for ‘new’ technology and begin supporting 

program development and expansion—i.e., fund 

maintenance of programs and people not just computer 

systems and hardware (non-computer) items such as 

equipment.” 

“Better coordination among federal agencies and better 

communication with state and local government.” 

“WMD activities should be in a separate cabinet level 

agency, not buried within FEMA or FBI, for example. 

The medical community must be trained and be given 

the necessary resources to deal with a large scale event.” 

“Continue funding for personnel positions that have the 

dual-use roles of terrorism preparedness and general 

public health response.” 

“Feds need much more coordination, for funding, 

response, information, etc.” 

 “A great help would be for issues of response to be 

worked out at the federal level, example: ‘what level of 

personal protection is needed in an anthrax threat 

situation?’ We have had health people and local 

responders attend federal training and get different 

answers. This should not have to be resolved in each 

locality.” 

“There is a fractured approach to ‘bioterrorism’ at the 

federal level leading to a fractured response at the state 

level. There are events which occur (vinyl chloride 

finding in drinking water, industrial chemical exposures, 

chemical spills w/health effects, etc.) which require the 

same government response as if it were a conventional 

‘bioterrorism’ activity. Thus, I believe the bioterrorism’ 

definition should be broader. i.e., the event which due 

to its severity, size, location, actual or potential impact 

on the public’s health or welfare or the necessary 

response effort is so complex that it requires 

extraordinary coordination of federal, state and local 

resources.” 

“More training is needed to help prepare local 

medical/hospital groups.” 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-8-8 

Local EMS 

“Provide better access to: funding, training, 

information.” 

“Healthcare is being strangled by funding cutbacks 

while the expectations of us are increasing—we are 

lucky to still provide our traditional role of showing up 

for a heart attack. Medicare reimbursements are down, 

HMO’s will not approve transports, etc. This forces 

hospitals & EMS systems to do more with less and the 

result is a loss of flexibility. . . We are in a crisis from a 

simple flu epidemic and the Feds want us to be prepared 

for WMD??? ... It is time the U.S. government agencies 

realize that we are concentrating on survival—not 

preparing for WMD.” 

“[WMD is] not a big threat overall and [we] don’t know 

where to start.” 

“More training programs geared for EMS, not geared 

for fire department with EMS assistant.” 

“We need more awareness and the availability for more 

hands on training.” 

“We feel very unprepared to handle WMD incidents due 

to lack of training in that field.” 

“Most volunteers in small rural or semi-rural 

departments do not have the background, the expertise, 

to fully absorb and/or use the type of information being 

given out by Federal organizations. Many do not know 

what information is available to them nor how to 

request it and from whom. If they do receive booklets 

or information, it seems to be geared toward large 

departments in large cities with a great deal more 

equipment to handle large disasters. It is difficult for 

smaller communities to relate to most of the 

information—the ‘it can’t happen here’ syndrome... 

terrible things can happen in small communities as well 

as large cities. Suggestions: (1) Several relatively 

simplistic examples of basic preparedness guidelines / 

SOPs for today... Emergency plans in some 

communities date back to the Cold War; (2) Examples 

of exercises for mutual aid communities with small 

departments would also be helpful. Don’t just tell them 

to hold them, tell them how; (3) Booklets discussing 

basic equipment that small departments should have or 

have access to... Volunteers are very capable of doing 

many things and are wiling to give their all, they just 

may not have the type of training necessary to initiate 

disaster preparedness guidelines for WMD and could 

use some help with the paperwork. Help to get things 

set up—then they will run with it.” 

Regional EMS 

“Training should be provided for all emergency services 

providers no matter what the populations size is.” 

“Biggest need is disseminating information about 

available programs (training, information, and 

equipment).” 

“We need help to buy equipment and supplies.” 

“Many of our corps are volunteer and either do not have 

the time or staff to participate in these exercises.” 

“Generally, numerous federal efforts need to be 

consolidated and centrally coordinated.” 

“Coordinate on a regional level (planning districts) for 

more effective planning.” 

“Federal agencies should investigate the regulatory role 

of EMS agencies in California so monies can be better 

disseminated between first responders and transport 

agencies.” 

“Coordination between MMRS and DOJ programs is 

poor.” 

“Incorporation of hospitals/other medical facilities 

within WMD is poor -> most plans do not cover this 

well.” 

“Too much repetition and cost to re-develop same 

training programs under a different federal logo... 

Money would be (much) better spent in equipment and 

intelligence systems.” 

“A summary or compendium of what is available and to 

whom would be helpful.”

State EMS 

“The common complaint about the Feds is “who is 

running the show?” DOD, DOJ, CDC, FEMA... There 

needs to be a clear lead—and the rest need to get off of 

the front pages... but don’t get their letterhead into the 

local arena—it only created confusion. Also, many lead 

state EMS agencies only do licensing and certifications, 

but are positioned within the government to do much 

more with all [unreadable] coordination.” 

“I would like to see Federal funding for an FTE for 

Emergency Planning at each State Department of 

Health. I see that as the biggest shortfall in our 

health/emergency medical preparedness.” 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-8-9 

“...need to understand that most state-level planning and 

preparedness activities generally follow an ‘all-hazards’ 

approach and as such may not specifically address 

WMD issues, but they are covered nonetheless.” 

“Be aware that all WMD events are local events with 

national ramifications. They can be most successfully

addressed by local responders who are properly trained

and equipped and who deal with hazardous chemicals, 

explosives, biological outbreaks (flu)... federal 

resources can assist them in their efforts but never 

supplant them.” 

“Federal agencies, especially the FBI, are never good 

about sharing threat information with the local agencies 

that have a legitimate ‘need to know.’ Yet these are the 

very people upon whom ‘the feds’ must rely if a WMD 

incident actually occurs. The FBI always wants 

information from the locals, but rarely shares what it 

knows with local law enforcement, much less the local 

EMS agencies or hospitals.” 

“Move faster. Require tighter timeframes for state 

planning and implementation activities.” 

“We need a clear definition of the roles of the various 

Federal agencies involved in WMD. It is not possible 

for us to discern a consistent national strategy to deal 

with WMD events. I hope national WMD strategy is 

not as confusing to Federal agencies as it is to us.” 

“OEP/HHS , including NDMS, NMRT, etc. should be 

given greater responsibility for WMD, building on its 

disaster preparedness activities.” 

“Focus less attention on the urban areas and start 

looking at suburban/rural America!... The Feds need to 

see WMD as a public health problem as much as a 

public safety problem.” 

“Consolidate for one-stop shopping.” 

“The public is not well addressed (information, 

improvement to manage risk, understanding event, 

assessing impact in chem/bio scenarios). We must do 

this or our job will be even greater.” ... “No good plan 

yet exists for distribution of pharmaceutical 

stockpiles.... [or] to address mental health aspects of 

WMD.” 

Local OEM 

“National pharmaceutical stockpile does not, in my 

opinion, address the needs of major cities at this time. 

Responses of C.D.C. stockpile personnel at our recent 

exercise clearly indicate a need to revise the program. 

Simply put, <<redacted>> should have a push package.” 

“There are so many challenges in preparing for 

domestic terrorism that it would be impossible to 

address [presumably in the small comment space 

provided with the survey]. The bottom line is that local 

governments and organizations do not have the 

resources to adequately address WMD and build upon 

what is already in place...” 

“More Federal money needs to be spent at the local 

level rather than being scarfed-up by bickering Federal 

agencies. Get some WMD policy coordination going at 

the Federal level.” 

“The FBI has come around very positively in working 

with locals in our area.” 

“I believe that federal money could best be used in 

maintaining fast response (regional) teams. They could 

be well trained and equipped to handle WMD situations. 

Simply granting out money to separate counties would 

never get them fully capable of handling any WMD 

situation.” 

“Most of the federal attention in this area has been on 

<<large city name redacted>>. In unincorporated 

<<redacted>> County, we have a population of well 

over 1 million, as well as the majority of large chemical 

complexes. We are told if we have an incident we 

should call on <<large city>>. That theory is fine if 

emergencies respect jurisdictional boundaries. Since 

they don’t, and a large-scale incident is likely to impact 

City and County, the City will have the capability to 

respond while the County’s capabilities are nil. 

Someone needs to figure out that the rest of us are out 

here.” 

“Consolidate and find direction.” 

“The Federal government must begin to use the Incident 

Command System if they wish to be effective. 

Currently they just talk ICS.” 

“...rural jurisdiction[s] are not often considered when 

we think of WMD, however there are many chemical 

and biological incidents we could be the starting point 

for.” 

“Make information available to local emergency 

managers.” 

“Federal agencies need to listen to local jurisdictions as 

to their needs, not perceived needs.” 

“WMD program needs to be under one (1) agency, not 

‘farmed’ out to multiple federal, local, special interest 

groups.” 

“There appears to be a alphabet soup of Federal 

organizations that offer grants, each grant having 

different rules. We need one Federal agency to be in 

charge of all grants and they need to be funneled 

through the states.” 

“DOJ computer system sucks.” 

“CDCs pharmaceutical stockpile program and release 

procedures are seriously FLAWED—will not work.” 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-8-10 

“...the grants to states is a total failure. My county 

developed a plan and time line to bring 4 agencies to the 

highest level of preparedness... We received 2 

successive years of DOJ equipment funding. Since the 

states are now involved we have not received any 

funding. Our plans have stopped.” 

“...too many federal agencies are involved, too much 

money is being given to federal agencies.” 

“A total lack of coordination and control exists at the 

federal level.” 

“Too many courses are being developed which conflict 

with each other.” 

“There is a dire need to a national strategy or a ‘WMD 

czar’... An across the board response strategy needs to 

be developed and disseminated.” 

“Hospitals are the weak link. They will be 

overwhelmed yet nothing had been done to encourage 

them to take any steps that will work.” 

“We have learned that when the Feds pass legislation 

and finally fund it, they never pass this funding down to 

where it is needed. Where is the year 2000 and 2001 

money??” 

“There is a need for 1 source at the Federal level to 

manage the program.” 

“All Federal funds/training/equipment needs to come 

through the state’ not directly to local government.” 

“There is so little funding at the local level, that I cannot 

even send representatives of other response agencies to 

get training. I haven’t to funding for basic needs like 

food and lodging, and mileage for these other 

providers.” 

“It is my...belief that the Feds should direct their 

programs at the local level, and bypass the state.” 

“Ensure all information is reaching the local level in a 

timely manner.” 

“The FBI has been extremely helpful and cooperative in 

explaining what should be done by the community and 

what we can expect from the FBI.” 

“A standardized threat assessment process should be 

adopted by the agencies involved in WMD funding.” 

“The WMD assessment what lengthy and hard to 

understand. The asking of forecasting needs 3 years 

into the future without knowing what would be 

approved in the first two years made completing this 

task very difficult.” 

“Programs provide training and equipment only. Our 

need is for ongoing funding for personnel to administer 

programs and for replacement of pharmaceuticals and 

equipment.” 

 “Funding of and the reliance on National Guard 

response teams for initial response to WMD incidents is 

not adequate to protect our citizens. Funding should be 

supplied to existing police and fire agencies who are 

going to be the first responders to all WMD incidents.” 

State OEM 

“There seems to be little or no attention toward the 

need for refresher training and new personnel 

training.” 

“Need is for significantly entangled coordination 

among congressional committees to prevent 

conflicting efforts, duplication or expenditures.” 

“[unreadable; probably something like eliminate] the 

expenditure of funds to ‘beltway bandits’.” 

“Cabinet level Czar for terrorism with funding 

guidance/control of participating agencies 

involvement. Would require a national fenced 

budget for terrorism with decentralized executation 

by departments following czar’s funding guidance. 

Czar must have the hammer to affect departmental 

cooperation much as the CJCS now has over Service 

budgets. Consider placing FEMA in charge of all 

consequence management funding to include the 

current OJP equipment program. FEMA has a longer 

history of funding states through EMAs. Explore 

methods to improve crisis management response 

capabilities by civilian agencies to preclude 

defaulting to ‘militarizing’ consequence responses. 

... FBI cooperation in threat assessments must be 

mandatory—not voluntary. Means changing WMD 

coordinators roles to primary jobs—not listing them 

as additional duties. DOJ training contractors must 

work through the state EMAs to fill classes—not deal 

directly with hospitals, fire companies, etc. 

Recommend national registry of specialized 

equipment vendors with online contact information. 

Same for planning and training contractors. Solve 

the problem of sharing appropriate intelligence trends 

and emergency information to consequence 

management agencies from state to county levels. 

The President must publicly push terrorism 

awareness. Most governors will not take the lead on 

their own. Beneficial spin-offs from counterterrorism 

preparedness should be stressed, e.g., public health 

disease surveillance, R&D on detection, drugs, 

antidotes, etc. Legislature standards of compliance 

for cyber protection by government, business and 

industry. Continue/expand tax incentives for 

terrorism by the television and motion picture 

industries. Increase funding for U.S. Customs 

inspections at ports of entry.” 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

G-8-11 

“The more strings that are attached to federal funds—

the less useful they become.” 

“The COBRA training program at DOJ’s Center for 

Domestic Preparedness is very highly rated by all 

state and local preparedness who attend from our 

state. Several key staff from state agencies (police, 

health, national guard, emergency management) 

participated in the TOPOFF exercise in Portsmouth, 

New Hampshire in May, 2000. The experience was 

VERY helpful to understand local-state-federal 

response to WMD.” 

“FEMA’s terrorism planning grants which are 

supposed to result in state and local WMD response 

plans being developed in a short period of time for a 

small amount of money are particularly naive. 

Development of comprehensive WMD response 

plans for an exotic terrorist attack... is a very complex 

undertaking which raises numerous controversial 

issues.” 

“There are so many different programs that it is 

impossible to make reliable judgments on which ones 

to take advantage of.” 

“The response time for federal assistance teams is too 

long for them to make a difference...” 

“CWIRP results not well marketed to the Nation.” 

“The Federal WMD funding is going to many nonstate [chem/emergency response/bomb] teams 

duplicating much of the current state response 

systems. States have been left out of the MMRS and 

120 cities program making for a difficult response 

network with no one leading the effort... Many of the 

federal training programs are the same thing with a 

different name, created by different contractors... 

state and local government have been left out of the 

process... We have asked for technical assistance and 

are yet to see any help!” 

“Extremely rural areas... cannot be assessed, 

analyzed or dealt with the same as other urban, 

suburban or rural areas and by trying to make it fit, 

no one wins.” 

“Absence of a single federal agency for combating 

terrorism (initiative to redefine FEMA’s role is not 

the solution.)” 

“Give the preparedness role to FEMA, or to an office 

in the White House. DOJ should not have any role in 

consequence management.” 

“One single federal point of contact. Study to 

measure effectiveness of current programs, 

integrating state EM office as a broker for local 

governments.” 

“In too many cases, Federal programs completely 

bypass the state. This confuses and complicates the 

state’s efforts to build a comprehensive response 

strategy... there are too many programs, and most 

ignore the states efforts.” 

“The SBCCOM program did nothing for the state 

other than allow some limited, individual training. 

The Equipment Procurement Grant has been too 

narrowly focused, again, ignoring the state’s attempts 

to develop a statewide response capability.” 

“All [Federal] actions should be directed towards 

multi-hazard incidents. Same people will be 

involved for flood, fire, tornado, bombing, etc.” 

“A national strategy is needed. A single coordinating 

agency is needed for all Federal programs. Would 

like to see more emphasis on programs/training for 

hospitals related to potential WMD incidents.” 

“[Our organization’s experiences involving Federal 

WMD programs] have resulted in improved working 

relationship w/FBI offices in the State—good for 

state agencies and good for locals.” 

“It seems all the federal WMD programs are 

developed to help the larger community. It does not 

appear the programs have been adapted to meet state 

needs and issues.... All the federal programs are 

designed to provide support and training for 

individual communities—not how a state government 

should plan a response.” 

“One of the most significant shortfalls in the WMD 

training arena is the area of sustainment of 

proficiency among emergency responders.... while 

the train-the-trainer approach is the ultimate solution, 

courses provided by the CDP, N-L-D, LSU, etc...do 

not truly qualify attendees as ‘WMD experts’ or 

‘WMD trainers’.” 

“..the training provided via CDP, NTS, and other 

consortium members is excellent. The number of 

seats provided to states, however, are far too limited 

to begin to meet the demand. Propose that the 

consortium of National Training Centers focus on 

specialized WMD courses and that the WMD ‘Basic 

Track’ (e.g., Awareness—Operations—Technician—

Incident Command) be left to the States to 

administer.” 

“Emergency responders are often confused regarding 

which training to attend. Formalizing training 

standards and implementing accreditation to certify 

training institutions would bring increased 

standardization to the WMD training arena.” 

“We do not need DOJ/OJP to tell us how to do 

exercise development and evaluation. FEMA has 

taught us how to do this years ago. States need to 

administer this program at the state level, not directly 

from fed to locals.” 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

H-1 

APPENDIX H—HARVARD EXECUTIVE SESSION MEMORANDUM, 

“INTERGOVERNMENTAL DIMENSIONS OF DOMESTIC PREPAREDNESS” 

Memorandum 

To: The Honorable Tom Ridge, Office of Homeland Security 

From: The Executive Session on Domestic Preparedness, John F. Kennedy School of 

 Government, Harvard University 

Date: November 2, 2001 

RE: INTERGOVERNMENTAL DIMENSIONS OF DOMESTIC PREPAREDNESS

Attached please find a memorandum titled “Homeland Security: Domestic Preparedness After Sept. 

11, 2001.” The memorandum was produced by the Executive Session on Domestic Preparedness, a 

working group of domestic preparedness specialists, elected officials, federal agency 

representatives, and academics that convenes semi-annually at the John F. Kennedy School of 

Government, Harvard University. 

The memorandum highlights issues of particular importance to practitioners at the state and 

local level. The ideas put forth in the document have emerged from several meetings of 

Executive Session members, all of whom are engaged in some aspect of domestic preparedness. 

The members and staff of the Executive Session on Domestic Preparedness are ready to explore 

any issues of interest to the Office of Homeland Security as it undertakes the challenge of 

coordinating domestic preparedness efforts across the country.

cc: Senate leadership 

 House leadership 

 Select committee members 

A Joint Program of the Robert and Renee Belfer Center for Science and International Affairs 

And the A. Alfred Taubman Center for State and Local Governments

EXECUTIVE SESSION ON DOMESTIC PREPAREDNESS

79 John F. Kennedy Street

Cambridge, MA 02138

Phone: 617-495-1410

Fax: 617-496-7024
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

H-2 

Homeland Security: Domestic Preparedness After Sept. 11, 2001 

As the Office of Homeland Security begins to assemble resources to coordinate the nation’s 

counterterrorism efforts, challenges for adequate domestic preparedness will inevitably emerge. 

This memorandum highlights issues of intergovernmental relations that are of particular 

importance to state and local practitioners. 

The Executive Session on Domestic Preparedness (ESDP) is a standing task force of senior 

practitioners and academic specialists who have been working together for two years on issues of 

terrorism and emergency management. The ESDP brings together experts with operational 

experience in diverse professional fields related to domestic preparedness – emergency 

management, law enforcement, fire protection, public health, emergency medicine, national 

security and defense, and elected office – to develop practical recommendations for 

policymakers and practitioners at all levels of government. 

Federal, State, and Local Roles 

The responsibility for preparing for and responding to a catastrophic terrorist attack is shared by 

the federal, state, and local governments. Nevertheless, local practitioners will almost inevitably 

be the first responders following a WMD incident. Much of this has to do with proximity: 

federal personnel cannot be in all places at all times. In general, it takes federal assets at least 

four hours to assemble at a disaster scene; it may be several days before the full panoply of 

federal resources are mobilized and transported to the scene. In addition to their proximity to the 

attack site, state and local agencies already have institutional infrastructure and equipment in 

place for responding to natural and man-made disasters, which can be leveraged for responding 

to terrorism. Still, state and local governments rely on the federal government to develop 

national priorities, assist state and local governments with threat assessments, determine gaps in 

national preparedness, and provide technical assistance and specialized resources for state and 

local planning that meets national priorities. In addition, contentious issues such as funding – 

which have become more critical since September 11, with state and local governments devoting 

massive resources to protecting citizens and potential targets, responding to threats and hoaxes, 

and bolstering preparedness – must be addressed at the federal level. Nationwide priorities must 

be clearly established so that training; equipment, and resources can be properly targeted to 

fulfill state and local needs. 

This memo, therefore, identifies the key issues that the Office of Homeland Security will need to 

address as it works with state and local officials. From our unique vantage point, the ESDP has

2 

EXECUTIVE SESSION ON DOMESTIC PREPAREDNESS

79 John F. Kennedy Street

Cambridge, MA 02138

Phone: 617-495-1410

Fax: 617-496-7024
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

H-3 

focused on three major issues of particular importance to state and local governments that are 

working toward achieving domestic preparedness: prevention, preparedness, and sustainment. 

Prevention 

The shock of September 11 starkly emphasized the need to improve America’s ability to deter, 

prevent, or interdict an attack. Many of the prevention techniques that are already in place can be 

enhanced through intergovernmental and interagency cooperation. 

Focus on terrorism. All law enforcement agencies must work together to strengthen the 

interagency and intergovernmental focus on terrorism. This may be easier for large cities 

such as New York or Washington, D.C., which have been aware of, and preparing for, the 

threat of terrorism for years. For many other jurisdictions, the threat of terrorism remains 

relatively low on the spectrum of public safety priorities. Only by establishing relationships 

and sharing information can law enforcement and intelligence agencies properly identify and 

prioritize security threats for specific communities. One avenue for relationship building is 

the FBI’s counterterrorism task forces, which are active in approximately thirty-five 

metropolitan areas. Similar initiatives need to be established around the country, to address 

the needs of large and small jurisdictions alike. 

Investigative techniques. Federal and local law enforcement agencies have very strong 

specialized capabilities to investigate crimes after they occur; yet they are less specialized 

when it comes to preventing crime. Therefore, dedicated terrorism prevention capabilities, 

including law enforcement agents, analysts, and interpreters, should be utilized to gather and 

assess information, without being distracted by other investigations. Intelligence and law 

enforcement personnel working on counterterrorism matters should also receive special 

training on working with their communities regarding civil rights and civil liberties concerns 

that will be of particular import to their work. 

