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THE SILENT WAR: ARE FEDERAL, STATE AND

LOCAL GOVERNMENTS PREPARED FOR BIOLOGICAL AND CHEMICAL ATTACKS?

HEARING

BEFORE THE

SUBCOMMITTEE ON GOVERNMENT EFFICIENCY,

FINANCIAL MANAGEMENT AND

INTERGOVERNMENTAL RELATIONS

OF THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED SEVENTH CONGRESS

FIRST SESSION

OCTOBER 5, 2001

Serial No. 107–95

Printed for the use of the Committee on Government Reform

(

Available via the World Wide Web: http://www.gpo.gov/congress/house

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

DAN BURTON, Indiana, Chairman

BENJAMIN A. GILMAN, New York

CONSTANCE A. MORELLA, Maryland

CHRISTOPHER SHAYS, Connecticut

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

STEPHEN HORN, California

JOHN L. MICA, Florida

THOMAS M. DAVIS, Virginia

MARK E. SOUDER, Indiana

STEVEN C. LATOURETTE, Ohio

BOB BARR, Georgia

DAN MILLER, Florida

DOUG OSE, California

RON LEWIS, Kentucky

JO ANN DAVIS, Virginia

TODD RUSSELL PLATTS, Pennsylvania

DAVE WELDON, Florida

CHRIS CANNON, Utah

ADAM H. PUTNAM, Florida

C.L. ‘‘BUTCH’’ OTTER, Idaho

EDWARD L. SCHROCK, Virginia

JOHN J. DUNCAN, JR., Tennessee

——— ———

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

PATSY T. MINK, Hawaii

CAROLYN B. MALONEY, New York

ELEANOR HOLMES NORTON, Washington,

DC

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

ROD R. BLAGOJEVICH, Illinois

DANNY K. DAVIS, Illinois

JOHN F. TIERNEY, Massachusetts

JIM TURNER, Texas

THOMAS H. ALLEN, Maine

JANICE D. SCHAKOWSKY, Illinois

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

——— ———

———

BERNARD SANDERS, Vermont

(Independent)

KEVIN BINGER, Staff Director

DANIEL R. MOLL, Deputy Staff Director

JAMES C. WILSON, Chief Counsel

ROBERT A. BRIGGS, Chief Clerk

PHIL SCHILIRO, Minority Staff Director

SUBCOMMITTEE ON GOVERNMENT EFFICIENCY, FINANCIAL MANAGEMENT AND

INTERGOVERNMENTAL RELATIONS

STEPHEN HORN, California, Chairman

RON LEWIS, Kentucky

DAN MILLER, Florida

DOUG OSE, California

ADAM H. PUTNAM, Florida

JANICE D. SCHAKOWSKY, Illinois

MAJOR R. OWENS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

EX OFFICIO

DAN BURTON, Indiana HENRY A. WAXMAN, California

J. RUSSELL GEORGE, Staff Director and Chief Counsel

MATT PHILLIPS, Professional Staff Member

MARK JOHNSON, Clerk

DAVID MCMILLEN, Minority Professional Staff Member

(III)

C O N T E N T S

Page

Hearing held on October 5, 2001 ............................................................................ 1

Statement of:

Lillibridge, Scott R., M.D., Special Assistant to the Secretary for National

Security and Emergency Management, Department of Health and

Human Services; Bruce Baughman, Director, Planning and Readiness

Division, Federal Emergency Management Agency; Craig Duehring,

Principal Deputy Assistant Secretary of Defense for Reserve Affairs,

Department of Defense; Woodbury Fogg, director, New Hampshire Office of Emergency Management, co-chair, Terrorism Committee, National Emergency Management Association; Mark Smith, M.D., Washington Hospital Center, representing the American Hospital Association; and Kyle B. Olson, vice president and senior associate, Community Research Associates .............................................................................. 83

McHale, Sang-Mi, survivor of 1995 sarin gas attack in Tokyo; Amy

Smithson, Ph.D., director, chemical and biological weapons nonproliferation project, the Stimson Center; Martin O’Malley, mayor, city

of Baltimore; Edward T. Norris, commissioner, Baltimore City Police

Department; Don Lynch, emergency management director, Shawnee

City and Pottawatomie County, OK, and former emergency management director, Oklahoma County, OK; Diana Bonta, Dr.P.H., R.N.,

director department of health services, State of California; Janet

Heinrich, Dr.P.H., R.N., Director, Health Care and Public Health

Issues, U.S. General Accounting Office; and Lt. Gen. James Peake,

M.D., Surgeon General, U.S. Army ............................................................. 8

Letters, statements, etc., submitted for the record by:

Baughman, Bruce, Director, Planning and Readiness Division, Federal

Emergency Management Agency, prepared statement of ......................... 95

Bonta, Diana,Dr.P.H., R.N., director department of health services, State

of California, prepared statement of ........................................................... 59

Cummings, Hon. Elijah E., a Representative in Congress from the State

of Maryland, prepared statement of ............................................................ 169

Duehring, Craig, Principal Deputy Assistant Secretary of Defense for

Reserve Affairs, Department of Defense, prepared statement of .............. 105

Fogg, Woodbury, director, New Hampshire Office of Emergency Management, co-chair, Terrorism Committee, National Emergency Management Association, prepared statement of .................................................... 122

Horn, Hon. Stephen, a Representative in Congress from the State of

California, prepared statement of ................................................................ 3

Lillibridge, Scott R., M.D., Special Assistant to the Secretary for National

Security and Emergency Management, Department of Health and

Human Services, prepared statement of ..................................................... 87

Lynch, Don, emergency management director, Shawnee City and

Pottawatomie County, OK, and former emergency management director, Oklahoma County, OK, prepared statement of ................................... 44

Maloney, Hon. Carolyn B., a Representative in Congress from the State

of New York, prepared statement of ........................................................... 6

Norris, Edward T., commissioner, Baltimore City Police Department, prepared statement of ........................................................................................ 37

O’Malley, Martin, mayor, city of Baltimore, prepared statement of ............ 28

Olson, Kyle B., vice president and senior associate, Community Research

Associates, prepared statement of ............................................................... 152

Smith, Mark, M.D., Washington Hospital Center, representing the American Hospital Association, prepared statement of ...................................... 138

Page

IV

Letters, statements, etc., submitted for the record by—Continued

Smithson, Amy, Ph.D., director, chemical and biological weapons nonproliferation project, the Stimson Center, prepared statement of ............ 12

(1)

THE SILENT WAR: ARE FEDERAL, STATE AND

LOCAL GOVERNMENTS PREPARED FOR BIOLOGICAL AND CHEMICAL ATTACKS?

FRIDAY, OCTOBER 5, 2001

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON GOVERNMENT EFFICIENCY, FINANCIAL

MANAGEMENT AND INTERGOVERNMENTAL RELATIONS,

COMMITTEE ON GOVERNMENT REFORM,

Washington, DC.

The subcommittee met, pursuant to notice, at 10 a.m., in room

2154, Rayburn House Office Building, Hon. Stephen Horn (chairman of the subcommittee) presiding.

Present: Representatives Horn, Putnam, Schakowsky, Maloney,

and Cummings.

Also present: Representative Ehrlich.

Staff present: J. Russell George, staff director and chief counsel;

Matt Phillips, professional staff member; Mark Johnson, clerk;

Bonnie Heald, communications director; Jim Holmes, intern; David

McMillen, minority professional staff member; and Jean Gosa, minority clerk.

Mr. HORN. A quorum being present, the hearing of the Subcommittee on Government Efficiency, Financial Management and

Intergovernmental Relations will come to order.

On September 11, 2001, the world witnessed the most devastating and horrific attacks ever committed on U.S. soil. Despite the

damage and enormous loss of life those attacks caused, they failed

to cripple the Nation. To the contrary, this Nation has never been

more united in its fundamental belief in freedom and its willingness to protect that freedom.

The diabolical nature of these attacks was an unimaginable

wake-up call to all Americans: We must be prepared for the unexpected. We must have the mechanisms in place to protect this Nation and its people from further attempts to cause such massive destruction.

Today, the subcommittee will examine the Nation’s ability to respond to the possibility of a biological or chemical attack. Even

though most experts believe that the likelihood of such an attack

is relatively low, we must ensure that the Nation has an emergency management structure that is prepared to handle even the

most remote possibility of such an attack.

The aftermath of the September 11th attacks clearly demonstrated the need for adequate communications systems and rapid

deployment of well-trained emergency personnel. Yet despite bilVerDate 11-MAY-2000 08:46 Sep 24, 2002 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 C:\DOCS\81522.TXT HGOVREF1 PsN: HGOVREF1
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lions of dollars in spending on Federal emergency programs, there

are serious questions as to whether the Nation’s public health system is equipped to handle a massive chemical or biological attack.

A September 2000 report from the General Accounting Office— and that is part of the legislative branch headed by the Comptroller General of the United States—GAO found that the 1999 outbreak of the West Nile Virus severely taxed the New York public

health system. This outbreak, which was ultimately contained, affected hundreds of people. A biological attack could affect thousands more.