Information sharing. There is an inclination to withhold information either for security 

reasons or because information may be unconfirmed or incomplete. Lack of established 

relationships and trust, and differences in organizational cultures, also stymie the flow of 

information. Timely information sharing among federal, state, and local authorities, however, 

is critical to preventing or interdicting an attack. Federal agencies must share crucial 

intelligence with state and local responders who will be “on the ground” if a disaster strikes. 

Reciprocally, federal law enforcement agencies need to know what local law enforcement or 

public health officials may be investigating as suspicious. This approach to information 

sharing must be systematic, not ad hoc; certain situations should automatically trigger formal 

information sharing. Memorandums of understanding and regular working relationships can 

help break down historic communication divides. 

Public health infrastructure. Improved monitoring and surveillance are essential to detect and 

identify a bioterrorism attack or a naturally occurring emergent infectious disease, and 

quickly mitigate the impact of an outbreak. Public health agencies need more resources to 

improve infrastructure, especially to take advantage of advances in telecommunication and 

information technologies. Hospitals and public health laboratories need the capacity (lacking

3 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

H-4 

in many facilities) to assist public health departments by testing specimens in times of crisis. 

Staffing levels and skills may not be appropriate to meet the challenge of a natural or 

intentional disease outbreak and must therefore be reevaluated. In addition to revitalizing the 

core surveillance and detection capabilities of the public health system, the government 

needs to facilitate dissemination of information among health care professionals and the 

public, taking advantage of new media such as the Internet. 

Legal authority. Federal, state, and local authorities need to ensure that adequate legal 

authority exists to prevent or address a catastrophic terrorist threat or attack. Many existing 

statutes establish aspects of legal authority; however, significant gaps remain. Vague, 

outdated, and contradictory laws; overlapping jurisdictions; and procedural and professional 

divides among law enforcement, national security, and public health officials have created a 

confusing set of laws that do not conform easily to the needs of terrorism response. Advance 

legal preparation is an integral aspect of a comprehensive national domestic preparedness 

program. 

Preparedness 

Unfortunately, every attack cannot be prevented. In the aftermath of the attack on the World 

Trade Center, the first priority was to rescue as many victims as possible. Miraculously, response 

personnel were able to pull survivors out of the rubble. It was in those first minutes, hours, and 

days that rescue workers had the greatest opportunities for mitigating the impact of a disaster by 

saving lives. After several days of rescue efforts, the focus turned to recovery –which is 

primarily the responsibility of state and local governments – including removing debris, 

identifying victims, and cleaning up surrounding areas. Because time is of the essence, 

particularly when it comes to rescue operations, agencies across geographic and political strata 

must be prepared to respond rapidly to a crisis and integrate their capabilities with those of other 

responding agencies. 

Domestic preparedness relies on cross-jurisdictional and cross-professional cooperation and 

coordination between agencies, non-governmental private and not-for-profit organizations, and 

levels of government that are not accustomed to working together. This is crucial in planning and 

in response. 

All-hazards disaster management. Where possible, domestic preparedness should rely on the 

existing systems of disaster management. Training and the construction of systems that have 

the ability to respond to more routine emergencies, but that can “flex” to address larger or 

unconventional emergencies are the best investment of a jurisdiction’s resources. By utilizing 

this approach, response agencies will use plans and skills regularly, thus ensuring that 

agencies are well versed in response protocol, and experienced in working together. This 

will make it easier for various agencies to collaborate should they need to respond to a 

terrorist incident. 

Medical surge capacity. Surge capacity is the ability of the healthcare community to handle 

an abnormally large influx of patients. In the past decade, managed care and other health cost 

containment strategies have diminished the reserve capacity of our nation’s health care

4 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

H-5 

 system. Because of inadequate surge capacity, appropriate medical care for victims of mass 

casualty incidents is far from guaranteed. Government regulations attempt to remedy this 

problem by requiring that hospitals have sufficient numbers of personnel to meet patient 

needs for emergency care. Such mandates, however, are vague, unfunded, and do not apply 

to laboratories, public health officials, or ambulatory providers – groups that are vital in a 

mass-casualty event. Therefore, the country needs to think about nontraditional ways to 

buttress medical surge capacity, including non-hospital alternatives. Possibilities include 

bringing the military, with field medical facilities, or Veterans Hospitals into response 

planning for a major attack; developing reciprocity agreements (including liability and 

worker compensation issues) among states for licensed professional personnel; utilizing 

gymnasiums, armories, and other facilities for mass-casualty incidents; and networking with 

home-healthcare providers. 

Standardized operational management. When multiple agencies – which may or may not be 

familiar with one another – respond to a disaster, their management systems need to be 

highly integrated to avoid confused, delayed, or redundant response efforts. A paradigm of 

operational command known as the incident management system (IMS), used by the fire 

service since the 1970’s, is beginning to be widely adopted by other state and local response 

agencies. Efforts to standardize incident management methodology across professions and 

levels of government should be pursued. 

Training and technical assistance. The federal government has served a central role in 

providing assistance to state and local first responders to better prepare them to address the 

terrorist threat. Four principles should guide these efforts: 

Wherever possible, training and technical assistance should reinforce an all 

hazards approach to disaster management; 

First responders need specialized training in recognizing and treating victims 

exposed to chemical, biological, and radiological weapons; 

Diffusion of skills to more jurisdictions and professions is essential; and 

Training must be sustained over time so new personnel are familiar with the 

protocol and trained personnel do not forget skills. 

Communication infrastructure. Communication systems need to be improved in two respects: 

capacity and interoperability. In any major disaster, communication systems are pushed to or 

beyond their maximum operating capacity. Telephone lines must be up and running, 

however, if responders are to communicate and victims and concerned parties are to access 

crucial information. Thus, communications capacity must be expanded in order to function 

effectively in a disaster. In addition, backup communication systems should be in place to 

meet the operational needs of first responders. 

Interoperability is a second concern: telephones, radios, and walkie-talkie systems used by 

emergency agencies are not always compatible and responders cannot communicate with one 

another. Universally accepted interoperability standards and equipment are needed so that 

radio and telephone communication can take place between responding units. 

Public Affairs. The role of a public affairs strategy before, during and after a terrorist attack 

is also critical. Concerned citizens turn to the media for information, reassurance, and

5 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

H-6 

critical advice. The media must fill a 24-hour news cycle. If public affairs liaisons are not 

identified, or if those individuals fail to contribute effectively to news coverage, reporters 

will be forced to look elsewhere for information. Elected officials and response agencies 

alike must develop public affairs strategies before a disaster occurs. During a crisis, 

government officials need to provide a clear and consistent message to the public. 

Sustainment 

Although there is almost universal support for expanded emergency preparedness and 

counterterrorism programs in the immediate wake of the attack on the World Trade Center and 

the Pentagon, this support could wane over time. We must view domestic preparedness as a 

continuing public necessity, rather than only a response to a specific incident. Thus, as capacity 

is expanded, there needs to be forethought as to how this new capacity will be sustained if we 

manage to deter or prevent future attacks. Sustainment is vital at both the operational and 

programmatic levels. 

Operational sustainment. Sustaining operational capabilities is a challenge because given the 

relatively low probability that terrorism will affect any single location, equipment specific to 

domestic preparedness will not be frequently used and may suffer neglect. The best way to 

circumvent this scenario is to build on the all-hazards approach wherever possible. Training 

and equipment will be used in regular operations and therefore will be maintained. For 

WMD-specific training and equipment, federal, state, and local governments should explore 

cost-sharing incentives so that the responsibility for training is properly distributed and can 

be sustained over the long-term. 

A sustainment initiative must also recognize that as personnel enter and exit the system, 

skills are lost and must be restored. Thus a unit that is certified as “prepared” at one point in 

time may lose a critical mass of trained individuals and thus be effectively “unprepared” 

weeks, months, or years later. Moreover, skills – like equipment – degrade over time if they 

are not routinely used. Building on the all-hazards approach, and exercising skills specific to 

terrorism or WMD response, is essential to sustaining readiness of personnel 

Programmatic sustainment. Sustainment is also an issue at a policy level. If the U.S. is 

successful in preventing further attacks, the dedication of resources the domestic 

preparedness program may be called into question. A long-term strategy and system of 

accountability will lead to the program’s overall success. 

The challenges facing the federal government in the wake of Sept. 11, 2001 are extremely 

complex. There is a military response to be waged, a major criminal investigation to be 

concluded, intelligence to be deciphered, an international coalition to be maintained, and a 

money trail to be followed. Homeland Security is just one piece of a very large puzzle. 

It is, of course, a very important piece. Effective collaboration among levels of government – 

each drawing on distinctive strengths – is necessary for the United States to prepare for the 

spectrum of threats it faces. 

6 
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction

H-7 

This document represents the consensus view of the Executive Session on Domestic 

Preparedness, but the totality of the ideas and recommendations included herewith do not 

necessarily reflect the views of each member. 

Executive Session on Domestic Preparedness 

Members 

Graham T. Allison 

Professor of Government and Director, 

Belfer Center for Science and International Affairs, 

Kennedy School of Government 

Alan Altshuler 

Professor of Urban Policy and Planning and Director, 

Taubman Center for State and Local Government, 

Kennedy School of Government 

Joseph Barbera 

Clinical Associate Professor of Emergency Medicine, 

George Washington University 

Peter Beering 

Indianapolis Terrorism Preparedness Coordinator, IN 

Thomas N. Burnette, Jr. 

Lieutenant General (Ret.), Former Deputy Commander in 

Chief, U.S. Joint Forces Command, VA 

Ashton B. Carter 

Professor of Science and International Affairs, 

Kennedy School of Government 

Hank Christen 

Emergency Response Consultant, 

Unconventional Concepts, Inc., FL 

Rebecca Denlinger 

Chief, Cobb County Fire Department, GA 

John Fenimore 

Major General (Ret.), Adjutant General, 

New York National Guard 

Ellen Gordon 

Administrator, Iowa Emergency Management Division 

Margaret Hamburg 

Vice President for Biological Programs 

Nuclear Threat Initiative, Washington, DC 

Clarence Harmon 

Former Mayor, City of St. Louis, MO 

Francis X. Hartmann 

Executive Director, Program in Criminal Justice Policy/ 

Management and Malcolm Wiener Center for Social Policy, 

Kennedy School of Government 

Philip Heymann 

Professor of Law, Harvard Law School 

Arnold M. Howitt 

Executive Director, Taubman Center for State and 

Local Government, Kennedy School of Government 

Juliette Kayyem 

Executive Director, Executive Session on Domestic 

Preparedness, Kennedy School of Government 

Thomas Kinnally 

Administrator, National Domestic Preparedness Office 

Peter LaPorte 

Director, District of Columbia Emergency Management 

Agency 

Bruce M. Lawlor 

Major General, Commander, Joint Task Force, Civil Support, 

U.S. Joint Forces Command, VA 

Marcelle Layton 

Assistant Commissioner, Bureau of Communicable 

Disease, New York City Department of Health 

Scott Lillibridge 

Special Assistant to the Secretary for Bioterrorism 

U.S. Department of Health and Human Services 

John Magaw 

Acting Executive Director, Office of National 

Preparedness, Federal Emergency Management Agency 

Paul Maniscalco 

Deputy Chief, New York City Emergency Medical Services 

Command 

Gary McConnell 

Director, Georgia Emergency Management Agency 

Stanley McKinney 

Emergency Management Advisor for WMD Preparedness, 

Office for Domestic Preparedness, Office of Justice 

Programs, U.S. Department of Justice 

Matthew S. Meselson 

Professor of the Natural Sciences, Harvard University 

Steven Miller 

Director, International Security Program, 

Kennedy School of Government 

Andrew Mitchell 

Deputy Director, Office for Domestic Preparedness, 

Office of Justice Programs, U.S. Department of Justice 

Paul D. Monroe, Jr. 

Major General, Adjutant General, California National Guard 

Phillip E. Oates 

Major General, Adjutant General, Alaska National Guard 

Charles Ramsey 

Chief, Metropolitan Police Department, Washington, D.C. 

James Terry Scott 

Lieutenant General (Ret.), Partner, Watson and 

Associates, Texas 

Leslee Stein-Spencer 

Chief, Division of Emergency Medical Services and 

Highway Safety, Illinois Department of Public Health 

Darrel Stephens 

Chief, Charlotte-Mecklenburg Police Department, NC 

Jessica Stern 

Lecturer in Public Policy, Kennedy School of Government 

Steve Storment 

Assistant Chief, Phoenix Fire Department, AZ 

Patrick J. Sullivan, Jr. 

Sheriff, Arapahoe County, CO 

Ralph Timperi 

Assistant Commissioner, Massachusetts Department of 

Public Health and Director, Massachusetts Department of 

Public Health State Laboratory 

Alan D. Vickery 

Deputy Chief, Special Operations, Seattle Fire Department 

Frances E. Winslow 

Director, Office of Emergency Services, San Jose, CA 

 

Executive Session Staff 

Arnold M. Howitt Robyn Pangi 

Director Research Associate 

Juliette Kayyem Patricia Chang 

Executive Director Research Assistant 

Rebecca Storo Rebecca Horne 

Assistant Director Project Assistant 
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APPENDIX I--NATIONAL EMERGENCY MANAGEMENT ASSOCIATION WHITE PAPER 

ON DOMESTIC PREPAREDNESS 

 NATIONAL EMERGENCY MANAGEMENT ASSOCIATION

 WHITE PAPER ON DOMESTIC PREPAREDNESS 

October 1, 2001 

SUPPORTING ORGANIZATIONS: Adjutants General Association of the United States 

 International Association of Emergency Managers 

 National Emergency Management Association 

 National Guard Association of the United States 

BACKGROUND

Emergency management as a discipline has been shaped by historical events, both nationally and internationally. During 

World War II, it became apparent for the first time that our nation was susceptible to enemy attack. As a result, the first 

organization and function of what is called “Civil Defense” was established. The majority of civil preparedness and disaster 

response capability at the local level had its foundation in the Civil Defense program. Federal financial assistance to state 

and local jurisdictions for civil defense programs was begun in 1958 and provided federal matching funds (50/50) for 

personnel and administrative expenditures for civil defense preparedness. Attack preparedness was mandated as a joint 

federal-state-local responsibility. This funding base provided the very foundation upon which civil preparedness (what we 

now refer to as emergency management) was built. 

The recent terrorist attacks demonstrate the fact that the nation needs to develop a capability reminiscent of the past when 

there existed a robust state and local emergency management and response capability. A strengthened national program 

incorporating today’s all hazards approach to emergency preparedness is imperative. Congress, federal agencies, 

governors, state and local emergency management directors, other local officials and all disciplines of emergency 

responders must work together to develop a strategy for standardized, bottom-up national capabilities to effectively respond 

to catastrophic disaster situations. 

In addition to the States’ Principles for a National Domestic Preparedness Strategy, adopted in August 2000, NEMA thinks it 

critical that the following enhancements be incorporated into a nationwide strategy for catastrophic disaster preparedness. 

Items are listed by category and not necessarily by priority. 

Emergency Preparedness and Response 

Congress should provide to the states immediate federal funding for full-time catastrophic disaster coordinators 

in moderate and high-risk local jurisdictions of the United States, including the 120 largest cities where training 

and equipment was provided under the Nunn-Lugar-Domenici domestic preparedness programs. These 

personnel will have responsibility for developing and maintaining terrorism consequences plans, procedures, 

exercises, and resources. For those states with appropriate jurisdictional staffing levels already in place, the 

flexibility to utilize federal funds to enhance the overall emergency preparedness program based on identified 

priorities is critical. Measures should be implemented to ensure this funding does not supplant existing state 

and local emergency management funding commitments. 

States need financial assistance to improve catastrophic response and Continuity of Operations Plans (COOP) 

and Continuity of Government (COG) for states. FEMA should be provided additional funding to develop, 

construct and/or retrofit federal/state/local command and control centers (Emergency Operating Centers) for 

NBC events. These coordination centers must exist at each level of government. Alternate EOC locations 

must be available should the primary center be damaged or destroyed by the event. 

Interstate and intrastate mutual aid assistance must be recognized and supported by the federal government 

as an expedient, cost-effective approach to disaster response and recovery. The Emergency Management 

Assistance Compact (EMAC) has been adopted by forty-one states and two territories with additional states 

planning to join. EMAC is an interstate mutual aid agreement ratified by Congress, passed by state 

legislatures and signed into law by governors, and is well coordinated with the Federal Response Plan. Other 

states utilize the existing Interstate Civil Defense and Disaster Compact as well as regional compacts that are 
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similarly coordinated with existing plans. These complementary operational systems should be linked as the 

framework and procedures for all response and recovery activities. 

The Emergency Management Accreditation Program (EMAP) should be implemented and recognized by 

federal agencies as a strategic tool to build greater multi-discipline/all-hazards capabilities at the state and local 

level, including domestic terrorism. EMAP is a voluntary, national standards and accreditation program for 

state and local emergency management programs. The initiative is being developed in partnership by NEMA, 

FEMA and the International Association of Emergency Managers and is currently in the pilot phase. 

FEMA, State and local emergency managers must implement renewed emphasis on family and community 

preparedness to ensure Americans have necessary skills to survive a catastrophic disaster. 

A standardized national donations management protocol is needed to address the outpouring of food, clothing, 

supplies, and other items that are commonly sent to impacted states and localities following a disaster. If not 

handled properly, large amounts of unnecessary or inappropriate donations can add another level of 

complication to the disaster itself. We believe the “shoring up” of State and local emergency management 

agencies will provide the necessary organization to improve this system; however, additional planning and an 

information management capability are desperately needed. 

Health and Medical 

The medical surge capacity must be strengthened. The emergency management, medical and public health 

professions must work with lawmakers to ensure each region of our nation has a certain minimum surge 

capacity to deal with mass casualty events. Hospitals should agree to provide defined and standardized levels 

of resources, capabilities and assistance to handle mass casualties, especially those contaminated by 

chemical/biological agents. Funding for equipment and supplies to accomplish this mission should be provided 

to develop this additional capability, in exchange for their agreeing to participate as a local receiving hospital 

and as part of the U.S. Public Health Service’s National Disaster Medical System (NDMS). Funding for the 

health care system for emergency planning and extraordinary operation response costs that are not available 

from any other means must be provided by the federal government. Additionally, the federal government needs 

to provide the equipment and supplies to accomplish this mission and develop this additional capability; also, 

states need assistance to complete the National Pharmaceutical Stockpile distribution response plan. 

State-Local Disaster Medical Assistance Teams should be developed across the country with standardized 

equipment, personnel and training. These teams would serve as the first line of response to support impacted 

communities within impacted states, and could be required to respond outside the state as a mutual aid 

resource upon request. Self-contained capability to respond outside their jurisdiction should be provided by 

military Reserve Component assets available in each state. 

The current sixty U.S. Public Health Service NDMS Disaster Medical Assistance Teams (DMAT) should be 

uniformly enhanced for Weapons of Mass Destruction (WMD) response, including focus on personnel 

protection and training for WMD. Currently only four of the teams have been upgraded and equipped to serve 

as National Medical Response Teams (NMRTS). 

Additional WMD Recommendations 

The Department of Justice should immediately release the FY00 and FY01 equipment funds in order to begin 

implementation of these recommendations, and then require a basic statewide strategy in order to receive 

FY02 funds; and further, provide funding to states to administer the equipment program. Also, allow greater 

flexibility with the approved equipment list in order to accomplish any of these recommendations. Specifically, 

this should include the use of funds for the purchase of necessary equipment for hospitals and the health care 

industry, regardless of the private sector ownership of these critical “first receiver” response system 

components. In addition, Congress should increase funding to DOJ to provide detection, personnel protection 

and decontamination equipment for the nation’s emergency response agencies. Lastly, federal training and 

maintenance money must be included in any national terrorism response program. 

NEMA White Paper on Domestic Preparedness 

October 1, 2001 
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Congress and the Department of Defense should authorize homeland defense as a key federal defense 

mission tasking for the National Guard. By providing this authorization and removing restrictive language and 

funding on utilization of National Guard assets and personnel, the civil-military integrated response will be 

dramatically improved. In addition, Congress should provide funding to DoD for full-time staffing of state joint 

civil-military emergency operations centers. Further, Congress should provide funding to National Guard 

Bureau to complete fielding of National Guard Civil Support Teams in additional states and territories. 

State-Local Urban Search and Rescue capabilities should be developed across the country with standardized 

equipment, personnel and training. These teams would serve as the first line of response to support impacted 

communities within impacted states, and may be required to respond outside the state as a mutual aid 

resource upon request. Self-contained capability to respond outside their jurisdiction should be provided by 

National Guard assets available in each state. Further, standardization of the national USAR format and 

approach should be accomplished in such a way that there is a gradation in the USAR response teams to 

enhance overall national capability. 

The Department of Defense should undertake a review of the distribution of aviation assets to the National 

Guard in each state, territory and District of Columbia. 

National interagency and intergovernmental information management protocols are needed to support 

information sharing (ie. Damage/Situation Reports, Warning/Intelligence Reports, Resource Coordination). 

Further, an unclassified version of INTELINK needs to be developed for use by the greater emergency 

response community. 

Better federal interagency coordination is needed to assist states in identifying and accessing the full range of 

federal resources and assistance available to them. Currently, states are left on their own to identify individual 

agency programs and then contact each agency to determine programs and resources available. 

Security clearances must be more standardized and reciprocal between agencies and levels of government. 

Use of a compartmented, need-to-know system would greatly facilitate secure sharing of critical intelligence. 

Additionally, a critical need exists to enhance the ability of local and state officials to receive federal security 

clearances more expediently. 

FEMA’s fire grant program should be expanded and modified to strengthen regional and national, not just local, 

fire protection capabilities to respond to catastrophic disasters. State level involvement in the program would 

allow increased coordination and prioritization of resource needs within each state. A comprehensive national 

strategy would ensure best use of available funding provided to local fire departments to enhance regional and 

national response capabilities. 