Today, the subcommittee will examine how effectively Federal,

State and local agencies are working together to prepare for such

emergencies. We want the people of this Nation to know that they

can rely on these systems, should the need arise.

I want to note that we had hoped to have Mayor Giuliani with

us today, but the city’s ongoing needs, rightly, take a higher priority. At the conclusion of today’s hearing, we will recess and reconvene at a later date to allow the Mayor an opportunity to contribute his expertise to this hearing. In addition, the subcommittee will

be conducting similar hearings throughout the country.

We are fortunate to have witnesses today whose valuable experience and insight will help the subcommittee better understand the

needs of those on the front-lines—representatives of the Nation’s

hospitals and its cities, counties and States. We want to hear about

their capabilities and their challenges. And we want to know what

the Federal Government can do to help.

We welcome all of our witnesses and we look forward to your testimony.

We’ll start now with an opening statement from the ranking individual, Mrs. Maloney, and Ms. Schakowsky and we want to

thank them for the help they’ve given us in gaining this particular

group of individuals.

And so I now yield up to 5 minutes to Mrs. Maloney, the gentlewoman from New York.

[The prepared statement of Hon. Stephen Horn follows:]

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Mrs. MALONEY. Thank you, Chairman Horn, and Ranking Member Schakowsky for holding this hearing. I would also like to thank

our panel of witnesses.

Over the past few weeks I have been to Ground Zero many times

in New York. The amount of destruction and devastation I have

witnessed, more than any other assault on U.S. soil, is indescribable and overwhelming. While we have maintained our strength

and resolve to rebuild and come back stronger than ever, I shudder

at the thoughts of what-ifs: What if those planes had contained a

chemical component or had the capability of releasing a biological

weapon? How would our response teams have reacted? And could

we have handled a two-pronged attack?

We now have to think of scenarios that would normally, in the

past, have been unthinkable, in order to prepare for any type of attack that may come. The FBI disregarded a report of a man who

showed up at a flight school wanting to learn how to steer a plane,

but he didn’t care about learning how to take-off or land. Now we

have to take every threat seriously. As we quickly learned on September 11th, the world is different and this war is different than

any we have fought in the past.

The terrorists are becoming more sophisticated and their network is widespread. They are using unconventional, unpredictable

means. If they are willing to give up their lives, they can do enormous harm. And the enormous harm could include chemical or biological attacks that threaten the lives of millions of Americans.

I am concerned that despite all the carnage we’ve seen in the financial capital of the world, we are not making sufficient preparations for a worst-case scenario, that we are more complacent than

we are prepared.

I am told that anthrax and smallpox represent two of the most

likely forms of biological warfare. We have 7 to 10 million doses of

smallpox vaccine and there are 280 million Americans. One vial of

anthrax has the potential to kill tens of thousands of people in the

New York City subway system. If anyone can convince me by the

end of this hearing that we have the infrastructure in place to

react to such an attack and prevent mass carnage, I will be pleasantly surprised.

I look forward to learning about our local, State and Federal

Government’s level of preparedness and ability to coordinate and

cooperate with each other. It is important to identify the weaknesses in our infrastructure and then work to address them so we

can improve our reaction in a time of crisis.

I am also interested in learning about the availability and effectiveness of vaccines and antibiotics for certain bioweapons. Are we

partnering with our pharmaceutical companies to prepare for an

attack or are we going about business as usual after September

11th? We must draw on all of our resources, both public and private, to detect and respond to all terrorism.

Again, I thank the chairman and the ranking member for calling

this hearing, and I thank all of our panelists for being here. I hope

that this will be the first of many hearings that will focus on this

tremendously important issue to our country.

[The prepared statement of Hon. Carolyn B. Maloney follows:]

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Mr. HORN. I thank the gentlewoman.

We will now swear in the witnesses. This is an investigating

committee, and we ask that you stand, raise your right hands. And

this includes also the staff behind you; just take the oath, too, so

we don’t have to keep making changes. The clerk will then get the

names of the support.

[Witnesses sworn.]

Mr. HORN. I will note for the record that all the witnesses and

their support staff have taken the oath.

We start with a very interesting individual in particular. Our

first witness has a very unique perspective to share with us, and

that’s Mrs. McHale, who was a victim of the chemical attack that

occurred in Tokyo in 1995; and we appreciate very much her willingness to come before the committee and relate her experience.

Mrs. McHale, it’s a pleasure to have you.

Mrs. MCHALE. Thank you, Mr. Chairman, members of the committee.

Mr. HORN. We’re going to have to have the clerk maintain getting the microphone there with everybody.

We have a terrible system in this place, and you would think,

with all the billions we give out to the executive branch, we don’t

give much to ourselves.

So here we are. OK.

STATEMENTS OF SANG-MI McHALE, SURVIVOR OF 1995 SARIN

GAS ATTACK IN TOKYO; AMY SMITHSON, Ph.D., DIRECTOR,

CHEMICAL AND BIOLOGICAL WEAPONS NONPROLIFERATION PROJECT, THE STIMSON CENTER; MARTIN O’MALLEY,

MAYOR, CITY OF BALTIMORE; EDWARD T. NORRIS, COMMISSIONER, BALTIMORE CITY POLICE DEPARTMENT; DON

LYNCH, EMERGENCY MANAGEMENT DIRECTOR, SHAWNEE

CITY AND POTTAWATOMIE COUNTY, OK, AND FORMER

EMERGENCY MANAGEMENT DIRECTOR, OKLAHOMA COUNTY, OK; DIANA BONTA, Dr.P.H., R.N., DIRECTOR DEPARTMENT

OF HEALTH SERVICES, STATE OF CALIFORNIA; JANET

HEINRICH, Dr.P.H., R.N., DIRECTOR, HEALTH CARE AND PUBLIC HEALTH ISSUES, U.S. GENERAL ACCOUNTING OFFICE;

AND LT. GEN. JAMES PEAKE, M.D., SURGEON GENERAL, U.S.

ARMY

Mrs. MCHALE. My name is Sang-mi McHale. I am here to testify

about my experience of being poisoned in the Tokyo subway in

1995, but first of all, I would like to express my deepest sympathy

toward the victims and their families of the recent terrorist attacks. I would also like to express my greatest respect and support

for the rescue workers and both State and municipal government

officials who have been working tirelessly since the tragedy.

On the morning of March 20, 1995, I was on my way to Saint

Luke’s International Hospital in Tokyo for a prenatal checkup. I

was 36 weeks pregnant. I had been living in Japan with two young

children, since 1992, and with my husband who had been assigned

to the U.S. Embassy in Tokyo as a staff assistant to Ambassador

Walter Mondale. I arrived at the subway station around 8 a.m. The

train arrived shortly after I reached the platform.

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As I boarded, I saw on the floor by the door a rectangular package wrapped in a newspaper, a sticky looking transparent substance was oozing from it. I walked by the package and sat diagonally across from it. It was about 6 feet away. I don’t remember

a particular smell, but I somehow felt the air being thick.

Within a minute or two after the train started moving, I noticed

that I was having difficulty breathing, and I started to cough. I remembered reading a little article earlier that week in the newspaper about a chemical substance in a train which made some passengers sick. I worried that exposure to my chemical might be

harmful to my baby and decided to move to the next car. Even from

the next car I could still see through the window both the substance and the other passengers. The passengers who remained in

the last car were all covering their mouths, coughing hard and had

reddened faces. They all appeared sick.

At the next station, as soon as the door opened, all the people

from the last car rushed to get off except for an old man who was

sitting directly across from the chemical substance. He was still in

the seat and appeared unconscious. He had turned purple and soon

went into convulsions. A passenger from the end car returned into

the car and dragged him out. I later learned that this old man was

one of the first victims to lose his life that morning.

At that moment, there was an announcement in the train that

there had been a bomb incident on a different line and that all subways were halting service. We all gasped and hurried off the train.

Luckily, the stairs to the street level were nearby. I found a public

phone and called my husband. Placing a call was hard because my

vision started getting blurry. Distinguishing the taxies from the

regular cars was difficult as well. Many people were gathered at

the intersection, some sitting on the curb and some people were

helping the others.

Soon I started hearing sirens, and I remember seeing an ambulance nearby. I was lucky enough to get a taxi about 50 minutes

later and went to the hospital. Again, I was lucky that I already

had an appointment with a doctor, because I could see my doctor

fairly quickly. He was alarmed at my condition and told me to stay

in the hospital. I was soon given a room in a maternity ward and

was placed on an IV. My symptoms included a fever, a headache,

and blurry vision.

The Japanese authorities identified the chemical substance as

Sarin rather quickly, I think, for by that afternoon I was given an

antidote to Sarin, atropine. Apparently, the hospital had enough

doses for all the patients who needed it.

I was released from the hospital 2 days later and quickly recovered except for miosis, darkened vision, which lasted about 2

months. After the incident, the hospital provided great care and

conducted Sarin victim surveys, periodically monitoring the emotional distress among the patients, and offered counseling for those

in need.