The National Warning System (NAWAS), maintained by FEMA, has been downsized in recent years. This 

system was designed to provide rapid communications and warning capabilities between federal, state and 

local emergency management agencies. The Congress should provide funding to rapidly upgrade and expand 

a sustainable national intergovernmental communication and warning system. 

FEMA, in collaboration with state, local, private and other federal agency emergency response partners, should 

rapidly develop a standardized emergency responder identification and accounting system to improve 

personnel credentialing and accountability at scenes of catastrophic disasters. 

The Environmental Protection Agency should be provided funding to develop additional guidance on “shelter 

in-place” strategies for nuclear/biological/chemical (NBC) events, especially in urban centers. 

There is a need for technology transfer from the federal government and its contractors to state and local 

governments to support an automated decision support system. Several federal agencies have data that is 

unclassified that could be used for planning, response and recovery activities. These federally developed 

systems would contribute immensely to accomplishing many of the recommendations set forth in this paper 

and do so in a cost effective manner. 

For more information: National Emergency Management Association, PO Box 11910, Lexington, KY 40578 

Phone: (859) 244-8233, FAX: (859) 244-8239, www.nemaweb.org

NEMA White Paper on Domestic Preparedness 

October 1, 2001 
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APPENDIX J--THE PRESIDENT’S EMERGENCY SUPPLEMENTAL FUNDS FOR 

COMBATING TERRORISM126

The Administration’s budget request for combating terrorism, for Fiscal Year 2002, was $10.3 

billion in midsummer of 2001. Following the attacks on 11 September, the President requested 

$20 billion in “Emergency Supplemental Funds.” The Congress responded by appropriating $40 

billion in two segments. The Congress appropriated the “Emergency Supplemental Funds”, with 

the stipulation that the President must obtain prior approval before they can be obligated for a 

specific agency. The Congress also appropriated $20 billion for an “Emergency Response 

Fund.” The President has discretion over these funds, though only a portion of the $20 billion is 

available for immediate access. Of the remaining amount in the “Response” fund, the Congress 

has 15 days to disapprove or adjust the funds following notification of proposed obligation from 

the President. The $40 total includes: $10.2 billion for direct recovery efforts, including $6.3 

billion for New York City; $10.8 billion for indirect recovery efforts, including $1.3 billion for 

airline safety; and $19 billion for combating terrorism. 

*Note: Other in the tables denotes physical security protection for Federal buildings and postal facilities. 

Table J.1—Post-September 11 Emergency Funds 

 

126 The budget figures in this appendix are taken from the OMB July 2001 Report to Congress on Combating 

Terrorism Spending, the OMB press releases on the President’s Emergency Supplemental request, as well as 

reported Congressional activities as of 5 December 2001. 

Emergency Supplemental Funds 

(in millions)

Agency 

Emergency 

Supplemental 

House 

(pending)

Senate 

(pending)

Agriculture 45.1 0 0

Commerce 26.9 20.0 0

Energy 117.7 117.6 245.0

EOP 50.1 0 0

EPA 76.0 161.1

FEMA 5,500 4,960.0 9,500.0

GSA 200.5 87.3 0

HHS 1,595.0 1,784.6 0

Interior 85.5 77.7 0

Justice 1,112.1 1,528.8 1,396.0

Labor 2,012.6 1,520.1 0

NASA 93.1 27.4 82.0

Nat’l Security 7,349.0 7,243.0 7,349.0

State 0 181.2 0

Transportation 733.5 734.3 800

Treasury 315.2 445.7 300

USAID 0 0 0

VA 2.0 2.0 0

Other* 1,730.2 1109.2 328.0

Total $20,000.0 $20,000.0 $20,000.0

Emergency Response Fund 

(in millions)

Agency 

Discretionary 

Response Fund 

Agriculture 95.0

Commerce 0.1

Energy 5.0

EOP 88.5

EPA 0

FEMA 2,000.0

GSA 8.6

HHS 126.2

Interior 3.1

Justice 87.8

Labor 29.0

NASA 0

Nat’l Security 13,396.2

State 427.9

Transportation 614.5

Treasury 59.8

USAID 912.1

VA 0.2

Other* 2,146.0

Total $20,000.0
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The following section provides more detail from the President’s Emergency Supplemental on 

spending for those issues on which this Panel had focused its attentions. 

Office of Homeland Security 

The President requested $50.1 for the Executive Office of the President in the supplemental 

request. There is $88.5 million in the “Response Fund,” which likely explains the “0” for that 

item in the House and Senate versions of the supplemental. Most of those funds are presumably 

for the Office of Homeland Security. 

Health and Medical Issues 

The President’s emergency supplemental budget includes $1.59 billion to be funneled through 

the “Public Health and Social Services Emergency Fund” under the auspices of the HHS Office 

of the Secretary. The funds are designated as follows: 

- National Pharmaceutical Stockpile, $643.6 million 

- Smallpox acquisitions, $509 million 

- Food inspection and data system modernization, $61 million 

- Local hospital assistance, $50 million 

- Metropolitan Medical Response Systems, $50 million 

- Epi-X (surveillance system), $10 million 

- Health Alert Network, $30 million 

- Food and Drug Administration evaluation for vaccines, $34.6 million 

- CDC laboratory system, $20 million 

- Training, $55 million 

- State laboratory assistance, $15 million 

- Emergency communications, $13 million 

- Rapid toxic screening expansion, $10 million 

- Surge capacity (international and national), $10 million 

- Evaluating mask and respirator effectiveness, $15 million 

Immigration and Border Control 

The Coast Guard is receiving $203 million, of which $33 million is to support maritime threat 

assessments and port vulnerability assessments. The rest of the supplemental funding is for 

personnel. 

The FAA received $408 million in the President’s supplemental. These funds are for 

procurement to help airlines and airports increase their safety and security. 

The Customs Service received $107.5 million to increase inspection efforts at high-risk seaport 

and land borders from the President’s emergency supplemental. 
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APPENDIX K--THE IMMEDIATE NEEDS OF AMERICA’S FIRE SERVICE 
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APPENDIX L--AMA REPORT AND RECOMMENDATIONS 

AMA Report and Recommendations on 

Medical Preparedness for Terrorism and Other Disasters 

Physicians and other health professionals will play a crucial role as caregivers and community 

leaders during a crisis precipitated by an act of terrorism. The AMA as a focal point for 

organized medicine, therefore, will play an important role in representing and informing the 

individual physicians who will be on the front lines. 

The AMA and its Federation of state, county and specialty societies has a unique capability to 

convene necessary experts and stakeholders on this issue. When a national plan is developed for 

terrorism preparedness, the AMA is well-positioned to work with and through its Federation to 

inform physicians about this subject. When a plan is developed, the AMA can also extract and 

communicate those elements that are most relevant for physicians and deliver this message to 

them through its affiliated organizations and through various and practical means. 

The Council on Scientific Affairs produces reports on scientific subjects of concern to its 

membership. The Council presented a report entitled “Medical Preparedness for Terrorism and 

Other Disasters” to the House of Delegates at the 2000 Interim Meeting for its House of 

Delegates. 

Some of the recommendations made by the Council on Scientific Affairs that were adopted as 

AMA Directives: 

• The AMA calls for the creation of a public-private entity (including federal, military, 

and public health content experts) that will collaborate with medical educators and 

medical specialty societies to: (a) develop audience-specific medical education curricula 

on disaster medicine and the medical response to terrorism, with a first charge to develop 

curricula on bioterrorism, and disseminate these to medical students, physicians in 

training, and physicians in practice; (b) develop information resources on disaster 

medicine and the medical response to terrorism for civilian physicians and other health 

care workers; (c) encourage and work with state and specialty societies, the Centers for 

Disease Control and Prevention, the pharmaceutical industry, and other appropriate 

federal, military and private organizations to develop model plans for community medical 

response to disasters, including terrorism; and (d) address the issue of reliable, timely, 

and adequate reporting of dangerous diseases by community physicians to public health 

authorities. 

• The AMA encourages the Federation of Medicine to become involved in planning for the 

medical component of responses to disasters, including terrorism, at levels appropriate to 

the Federation component: (a) county/local medical societies and organized medical 

staffs are encouraged to become involved in local public health and community planning 

and physician education; (b) state societies are encouraged to become involved in state 

response planning and physician education; and (c) specialty societies are encouraged to 

take the lead in conducting and encouraging education of their members in essential 
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components of disaster medicine, as well as encouraging their members to participate in 

local response planning. 

• The AMA encourages the JCAHO and state licensing authorities to include the 

evaluation of hospital plans for terrorism and other disasters as part of the periodic 

accreditation and licensure visits by their representatives. 

With the Council of Scientific Affairs report and subsequent AMA House of Delegates action, 

we know this is a subject of importance to physicians. The AMA has in place tools and 

technologies for informing physicians and medical organizations about this topic. Therefore, the 

AMA must be an integral part of any national response plan. 
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AMA Council on Scientific Affairs Contacts 

Scott Deitchman, MD, MPH 

Member, AMA Council on Scientific Affairs 

404 639-1534 

404 639-2170 (fax) 

sdeitchman@earthlink.net 

Barry Dickinson, PhD 

Secretary, AMA Council on Scientific Affairs 

312 464-4549 

312 464-5841 (fax) 

barry_dickinson@ama-assn.org 

Jim Lyznicki, MS, MPH 

Assistant Secretary, AMA Council on Scientific Affairs 

312 464-4520 

312 464-5842 (fax) 

jim_lyznicki@ama-assn.org 
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APPENDIX M--JCAHO STANDARD 

JCAHO Revised Emergency Management Standard 

EFFECTIVE January 1, 2001 

Standard 

EC.1.4 A plan addresses emergency management 

Intent of EC.1.4 

The emergency management plan describes how the organization will establish and maintain a 

program to ensure effective response to disasters1

 or emergencies affecting the environment of 

care. The plan should address four phases of emergency management activities; mitigation, 

preparedness, response, and recovery.2

The plan provides processes for: 

a. identifying specific procedures in response to a variety of disasters based on a hazard 

vulnerability analysis3

 performed by the organization; 

b. initiating the plan (including a description of how, when, and by whom the plan is activated); 

c. defining, and when appropriate, integrating the organization’s role with community-wide 

emergency response agencies (including the identification of who is in charge of what 

activities and when are they in charge) to promote inter-operability between the health care 

organization and the community; 

d. notifying external authorities of emergencies; 

e. notifying personnel when emergency response measures are initiated; 

f. identifying personnel during emergencies; 

g. assigning available personnel in emergencies to cover all necessary staff positions; 

h. managing the following during emergencies and disasters: 

• patients activities including scheduling, modification, or discontinuation of services, 

 control of patient information, and patient transportation 

• staff activities (e.g., housing, transportation, and incident stress debriefing), 

• staff family-support activities, 

• logistics of critical supplies (e.g., pharmaceuticals, medical supplies, food supplies, linen 

 supplies, water supplies), 

• security (e.g., crowd control, traffic control), and 

• interaction with the news media. 

 

1 Disaster A natural or man-made event that significantly disrupts the environment of care, such as damage to the 

organization’s building(s) and grounds due to severe wind storms, tornadoes, hurricanes, or earthquakes. Also, an 

event that disrupts care and treatment, such as loss of utilities (power, water, telephones) due to floods, civil 

disturbances, accidents, or emergencies within the organization or in the surrounding community. Disasters are 

sometimes referred to as “potential injury creating events” (i.e., “PICE”). 

2 Mitigation activities are those a healthcare organization undertakes in attempting to lessen the severity and impact 

a potential disaster or emergency may have on its operation while preparedness activities are those an organization 

undertakes to build capacity and identify resources that may be utilized should a disaster or emergency occur. 

3 Hazard vulnerability analysis is the identification of hazards and the direct and indirect effect these hazards may 

have on the health care organization 
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i. evacuating the entire facility (both horizontally and, when applicable, vertically) when the 

environment cannot support adequate patient care and treatment; 

j. establishing an alternative care site(s) that have the capabilities to meet the clinical needs of 

patients when the environment cannot support adequate patient care including processes that 

address (when appropriate): 

• management of patient necessities (e.g., medications, medical records) to and from the 

alternative care site, 

• patient tracking to and from the alternative care site, 

• inter-facility communication between the organization and the alternative care site, 

• transportation of patients, staff and equipment to the alternative care site, 

• continuing and/or re-establishing operations following a disaster. 

The plan identifies: 

k. an alternative means of meeting essential building utility needs (e.g., electricity, water, 

ventilation, fuel sources, and medical gas/vacuum systems) when the organization is 

designated by its emergency preparedness plan to provide continuous service during a 

disaster or emergency; 

l. backup internal and external communication systems in the event of failure during disasters 

and emergencies; 

m. facilities for radioactive or chemical isolation and decontamination; and 

n. alternate roles and responsibilities of personnel during emergencies, including who they 

report to within a command structure that is consistent with that used by the local 

community. 

The plan establishes: 

o. an orientation and education program for personnel who participate in implementing the 

emergency management plan. Education addresses: 

1. specific roles and responsibilities during emergencies, 

2. the information and skills required to perform duties during emergencies, 

3. the backup communication system used during disasters and emergencies, and 

4. how supplies and equipment are obtained during disasters or emergencies; 

p. ongoing monitoring of performance regarding actual or potential risk related to one or more 

of the following: 

• staff knowledge and skills; 

• level of staff participation; 

• monitoring and inspection activities; 

• emergency and incident reporting; or 

• inspection, preventive maintenance, and testing of equipment; and 

q. how an annual evaluation of the emergency preparedness safety management plan’s 

objectives, scope,, performance, and effectiveness will occur.
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APPENDIX N--STATEMENT ON VACCINE DEVELOPMENT 

Statement on Vaccine Development 

Council of the Institute of Medicine 

November 5, 2001 

The events following the tragedies of September 11, 2001, have reemphasized a serious 

defect in America's capacity to deal with biological agents used in terrorist attacks. The 

capacity to develop, produce, and store vaccines to deal with these agents are 

inadequate to meet the nation's needs. In 1993 the Institute of Medicine published THE 

CHILDREN'S VACCINE INITIATIVE: ACHIEVING THE VISION. In assessing the 

national and international situation, the committee said, "because the private sector 

alone cannot sustain the costs and risks associated with the development of most CVI 

vaccines, and because the successful development of vaccines requires an integrated 

process, the committee recommends that an entity, tentatively called the National 

Vaccine Authority (NVA), be organized to advance the development, production, and 

procurement of new and improved vaccines of limited commercial potential but of 

global public health need" [1]. 

In a 1992 report, EMERGING INFECTIONS: MICROBIAL THREATS TO HEALTH 

IN THE UNITED STATES, another IOM committee recommended the development of 

an integrated management structure within the federal government for acquiring 

vaccines, as well as a facility for developing and producing vaccines with government 

support [2]. 

Evidence for the inability of the private sector to meet the country's needs for vaccines 

has accumulated substantially since the 1993 report. Fewer private companies are 

manufacturing vaccines. Continually needed vaccines such as the tetanus and influenza 

vaccines are in increasingly short supply. The availability of influenza vaccines has 

been delayed over the past several years and in 2000, one company stopped production. 

Pneumococcal conjugate vaccine is unavailable in several states because of the sole 

source manufacturer's inability to meet demands. Only one source is currently available 

for meningococcal varicella and measles-mumps-rubella vaccines. 

There are just four major vaccine manufacturers in the world today, and only two in the 

United States [3]. There were four times that number only 20 years ago. There are 

many small new research and development companies backed by venture capital and 

devoted to vaccine development. Many are working on anticancer vaccines for which 

market forces may be enough to keep them in production. However, good products 

developed by these startups to combat infectious diseases often do not come to market 

because of the very large costs of testing in pilot studies and in manufacturing.

Currently, the United States has a single licensed anthrax vaccine product, 

manufactured by a single plant. Because the Food and Drug Administration (FDA) had 

identified problems in the manufacturing process during regular inspections, the plant 

was closed for renovations in 1998, and to date, no new lots of anthrax vaccine have yet 

been cleared for release. 
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Prior to the events of September 11, the delays and problems faced by both the 

Department of Health and Human Services and Department of Defense in developing 

and procuring a cell-culture smallpox vaccine provide convincing evidence that major 

changes are needed at the national level. With the government guaranteeing payment in 

this time of national need, several potential manufacturers have come forward. This is 

an ad hoc example of a larger national need for mechanisms to obtain other public-good 

vaccines on an ongoing basis, and not just under extenuating circumstances when there 

is a great deal of public awareness of the need for vaccines. 

The Children's Vaccine Initiative committee listed the functions of a National Vaccine 

Authority as shown in Appendix 1. While these activities focused on the Children's 

Vaccine Initiative, they now have a broader importance to America, as the potential 

need for vaccines required to meet biological threats increases. The IOM Council 

believes the Authority should focus its attention upon vaccines that will not be 

adequately produced by existing public or private entities. Important functions of the 

Authority would include: conducting in-house vaccine-related research and 

development, assisting companies in the production of pilot lots of vaccines; and 

arranging and contributing to the procurement of National Vaccine Authority vaccines. 

An especially important function would be to provide opportunities for the production 

of pilot lots of vaccines developed by small biotechnology firms, and to produce 

vaccines when market forces are not sufficient to facilitate large-scale production. 

The IOM Council further believes the Authority should facilitate communications 

among relevant contributors to vaccine research and development, including academic 

research efforts, manufacturers, regulatory agencies, and the public. The Authority 

should not interfere in any way with public or private research or development efforts 

to create new vaccines. It should be available to assist such efforts when opportunities 

arise. It should interact with other public and private entities to assure a timely and 

effective system for storage and distribution of appropriate vaccines. It should identify 

mechanisms to expand current forms of liability protection for the adverse effects of 

vaccines, including expansion of federal efforts for indemnification of manufacturers. 

The Authority could become a source of appropriate reliable information to the media 

health care personnel, policy-makers, and the public. The FDA could work closely with 

such an Authority to oversee vaccine development and production as well as facilitate 

their oversight processes and reduce regulatory complexities. In some cases, it might 

find mechanisms to guarantee a price for vaccines to stimulate private sector 

production, as has occurred with smallpox vaccine in the current situation. 

Recently, proposals have been made for the creation of a government-owned, 

contractor-operated national vaccine facility. The IOM Council believes this is one in a 

spectrum of public-private ventures by which a NVA could facilitate development and 

production of needed vaccines. The conduct of research, development, production, and 

distribution of vaccines in such a facility should be the responsibility of a private 

contractor selected by a competitive bidding process. This effort should not preclude 

other collaborations with private contractors in other public-private projects. Funding 

for such a facility will initially require a substantial financial investment [4]. While a 
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major priority for this facility would be to develop vaccines necessary to protect 

American troops and for use against bioterrorism, the facility also should be charged 

with production of other vaccines that are in scarce supply and would not otherwise be 

provided in the public or private sectors. In some cases in which there are few private 

sector uses, the facility would become the principal source of such vaccines. In other 

cases, a variety of public and private partnerships could be undertaken to produce 

needed vaccines [5].

The Council of the Institute of Medicine of the National Academies believes that the 

development of a National Vaccine Authority is long overdue. It could be created 

within the Department of Health and Human Services, in collaboration with the 

Department of Defense or as a joint effort of the two departments. Moreover, the 

Council believes that establishment of a government-owned, contractor-operated 

facility for research, development, and production of vaccines is essential to meeting 

the country's public health needs, particularly those related to bioterrorism and 

protection of our armed forces. This facility also should play a role in development and 

production of other vaccines required for the public health that are not currently 

available in the open market. The Council encourages the president of the United 

States, the secretary of health and human services, secretary of defense, and the director 

of the Office of Homeland Security to evaluate these recommendations as critical 

elements for maintaining the country's health. 

COUNCIL OF THE INSTITUTE OF MEDICINE 

Kenneth I. Shine, M.D. (Chairman) 

President, Institute of Medicine 

Washington, D.C. 

Nancy C. Andreasen, M.D., Ph.D. 

Andrew H. Woods Chair of Psychiatry 

Director, Mental Health Clinical Research Center 

University of Iowa Hospitals and Clinics 

Iowa City 

Enriqueta C. Bond, Ph.D. 

President 

Burroughs Wellcome Fund 

Research Triangle Park, N.C. 

Jo Ivey Boufford, M.D. 

Dean 

Robert F. Wagner Graduate School of Public Service 

New York University 

New York City 
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Harvey R. Colten, M.D. 

President and Chief Medical Officer 

iMetrikus, Inc. 

Carlsbad, Calif. 

Johanna T. Dwyer, D.Sc. 

Director 

Frances Stern Nutrition Center 

New England Medical Center 

Boston 

Anthony S. Fauci, M.D. 

Director 

National Institute of Allergy and Infectious Diseases 

National Institutes of Health 

Bethesda, Md. 

James R. Gavin III, M.D., Ph.D. 

Senior Scientific Officer 

Howard Hughes Medical Institute 

Bethesda, Md. 

Ada Sue Hinshaw, Ph.D. 

Dean 

School of Nursing 

University of Michigan 

Ann Arbor 

Brigid L.M. Hogan, Ph.D. 

Investigator, Howard Hughes Medical Institute and Hortense B. Ingram Professor 

Department of Cell Biology 

Vanderbilt University School of Medicine 

Nashville, Tenn. 

Thomas S. Inui, M.D. 

President and CEO 

The Fetzer Institute 

Kalamazoo, Mich. 

Michael M.E. Johns, M.D. 

Executive Vice President for Health Affairs 

Director, Robert W. Woodruff Health Science Center 

Emory University 

Atlanta 
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Mary-Claire King, Ph.D. 

American Cancer Society Professor of Medicine and Genetics 

University of Washington 

Seattle 

Lawrence S. Lewin, M.B.A. 

Executive Consultant 

Washington, D.C. 

Joseph B. Martin, M.D., Ph.D. 

Dean of the Faculty of Medicine 

Harvard Medical School 

Boston 

William L. Roper, M.D. 

Dean 

School of Public Health 

University of North Carolina 

Chapel Hill 

Stephen M. Shortell, Ph.D. 

Blue Cross of California Distinguished 

 Professor of Health Policy and Management 

Professor of Organization Behavior 

School of Public Health 

University of California, Berkeley 

Edward H. Shortliffe, M.D., Ph.D. 

Professor and Chair 

Department of Medical Informatics 

Columbia Presbyterian Medical Center 

Columbia University 

New York City 

Kenneth E. Warner, Ph.D. 

Avedis Donabedian Distinguished University 

Professor of Public Health 

Dept. of Health Management & Policy 

School of Public Health 

University of Michigan 

Ann Arbor 

Gail R. Wilensky, Ph.D. 

John M. Olin Senior Fellow 

Project HOPE 

Bethesda, Md.
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Ex Officio Members (non-voting): 

David R. Challoner, M.D. 

IOM Foreign Secretary 

Director 

Institute for Science and Health Policy 

University of Florida 

Gainesville 

Harold J. Fallon, M.D. 

IOM Home Secretary 

Dean Emeritus 

School of Medicine 

University of Alabama 

Birmingham 

REFERENCES 

1. Mitchell, V.S., Philipose, N.M., and Sanford, J.P., eds. The Children's Vaccine 

Initiative: Achieving the Vision. Washington, D.C.: National Academy Press, 1993. 

2. Lederberg, J., Shope, R.E., and Oaks, S.C., Jr., eds. Emerging Infections: Microbial 

Threats to Health in the United States. Washington, D.C.: National Academy Press, 

1992. 

3. Merck Vaccine Division (parent company is Merck Pharmaceuticals) and Wyeth-Lederle 

Vaccines (parent company is American Home Products Corporation) are U.S.-based companies. 

Aventis Pasteur and GlaxoSmithKline operate within the United States and have products 

licensed by the FDA for use in the United States, but they are companies based in other 

countries. 

4. Department of Defense. Report on Biological Warfare Defense Vaccine Research 

and Development Programs. July 2001. 

5. Pearson, G.W. The Children's Vaccine Initiative: Continuing Activities. 

Washington, D.C.: National Academy Press, 1995. 
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APPENDIX 1: FUNCTION OF A NATIONAL VACCINE AUTHORITY 

-- Define the need 

-- Assess the market 

-- Establish priorities for U.S. CVI vaccine development in conjunction with the global 

CVI 

-- Characterize desired vaccine products 

-- Assemble intellectual property rights 

-- Advance CVI product development through the private sector 

-- Conduct in-house vaccine-related research and development 

-- Assist companies in the production of pilot lots of vaccine 

-- Support clinical testing and field trials of candidate vaccines 

-- Transfer CVI-related vaccine technology to developing country manufacturers 

-- Train U.S. and overseas nationals in the principles of vaccine development, pilot 

manufacture, and quality control 

-- Arrange and contribute to the procurement of NVA vaccines 

-- Evaluate and redefine needs 

-- Represent the United States in international CVI forums, such as the Consultative 

Group 

NOTE: Mitchell, V.S., Philipose, N.M., and Sanford, J.P., eds. The Children's Vaccine 

Initiative: Achieving the Vision. Washington, D.C.: National Academy Press, 1993, p. 

133. 

In addition to these functions, the need for vaccines to fulfill anti-terrorist and military 

requirements should be included. 
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APPENDIX O--CANTIGNY CONFERENCE ON STATE HEALTH POWERS & 

BIOTERRORISM 

Cantigny Conference 

on 

State Emergency Health Powers & the Bioterrorism Threat

April 26-27, 2001

Sponsored by: 

The Centers for Disease Control and Prevention 

American Bar Association Standing Committee on Law and National Security 

 The National Strategy Forum 

Underwritten by: 

Alfred P. Sloan Foundation

Reporters: 

James J. Misrahi 

Centers for Disease Control and Prevention 

Matthew Foley 

National Strategy Forum 
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Table of Contents 

Executive Summary............................................................................. ................................ 2

Session One: In a Bioterrorism Event, 

What Public Health Powers are Needed? ............................................................................5 

 Overview 

 Federal Needs for State/Local Preparedness 

 State & Local Perspective on Bioterrorism Role 

Session Two: What is the Status of Current Emergency Health Powers? ............................8 

 Legal Overview 

 A “Traditional” State Law 

 A “Newer” State Law 

Keynote Address .................................................................................................................10 

Session Three: What are the Gaps? .....................................................................................11 

 Legal Gaps 

 Procedural Challenges to Taking Effective Action 

 Expertise and Skills Needed to Successfully Implement 

Session Four: What are the Next Steps? .............................................................................13 

 Framework for Improving and Expanding Public Health Response 

 Future Action Items 

 Initiatives of Cantigny Working Group 

Appendix A: Checklist of Emergency Health Powers........................................................... 18 

Appendix B: Wisconsin Public Health Statute..................................................................... 19 

Appendix C: Colorado Regulations Pertaining to a Bioterrorist Event.............................. 23 

Appendix D: Participants and Affiliations.........................................................................30 

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APPENDICES FROM THIS DOCUMENT ARE AVAILABLE AT: www.rand.org/nsrd/terrpanel
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Executive Summary 

 On April 26-27, 2001, the Centers for Disease Control and Prevention, American Bar 

Association Standing Committee on Law and National Security, and the National Strategy 

Forum cosponsored a conference on “State Emergency Public Health Powers & the Bioterrorism 

Threat.” Underwritten by the Alfred P. Sloan Foundation, the conference was held at the 

Cantigny Conference Center on Colonel Robert R. McCormick’s former estate in suburban 

Chicago. The conference discussed the role of state emergency public health powers in 

responding to bioterrorism—the use by terrorists of biological agents that have the potential to 

cause fatal or incapacitating diseases in a population. 

 The conference uniquely brought together six different groups that have not traditionally 

shared the same forum: public health attorneys, public health officers, non-profit organizations, 

national security attorneys, the national defense community, and academia. The conference 

focused on identifying what public health powers would be needed in a bioterrorism event; 

assessing the status of current emergency health powers, determining the gaps in such powers; 

and developing a framework for future action. The purpose of the conference was not to 

advocate the implementation of an overall federal solution, but rather, to discuss a grass-roots 

approach for improving emergency public health powers. The views expressed at the conference 

are those of the participants and not necessarily of the organizations with which they are 

affiliated. Conference participants reached the following broad conclusions: 

• Many legal and regulatory authorities for responding to an emergency already exist. States must reexamine 

their health and emergency laws, particularly older laws that were passed 50-80 years ago. 

• States may not be adequately prepared for responding to a event of bioterrorism. Public health officers 

may be unaware of legal authorities, lack access to expert legal advice, or may not be in communication 

with concerned organizations. 

• States must identify gaps in authority and develop procedures for informed, rapid decisionmaking in a 

crisis. These procedures must be tested in exercises that include state public health officers, legal advisors, 

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and emergency responders—including officials from neighboring jurisdictions. 

• If a bioterrorism event occurs, an effective, well-rehearsed response will ensure public safety, and diminish 

the likelihood of panic that a terrorist may hope to cause. 

In addition, conference participants recognized the need for further work in the following areas: 

I. Legal Reform. Development of clear laws and understanding of law as a form of public 

health infrastructure. 

• Analysis of existing legal authorities in order to improve the public health response to an emergency. 

• Development of a model law with national experts. 

• Coordination with academia to improve the public health infrastructure. 

• Providing legal advice to the public health community and assisting public health officers to network with 

other professional organizations. 

• Research into issues of immunity and indemnification at the federal and state level. 

II. Legal Preparedness. Determining practices and procedures for areas where legal authorities 

are clear through the use of checklists, model laws, and draft executive orders. 

• Drafting of executive orders to be used by political leaders in the event of bioterrorism. 

• Improvement of public health regulations. 

• Discussion with political leaders concerning indemnification of public health workers. 

• Development of procedures to allow medical personnel to work across different jurisdictions. 

• Analysis of gaps in current public health authorities among different jurisdictions. 

• Inclusion of local government attorneys in discussions of bioterrorism. 

• Development of a bioterrorism plan that references legal authorities and includes different interest groups. 

III. Education and Training. Analyzing and correcting deficiencies revealed by exercises. 

Inclusion of lawyers in exercises and establishment of training standards. 

• Organization of regional and state conferences on the bioterrorism threat. 

• Clearer understanding of bioterrorism from an epidemiological perspective. 

• Education on post-traumatic stress. 

• Development of training exercises and evaluation of the results. 

• Standardization of training exercises. 

• Development of a program for civilian biodefense. 

IV. Operations and Planning. Clear understanding of how emergency plans will be 

implemented, as well as roles and responsibilities of different key actors. Minimizing political 

and legal delays. 

• Encouragement of state officials to study federal emergency powers. 

• Interagency cooperation in developing a clear support role for the Department of Defense. 

• Dissemination of information concerning resources of the Department of Defense. 

• Clear communication between health officials and the public during a crisis. 

• Discussion of the formation of an on-call emergency response team of experts with rotating membership. 

• Development of programs and operations by a national network of public health experts. 

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V. Partnerships. Outreach to other professional communities such as law enforcement, 

emergency responders, and the media. 

• Outreach to National Association of Governors. 

• Discussion of public health response at the International Chiefs of Police Conference on Bioterrorism. 

• Outreach to emergency response groups, e.g., police, fire, National Guard. 

• Outreach to state governor’s legal staff. 

• Elevation of the status of public health in the national security community. 

• Network and organization of public health departments and lawyers. 

• Development of a multi-disciplinary approach to respond to bioterrorism. 

• Discussion of the bioterrorism threat at the American Bar Association Annual Convention. 

• Outreach to political leaders at the state and local level.

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Session One: In a Bioterrorism Event, What Public Health Powers are Needed?

Moderator: Elizabeth Rindskopf Parker, American Bar Association Standing Committee on Law 

and National Security 

Overview: Gene Matthews, Centers for Disease Control and Prevention.

• This is a unique gathering of six different groups who have not traditionally collaborated: public health law 

attorneys, public health officers, non-profit organizations, national security attorneys, national defense 

community, and academia. 

• This discussion is not intended to lead to a “big bang” federal approach, but rather to discuss a grass-roots 

approach for reviewing and improving emergency public health powers at the state and local level. 

• Our goal is to develop the outline of an action plan to assist state and local health officers to review the 

legal powers needed in a bioterrorism emergency. 

Federal Needs for State/Local Preparedness, Scott Lillibridge, Centers for Disease Control and 

Prevention.

• The term weapons of mass destruction has many different definitions; we will discuss agents that have the 

potential to create an epidemic among large populations without the use of additional weapons or 

perpetrators. 

• The federal government is working to improve public health preparedness at the macro-level: efforts to 

increase early detection in state laboratories; funds to increase surveillance, training, and planning; 

establishment of a health alert network to facilitate communication. 

• Issues for the federal government include: 1) manage information in an emergency, e.g., access to medical 

or other records that may be privileged, inter-agency sharing of records and information; 2) control of 

property, e.g., temporary closure of facilities, procurement of medicines and vaccines, rationing of 

medicines; and 3) control of persons, e.g., mandatory health examinations, implementation of quarantine, 

restrictions on public gatherings to prevent the spread of disease. 

State & Local Health Perspective on Bioterrorism Role, Rex Archer, Kansas City Department of 

Health.

• There is a need for increased training and resources for state and local public health departments. Public 

health officers should have a higher profile within the political infrastructure and the public. Laws are 

meaningless without the practical ability to carry them out. 

• Greater efforts are required in the areas of record collection and data sharing. States need to have clear 

procedures for reporting of diseases, collecting data on workplace absenteeism, and obtaining information 

from pharmacies. There is also a need to streamline licensing requirements for medical professionals 

across state lines. In addition, the practices of managed care organizations may impact negatively on 

disease surveillance; for example, by discouraging doctors from ordering confirmatory tests. 

• Local health officers are authorized to control the use of property in a public health emergency. For 

example, public health officers may need to commandeer hotel rooms, which may be useful during an 

event because these rooms generally operate on separate ventilation systems. In addition, public health 

officers may have to commandeer drive-through facilities, such as those found at fast food restaurants, that 

could be used to dispense medicines in an emergency. While public health authorities are relatively strong, 

there is little practical experience in using compulsory measures, as they have not been needed for more 

than 50 years. Increased authority may be needed. 

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• Greater efforts are required with respect to management of persons. For example, few health facilities have 

the surge capacity to deal with a large number of casualties. In addition, the chain of command during a 

public health emergency must be clarified. 

Discussion points and comments.

• Long history of using the power of government to control infectious disease. The history of using the 

power of government to control infectious diseases dates back to the Middle Ages. In the modern era, as 

the risk of infectious diseases began to decline (circa 1950), courts began to develop greater protections for 

individuals. 

• Greater need for education of the public and health professionals. When people think of public health 

they tend to think more of Mother Teresa than Elliot Ness. But in an emergency, public health officers may 

need to give orders. Even many medical care practitioners don’t realize how public health and medicine fit 

into national security. 

• Need to obtain the public’s trust. Compulsory public health measures require public trust. The public 

does not realize that more people are killed by infectious diseases than by accidents, or that the risk of a 

pandemic is greater than that of nuclear war. 

• Need for polling and working with human relations experts. Polling and focus group evaluations 

should be conducted to find out whom the public will trust most in a crisis; for example, federal or state 

officials, military or civilian leaders, public health officers or law enforcement. Public health officers may 

use the results of such polling to better communicate with the public in times of crises. In addition, cultural 

and linguistic diversity must be taken into account as some communities may have greater mistrust of 

government. 

• Legislative foresight and strengthening of legal infrastructure. There are two conflicting dangers that 

arise from an insufficient legal infrastructure: 1) overreaction, when, for example, the pubic becomes 

inflamed and pressures political leaders; and 2) underreaction, when public health officers fail to act 

because they believe that they lack sufficient legal authority or political support. Avoiding these dangers 

requires a prior legislative scheme. In an emergency, a sound legal basis for action will be particularly 

important. 

• Enforcement authority needs to be clarified. This requires partnering with local law enforcement. In 

New York City, for example, every public health officer is also a “peace officer” and is accompanied by a 

police officer when enforcing a detention order for a tuberculosis patient. 

• Experience with partnerships and collaborations. Public health officers operate mainly through 

partnerships and collaborations and have little experience in using coercive public health measures. 

Exercising such authority may require, for example, that public health officers carry badges identifying 

themselves. In addition, whether using coercive measures negatively impacts a public health officer’s 

ability to work cooperatively with the public or private industry needs to be discussed. 

• Experience with coercive public health powers. Most public health interventions will be voluntary; 

however, statutory mechanisms need to be in place for dealing with uncooperative people. Public health 

officers have some experience in issuing quarantine orders for tuberculosis patients, nuisance abatement, 

and in closing hotels, restaurants, and schools for public health reasons. While these authorities may be 

exercised during a bioterrorism event, the magnitude and implementation will be completely different. In 

addition, different biological agents may necessitate different containment strategies. 

• Certification of other doctors to perform duties of medical examiners. In many communities, a 

medical examiner may be the only person authorized to investigate and determine the cause of a suspicious 

death. In an emergency, other doctors may have to be certified to perform this function. 

• Political issue. Response to a public health emergency, such as bioterrorism or a pandemic epidemic, will 

be widespread and quickly elevated to elected officials including the state governor. This is not strictly a 

public health issue, but also a political issue. Clear, open, and lawful response by government officials is 

necessary for public support and preservation of our national values. Rapid determination of the 

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appropriate balance between coercive government action and individual civil rights is critical. 

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Session Two: What is the Status of Current Emergency Health Powers?

Moderator: Suzanne Spaulding, American Bar Association 

Legal Overview, Larry Gostin, Georgetown University Law Center.

• States are the reservoirs of police powers. The federal government has broad authority under the 

Commerce Clause, but it may not generally commandeer the levers of state government. While there are a 

few exceptions, notably New York City, legal authorities to exercise emergency health powers are rarely 

local. Tribal governments are also sovereign entities and therefore must be involved in the process. 

Overlapping jurisdictions in a metropolitan area could cause confusion. Different levels of government 

must clarify which agency has the lead responsibility and authority. 

• State laws dealing with public health arose through a piecemeal process and therefore are antiquated and 

overly specific. The present model focuses on detection (disease reporting, partner notification), 

identification (outbreak investigations, laboratory control), intervention (school-based vaccinations, directly 

observed therapy, quarantine), and deterrence (criminal statutes, civil confinement). 

• Balanced against statutory authorities are constitutional constraints such as the due process requirements of 

notice and a fair hearing. There are also substantive laws which limit other statutory authorities, e.g., duty 

not to discriminate. During the last mass quarantine courts were highly suspicious and critical. A good 

example is Jew Ho v. Williamson, 103 F. 10, 24 (C.C.N.D. Cal. 1900), where a federal court ruled a 

quarantine imposed only in predominately Asian-American communities to be unconstitutional. Laws 

protecting individual rights appear to have superceded those preserving the “common good.” 

A “Traditional” State Law, John Chapin, Steven Marshall, and Dan Stier, Wisconsin Department 

of Health and Family Services.

• Wisconsin has had a public health statute since the founding of the State in 1848. Initially, public health 

was entirely local with authority vested in the local boards of health. Eventually, a state board of health 

was created with authority to enact statewide regulations for quarantine. In 1905, tuberculosis was 

specifically named as a disease of public health importance with a specific set of mechanisms to control the 

disease. While the statute was recodified in 1993, it remained a “traditional” public health statute. 

• The key judicial opinions are very old and narrow. A 1909 opinion, for example, states that in order to 

control disease public health powers bordering on “despotism” are necessary. 

• The current statute only addresses “communicable” diseases. There are no specific provisions dealing with 

bioterrorism or hoaxes. Furthermore, while there are regulations for dispensing drugs to tuberculosis 

patients, the statute does not address the issue of who may dispense drugs in the event of a mass-casualty 

event. 

A “Newer” State Law, Dr. Richard Hoffman, Colorado Department of Health and Environment.

• Colorado passed a law in March 2000 that specifically addresses bioterrorism, pandemic influenza, and 

novel infections. The legislature enacted the law without controversy because the public health department 

was not seeking any additional authorities and required no funding. Rather, the law was designed to 

remove legal impediments to different groups working together. 

• Under the plan, the Colorado Department of Health and Environment may require that hospitals, managed 

care organizations, and local health departments plan for a bioterrorism emergency. In exchange for filing 

an approved plan, these entities receive legal immunity. The definition of a “volunteer civil defense 

worker” was also changed to include a health care worker, thereby expanding eligibility for death benefits. 

Furthermore, additional regulations have been written authorizing the establishment of a command center, a 

communications network, and the purchasing of protective equipment for first responders. In addition, a 

committee was formed to prioritize the dispensing of vaccines among high-risk groups. 

• Draft executive orders have been written authorizing the rationing of pharmaceuticals, suspension of 

licensing requirements for doctors and nurses, and confiscation of cellphones and other communication

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• devices for use by emergency responders. The State compensates the owners for these takings.

Discussion points and comments.

• Gilmore Commission. This commission focuses on partnerships between and among health professionals, 

emergency responders, and legal experts. New York City is considered a model for informed partnerships 

demonstrated through training and exercises. The Gilmore Commission, among other things, has 

recommended the drafting of a model law. 

• Intergovernmental Committee. An intergovernmental committee should include a range of both public 

and private professionals such as emergency room doctors and specialists in post-traumatic stress 

syndrome. Colorado’s intergovernmental committee includes the state attorney general and proved useful 

during the “Topoff” exercise. 

• Legal resources. Not all public health departments will have the same access to legal resources. 

Notwithstanding, pre-prepared executive orders may be useful. 

• Revising public health laws. There is a risk that revising public health statutes will lead the legislature to 

weaken, not strengthen, them as may occur with any law where different interest groups may conflict. 

Many issues, however, that can be addressed through legislation may also be addressed through executive 

order. While broad authorities may be desirable, practical exercises need to be performed to know how 

these authorities will work in a crisis situation and to identify any gaps. 

• Investigative authorities not clear. Public health departments are unclear about using the resources of the 

private sector. Rules protecting patient confidentiality may impede public health surveillance. There is 

also a distinction between surveillance and research, the latter being governed by regulations for the 

protection of human subjects. 

• Federal/State coordination. Many state public health officers are unaware of federal quarantine laws and 

other federal authorities. The surgeon general is also authorized to impose a quarantine in time of war. 

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Keynote Address: Dr. John Hamre, Center for Strategic and International Studies 

• In the absence of an overarching struggle, the present era has witnessed the resurgence of old animosities. 

Today, there is either a war or a civil war in every time zone. These wars are particularly vicious, e.g., 

mutilation of children in Sierra Leone and narco-traffickers controlling large parts of Colombia. While 

none of these battles represent a direct threat to the United States, they undermine the concept of a stable 

international order. The era has also seen the emergence of international terrorists and other trans-national 

actors who have access to financial, technological, and military resources, e.g., Osama-Bin Laden, drug 

gangs in the former Soviet Union. 

• In the past, terrorism was isolated, episodic, and incoherent; now the opposite is true, terrorism is coherent, 

organized, and skilled. The present era must deal with the residue of the past era, particularly the Cold War 

inventory of chemical and biological weapons. In addition, in producing these weapons, a knowledge base 

of how to build these weapons was also created. Today, there is a dangerous mix around the world of 

privation and knowledge. 

• While we cannot eliminate the knowledge base relating to biological weapons, we can create economic 

diversions, for example, by getting scientists involved in positive research. As a nation, we should be more 

interested in eliminating the production capacity and stocks of biological weapons. 

• Many consider biological weapons to be more dangerous than nuclear weapons because they can be used 

anonymously and it is more difficult to track the perpetrator. 

• In the event of a terrorist attack, the government must respond effectively, or the public will become 

frightened and overreact, e.g., internment of Japanese-Americans after Pearl Harbor. 

• Suggestions for how the United States can control the threat include: 1) stigmatizing ownership and use of 

biological weapons; 2) eliminating biological inventory of the Cold War; 3) pushing European allies on the 

issue of non-proliferation; 4) retooling intelligence system by thinking more along the lines of networking, 

e.g., attending international science conferences, rather than relying on satellite photographs; and 5) 

reconsidering the structure of deterrence, e.g., threatening nuclear retaliation in response to a biological or 

chemical attack is not credible. 