Several things helped me that day: First, the knowledge that a

similar incident involving chemical substance occurred in a train

before; second, my health consciousness just because I was pregnant, which made me move to that next car; third, my general beVerDate 11-MAY-2000 08:46 Sep 24, 2002 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6633 C:\DOCS\81522.TXT HGOVREF1 PsN: HGOVREF1
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lief that Japan is actually much less safe than its reputation, which

made me pay attention to my surroundings.

Last, I’m happy to report to you that I delivered a healthy baby

boy 3 weeks later, after the incident, at the same hospital, and he

is now a happy first grader.

I hope this has been helpful. Thank you very much.

Mr. HORN. It has been. We’re very glad for your family, and we

thank you very much. And if you can stay with us, we’d appreciate

it.

Let us now go to Dr. Amy Smithson, the Director of Chemical

and Biological Weapons Nonproliferation Project from the Stimson

Center. So, Dr. Smithson.

Dr. SMITHSON. Good morning, Mr. Chairman, and thank you for

the invitation to appear here today.

What you have just heard is the account of a woman who was

exposed to the nerve agent, Sarin. Nerve agents were essentially

discovered in the mid-1930’s. In laymen’s terms, what happens

when you’re exposed to very small amounts of this stuff is, your

system short-circuits and death can occur very rapidly, within minutes. Other examples of nerve agents, aside from Sarin, would include VX and Tabun.

There are two other basic categories of chemical warfare agents,

including blister agents where exposure can occur on the skin or

through the lungs and the result is as the category would describe,

heavy, heavy blistering and other side effects that can be much

more serious. Examples of blister agents, which were used quite

frequently during World War I, included mustard gas.

A third category of chemical weapons is called a blood agent, and

examples of that agent include hydrogen cyanide.

Earlier, in an opening statement, I heard mention of one of the

biological agents that is discussed quite frequently these days, anthrax.

There are two basic kinds of biological agents, and let’s keep in

mind that these are things that have to be alive when they reach

the human lung in a very, very small particle size, 1 to 10 microns,

in order to infect us and make us ill. And one of the rumors that

keeps making the rounds these days is that crop dusters are well

suited for the purposes of distribution of biological agents. Having

spent quite some time with people who fly these aircraft, they assure me that this is not as easily done as is often portrayed today.

Crop dusters disperse materials in a micron size of 100 microns

and above. And that is a far cry from the very small particle size

that would be needed to infect us. So let’s get things straight about

crop dusters, please.

In terms of biological agents, they come in two basic categories:

contagious and noncontagious. Anthrax would be the example that

we have heard most often. There is a case down in Florida. But

last year, when there was a case in North Dakota, the only people

who took notice were those in health and public health communities. In our heightened state, I think there are a lot of persons

who are afraid that this is a sign of something worse to come. I

simply do not believe that to be the case.

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Smallpox and plagues are examples of contagious biological warfare agents. And these do present a problem if indeed they were

ever to be released, a very serious problem.

I’d like to return to the case of the cult that did this woman

harm to illustrate how difficult it is to achieve a capability to disseminate these agents in a way that would cause mass casualties.

Aum Shinrikyo was my nightmare case. This was a cult determined to acquire these capabilities and use these weapons. They spent over $30 million on their chemical warfare program.

They had a state-of-the-art chemical production facility. They had

over 100 scientists and technicians in this program. And they could

not figure out how to make the significant quantities of chemical

agent that would really cause mass casualties of the type that

we’re seeing in New York City a couple of week ago. That’s one

thing we should keep in mind.

The biological warfare program was also quite significant. And

they tried for several years to acquire this capability. But the thing

we need to understand is that they flopped totally and utterly. Not

only could they not acquire the lethal seed cultures, they were unable to disperse what they thought they had in a manner that

would cause us to fall ill.

So let’s look to what terrorists can do and the hurdles that face

them in trying to acquire these types of capabilities, and not get

carried away with hyperbole and with speculation.

In terms of what worries me, what worries me is, this country

is peppered with over 850,000 facilities that work with hazardous

and extremely hazardous chemicals. These facilities, if someone

were to sabotage them, would have a very, very dangerous outcome. And there’s information that has now been made publicly

available about these facilities. And if there is one thing that I ask

from you today it is that you take steps to make sure that information is contained.

The remarks that I will conclude with here are based on a study

that I did surveying 33 cities across this country in their readiness

to contend with a chemical or a biological disaster.