• Policymakers need to inform the public about the danger of biological weapons. In general, there is great 

public skepticism that government can handle this issue responsibly. 

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Session Three: What are the Gaps?

Moderator: Marci Layton, New York City Department of Health 

Legal Gaps, David Fidler, University of Indiana School of Law.

• Debate has focused on two positions: legal gaps and legal obstacles. The first position states that there are 

legal gaps in the substantive law, i.e., that existing health laws are outdated and need modernization to 

provide a solid legal foundation for responding to bioterrorism. The objective of this position is legal 

reform.. The second position states that existing authorities are broad enough to encompass bioterrorism 

and that rather than reform existing authorities, we need to remove obstacles that interfere with our 

objectives. The objective of this position is legal preparedness. Both positions are valid. 

• Colorado has examined its existing laws and developed strategies to remove obstacles to collaborations and 

increase input into the political framework. Every state should evaluate and make appropriate changes like 

Colorado. States should move ahead with legal reform or legal preparedness. 

• There is a consensus that legal obstacles exist to the effective use of state emergency health powers, e.g., 

the federal government has problems getting information from state and local governments; federal privacy 

laws may unduly interfere with state action; and, state licensing requirements may interfere with emergency 

assistance offered by doctors and nurses from other jurisdictions. 

Procedural Challenges to Taking Effective Action, Thomas Inglesby, Johns Hopkins Center for 

Civilian Biodefense Studies.

• Our objectives in the event of a bioterrorism incident are to minimize death and end the epidemic. In order 

to achieve these objectives, public health capacities are needed: detect an epidemic, confirm cases of 

disease, track cases in real time, coordinate and advise hospitals, administer public health interventions, 

communicate among health officers and the public, and manage scarce resources. 

• Assuming that we have all of the necessary public health powers, there are still procedural challenges with 

which we must deal: 1) decision-making processes—deciding who will be the decision-maker, and making 

certain that elected officials have access to the experts; 2) public persuasion—offering the public 

explanations of the risk that are comprehensible and persuading them that the government is acting in their 

best interests; and 3) implementation—dealing with large casualties with which public health officers are 

not accustomed. 

• We must proceed on parallel tracks, addressing both legal authorities and procedural challenges. This may 

require a change in the health care system which currently treats the individual patient with the highest 

regard and is less concerned with the public good. 

Expertise and Skills Needed to Successfully Implement, Diana Bontá, California Department of 

Health Services.

• Public health departments don’t usually operate on a 24-hour basis. It will be difficult to sustain the level 

of expertise needed to respond to an emergency. In addition, there needs to be better coordination between 

public health and emergency medical services. It is not unusual for public health officers to work with 

members of hazmat teams. 

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• There needs to be a media strategy for public information and rumor control. Public health departments 

should consider establishing 1-800 numbers. 

• There needs to be better coordination between law enforcement and public health officers. In particular, a 

plan needs to be in place for dealing with hoaxes and suspected releases of biological agents. 

Discussion points and comments.

• Legal immunity and indemnification. The corollary of responsibility is liability; officials should not be 

afraid to exercise their authorities. Public health officers who develop plans to combat bioterrorism and 

proceed in good faith with those plans could be immunized or indemnified. While it may be possible to 

remove liability from planning, liability should not be inadvertently imposed if a plan is not followed 

through precisely—which often happens in an emergency. Policymakers should be wary about 

inadvertently creating a standard of care. In addition, qualified immunity only protects persons and not 

entities. The risk in granting immunity to those who develop plans is that those who do not develop plans 

and do not have immunity may be powerless in an emergency. States should also consider whether to 

provide immunity to volunteers who are “deputized” by public health officers to render medical assistance 

in an emergency. 

• Balanced response. While it is important to remove obstacles to responding to a bioterrorism event, 

governmental structures that are designed to protect the individual, e.g., privacy laws, human subjects 

protections, should not be dismantled. 

• Exercises. Exercises are a valuable tool for determining weaknesses in planning. The Topoff exercise 

helped Colorado in analyzing issues and framing a response. Joint Task Force—Civil Support (DOD) can 

be a valuable planning resource in helping states develop such exercises. Private consulting companies are 

also available to assist government agencies in training. More work needs to be done in developing 

standards for these exercises. 

• Legal obstacles.. In an emergency, public health officers may need to respond rapidly in order to contain 

an epidemic and save lives. Laws such as the Administrative Procedure Act (APA) or state “open meetings 

laws” may delay an emergency public health response. Many of these laws, for example, require that the 

board of health provide notice and an opportunity for a public meeting before acting. Many manufacturers, 

in developing vaccines, also require informed consent and duty to warn as part of their contracts. 

• Broader planning. A bioterrorism event is not likely to be limited to one jurisdiction. Rather, a 

bioterrorism event will spread and should be considered a national security threat. Linking public health 

officers with emergency preparedness people is a good start; however, planning needs to take neighboring 

states and the Federal government into account. 

• Federal response. In a bioterrorism event, the federal government will mobilize resources and tools to 

manage the event at a macro-level. Implementation at the local level, however, remains a key life-saving 

component. The federal government’s response to an event should prevent different jurisdictions from 

competing for scarce resources. The National Pharmaceutical Stockpile Program, for example, should find 

ways to further break down the quantity of pharmaceuticals sent to a particular jurisdiction to conserve 

resources that might be needed elsewhere 

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Session Four: What are the Next Steps?

Moderator: Kathy Cahill, Centers for Disease Control and Prevention 

Summary framework for improving and expanding public health response.

• Legal Reform. Need for clear laws and understanding of law as a form of public health infrastructure. 

• Legal Preparedness. Process of determining practices and procedures for areas where legal authorities are 

clear through the use of checklists, model laws, and draft executive orders. Issues of liability and 

availability of legal resources among different health departments need to be resolved. 

• Education and Training. Exercises are helpful, but they haven’t yet focused on the legal lessons learned. 

It is important that deficiencies revealed by exercises are analyzed and corrected. It is critical that lawyers 

be included in these forms of training. There needs to be some mechanism for establishing standards for 

these exercises. 

• Operations and Planning. It is critical that the key actors understand their roles and responsibilities. 

There must be a clear understanding of how emergency plans will be implemented. Political and legal 

delay must be kept to a minimum. 

• Partnerships. Now is the time for public health practitioners to begin building bridges to other 

professional communities such as law enforcement, emergency responders, and the media. Public health 

officers need to understand the public’s perception of disease outbreaks, and determine the best way to 

communicate with the public. 

Future action items. 

• Model laws. 

• Exercises. 

• Checklists. 

• Training within the legal community. 

• Outreach to ethics community. 

• Communication and partnerships. 

• Early warning systems. 

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Initiatives of Cantigny Working Group

• Rex Archer, Kansas City Department of Health. Will raise awareness of the bioterrorism threat and 

devote efforts to making the local public health officer a trusted member of the community. Will begin 

process of drafting executive orders for political leaders. 

• Odyssias Athanasiou, City of Portsmouth Health Department. Will discuss bioterrorism threat with 

attorneys. 

• Galen Beaufort, Kansas City Law Department. Will begin analyzing existing legal authorities in order to 

improve the public health response to an emergency. 

• Diana Bontá, Department of Health Services. Will raise Cantigny meeting with National Association of 

Governors. Specifically, will address the possibility of creating an on-call emergency response team of 

experts with rotating membership. 

• M.E. Spike Bowman, Federal Bureau of Investigation. Will encourage state officials to study federal 

emergency powers. 

• Daniel Callahan, Office of the Attorney General of Illinois. Will discuss public health response at the 

International Chiefs of Police Conference on Bioterrorism. 

• Julieann Casani, Maryland Department of Health & Mental Hygiene. Will focus on improving 

regulations, rather than drafting legislation. 

• John Chapin, Wisconsin Department of Health & Family Services. Will begin reaching out to other 

emergency response groups, e.g., police, national guard, hazmat, and fire. Will discuss gender issues 

because in Wisconsin the majority of local health officers are women. 

• Joni Charme, Department of Defense Joint Task Force Civil Support. Sole purpose of division is to 

provide assistance to the states. Will begin paving a legal role for clear DOD support. Will appeal for 

further inter-agency support. 

• David Fidler, Indiana University School of Law. Will provide legal advice and assist in networking. Also 

will developing a law school course called “Weapons of Mass Destruction and the Rule of Law.” 

• Richard E. Friedman, National Strategy Forum. Need to gauge public reaction to the use of emergency 

powers for advance planning purposes; will organize regional and state conferences and draft state 

compacts. 

• Richard Goodman, Centers for Disease Control and Prevention. Will work for a clearer understanding of 

the bioterrorism threat from an epidemiological perspective. 

• Lawrence Gostin, Georgetown University Law Center. Will work with a group of national experts to help 

draft a model law. Will work with academia to improve the public health infrastructure. 

• Richard Hoffman, Colorado Department of Health & Environment. Will pursue indemnification and offer 

sample draft executive orders. Will educate staff on issues of post-traumatic stress. Will conduct a training 

exercise using pandemic influenza as a model. Discussed the need for a web site. 

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• Cynthia Honssigner, Colorado State Health Department. Will look into federal laws and research issues 

of immunity and indemnification. Will outreach with state governor’s legal staff and National Association 

of Governors. 

• Tom Inglesby, Johns Hopkins Center for Civilian Biodefense Studies. Will work to elevate status of 

public health among national security community and in state programs. 

• Martha Katz, Centers for Disease Control and Prevention. Will follow-up with issues of communications 

and federal quarantine. 

• Barry Kellman, DePaul University College of Law. Will begin building partnerships with outside 

organizations. 

• Marci Layton, New York City Department of Health. Will begin to address inter-jurisdictional issues and 

work on executive orders and checklists. 

• Wilfredo Lopez, New York City Department of Health. Will work more closely with legal staff and 

analyze Colorado regulations. 

• Steven Marshall, Wisconsin Division of Public Health. Will work to develop a bioterrorism plan that 

references legal authorities and includes different interest groups, e.g., local health, managed care, 

hospitals, pharmacies, media, federal officials. Will work to develop a training exercise and evaluate the 

results. 

• Gene Matthews, Centers for Disease Control and Prevention. Will continue to network and organize 

public health departments and lawyers. 

• Kathy McDill, Department of Defense Joint Task Force Civil Support. Will disseminate information 

concerning resources of the Department of Defense. 

• Clement McGovern, Department of Justice. Will encourage states to reach out to U.S. Attorneys’ Offices 

and the Federal Bureau of Investigation. Local officials, for example, should coordinate with federal 

officials to ensure that the victims of an event are not repeatedly interviewed by different law enforcement 

officers. 

• Dan O’Brien, Maryland Department of Health & Mental Hygiene. Will begin outreach to National 

Association of State Attorneys General. 

• Terry O’Brien, Will work on a multi-disciplinary approach towards the threat of bioterrorism. 

• Paula Olsiewski, Alfred P. Sloan Foundation. Will begin developing a program for civilian biodefense. 

• Elizabeth Rindskopf Parker, University of Wisconsin System. Will discuss Cantigny conference at 

American Bar Association Annual Convention. 

• Robert Sullivan, City of Portsmouth, NH. Will work through professional organizations with municipal 

lawyers on the state and national level regarding a new national organization or association to increase 

awareness of the bioterrorism threat and the potential responses to that threat discussed at the conference. 

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• Dan Stier, Wisconsin Department of Health and Family Services. Will tap into a national network of 

public health experts to develop programs and operations. 

• Kathleen Toomey, Georgia Department of Human Resource. Noted that public health has moved away 

from servicing a community to a position of regulation. Will work towards increasing the legitimacy of 

public health programs in the eyes of the public and facilitate the ability of public health officers to access 

needed tools and resources. 

• Michael Wermuth, RAND. Will advocate the standardization of training exercises and the promulgation 

of a model law. 

• Keith Yamanaka, California Department of Health Services. Will begin outreach to political leaders. 

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APPENDIX P–MEDIA AND HEALTH COMMUNICATION—THE OHIO MENINGITIS 

INCIDENT127

Background 

In late May 2001, two Ohio students died of meningitis. On the first of June, a student at a 

neighboring school who had attended the funeral of one of the other students also became ill with 

meningitis. Four local health departments, the Ohio state health department, and the Centers for 

Disease Control and Prevention (CDC) became involved and recommended that approximately 

3,000 students at three involved high schools begin taking prophylactic antibiotics. This 

recommendation was consistent with national guidelines that had been in place for years and that 

had historically produced excellent results. 

The Confusion Begins 

On Sunday June 3, a physician at a local hospital recommended that “inclusion criteria for 

. . . antibiotic prophylaxis . . . include any person having close, personal, and intimate contact 

with students . . . (from any of the three schools).” Thus persons who are called “contacts of 

contacts” were being told to take antibiotics. The national guidelines do not recommend that 

contacts of contacts take antibiotics, because they are not considered to be at risk for developing 

meningococcal disease. The recommendation by the local physician was inconsistent with the 

national guidelines and with what was recommended by Federal, State, and local health officials. 

Compounding the Problem 

On June 4, headlines in the Akron, Ohio Beacon Journal stated: “Thousands wait in the rain for 

antibiotics.” In that article, citizens reported hearing rumors that the National Guard was being 

called out to quarantine the area, that people were fearful about leaving their homes, and that 

parents were afraid to let their children eat school lunches. 

By June 6, the Beacon Journal headlines read, “37,000 line up for drugs to prevent meningitis.” 

The paper reported people saying that they had decided to take antibiotics since their relatives 

had attended one of the schools, that school officials were canceling the rest of the school year at 

several schools, that graduation at another school and many sport events had also been canceled, 

and that people were afraid to take their children to the grocery store. An AP story reported that 

people were refusing even to touch writing pens provided when obtaining antibiotics, that 

children were not allowed to touch anything when they went shopping at the local Wal-Mart, that 

a student stated that “everybody’s panicking,” and that “the disease has spread confusion and 

fear.” 

On June 7, the New York Times reported that one of the mayors was studying “downtown 

lunchrooms for signs of returning life” and had stated that, “on an emotional and psychological 

level,” the event was not over. The same day, the Beacon Journal wrote, ”On the heels of three 

local cases of meningococcal disease comes the true epidemic—one of fear and panic.” The 

 

127 Observations from panel member M. Patricia Quinlisk, M.D., Medical Director/State Epidemiologist, 

Department of Public Health, State of Iowa 
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Beacon Journal also reported false rumors about an epidemic of West Nile Virus, about the 

hundreds of calls to the local health department, and that residents of the community were still 

concerned about being exposed to meningitis. A local infectious disease doctor is reported to 

have said that the panic was being fueled by the fact that there appears to be no central system of 

spreading information to the public. 

Observations 

Various health and medical authorities presented inconsistent information and recommendations. 

The rational and historical underpinnings of the national standard and recommendations about 

treatment were not clearly explained in the media. This fueled the community’s concerns and 

confusion about this rare and potentially fatal disease, contributing to the panic. 

Incident response plans should include procedures for rapid implementation of effective 

communication strategies. When an incident occurs, a variety of communication tools may, if 

used effectively, help to alleviate public concern and fear. These include rumor control and 

health information hotlines; regular media briefings and other methods for providing updates to 

the media; mass e-mail messages; posting information on Internet sites, as well as providing 

hard-copy information (fact sheets, brochures, flyers) to affected communities; group discussions 

with selected populations; and partnering with community leaders for additional assistance with 

information distribution. Some of these were used in Ohio during this incident. 

To minimize the potential for fear and panic, public health and medical officials at all levels 

must plan in advance for similar incidents, especially for biological ones. Officials must agree 

that only a few pre-selected health and medical professionals at each level will speak for their 

public health and medical community, to ensure that the public, including the media, are given 

accurate, consistent, and timely information. When an incident occurs, officials of the affected 

communities at each level should coordinate the release of public information. 
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APPENDIX Q—HOMELAND SECURITY PRESIDENTIAL DIRECTIVE-2 

For Immediate Release 

Office of the Press Secretary 

October 30, 2001

Homeland Security Presidential Directive-2 

October 29, 2001 

SUBJECT: Combating Terrorism Through Immigration Policies 

A. National Policy 

The United States has a long and valued tradition of welcoming immigrants and visitors. But 

the attacks of September 11, 2001, showed that some come to the United States to commit 

terrorist acts, to raise funds for illegal terrorist activities, or to provide other support for terrorist 

operations, here and abroad. It is the policy of the United States to work aggressively to 

prevent aliens who engage in or support terrorist activity from entering the United States and to 

detain, prosecute, or deport any such aliens who are within the United States. 

1. Foreign Terrorist Tracking Task Force 

By November 1, 2001, the Attorney General shall create the Foreign Terrorist Tracking Task 

Force (Task Force), with assistance from the Secretary of State, the Director of Central 

Intelligence and other officers of the government, as appropriate. The Task Force shall ensure 

that, to the maximum extent permitted by law, Federal agencies coordinate programs to 

accomplish the following: 1) deny entry into the United States of aliens associated with, 

suspected of being engaged in, or supporting terrorist activity; and 2) locate, detain, prosecute, 

or deport any such aliens already present in the United States. 

The Attorney General shall appoint a senior official as the full-time Director of the Task 

Force. The Director shall report to the Deputy Attorney General, serve as a Senior Advisor to 

the Assistant to the President for Homeland Security, and maintain direct liaison with the 

Commissioner of the Immigration and Naturalization Service (INS) on issues related to 

immigration and the foreign terrorist presence in the United States. The Director shall also 

consult with the Assistant Secretary of State for Consular Affairs on issues related to visa 

matters. 

The Task Force shall be staffed by expert personnel from the Department of State, the INS, the 

Federal Bureau of Investigation, the Secret Service, the Customs Service, the Intelligence 

Community, military support components, and other Federal agencies as appropriate to 

accomplish the Task Force's mission. 

The Attorney General and the Director of Central Intelligence shall ensure, to the maximum 

extent permitted by law, that the Task Force has access to all available information necessary to 

perform its mission, and they shall request information from State and local governments, 

where appropriate. 
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With the concurrence of the Attorney General and the Director of Central Intelligence, foreign 

liaison officers from cooperating countries shall be invited to serve as liaisons to the Task Force, 

where appropriate, to expedite investigation and data sharing. 

Other Federal entities, such as the Migrant Smuggling and Trafficking in Persons Coordination 

Center and the Foreign Leads Development Activity, shall provide the Task Force with any 

relevant information they possess concerning aliens suspected of engaging in or supporting 

terrorist activity. 

2. Enhanced INS and Customs Enforcement Capability 

The Attorney General and the Secretary of the Treasury, assisted by the Director of Central 

Intelligence, shall immediately develop and implement multi-year plans to enhance the 

investigative and intelligence analysis capabilities of the INS and the Customs Service. The goal 

of this enhancement is to increase significantly efforts to identify, locate, detain, prosecute or 

deport aliens associated with, suspected of being engaged in, or supporting terrorist activity 

within the United States. 

The new multi-year plans should significantly increase the number of Customs and INS special 

agents assigned to Joint Terrorism Task Forces, as deemed appropriate by the Attorney General 

and the Secretary of the Treasury. These officers shall constitute new positions over and above 

the existing on-duty special agent forces of the two agencies. 

3. Abuse of International Student Status 

The United States benefits greatly from international students who study in our country. The 

United States Government shall continue to foster and support international students. 

The Government shall implement measures to end the abuse of student visas and prohibit 

certain international students from receiving education and training in sensitive areas, including 

areas of study with direct application to the development and use of weapons of mass 

destruction. The Government shall also prohibit the education and training of foreign nationals 

who would use such training to harm the United States or its Allies. 

The Secretary of State and the Attorney General, working in conjunction with the Secretary of 

Education, the Director of the Office of Science and Technology Policy, the Secretary of Defense, 

the Secretary of Energy, and any other departments or entities they deem necessary, shall 

develop a program to accomplish this goal. The program shall identify sensitive courses of 

study, and shall include measures whereby the Department of State, the Department of Justice, 

and United States academic institutions, working together, can identify problematic applicants 

for student visas and deny their applications. The program shall provide for tracking the status 

of a foreign student who receives a visa (to include the proposed major course of study, the 

status of the individual as a full-time student, the classes in which the student enrolls, and the 

source of the funds supporting the student's education). 

The program shall develop guidelines that may include control mechanisms, such as limited 

duration student immigration status, and may implement strict criteria for renewing such 

student immigration status. The program shall include guidelines for exempting students from 

countries or groups of countries from this set of requirements. 
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In developing this new program of control, the Secretary of State, the Attorney General, and the 

Secretary of Education shall consult with the academic community and other interested 

parties. This new program shall be presented through the Homeland Security Council to the 

President within 60 days. 

The INS, in consultation with the Department of Education, shall conduct periodic reviews of all 

institutions certified to receive nonimmigrant students and exchange visitor program 

students. These reviews shall include checks for compliance with record keeping and reporting 

requirements. Failure of institutions to comply may result in the termination of the institution's 

approval to receive such students. 

4. North American Complementary Immigration Policies 

The Secretary of State, in coordination with the Secretary of the Treasury and the Attorney 

General, shall promptly initiate negotiations with Canada and Mexico to assure maximum 

possible compatibility of immigration, customs, and visa policies. The goal of the negotiations 

shall be to provide all involved countries the highest possible level of assurance that only 

individuals seeking entry for legitimate purposes enter any of the countries, while at the same 

time minimizing border restrictions that hinder legitimate trans-border commerce. 

As part of this effort, the Secretaries of State and the Treasury and the Attorney General shall 

seek to substantially increase sharing of immigration and customs information. They shall also 

seek to establish a shared immigration and customs control database with both countries. The 

Secretary of State, the Secretary of the Treasury, and the Attorney General shall explore 

existing mechanisms to accomplish this goal and, to the maximum extent possible, develop new 

methods to achieve optimal effectiveness and relative transparency. To the extent statutory 

provisions prevent such information sharing, the Attorney General and the Secretaries of State 

and the Treasury shall submit to the Director of the Office of Management and Budget proposed 

remedial legislation. 