One thing you need to keep in mind when you think about what

the Federal Government can do to help this country get prepared

for this type of an event is that all emergencies are local, and that

the lives that are saved will be lives saved by local rescuers. If you

need to understand that point, remember what happened on September 11th at the Pentagon and at the World Trade Center. It

wasn’t some Federal rescue team that swooped in; it was the local

firefighters, police, EMS and physicians. And if you are to get this

country ready, I would encourage to you get the domestic preparedness program back on track.

The initial intent of this program was to get the locals ready. But

last year, out of $8.7 billion spent in this program, only $311 million went to readiness in our communities across this country.

So with that, I see my time is up. I would be delighted to elaborate on the lessons that I learned in my survey from many people

who I consider to be much more authoritative than myself.

Mr. HORN. We will have questions from our colleagues on both

sides, so stick with us.

[The prepared statement of Dr. Smithson follows:]

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Mr. HORN. Now I’d like to give a welcome by Mr. Ehrlich, the

very able person representing the city and State of Maryland; and

he is going to introduce the mayor of Baltimore and the commissioner of the Baltimore City Police.

And that’s bipartisan, because Mr. Ehrlich is a Republican. Yes,

they’ve had only one Republican mayor; as I remember, it has been

all Democratic.

So we’re glad to have you here, and the same for the Chief.

So, Mr. Ehrlich.

Mr. EHRLICH. Mr. Chairman, thank you. I appreciate this opportunity.

Ranking Member Schakowsky and Mr. Chairman, members of

the committee, on July 18th, we thought at the time we had a

major incident, and certainly for Baltimore, MD, it was major. That

day, a 60-car CSX freight train, traveling to New Jersey, derailed

under Howard Street in Baltimore, MD. Subsequent fires sent

smoke billowing out of both ends of the tunnel, a cloud over Camden Yards. Fire caused water main breaks in the tunnel, literally

flooding streets above.

The entire city was shut down. The U.S. Coast Guard shut down

the Inner Harbor. Thirty thousand fans were removed from Camden Yards. Intense heat and fire were a problem, preventing our

firefighters from initially getting to the flames. Our city’s police

and fire departments worked together with the mayor’s office

around the clock for the next few days, and the fire was subdued.

It was a total team effort and a dire situation—a wonderful example of what cooperation can do.

In the aftermath of September 11th, our city, under the mayor’s

leadership, has done some things that could not have been thought

of 3 weeks ago. We’ve hired a former New York City Police Department official to come up with a terrorism plan, which the mayor,

I’m sure, will talk about. We’ve beefed up security at the city government buildings and around Penn Station. We brought in

branches to protect Baltimore’s own World Trade Center. Emergency medical personnel are now connected to major emergency

rooms online with what Mayor O’Malley calls our, ‘‘first-time, realtime reporting time,’’ that will help our health department track

any unusual spikes in cold and flu symptoms that might warn of

an attack.

I really appreciate these two gentlemen, friends of mine, great

public servants, taking the time to come to speak to our committee,

to our Congress, to our Nation today. Both are proactive, both are

forward-thinking, both are aggressive, both are thoughtful, both

understand the dimension of the problem that they particularly

face today.

They need—they have to have cooperation from the Federal Government, all agencies of the Federal Government.

I had the opportunity to talk to Commissioner Norris and the

mayor prior to this hearing. If the message in the past has been,

‘‘You protect your turf, we’ll protect ours,’’ those days are long gone.

Let the message go out from September 11th forward that sort of

mind-set is no more and cannot be the case in this new world we

live in.

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So, Mr. Chairman, I want to welcome my two friends and true

leaders in a time of great national emergency, Mayor Martin

O’Malley and Police Commissioner Ed Norris.

Mayor, thank you.

Mr. HORN. Welcome Mayor O’Malley. We look forward to your

testimony.

Mr. O’MALLEY. Thank you, Mr. Chairman.

And thank you, Congressman Ehrlich, for your introduction and

for being part of this committee’s hearing today. I want to thank

you for the opportunity to join you today, as we all try to struggle

with this new unconventional war, which, I would submit to you,

is one that is being fought on two fronts.

One of those fronts is far away from American soil. We have our

soldiers on the ground, we have the best technology, the best and

most rapid communication systems to forward intelligence to them,

so they can accomplish their mission.

The other front is the one that all of us sadly witnessed in New

York City and also in Washington. It is a front where we have already sustained many, many casualties, not only civilian casualties, but also casualties among our first responder local fire and police officers. And while much of the discussion and grief has been

about the 6,000 lives lost, we should not lose sight of the fact that

thanks to preparedness, thanks to the efficiency and bravery of

those first responders, there were about 40,000 lives that were

saved. And that is really the key to all of us who are in big cities.