5. Use of Advanced Technologies for Data Sharing and Enforcement Efforts 

The Director of the OSTP, in conjunction with the Attorney General and the Director of Central 

Intelligence, shall make recommendations about the use of advanced technology to help enforce 

United States immigration laws, to implement United States immigration programs, to facilitate 

the rapid identification of aliens who are suspected of engaging in or supporting terrorist 

activity, to deny them access to the United States, and to recommend ways in which existing 

government databases can be best utilized to maximize the ability of the government to detect, 

identify, locate, and apprehend potential terrorists in the United States. Databases from all 

appropriate Federal agencies, state and local govern-ments, and commercial databases should 

be included in this review. The utility of advanced data mining software should also be 

addressed. To the extent that there may be legal barriers to such data sharing, the Director of 

the OSTP shall submit to the Director of the Office of Management and Budget proposed 

legislative remedies. The study also should make recommendations, propose timelines, and 

project budgetary requirements. 

The Director of the OSTP shall make these recommendations to the President through the 

Homeland Security Council within 60 days. 
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6. Budgetary Support 

The Office of Management and Budget shall work closely with the Attorney General, the 

Secretaries of State and of the Treasury, the Assistant to the President for Homeland Security, 

and all other appropriate agencies to review the budgetary support and identify changes in 

legislation necessary for the implementation of this directive and recommend appropriate 

support for a multi-year program to provide the United States a robust capability to prevent 

aliens who engage in or support terrorist activity from entering or remaining in the United 

States or the smuggling of implements of terrorism into the United States. The Director of the 

Office of Management and Budget shall make an interim report through the Homeland Security 

Council to the President on the recommended program within 30 days, and shall make a final 

report through the Homeland Security Council to the President on the recommended program 

within 60 days. 

GEORGE W. BUSH 
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APPENDIX R—MARITIME DOMAIN AWARENESS 

MEMORANDUM OF AGREEMENT 

AMONG 

THE DEPARTMENT OF DEFENSE, 

THE UNITED STATES COAST GUARD, 

THE IMMIGRATION AND NATURALIZATION SERVICE, AND 

THE BUREAU OF CONSULAR AFFAIRS, DEPARTMENT OF STATE

SUBJECT: MARITIME DOMAIN AWARENESS 

PURPOSE: As agreed to among the DEPARTMENT OF DEFENSE, the UNITED STATES 

COAST GUARD, the IMMIGRATION and NATURALIZATION SERVICE, and the Bureau of 

Consular Affairs, DEPARTMENT OF STATE, this Memorandum of Agreement (MOA) 

establishes a framework and foundation for multi-agency cooperative efforts aimed at improving 

U.S. Maritime security. 

BACKGROUND: Complexity and ambiguity are hallmarks of today’s national security 

environment. Transnational asymmetric threats employed by nations, small groups, or networks 

of individuals using legitimate activities, including commerce, are now likely sources of physical 

or economic harm to U.S. citizens. 

Confronting this new class of threats is not a simple task – increased security at geographic 

borders often conflicts with our economic interests. The ultimate goal is a solution that improves 

the flow of legitimate commerce while enhancing security. In simple terms, the goal is to

promote the good, such as facilitating the unimpeded movement of legitimate people and cargo, 

while stopping the bad, such as preventing weapons of mass destruction from entering the 

country. Achieving this goal requires a significant improvement in the management and analysis 

of information on possible threats and, more pointedly, improved inter-agency cooperative 

efforts. 

Domain awareness is the effective knowledge of activities and elements that threaten the safety, 

security, or environment of the United States or its citizens. Today, the United States has much 

better information about what occurs at its aerospace and land-based borders than it does at its 

maritime borders. At present, U.S. Maritime Domain Awareness capabilities are limited. 

However, ongoing activities, agency operations, and existing databases already contain some of 

the resources and information needed to develop a much-improved maritime awareness 

capability. For example, the U.S. Customs Service has an information system that mines various 

databases, including cargo movement, in order to investigate trade crimes. The Coast Guard 

collects information from a variety of sources, including port arrival notices, aircraft 

surveillance, at-sea boardings, marine safety inspections, state registrations, and commercial 

sources to enforce laws and safety regulations. Naval and Coast Guard Intelligence have 

significant capabilities in vessel tracking. The Immigration and Naturalization Service and the 

Bureau of Consular Affairs, Department of State have significant information on the movement 
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of people across U.S. borders. However, no single framework exists to effectively look at 

threats across the broad spectrum of issues. What is necessary is the establishment of an 

organizational structure with the connectivity to create a virtual national data repository 

with the supporting analytical and communications capabilities to develop effective 

maritime awareness and coordinate appropriate responses. 

STATEMENT OF OBJECTIVE: The undersigned agencies agree that an integral element of 

Homeland Security is the protection of the U.S. maritime borders and the Marine Transportation 

System from a variety of threats ranging from terrorists introducing a weapon of mass 

destruction, to port closures due to maritime accidents, to environmental threats. The agencies 

further agree that the concept of Maritime Domain Awareness is an important step in the process 

and that this can only be achieved by extensive inter-agency cooperation. This cooperation will 

manifest itself in a maritime fusion center that draws on the expertise and data mining 

capabilities of the various agencies. The Coast Guard Intelligence Coordination Center, which is 

collocated at the National Maritime Intelligence Center in Suitland MD, provides the framework 

for additional agency participation and will provide the necessary synergy for data sharing and 

cooperative analysis of maritime threats to Homeland Security. This center will also facilitate 

rapid dissemination to appropriate law enforcement agencies once a threat is detected. 

ACTION: The agencies agree to establish and participate in an interagency sub-working group 

under the auspices of the Defense Policy Interagency Working Group. This sub-working group 

will be known as the National Maritime Security Coordinating Committee, and will be 

comprised of members from the agencies at the Deputy Assistant Secretary level. Additional 

agencies will be included in the Council as necessary. Nothing in this MOA commits any 

agency to share particular databases, or to make long term resource commitments. 

Within two weeks of signing this MOA, the Committee will meet for the purpose of: 

Selecting co-chairs of the committee. 

Developing a concept paper on Maritime Domain Awareness that includes a roadmap for 

implementation. The concept paper, due within 30 days of the first meeting of the 

Committee, will lay out goals and a notional timeline for implementation, and will address 

organizational structure, operational response and management, IT/ADP/IRM issues, and 

program support and funding. 

The Committee will oversee the development of the Maritime Domain Awareness initiatives and 

will advise the Defense Policy Interagency Working Group on the broad range of U. S. Maritime 

Security issues. The Committee may create subordinate working groups as necessary. 

EFFECTIVE DATE/MODIFICATION/TERMINATION: The terms of this Agreement will 

become effective on the date the last party signs the Agreement. This Agreement may be 

modified only upon the mutual written consent of all the parties. The terms of this Agreement, 

as modified with the consent of all parties, will remain in effect until all of the parties agree to 

terminate said Agreement. Any party upon (60) days written notice to the other parties may 

terminate its participation in the Agreement. In that event, the Agreement will continue in force 

for the other parties. 
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____/Signed/ ___ 12 JAN 2001 ____/Signed/ _ 12 JAN 2001

MR. J. WILLIAM LEONARD date ADMIRAL JAMES M. LOY date 

DEPUTY ASSISTANT SECRETARY OF DEFENSE COMMANDANT, U. S. COAST GUARD 

 FOR SECURITY AND INFORMATION 

 OPERATIONS 

____/Signed/ _ 12 JAN 2001 ____/Signed/ ___ 12 JAN 2001

MR. GEORGE C. LANNON date MS. MARY ANN WYRSCH 

date 

DEPUTY ASSISTANT SECRETARY FOR ACTING COMMISSIONER, IMMIGRATION 

 VISA SERVICES, BUREAU OF CONSULAR AND NATURALIZATION SERVICE 

 AFFAIRS, DEPARTMENT OF STATE 
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 17 November 2000 

MARITIME DOMAIN AWARENESS 

Background: Complexity and ambiguity are hallmarks of today’s national security environment. 

Major theatre war is no longer the most credible threat to U.S. national security. Transnational 

asymmetric threats employed by nations, small groups, or networks of individuals using 

legitimate activities, including commerce, are now the most likely source of physical or 

economic harm to U.S. citizens. 

Confronting this new class of threats is not a simple task because securing U.S. borders conflicts 

with economic interests, which require fast and efficient cross-border transportation systems. 

The solution requires a balance between security interests and economic interests. In simple 

terms, the goal is to promote the good, such as facilitating the unimpeded movement of legal 

people and cargo, while stopping the bad, such as by preventing accidents and intercepting the 

illegal. Achieving this goal requires us to significantly improve the collection and analysis of 

information on possible threats. 

Domain awareness is the effective knowledge of all activities and elements that threaten the 

safety, security, or environment of the United States or its citizens. Today, the United States has 

much better information about what occurs at its aerospace and land-based borders than it does at 

its maritime borders (though perhaps not enough). Asymmetric transnational threats have a 

relatively open gateway to U.S. via the marine transportation system. 

U.S. Maritime Domain Awareness capabilities are very limited, but ongoing collection activities 

and existing databases already contain some of the information needed to develop a much 

improved maritime awareness capability. For example, the Customs Service has an information 

system that documents the import of cargo so they can enforce Customs laws. And, the Coast 

Guard collects information from a variety of sources, including port arrival notices, aircraft 

surveillance, at-sea boardings, marine safety inspections, state registrations, and commercial 

sources to enforce laws and safety regulations. However, what is needed is an entity with the 

necessary network connectivity to create a virtual national data repository and the 

supporting analytical and communications capabilities to develop effective maritime 

awareness and coordinate appropriate responses.

Coast Guard capabilities, attributes, and authorities, when combined make it a strong candidate 

for managing a National Maritime Awareness Center. The Coast Guard is a maritime military 

service and a law enforcement agency. Coast Guard forces effectively and efficiently engage a 

broad spectrum of transnational asymmetric threats daily, and the Coast Guard is a trusted interagency partner. Moreover, the Coast Guard already operates interoperable intelligence centers, 

operations centers, and inter-agency communications networks, all of which are linked to Coast 

Guard stations, cutters, and aircraft. 

Current Capabilities: The Coast Guard Intelligence Coordination Center (ICC), co-located with 

the Naval Intelligence Center in Suitland, MD, provides the foundation for the National 

Maritime Intelligence Center (NMIC). The ICC is a relatively small, fewer than 50 people, 

organization that is the Coast Guard’s link to national intelligence capabilities and serves as the 
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Coast Guard’s strategic intelligence information repository and analysis center. In addition to 

links to national intelligence organizations, ICC has direct access to Coast Guard Marine Safety 

and Law Enforcement databases and the Joint Maritime Information Element (JMIE) program. 

While not designed specifically for this effort, the Joint Maritime Information Element (JMIE) is 

a database of maritime information that could serve as a key element of an expanded maritime 

awareness data repository. The JMIE database is capable of being significantly expanded 

through the addition of data sources. 

The ICC is fully employed by its current responsibilities. However, it possesses the basic 

infrastructure to provide effective maritime awareness with only marginal expansion. For 

example, with the addition of only six Coast Guard reserve personnel, ICC has supported the 

Pacific Northwest Special Interest Vessel (SIV) initiative. This is a 5-position x 16-hour watch 

effort that supports the SIV program in tracking people and vessels that may be engaged in 

collecting intelligence while in U.S. waters. 

Finally, the National Response Center (NRC), which is co-located with the Coast Guard 

Command Center, already has the capability to accommodate inter-agency Presidential Directive 

(PD) processes and communicate actionable information to appropriate agencies. 

What Is Needed: The ideal National Maritime Awareness Center would have the 7-position X 

24-hour capability to rapidly mine and fuse relevant information from various government and 

private sector data bases. A supporting risk-management analysis team is needed to transform 

raw data into actionable information. Additionally, a more robust data storage, mining and 

decision support capability is required to access and evaluate the necessary information in a 

timely manner. Most important is the requirement for seamless information sharing and 

selfless cooperation among federal agencies and private industry. Absent this, awareness 

will necessarily be limited. 

Figure 1: Proposed Data Flow 
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Figure 1 above, graphically depicts this process, including key information sources. Ideally, the 

system would provide total visibility of vessel registry, marine safety and law enforcement 

history, crew, cargo, planned ports of call, and position for every vessel entering or transiting the 

U.S. Exclusive Economic Zone. 

Potential Maritime Domain Awareness threat scenario: 

Data mining and decision support tools alert the ICC watch stander at NMIC suggesting a 

potential threat exists aboard a vessel scheduled to dock in Long Beach, CA within 24 hours. 

This information is evaluated by the ICC watch stander and also passed to Intel analysts for 

further study. 

After reviewing the available data and coordinating with other intelligence sources, the ICC 

disseminates a specific warning order to activate detection and monitoring sensors. 

Sensors are queued to locate and track the vessel (national assets to CG aircraft). 

NSC chairs PD process to determine appropriate course of action. 

The NRC acknowledges the receipt of the data transfer from the NMIC as a potential event and 

makes appropriate notifications to effect an intercept. The notifications would typically include: 

 - Coast Guard (as likely intercept force) 

FBI 

USCS 

 - DOD (Soldier’s Biological and Chemical Command for technical support) 

 - Department Of State 

 - HHS (Center for Disease Control and the Agency for Toxic Disease Symptom Registry) 

 - ICC (The ICC also receives notification of threat events from the NRC in its current role 

as the National Chemical/Biological Hotline.) 

 - Director of Military Support – includes representation by all military services 

 - National Response Team 

 - Applicable state and local agencies 

Appropriate forces dispatched to intercept the vessel at sea in order to prevent the threat from 

entering the coastal or port zones. 

Resource Requirements:

The ultimate system would require significant investment in additional people, infrastructure, 

and information technology. That cost estimate is under development. 

An interim, yet, much improved system that would simply link existing interagency databases 

and provide limited watch stander and analysis capability could be achieved for much less. A 

first-cut rough estimate is that a limited capability could be achieved with 25 - 35 people plus an 

information technology investment of $15M - $20M. 

Summary: Transnational asymmetric threats now pose the most credible national security threat 

to the American people. Maritime borders are the most vulnerable. Recent events have 

demonstrated the vulnerability of our ports and waterways. Maritime Domain Awareness is the 

key to improved maritime border security. The U.S. can significantly improve its Maritime 

Domain Awareness at a relatively modest cost by leveraging existing databases, information 

technology, and Coast Guard capabilities. 
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APPENDIX S—EXECUTIVE ORDER ON CRITICAL INFRASTRUCTURE 

PROTECTION 

For Immediate Release 

Office of the Press Secretary 

October 16, 2001 

Executive Order on Critical Infrastructure Protection 

Executive Order 

Critical Infrastructure Protection in the Information Age 

 By the authority vested in me as President by the Constitution and the laws of the 

United States of America, and in order to ensure protection of information systems for 

critical infrastructure, including emergency preparedness communications, and the physical 

assets that support such systems, in the information age, it is hereby ordered as follows: 

 Section 1. Policy. 

 (a) The information technology revolution has changed the way business is transacted, 

government operates, and national defense is conducted. Those three functions now 

depend on an interdependent network of critical information infrastructures. The protection 

program authorized by this order shall consist of continuous efforts to secure information 

systems for critical infrastructure, including emergency preparedness communications, and 

the physical assets that support such systems. Protection of these systems is essential to 

the telecommunications, energy, financial services, manufacturing, water, transportation, 

health care, and emergency services sectors. 

 (b) It is the policy of the United States to protect against disruption of the operation of 

information systems for critical infrastructure and thereby help to protect the people, 

economy, essential human and government services, and national security of the United 

States, and to ensure that any disruptions that occur are infrequent, of minimal duration, 

and manageable, and cause the least damage possible. The implementation of this policy 

shall include a voluntary public-private partnership, involving corporate and 

nongovernmental organizations. 

 Sec. 2. Scope. To achieve this policy, there shall be a senior executive branch board to 

coordinate and have cognizance of Federal efforts and programs that relate to protection of 

information systems and involve: 

 (a) cooperation with and protection of private sector critical infrastructure, State and 

local governments’ critical infrastructure, and supporting programs in corporate and 

academic organizations; 

 (b) protection of Federal departments’ and agencies’ critical infrastructure; and 

 (c) related national security programs. 

 Sec. 3. Establishment. I hereby establish the "President's Critical Infrastructure 

Protection Board" (the "Board"). 
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 Sec. 4. Continuing Authorities. This order does not alter the existing authorities or roles 

of United States Government departments and agencies. Authorities set forth in 44 U.S.C. 

Chapter 35, and other applicable law, provide senior officials with responsibility for the 

security of Federal Government information systems. 

 (a) Executive Branch Information Systems Security. The Director of the Office of 

Management and Budget (OMB) has the responsibility to develop and oversee the 

implementation of government-wide policies, principles, standards, and guidelines for the 

security of information systems that support the executive branch departments and 

agencies, except those noted in section 4(b) of this order. The Director of OMB shall advise 

the President and the appropriate department or agency head when there is a critical 

deficiency in the security practices within the purview of this section in an executive branch 

department or agency. The Board shall assist and support the Director of OMB in this 

function and shall be reasonably cognizant of programs related to security of department 

and agency information systems. 

 (b) National Security Information Systems. The Secretary of Defense and the Director 

of Central Intelligence (DCI) shall have responsibility to oversee, develop, and ensure 

implementation of policies, principles, standards, and guidelines for the security of 

information systems that support the operations under their respective control. In 

consultation with the Assistant to the President for National Security Affairs and the affected 

departments and agencies, the Secretary of Defense and the DCI shall develop policies, 

principles, standards, and guidelines for the security of national security information 

systems that support the operations of other executive branch departments and agencies 

with national security information. 

 (i) Policies, principles, standards, and guidelines developed under this subsection may 

require more stringent protection than those developed in accordance with subsection 4(a) 

of this order. 

(ii) The Assistant to the President for National Security Affairs 

 shall advise the President and the appropriate department or agency 

 head when there is a critical deficiency in the security practices of 

 a department or agency within the purview of this section. The Board, 

 or one of its standing or ad hoc committees, shall be reasonably 

 cognizant of programs to provide security and continuity to national 

 security information systems. 

 (c) Additional Responsibilities: The Heads of Executive Branch Departments and 

Agencies. The heads of executive branch departments and agencies are responsible and 

accountable for providing and maintaining adequate levels of security for information 

systems, including emergency preparedness communications systems, for programs under 

their control. Heads of such departments and agencies shall ensure the development and, 

within available appropriations, funding of programs that adequately address these mission 

areas. Cost-effective security shall be built into and made an integral part of government 

information systems, especially those critical systems that support the national security and 

other essential government programs. Additionally, security should enable, and not 

unnecessarily impede, department and agency business operations. 
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 Sec. 5. Board Responsibilities. Consistent with the responsibilities noted in section 4 of 

this order, the Board shall recommend policies and coordinate programs for protecting 

information systems for critical infrastructure, including emergency preparedness 

communications, and the physical assets that support such systems. Among its activities to 

implement these responsibilities, the Board shall: 

 (a) Outreach to the Private Sector and State and Local Governments. In consultation 

with affected executive branch departments and agencies, coordinate outreach to and 

consultation with the private sector, including corporations that own, operate, develop, and 

equip information, telecommunications, transportation, energy, water, health care, and 

financial services, on protection of information systems for critical infrastructure, including 

emergency preparedness communications, and the physical assets that support such 

systems; and coordinate outreach to State and local governments, as well as communities 

and representatives from academia and other relevant elements of society. 

 (i) When requested to do so, assist in the development of voluntary standards and best 

practices in a manner consistent with 15 U.S.C. Chapter 7; 

 (ii) Consult with potentially affected communities, including the legal, auditing, 

financial, and insurance communities, to the extent permitted by law, to determine areas of 

mutual concern; and 

 (iii) Coordinate the activities of senior liaison officers appointed by the Attorney 

General, the Secretaries of Energy, Commerce, Transportation, the Treasury, and Health 

and Human Services, and the Director of the Federal Emergency Management Agency for 

outreach on critical infrastructure protection issues with private sector organizations within 

the areas of concern to these departments and agencies. In these and other related 

functions, the Board shall work in coordination with the Critical Infrastructure Assurance 

Office (CIAO) and the National Institute of Standards and Technology of the Department of 

Commerce, the National Infrastructure Protection Center (NIPC), and the National 

Communications System (NCS). 

 (b) Information Sharing. Work with industry, State and local governments, and 

nongovernmental organizations to ensure that systems are created and well managed to 

share threat warning, analysis, and recovery information among government network 

operation centers, information sharing and analysis centers established on a voluntary basis 

by industry, and other related operations centers. In this and other related functions, the 

Board shall work in coordination with the NCS, the Federal Computer Incident Response 

Center, the NIPC, and other departments and agencies, as appropriate. 

 (c) Incident Coordination and Crisis Response. Coordinate programs and policies for 

responding to information systems security incidents that threaten information systems for 

critical infrastructure, including emergency preparedness communications, and the physical 

assets that support such systems. In this function, the Department of Justice, through the 

NIPC and the Manager of the NCS and other departments and agencies, as appropriate, 

shall work in coordination with the Board. 
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 (d) Recruitment, Retention, and Training Executive Branch Security Professionals. In 

consultation with executive branch departments and agencies, coordinate programs to 

ensure that government employees with responsibilities for protecting information systems 

for critical infrastructure, including emergency preparedness communications, and the 

physical assets that support such systems, are adequately trained and evaluated. In this 

function, the Office of Personnel Management shall work in coordination with the Board, as 

appropriate. 

 (e) Research and Development. Coordinate with the Director of the Office of Science 

and Technology Policy (OSTP) on a program of Federal Government research and 

development for protection of information systems for critical infrastructure, including 

emergency preparedness communications, and the physical assets that support such 

systems, and ensure coordination of government activities in this field with corporations, 

universities, Federally funded research centers, and national laboratories. In this function, 

the Board shall work in coordination with the National Science Foundation, the Defense 

Advanced Research Projects Agency, and with other departments and agencies, as 

appropriate. 