You know, Baltimore is not unlike many other large cities in

America in terms what we need to be doing right now, as quickly

as possible, to protect as many lives as possible in our cities in the

event that there are other attacks on our population centers. We’re

not the largest city, but we’re not the smallest either; and we take

our responsibility very, very seriously since we consider ourselves

truly to be on the front of one of the two fronts in this war.

Baltimore, however, is in a unique position because of our proximity and history to come up to speed very quickly. And we’ve done

that—and special thanks to Marc Morial and the Conference of

Mayors for the work that they’re doing to help all of us share best

practices with one another.

Any of you who know American history and, particularly, the

War of 1812 know that Baltimore does not wait for advice from

Washington when it comes to matters of self-defense. Indeed, if we

had, we would all be singing, ‘‘God Save the Queen,’’ still. So we

have moved forward ourselves, and we’re very lucky to have been

able to have some great resources around us.

Some of you may know that Baltimore was selected as a lead city

in the chemical warfare improved response program, due to our

proximity to Washington and also our proximity to the U.S. Army

Soldier and Biological/Chemical Command in Aberdeen, MD.

Also Baltimore is home to the only center for civilian biodefense

studies at Johns Hopkins University, and you’ll shortly hear from

our Police Commissioner, Ed Norris, formerly of the New York City

Police Department, where they have done extensive work on civil

preparedness in the wake of the first World Trade Center bombing.

And finally, I guess as Congressman Ehrlich mentioned, we had

an emergency just back in July that was a chemical emergency. It

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shut our city down for about 5 days. And Baltimore had a chance

to test our readiness in a chemical incident when a CSX train,

loaded with toxic chemicals, derailed and burst into flames, burning in a long tunnel that ran directly beneath our city. The fire was

in the southern end of that tunnel, and it happened in the middle

of a doubleheader at Camden Yards, which is located right at that

exit of the tunnel.

Now, during that train fire, as is the case in virtually any crisis,

local government was the first on the scene. In fact, the folks from

the NTSB located down here in Washington, a mere half-hour drive

away, did not show up until the next morning.

Local government is the first on the scene, and one thing that

is immediately apparent is that you have to set up a unified command structure; and this command structure, in this case, was

under our fire chief. It was effective. We coordinated fire, police,

health, State Department of the Environment, as well as the Coast

Guard and our State Department of Transportation; and it all went

very well. Key to this was also that the Governor ordered the State

agencies to defer to the local unified command structures.

Based on our experience, we learned a few things, and important

things, that everybody should be asking. Who are your critical personnel? Where is the command center? What is the unified command? Do you have redundant communications? Are you talking to

the public so that the public maintains an appropriate level of

alert? What do your mutual assistance agreements set into motion?

At the same time, as well as our emergency folks handled that

particular incident, when we watched with horror, with all Americans, what happened in New York and Washington, we realized we

needed to do more. We need to do more. And we’ve set about doing

several things on three different fronts, if you will, and every city

in America needs to be doing this.

Those fronts are the three that break down, just in a thumbnail,

into: security, emergency preparedness, and intelligence. I’m going

to defer to Commissioner Norris to talk to you about the most worrisome one of all of those to me, which is criminal intelligence.

On security, we’ve been able to recruit from New York City Chief

Lou Anemone, and we have been taking a series of steps to improve our preparedness, looking at public buildings, looking at the

public infrastructure, looking at the private infrastructure.

It is absolutely alarming the degree to which our rail system is

open to everyone. I’m talking—we are not unlike many other big

cities. When you think of the amount of chemicals and armaments

that move along our rail system that is clearly someplace where we

could use some Federal help in pushing greater security measures.

But we’re looking at all of those sorts of things, as I said, the public

buildings as well as the private infrastructure, bolstering police

and security presence at water supplies.

On the emergency preparedness, we are continuing to coordinate

with the Center for Civil Biodefense. We’ve worked with all of our

hospitals so that the ones who had bioterrorism plans have now

shared them with their colleagues. And on the intelligence front we

have created a biosurveillance system in a matter of just 2 short

weeks where we make sure that, in real time, we’re looking at the

symptoms being displayed in our emergency rooms, in our clinics,

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that our paramedics are seeing, we’re watching the number of dead

animals that our animal control people pick up and we’re looking

at absentee rates.

It’s simple. It hasn’t cost millions and millions of dollars. The

hospitals were willing to do it with local leadership. So we actually

do have a pretty good intelligence network set up to identify it

early.

My time is running out. I’m going to wrap up and defer to Commissioner Norris to go to the more worrisome side of this.

But in conclusion, I just want to again emphasize, as the doctor

did before me, that I think we have models that work like the

Chemical Warfare Improvement Response Program. Those models

involve direct local funding.