 (f) Law Enforcement Coordination with National Security Components. Promote 

programs against cyber crime and assist Federal law enforcement agencies in gaining 

necessary cooperation from executive branch departments and agencies. Support Federal 

law enforcement agencies’ investigation of illegal activities involving information systems for 

critical infrastructure, including emergency preparedness communications, and the physical 

assets that support such systems, and support coordination by these agencies with other 

departments and agencies with responsibilities to defend the Nation's security. In this 

function, the Board shall work in coordination with the Department of Justice, through the 

NIPC, and the Department of the Treasury, through the Secret Service, and with other 

departments and agencies, as appropriate. 

 (g) International Information Infrastructure Protection. Support the Department of 

State's coordination of United States Government programs for international cooperation 

covering international information infrastructure protection issues. 

 (h) Legislation. In accordance with OMB circular A-19, advise departments and 

agencies, the Director of OMB, and the Assistant to the President for Legislative Affairs on 

legislation relating to protection of information systems for critical infrastructure, including 

emergency preparedness communications, and the physical assets that support such 

systems. 

 (i) Coordination with Office of Homeland Security. Carry out those functions relating to 

protection of and recovery from attacks against information systems for critical 

infrastructure, including emergency preparedness communications, that were assigned to 

the Office of Homeland Security by Executive Order 13228 of October 8, 2001. The 

Assistant to the President for Homeland Security, in coordination with the Assistant to the 

President for National Security Affairs, shall be responsible for defining the responsibilities of 

the Board in coordinating efforts to protect physical assets that support information 

systems. 

 Sec. 6. Membership. (a) Members of the Board shall be drawn from the executive 

branch departments, agencies, and offices listed below; in addition, concerned Federal 

departments and agencies may participate in the activities of appropriate committees of the 

Board. The Board shall be led by a Chair and Vice Chair, designated by the President. Its 

other members shall be the following senior officials or their designees: 

 
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 (i) Secretary of State; 

 (ii) Secretary of the Treasury; 

 (iii) Secretary of Defense; 

 (iv) Attorney General; 

 (v) Secretary of Commerce; 

 (vi) Secretary of Health and Human Services; 

 (vii) Secretary of Transportation; 

 (viii) Secretary of Energy; 

 (ix) Director of Central Intelligence; 

 (x) Chairman of the Joint Chiefs of Staff; 

 (xi) Director of the Federal Emergency Management Agency; 

 (xii) Administrator of General Services; 

 (xiii) Director of the Office of Management and Budget; 

 (xiv) Director of the Office of Science and Technology Policy; 

 (xv) Chief of Staff to the Vice President; 

 (xvi) Director of the National Economic Council; 

 (xvii) Assistant to the President for National Security Affairs; 

 (xviii) Assistant to the President for Homeland Security; 

 (xix) Chief of Staff to the President; and 

 (xx) Such other executive branch officials as the President may designate. 

 Members of the Board and their designees shall be full-time or permanent part-time 

officers or employees of the Federal Government. 

 (b) In addition, the following officials shall serve as members of the Board and shall 

form the Board's Coordination Committee: 

 (i) Director, Critical Infrastructure Assurance Office, Department of Commerce; 

 (ii) Manager, National Communications System; 

 (iii) Vice Chair, Chief Information Officers’ (CIO) Council; 

 (iv) Information Assurance Director, National Security Agency; 

 (v) Deputy Director of Central Intelligence for Community Management; and 

 (vi) Director, National Infrastructure Protection Center, Federal Bureau of Investigation, 

Department of Justice. 
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 (c) The Chairman of the Federal Communications Commission may appoint a 

representative to the Board. 

 Sec. 7. Chair. (a) The Chair also shall be the Special Advisor to the President for 

Cyberspace Security. Executive branch departments and agencies shall make all reasonable 

efforts to keep the Chair fully informed in a timely manner, and to the greatest extent 

permitted by law, of all programs and issues within the purview of the Board. The Chair, in 

consultation with the Board, shall call and preside at meetings of the Board and set the 

agenda for the Board. The Chair, in consultation with the Board, may propose policies and 

programs to appropriate officials to ensure the protection of the Nation's information 

systems for critical infrastructure, including emergency preparedness communications, and 

the physical assets that support such systems. To ensure full coordination between the 

responsibilities of the National Security Council (NSC) and the Office of Homeland Security, 

the Chair shall report to both the Assistant to the President for National Security Affairs and 

to the Assistant to the President for Homeland Security. The Chair shall coordinate with the 

Assistant to the President for Economic Policy on issues relating to private sector systems 

and economic effects and with the Director of OMB on issues relating to budgets and the 

security of computer networks addressed in subsection 4(a) of this order. 

 (b) The Chair shall be assisted by an appropriately sized staff within the White House 

Office. In addition, heads of executive branch departments and agencies are authorized, to 

the extent permitted by law, to detail or assign personnel of such departments and agencies 

to the Board's staff upon request of the Chair, subject to the approval of the Chief of Staff 

to the President. Members of the Board's staff with responsibilities relating to national 

security information systems, communications, and information warfare may, with respect 

to those responsibilities, also work at the direction of the Assistant to the President for 

National Security Affairs. 

 Sec. 8. Standing Committees. (a) The Board may establish standing and ad hoc 

committees as appropriate. Representation on standing committees shall not be limited to 

those departments and agencies on the Board, but may include representatives of other 

concerned executive branch departments and agencies. 

 (b) Chairs of standing and ad hoc committees shall report fully and regularly on the 

activities of the committees to the Board, which shall ensure that the committees are well 

coordinated with each other. 

 (c) There are established the following standing committees: 

 (i) Private Sector and State and Local Government Outreach, chaired by the designee 

of the Secretary of Commerce, to work in coordination with the designee of the Chairman of 

the National Economic Council. 

 (ii) Executive Branch Information Systems Security, chaired by the designee of the 

Director of OMB. The committee shall assist OMB in fulfilling its responsibilities under 44 

U.S.C. Chapter 35 and other applicable law. 

 (iii) National Security Systems. The National Security Telecommunications and 

Information Systems Security Committee, as established by and consistent with NSD-42 

and chaired by the Department of Defense, shall serve as a Board standing committee, and 

be redesignated the Committee on National Security Systems. 
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 (iv) Incident Response Coordination, co-chaired by the designees of the Attorney 

General and the Secretary of Defense. 

 (v) Research and Development, chaired by a designee of the Director of OSTP. 

 (vi) National Security and Emergency Preparedness Communications. The NCS 

Committee of Principals is renamed the Board’s Committee for National Security and 

Emergency Preparedness Communications. The reporting functions established above for 

standing committees are in addition to the functions set forth in Executive Order 12472 of 

April 3, 1984, and do not alter any function or role set forth therein. 

 (vii) Physical Security, co-chaired by the designees of the Secretary of Defense and the 

Attorney General, to coordinate programs to ensure the physical security of information 

systems for critical infrastructure, including emergency preparedness communications, and 

the physical assets that support such systems. The standing committee shall coordinate its 

work with the Office of Homeland Security and shall work closely with the Physical Security 

Working Group of the Records Access and Information Security Policy Coordinating 

Committee to ensure coordination of efforts. 

 (viii) Infrastructure Interdependencies, co-chaired by the designees of the Secretaries of 

Transportation and Energy, to coordinate programs to assess the unique risks, threats, and 

vulnerabilities associated with the interdependency of information systems for critical 

infrastructures, including the development of effective models, simulations, and other 

analytic tools and cost-effective technologies in this area. 

 (ix) International Affairs, chaired by a designee of the Secretary of State, to support 

Department of State coordination of United States Government programs for international 

cooperation covering international information infrastructure issues. 

 (x) Financial and Banking Information Infrastructure, chaired by a designee of the 

Secretary of the Treasury and including representatives of the banking and financial 

institution regulatory agencies. 

 (xi) Other Committees. Such other standing committees as may be established by the 

Board. 

 (d) Subcommittees. The chair of each standing committee may form necessary 

subcommittees with organizational representation as determined by the Chair. 

 (e) Streamlining. The Board shall develop procedures that specify the manner in which 

it or a subordinate committee will perform the responsibilities previously assigned to the 

Policy Coordinating Committee. The Board, in coordination with the Director of OSTP, shall 

review the functions of the Joint Telecommunications Resources Board, established under 

Executive Order 12472, and make recommendations about its future role. 

 Sec. 9. Planning and Budget. (a) The Board, on a periodic basis, shall propose a 

National Plan or plans for subjects within its purview. The Board, in coordination with the 

Office of Homeland Security, also shall make recommendations to OMB on those portions of 

executive branch department and agency budgets that fall within the Board's purview, after 

review of relevant program requirements and resources. 

 
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 (b) The Office of Administration within the Executive Office of the President shall 

provide the Board with such personnel, funding, and administrative support, to the extent 

permitted by law and subject to the availability of appropriations, as directed by the Chief of 

Staff to carry out the provisions of this order. Only those funds that are available for the 

Office of Homeland Security, established by Executive Order 13228, shall be available for 

such purposes. To the extent permitted by law and as appropriate, agencies represented on 

the Board also may provide administrative support for the Board. The National Security 

Agency shall ensure that the Board's information and communications systems are 

appropriately secured. 

 (c) The Board may annually request the National Science Foundation, Department of 

Energy, Department of Transportation, Environmental Protection Agency, Department of 

Commerce, Department of Defense, and the Intelligence Community, as that term is 

defined in Executive Order 12333 of December 4, 1981, to include in their budget requests 

to OMB funding for demonstration projects and research to support the Board's activities. 

 Sec. 10. Presidential Advisory Panels. The Chair shall work closely with panels of senior 

experts from outside of the government that advise the President, in particular: the 

President's National Security Telecommunications Advisory Committee (NSTAC) created by 

Executive Order 12382 of September 13, 1982, as amended, and the National 

Infrastructure Advisory Council (NIAC or Council) created by this Executive Order. The 

Chair and Vice Chair of these two panels also may meet with the Board, as appropriate and 

to the extent permitted by law, to provide a private sector perspective. 

 (a) NSTAC. The NSTAC provides the President advice on the security and continuity of 

communications systems essential for national security and emergency preparedness. 

 (b) NIAC. There is hereby established the National Infrastructure Advisory Council, 

which shall provide the President advice on the security of information systems for critical 

infrastructure supporting other sectors of the economy: banking and finance, 

transportation, energy, manufacturing, and emergency government services. The NIAC 

shall be composed of not more than 30 members appointed by the President. The members 

of the NIAC shall be selected from the private sector, academia, and State and local 

government. Members of the NIAC shall have expertise relevant to the functions of the 

NIAC and generally shall be selected from industry Chief Executive Officers (and 

equivalently ranked leaders in other organizations) with responsibilities for the security of 

information infrastructure supporting the critical sectors of the economy, including banking 

and finance, transportation, energy, communications, and emergency government services. 

 Members shall not be full-time officials or employees of the executive branch of the Federal 

Government. 

 (i) The President shall designate a Chair and Vice Chair from among the members of 

the NIAC. 

 (ii) The Chair of the Board established by this order will serve as the Executive 

Director of the NIAC. 

 (c) NIAC Functions. The NIAC will meet periodically to: 

 (i) enhance the partnership of the public and private sectors in protecting 

information systems for critical infrastructures and provide reports on this issue to the 

President, as appropriate; 
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 (ii) propose and develop ways to encourage private industry to perform periodic risk 

assessments of critical information and telecommunications systems; 

 (iii) monitor the development of private sector Information Sharing and Analysis 

Centers (ISACs) and provide recommendations to the Board on how these organizations can 

best foster improved cooperation among the ISACs, the NIPC, and other Federal 

Government entities; 

 (iv) report to the President through the Board, which shall ensure appropriate 

coordination with the Assistant to the President for Economic Policy under the terms of this 

order; and 

 (v) advise lead agencies with critical infrastructure responsibilities, sector 

coordinators, the NIPC, the ISACs, and the Board. 

 (d) Administration of the NIAC. 

 (i) The NIAC may hold hearings, conduct inquiries, and establish subcommittees, as 

appropriate. 

 (ii) Upon the request of the Chair, and to the extent permitted by law, the heads of 

the executive branch departments and agencies shall provide the Council with information 

and advice relating to its functions. 

 (iii) Senior Federal Government officials may participate in the meetings of the 

NIAC, as appropriate. 

 (iv) Members shall serve without compensation for their work on the Council. 

 However, members may be allowed travel expenses, including per diem in lieu of 

subsistence, as authorized by law for persons serving intermittently in Federal Government 

service (5 U.S.C. 5701-5707). 

 (v) To the extent permitted by law, and subject to the availability of appropriations, 

the Department of Commerce, through the CIAO, shall provide the NIAC with administrative 

services, staff, and other support services and such funds as may be necessary for the 

performance of the NIAC's functions. 

 (e) General Provisions. 

 (i) Insofar as the Federal Advisory Committee Act, as amended (5 U.S.C. App.), may 

apply to the NIAC, the functions of the President under that Act, except that of reporting to 

the Congress, shall be performed by the Department of Commerce in accordance with the 

guidelines and procedures established by the Administrator of General Services. 

 (ii) The Council shall terminate 2 years from the date of this order, unless extended 

by the President prior to that date. 

 (iii) Executive Order 13130 of July 14, 1999, is hereby revoked. 
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 Sec. 11. National Communications System. Changes in technology are causing the 

convergence of much of telephony, data relay, and internet communications networks into 

an interconnected network of networks. The NCS and its National Coordinating Center shall 

support use of telephony, converged information, voice networks, and next generation 

networks for emergency preparedness and national security communications functions 

assigned to them in Executive Order 12472. All authorities and assignments of 

responsibilities to departments and agencies in that order, including the role of the Manager 

of NCS, remain unchanged except as explicitly modified by this order. 

 Sec. 12. Counter-intelligence. The Board shall coordinate its activities with those of the 

Office of the Counter-intelligence Executive to address the threat to programs within the 

Board's purview from hostile foreign intelligence services. 

 Sec. 13. Classification Authority. I hereby delegate to the Chair the authority to classify 

information originally as Top Secret, in accordance with Executive Order 12958 of April 17, 

1995, as amended, or any successor Executive Order. 

 Sec. 14. General Provisions. (a) Nothing in this order shall supersede any requirement 

made by or under law. 

 (b) This order does not create any right or benefit, substantive or procedural, 

enforceable at law or equity, against the United States, its departments, agencies or other 

entities, its officers or employees, or any other person. 

GEORGE W. BUSH 

THE WHITE HOUSE, 

 October 16, 2001. 

 
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APPENDIX T—EXECUTIVE SUMMARY OF CDC DRAFT SMALLPOX PLAN 

Executive Summary for CDC Interim Smallpox Response 

Plan and Guidelines 

 

In response to the potential use of biological agents against civilians, the Federal 

government has committed to upgrading preparedness, readiness, and national 

defenses against bio-terrorist weapons. The Centers for Disease Control and 

Prevention (CDC) has been designated as the lead agency for upgrading national public 

health capabilities for responding to biological terrorism. Many biological agents could 

be used to attack civilians, however, only a few, such as smallpox virus, have the ability 

to cause illness or panic to the extent that existing medical and public health systems 

would be overwhelmed. Although smallpox was globally eradicated by the late 1970’s, 

there remains concern that stores of smallpox virus may exist in laboratories other than 

the two WHO designated repositories. If an outbreak of smallpox were to occur, several 

factors could contribute to a more rapid spread of smallpox than was routinely seen 

before this disease was eradicated. These factors include: 1) virtually non-existent 

immunity to smallpox in the absence of naturally occurring disease and the 

discontinuation of routine vaccination in the United States in the early 1970’s, 2) 

potentially delayed recognition of smallpox by health personnel who are unfamiliar with 

the disease, and 3) increased mobility and crowding of the population. Because of these 

factors, a single case of smallpox would require an immediate and coordinated public 

health and medical response to contain the outbreak and prevent further infection of 

susceptible individuals. 

The possibility for the use of smallpox virus as a bio-terrorism agent and the potential 

for its rapid spread, have prompted the updating of a response plan previously 

developed by the Centers for Disease Control and Prevention’s (CDC) for responding to 

the potential importation of smallpox during the 1970’s. This updated “Interim Smallpox 

Response Plan and Guidelines” incorporates, and extends, many of the concepts and 

approaches that were successfully employed 30 to 40 years ago to control smallpox 

outbreaks. These overall concepts for outbreak containment contributed greatly to the 

eventual global eradication of smallpox. Thus, while this document is an updated plan, 

many of the elements in the plan have been extensively and successfully utilized in prior 

decades. Overall, this document outlines the public health strategies and approaches 

that would guide the public health response to a smallpox emergency. This interim 

document also identifies many of the federal, state, and local public health activities that 

must be undertaken in a smallpox emergency. This plan, much of which has been in 

place for years, will be regularly updated to reflect changes in capacities and resources 

for responding to a smallpox emergency. 

Smallpox 

Variola virus is the etiological agent of smallpox. The only known reservoir for the virus 

during the smallpox era was humans; there were no known animal or insect reservoirs 

or vectors. The most frequent mode of transmission is person-to-person spread via 

direct deposit of infective droplets onto the nasal, oral, or pharyngeal mucosal 

membranes, or the alveoli of the lungs from close, face-to-face contact with an 
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infectious individual. Indirect spread (not requiring face-to-face contact with an 

infectious individual) via fine-particle aerosols or fomites containing the virus has been 

reported but is less common. Fine-particle aerosol spread appears to occur more 

commonly with severe forms of smallpox, such as hemorrhagic smallpox, where virus 

titers are very high and sustained, or in cases where a significant cough (which can 

generate fine-particle aerosols) is present in the first week of illness (when 

oropharyngeal viral shedding is typically highest). 

In the majority of cases, symptoms of disease usually begin within 12-14 days (range 7-

17) following the exposure of a susceptible person to the virus and consists of a 2-3 day 

prodrome of high fever, malaise, and prostration with severe headache and backache. 

This pre-eruptive stage of the disease is then followed by the appearance of a 

maculopapular rash (eruptive stage) that progresses to papules (1-2 days after 

appearance of rash), vesicles (4-5th day), pustules (by 7th day), and finally scab lesions 

(14th day). The rash generally appears first on the oral mucosa, face, and forearms, 

then spreads to the trunk and legs. Lesions are also seen on the palms of the hands 

and soles of the feet. The skin lesions of smallpox are deeply embedded in the dermis 

and feel like firm round objects embedded in the skin. As the skin lesions heal and the 

scabs separate, pitted scarring gradually develops. Smallpox patients are most 

infectious during the first week of the rash when the oral mucosa lesions ulcerate and 

release the large amounts of virus into the saliva and are less infectious once the 

lesions have scabbed over. A patient is no longer infectious once all the scabs have 

separated (usually 3-4 weeks after the onset of the rash). The overall mortality rate 

associated with smallpox was approximately 30%. Other less common but more severe 

forms of smallpox include: 1) flat-type smallpox with a mortality rate >96%, 

characterized by severe toxemia and flat, velvety, confluent lesions that do not progress 

to the pustular stage, and 2) hemorrhagic-type smallpox, characterized by severe 

prodromal symptoms, toxemia, and a hemorrhagic rash that was almost always fatal 

with death usually occurring 5-6 days after the onset of the rash. (See Annex 1 – 

Overview of Smallpox and Medical Care of Smallpox Patients for a more complete 

discussion of smallpox) 

Smallpox Vaccine 

Smallpox vaccine is a highly effective immunizing agent. It is a live-virus vaccine 

composed of vaccinia virus, an orthopoxvirus that induces antibodies that also protect 

against smallpox. Its use in focused ring vaccination campaigns that utilized intensive 

surveillance and contact-tracing during the smallpox eradication program helped bring 

about the global eradication of smallpox. The last naturally-acquired case of smallpox 

occurred in Somalia in 1977. In May 1980, the World Health Assembly certified that the 

world was free of smallpox. Smallpox vaccine production ceased in the early 1980’s and 

current supplies of smallpox vaccine are limited. However, it is expected that new cellculture grown smallpox vaccines will become available for use within the next 2-4 years. 

Although smallpox vaccine is considered a safe vaccine, post-vaccination adverse 

events can occur. These adverse events and their rates as determined in a 1968 10-

state survey include: 1) inadvertent inoculation (529.2/million primary vaccinations), 2) 

generalized vaccinia (241.5/million primary vaccinations), 3) eczema vaccinatum 
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(38.5/million vaccinations), 4) progressive vaccinia (1.5/million primary vaccinations), 

and 5) post-vaccinial encephalitis (12.3/million primary vaccinations). Death also occurs 

in about one per million primary vaccinations and is usually a result of progressive 

vaccinia, post-vaccinial encephalitis, or severe eczema vaccinatum. 

Several groups have been identified as having a higher risk for developing postvaccination complications. These include: 1) persons with eczema (including a history 

of eczema) or other forms of chronic dermatitis, and 2) persons with altered immune 

states (e.g. HIV, AIDS, leukemia, lymphoma, immunosuppressive drugs, etc.). In 

addition, because of the small risk for fetal vaccinia, vaccination is not recommended 

during pregnancy. Children under 1 year of age, or older adolescents or young adults 

receiving primary vaccination may also have a greater risk of post-vaccination 

complications. Vaccinia Immune Globulin (VIG) is used to treat certain vaccine adverse 

reactions, however supplies of the VIG are also limited. CDC Interim Smallpox 

Response Plan and Guidelines 

This Interim Smallpox Response Plan is a working document that is updated regularly. 

Since state and local health officials are at the heart of an effective response to a 

smallpox emergency, their input is currently being sought, and it is anticipated that this 

plan will be updated frequently in the coming months. The plan is, however, operational 

and would be implemented should a smallpox emergency occur. The CDC Director may 

implement all or portions of the CDC Smallpox Response Plan under the “Criteria for 

Implementation” that are found in the next section. 

As this plan illustrates, an effective response to a smallpox emergency will necessitate 

extensive involvement and coordination of CDC with state and local public health 

activities. This interim document thus identifies many of the federal, state, and local 

public health activities that must be undertaken in a smallpox emergency. This 

document is organized into multiple sections. These sections outline criteria for 

smallpox response plan implementation, notification procedures for suspected cases, 

CDC and state and local responsibilities and activities—including some that should take 

place prior to a smallpox emergency—and CDC vaccine and personnel mobilization. 

This plan also provides Guidelines and Annexes to assist federal, state, and local health 

officials in implementing the specific activities that are essential for the management of 

a smallpox emergency. The general response strategy and priority activities are outlined 

below. 

General Strategy and Priority Activities for Smallpox Outbreak Containment 

As this plan states, the first and foremost public health priority during a smallpox 

outbreak is control of the epidemic. The following activities would be essential to 

accomplishing this goal. 

Ring Vaccination 

Any vaccination strategy for containing a smallpox outbreak should utilize the ring 

vaccination concept. This includes isolation of confirmed and suspected smallpox cases 
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with tracing, vaccination, and close surveillance of contacts to these cases as well as 

vaccination of the household contacts of the contacts. 

Vaccinating and monitoring a “ring” of people around each case and contact will help to 

protect those at the greatest risk for contracting the disease as well as form a buffer of 

immune individuals to prevent the spread of disease. This strategy would be more 

desirable than an indiscriminate mass vaccination campaign for the following reasons: 

1. Focused contact tracing and vaccination combined with extensive surveillance and 

isolation of cases was successful in stopping outbreaks of smallpox during the 

eradication program without the need for indiscriminate vaccination.1

2. Adverse events would be expected to be higher in an indiscriminate vaccination 

campaign due to vaccination of persons with unrecognized contraindications (e.g. 

undiagnosed immunosuppressive disorders such as HIV or AIDS). Careful screening for 

contraindications to vaccination would also be more difficult in a large scale vaccination 

campaign. The risks vs. benefits of vaccination ratio would be higher in such a 

campaign because of the inevitable vaccination of persons with high risk of adverse 

events and a low risk of smallpox. 

3. Current supplies of VIG would not be sufficient to treat the number of expected 

adverse events that would occur with a large, indiscriminate vaccination campaign. 

4. Current supplies of smallpox vaccine would be exhausted quickly if an indiscriminate 

campaign was utilized, potentially leaving no vaccine for use if smallpox cases 

continued to occur 

5. Mass, indiscriminate vaccination of a large population would require a very large 

number of health-care/public health workers to perform vaccination and deal with the 

higher number of adverse events 

6. Utilization of mass vaccination may lead to improper reliance on this strategy to 

control the outbreak with less focus on other essential outbreak control measure such 

as careful surveillance, contact tracing, and isolation of cases. This could also lead to 

inadequate supplies of vaccine for areas with the greatest need and potentially prolong 

the epidemic instead of controlling it. 

Depending upon, 1) the option for outbreak control that is selected, 2) the size of the 

outbreak, 3) personnel resources, 4) effectiveness of other outbreak control measures, 

and 4) vaccine availability, the size of the vaccinated “ring” of individuals surrounding a 

case or contact may be modified (expanded or contracted). However, the ring 

vaccination concept should be maintained overall. The determination of the initial 

 

1 Although individuals with smallpox are not infectious until the onset of rash, vaccinating contacts from 

the time of the onset of fever helps provide a buffer and assures that contacts who may have been 

exposed at the early onset of rash, when the rash may have been faint and unrecognized, have been 

vaccinated. 
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vaccination ring size or alteration of subsequent vaccination ring sizes will be made 

jointly by Federal and State health officials. 

Identification of Priority Groups 

The following are considered high risk groups and should be prioritized for vaccination 

in a smallpox outbreak: 

1. Face-to-face close contacts (= 6.5 feet or 3 meters), or household contacts to 

smallpox patients after the onset of the smallpox patient’s fever. 

2. Persons exposed to the initial release of the virus (if the release was discovered 

during the first generation of cases and vaccination may still provide benefit) 

3. Household members (without contraindications to vaccination) of contacts to 

smallpox patients2

 (to protect household contacts should smallpox case contacts 

develop disease while under fever surveillance at home) 

4. Persons involved in the direct medical care, public health evaluation3, or 

transportation of confirmed or suspected smallpox patients 

5. Laboratory personnel involved in the collection and/or processing of clinical 

specimens from suspected or confirmed smallpox patients 

6. Other persons who have a high likelihood of exposure to infectious materials (e.g. 

personnel responsible for hospital waste disposal and disinfection) 

7. Personnel involved in contact tracing and vaccination, or quarantine/isolation or 

enforcement, or law-enforcement interviews of suspected smallpox patients4

8. Persons permitted to enter any facilities designated for the evaluation, treatment, or 

isolation of confirmed or suspected smallpox patients5

 (only essential personnel should 

be allowed to enter such facilities) 

 

2 Household members of contacts who have contraindications to vaccination should be housed separately 

from the other vaccinated household members until the vaccination site scab has separated (~ 2 weeks) 

to prevent inadvertent transmission of vaccinia virus. They should be alsobe housed separately from the 

contact until the incubation period for smallpox has passed and the contact is released from surveillance. 

3 Includes personnel whose public health activities involve direct patient contact such as case 

interviewing.

4 Includes personnel whose public health activities involve direct patient contact such as case 

interviewing.

5 Only personnel without contraindications to vaccination should be chosen for activities that would 

require vaccination for their protection. Personnel with contraindications should not perform duties that 

would place them at risk for smallpox exposure and should otherwise only be vaccinated if an exposure 

has already occurred. 
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9. Persons present in a facility or conveyance with a smallpox case if fine-particle 

aerosol transmission was likely during the time the case was present (e.g. hemorrhagic 

smallpox case and/or case with active coughing).6

Additional Groups that Would Be Considered for Voluntary Vaccination 

Federal, State, and Local response personnel not involved in direct patient or contact 

evaluation or care but whose uninterrupted support of response activities is deemed 

essential may be considered for voluntary vaccination. Vaccination of these personnel 

will be dependent upon the size of the outbreak, availability of vaccine, the assessed 

risk for unintentional or unrecognized contact with smallpox cases, and a careful 

assessment of the benefits vs. the risks of vaccination. Only personnel within these nonpatient contact groups who have no contraindications will be considered for vaccination. 

Persons within these groups with contraindications should not be vaccinated. The 

decision to offer voluntary vaccination non-patient contact personnel will be made by the 

Director, CDC. These groups include, but are not limited to: 

1. Public health personnel in the area involved in surveillance and epidemiological data 

analysis and reporting whose support of these public health activities must remain 

unhindered 

2. Logistics/resource/emergency management personnel whose continued support of 

response activities must remain unhindered 

3. Law enforcement, fire, and other personnel involved in other non-direct patient care 

response support activities such as crowd control, security, law enforcement, and 

firefighting/rescue operations 

Overview: Activities and Guidelines 

This Interim Smallpox Response Plan and Guidelines document outlines, and in some 

cases, describes in detail, many of the pre- and post-event activities that need to be, or 

would be undertaken, in response to a smallpox emergency. These include: 

Surveillance and Epidemiological Investigations: 

• Pre-event rash surveillance 

• Smallpox clinical presentations and differential diagnosis guidelines 

• Smallpox case definitions 

• Notification procedures for suspected smallpox cases 

• Case and outbreak investigations 

General Vaccination activities: 

 

6 Evaluation of the potential risk for aerosol transmission and initiation of vaccination for non-direct 

contacts will be done by CDC, state, and local public health personnel. The decision to offer vaccination 

to non-direct contacts of smallpox cases will be made jointly by Federal and the State health officials.
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• CDC vaccine deployment 

• Clinic vaccination procedures and adverse event reporting 

• Rapid identification and vaccination of all priority groups (non-contact and contact) 

• Education and evaluation of vaccine responses with revaccination when needed 

• Education, recognition, and treatment of vaccine adverse events 

• Decontamination guidelines 

• Monitoring of vaccine utilization and supplies 

Quarantine/Isolation related activities: 

• Fever/rash surveillance and education of contacts (vaccinated and unvaccinated) 

• Isolation and care of smallpox patients during the infectious period 

Surveillance activities: 

• Identification and reporting of suspected smallpox cases through active surveillance at 

the local, state, national, and international levels 

• Surveillance of vaccine adverse events 

Epidemiology: 

• Epidemiological investigation of the outbreak to determine at-risk populations 

(contacts), source of outbreak, and risk factors for illness • Specimen collection and 

transportation guidelines 

Public/Media Communications: 

• Communications principles and guidelines • Pre-event communication education and 

information 

• Smallpox emergency communication operations and activities 

These inter-related, multifaceted activities are discussed in the Guides and Annexes 

that follow. In addition, this Interim Smallpox Plan identifies, and provides examples, of 

many of the specific activities, forms, and procedures that should be followed in 

preparation for, and in response to, a smallpox emergency. 

The CDC Interim Smallpox Response Plan and Guidelines is a draft document that will 

be updated as needed to reflect changes in capacities and resources for responding to 

a smallpox emergency. Public health authorities will be notified when updated drafts are 

available. 
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APPENDIX U—PANEL ACTIVITIES—CALENDAR YEAR 2001 

During the past year, the panel held five formal meetings: 

 March 29-30, 2001, RAND Washington Office, Arlington, VA 

 June 18-19, 2001, RAND Washington Office, Arlington, VA 

 August 26-27, 2001, RAND Washington Office, Arlington, VA 

 September 24, 2001, RAND Washington Office, Arlington, VA 

 November 12-13, 2001, RAND Washington Office, Arlington, VA 

During the course of those meetings, panel members received formal presentations as follows: 

“Rethinking the Role of Border Controls,” Commander Steven Flynn, U.S. Coast Guard, 

Senior Fellow, National Security Studies Program, Council on Foreign Relations 

“The Role of the Coast Guard in Combating Terrorism,” Rear Admiral Terry Cross, 

Assistant Commandant for Operations, U.S. Coast Guard 

“Terrorism Preparedness and Response for the U.S. Coast Guard,” Jeffrey High, Director 

of Waterways Management, U.S. Coast Guard 

“U.S. Customs and Border Security,” John McGowan, Executive Director, Enforcement 

Planning, Office of Field Operations, U.S. Customs Service 

“INS and Border Security,” Michael Cronin, Acting Executive Associate Commissioner 

for Programs, Immigration and Naturalization Service 

“The Role of the Military in Domestic Terrorism Preparedness,” Charles Cragin, Acting 

Assistant to the Secretary of Defense for Civil Support 

“The Use of the Military in Terrorism Response,” T.K. Custer, Director for 

Counterterrorism, Office of the Assistant Secretary-Special Operations/Low Intensity 

Conflict, Office of the Secretary of Defense 

“Organized Medicine’s Role in the National Response to Terrorism,” Dr. Scott 

Deitchman, American Medical Association Council for Scientific Affairs 

“Laboratory Response Network for Bioterrorism,” Dr. Scott Lillibridge, Director, 

Bioterrorism Prevention and Response, Centers for Disease Control and Prevention 

“Implementing Hospital Standards for Terrorism Response,” Margaret Van Ameringe, 

Vice President, External Affairs, Joint Commission on Accreditation of Healthcare 

Organizations 

“Cyber Security,” Richard Clarke, National Coordinator for Security, Counter-terrorism, 

and Infrastructure Protection, National Security Council 

“Critical Infrastructure Protection,” John Tritak, Director, Critical Infrastructure 

Assurance Office, Department of Commerce 

“Critical Infrastructure Protection,” Ron Dick, Director, National Infrastructure 

Protection Center, Federal Bureau of Investigation 

“Cyber Protection as a National Security Issue,” Captain Robert West, U.S. Navy, 

Deputy Commander, Joint Task Force-Computer Network Defense, U.S. Space 

Command 

“The Role of the Military in Information Assurance,” William Leonard, Deputy Assistant 

Secretary of Defense-Command, Control, Communications, and Intelligence, Office of 

the Secretary of Defense 
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“Public Safety Planning for Special Events,” David Tubbs, Director, Utah Olympics 

Public Safety Command 

“The Congress after 11 September,” The Honorable Curt Weldon, U.S. House of 

Representatives 

“Responding to Acts of Terror: the Aftermath of the Attack on the Pentagon,” Chief Ed 

Plaugher, Arlington County Fire Department (at the Pentagon crash site) 

“Congressional Actions since 11 September 2001,” Suzanne Spaulding, RAND 

Consultant 

“The Use of Imaging Intelligence for Combating Terrorism,” James Clapper, Director, 

National Imaging and Mapping Agency 

“Recent Changes in the Department of Defense to Address Homeland Security,” Dr. 

Michelle Van Cleave, Office of the Secretary of Defense 

Under the provisions of the Federal Advisory Committee Act, meetings of the panel are 

generally open to the public, except when national security classified information is being 

presented or discussed, or for one of the other exceptions stated in the Act. Notices of meetings 

are published in the Federal Register and posted on the panel’s web page on the RAND web site, 

http://www.rand.org. Unclassified minutes of the panel meetings are posted to the same web 

page as soon as the panel has approved them. 

Panel members and support staff also attended and participated directly in numerous 

conferences, workshops, and symposia on the subject of terrorism. In addition, panel members 

and staff attended numerous Congressional hearings on terrorism and presented testimony when 

appropriate. 
V-1 

APPENDIX V—RAND STAFF PROVIDING SUPPORT TO THE ADVISORY 

PANEL 

Executive Project Director 

Michael Wermuth 

Research Staff for the Report 

Kathryn Anderson 

Janice Blanchard 

David Brannan 

Jennifer Brower 

Peter Chalk 

Kim Cragin 

Lois Davis 

Paul Davis 

Linda Demaine 

Ron Fricker 

Bruce Hoffman 

Brian Houghton 

Gerald Jacobsen 

Lisa Jones 

Martin Libicki 

Scott McMahon 

Roger Molander 

David Mussington 

Sarah Cotton Nelson 

Jennifer Pace 

John Parachini 

Carolyn Rogers 

William Rosenau 

Jonathan Schachter 

Lila Shapiro 

Suzanne Spaulding 

Amy Wells 

Michael Wermuth 

Traci Williams 

Peter Wilson 

Danielle Zink

Administrative Support 

Nancy Rizor Sandra Hanson Christel Chichester Priscilla Schlegel 

Other RAND Staff Providing Support 

Nykolle Brooks 

Shirley Burch 

Molly Coleman 

Jess Cook 

Mary Evans 

David Feliciano 

Leanna Ferguson 

Hunter Granger 

Tyrone Greene 

Candace Hoffman 

Peter Hoffman 

Emily King 

Judy Lewis 

Lee Meyer 

Phillip Mazzocco 

Kathy Mills 

Kenneth Myers 

Carolyn Rogers 

Amy Rudibaugh 

Dan Sheehan 

Diana Thornton 

Carlos Vallejo 

Deanna Webber 

Elwood Whitaker 

Natalie Ziegler 

RAND Corporate Leadership for the Project 

Jeffrey Isaacson, Vice President, National Security Research Division, and Director, 

National Defense Research Institute (NDRI) 

Susan Everingham, Director, Forces and Resources Policy Center (NDRI) 

Stuart Johnson, Director, International Security and Defense Policy Center (NDRI)
LIST OF KEY RECOMMENDATIONS BY ENTITY

Executive and Legislative Branches Jointly

- Establish a government-owned, contractor-operated national vaccine and therapeutics facility 

- Create, provide resources for, and mandate participation in a “Border Security Awareness” database system 

- Negotiate more comprehensive treaties and agreements for combating terrorism with Canada and Mexico 

- Convene a “summit” to address Federal statutes changes that would enhance cyber assurance 

- Establish a homeland security undersecretary position in the Department of Defense 

The President

- Ensure that all border agencies are partners in intelligence collection, analysis, and dissemination 

- Establish “Trusted Shipper” programs 

- Include private and State and local representatives on the interagency critical infrastructure advisory panel 

- Establish a government-funded, not-for-profit entity for cyber detection, alerting, and warning functions 

- Develop and implement a comprehensive plan for cyber research, development, test, and evaluation 

Office of Homeland Security 

- Consolidate Federal grant program information and application procedures 

- Establish an information clearinghouse about Federal programs, assets, and agencies 

- Review and recommend changes to plans for vaccine stockpiles and critical supplies (with DHHS and DVA) 

- Develop on-going public education programs on terrorism causes and effects 

- Develop a comprehensive plan for researching terrorism-related medical issues 

- Develop an education plan on the legal and procedural issues for health and medical response to terrorism 

- Create an intergovernmental border advisory group 

- Fully integrate all affected entities into local or regional “port security committees” 

- Expand and consolidate research, development, and integration of border sensor, detection, and warning systems 

Relevant Executive Branch Agencies 

- Increase and accelerate the sharing of terrorism-related intelligence and threat assessments (All) 

- Design training and equipment programs for all-hazards preparedness (All) 

- Design Federal preparedness programs to ensure first responder participation, especially volunteers (All) 

- Redesign Federal training and equipment grant programs to include sustainment components (All) 

- Configure Federal military response assets to support and reinforce existing structures and systems (DoD) 

- Develop standard medical response models for Federal, State, and local level hazards (DHHS) 

- Reestablish a pre-hospital Emergency Medical Service Program Office (DHHS) 

- Revise current EMT and PNST training and refresher curricula (DOT/NHTSAO) 

- Review MMRS and NDMS authorities, structures, and capabilities (DHHS with OHS) 

- Establish a unified command and control structure to execute all military support to civil authorities (DoD) 

- Develop detailed plans for the use of the military domestically across the spectrum of potential activities (DoD) 

- Expand training and exercises in relevant military units with Federal, State, and local responders (DoD) 

- Direct new mission areas for the National Guard to provide support to civil authorities (DoD) 

- Publish a compendium of statutory authorities for using the military domestically to combat terrorism (DoD) 

- Improve the military full time liaison elements in the ten Federal Emergency Management Agency regions (DoD) 

The Congress 

- Increase funding to States and localities for combating terrorism 

- Fully resource the CDC Biological and Chemical Terrorism Strategic Plan 

- Fully resource the CDC Laboratory Response Network for Bioterrorism 

- Fully resource the CDC Secure and Rapid Communications Networks 

- Increase Federal resources for exercises for State and local health and medical entities 

- Require shippers to submit cargo manifest information simultaneously with shipments transiting U.S. borders 

- Expand Coast Guard search authority to include U.S. owned—not just “flagged”—vessels 

- Increase resources for the U.S. Coast Guard for homeland security missions 

- Create a commission to assess and make recommendations on programs for cyber security 

- Create a special “Cyber Court” patterned after the court established in the FISA 

State and Local Governments and the Private Sector 

- Implement the AMA Recommendations on Medical Preparedness for Terrorism 

- Implement the JCAHO Revised Emergency Standards 
LIST OF KEY RECOMMENDATIONS BY SUBJECT

State and Local Response Capabilities 

- Increase and accelerate the sharing of terrorism-related intelligence and threat assessments 

- Design training and equipment programs for all-hazards preparedness 

- Redesign Federal training and equipment grant programs to include sustainment components 

- Increase funding to States and localities for combating terrorism 

- Consolidate Federal grant program information and application procedures 

- Design Federal preparedness programs to ensure first responder participation, especially volunteers 

- Establish an information clearinghouse on Federal programs, assets, and agencies 

- Configure Federal military response assets to support and reinforce existing structures and systems 

Health and Medical Capabilities 

- Implement the AMA Recommendations on Medical Preparedness for Terrorism 

- Implement the JCAHO Revised Emergency Standards 

- Fully resource the CDC Biological and Chemical Terrorism Strategic Plan 

- Fully resource the CDC Laboratory Response Network for Bioterrorism 

- Fully resource the CDC Secure and Rapid Communications Networks 

- Develop standard medical response models for Federal, State, and local levels 

- Reestablish a pre-hospital Emergency Medical Service Program Office 

- Revise current EMT and PNST training and refresher curricula 

- Increase Federal resources for exercises for State and local health and medical entities 

- Establish a government-owned, contractor-operated national vaccine and therapeutics facility 

- Review and recommend changes to plans for vaccine stockpiles and critical supplies 

- Develop a comprehensive plan for research on terrorism-related health and medical issues 

- Review MMRS and NDMS authorities, structures, and capabilities 

- Develop an education plan on the legal and procedural issues for health and medical response to terrorism 

- Develop on-going public education programs on terrorism causes and effects 

Immigration and Border Control 

- Create an intergovernmental border advisory group 

- Fully integrate all affected entities into local or regional “port security committees” 

- Ensure that all border agencies are partners in intelligence collection, analysis, and dissemination 

- Create, provide resources for, and mandate participation in a “Border Security Awareness” database system 

- Require shippers to submit cargo manifest information simultaneously with shipments transiting U.S. borders 

- Establish “Trusted Shipper” programs 

- Expand Coast Guard search authority to include U.S. owned—not just “flagged”—vessels 

- Expand and consolidate research, development, and integration of sensor, detection, and warning systems 

- Increase resources for the U.S. Coast Guard for homeland security missions 

- Negotiate more comprehensive treaties and agreements for combating terrorism with Canada and Mexico 

Cyber Security 

- Include private and State and local representatives on the interagency critical infrastructure advisory panel 

- Create a commission to assess and make recommendations on programs for cyber security 

- Establish a government funded, not-for-profit entity for cyber detection, alert, and warning functions 

- Convene a “summit” to address Federal statutory changes that would enhance cyber assurance 

- Create a special “Cyber Court” patterned after the court established in FISA 

- Develop and implement a comprehensive plan for cyber security research, development, test, and evaluation 

Use of the Military 

- Establish a homeland security under secretary position in the Department of Defense 

- Establish a single unified command and control structure to execute all military support to civil authorities 

- Develop detailed plans for the use of the military domestically across the spectrum of potential activities 

- Expand training and exercises in relevant military units and with Federal, State, and local responders 

- Direct new mission areas for the National Guard to provide support to civil authorities 

- Publish a compendium of statutory authorities for using the military domestically to combat terrorism 

- Improve the military full-time liaison elements in the ten Federal Emergency Management Agency regions