You have to get the help to the first responders; and the first responders are not the States, they are the cities—direct local funding to the cities. I could talk to you at greater length about our

equipment wants and desires, our vaccination wants and desires

and things of that nature. And all of them are concerns, and none

of us are where we want to be, where we hope to be.

But the biggest concern of all of these is the lack of criminal intelligence, the lack of a connection between the 3,000 local law enforcement officers under my command in the city of Baltimore and

the 200 or so FBI agents who cover the entire metropolitan area.

I would ask you to do whatever you can on that front.

Because, again, this is a war on two fronts: one where we don’t

skimp, where we have the best technology, the best communication,

the best intelligence rushing to the front line; and another one

which is our local front, where none of those things are rushing to

the front lines of major cities’ fire and police departments.

Thank you.

[The prepared statement of Mr. O’Malley follows:]

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Mr. HORN. Well, thank you, Mayor. I think you have given outstanding thinking and results, and that would be good advice for

every mayor in the country. Hopefully—at your various national

conferences, I would hope that you and some of the other mayors

get that through to your fellow mayors.

As to the FBI, we will certainly be making some recommendations on that one to the attorney general, because I know exactly

what you’re talking about.

Commissioner, it’s a great pleasure to have you with us. And

we’re delighted to have you. Now, you are in charge of the city police department. And I take it there is a separate fire department.

Mr. NORRIS. Yes, sir.

Mr. HORN. Because I would certainly like—what you know about

the fire department and what they did would be very helpful in the

record.

Mr. NORRIS. Mr. Chairman, Mr. Ehrlich, members of the subcommittee, thank you for giving me the chance to talk with you

today.

The subcommittee has heard Mayor O’Malley describe the many

steps being taken to carry out his responsibility for the overall

safety and security of Baltimore. As police commissioner, I am the

individual responsible to the mayor for preventing criminal actions

that could lead to loss of life and property. I would like to focus

on just one area he has mentioned, the area of collaboration and

contact between the Federal authorities and local law enforcement.

There has been much discussion about the disconnect on Federal

agencies that share responsibility for homeland security. What has

not been discussed is the disconnect between Federal and local law

enforcement.

My main point to you today is that I believe all levels of law enforcement must do a dramatically better job of collecting and sharing intelligence. If we don’t, the chances are much greater that terrorists can operate at will and cause even bigger disasters in our

country.

Neither we nor any other local law enforcement agency we know

of has been asked to contribute manpower in any broadly coordinated way. For example, there are thousands of leads related not

only to the September events, but to the continuing threats the attorney general has repeatedly warned us about. Local law enforcement has the manpower to followup on a very-high-volume of leads.

The Federal agencies do not.

For example, the FBI has a total of 11,533 agents. There are

nearly 650,000 police officers in this country. We want to help, and

I think the Nation needs us to help. To prevent other terrorist incidents, pressure needs to be brought to bear on anyone who may be

planning any attacks.

Local law enforcement, not Federal agencies, are in daily contact

with literally millions of people every day. The NYPD, the department where I spent most of my career, and the last year as a deputy commissioner in charge of operations, has over 10 million documented interactions with citizens. Those include arrests, citations,

field interviews, stop-and-frisk. They don’t include the millions of

other discussions officers routinely have with citizens.

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We deal on a daily basis with network of registered informants.

We can debrief prisoners about suspicious activities that may be

terrorist in nature at the same time we debrief them about traditional crimes. But we have to know what the FBI knows about

threats, tips and even just rumors. We have to know more about

what there is to look for in our own communities, so we can protect

our own people and be more effective gatherers of intelligence for

the FBI.

While the FBI has done nothing to prevent us from doing this

work on our own, they have given us nothing but a watch list to

go on. In the week after the attack, the watch list had names, few

dates of birth, no addresses, no place of employment, no physical

descriptions and no photographs. By Friday of the same week, we

got a revised list which contained more information, but still no

pictures.

I do not understand this. When someone commits a murder,

rape, robbery, you plaster his picture all over police stations and,

whenever possible, in the media to help locate the individual before

he commits a crime. Now we’re looking for murderers of thousands

who may become the murderers of millions. Why aren’t we all

working together to find the people the FBI is looking for?

In short, I think the rules of engagement for law enforcement

have changed forever inside this country. It may have once made

sense for Federal agencies to withhold from local police their information about developing cases. Today, we all need each other if we

as a nation are going to successfully counter threats that can come

from virtually anywhere, at any time, in any form, including those

that could destroy whole cities.

To prevent recurrences of terrorism which could drive this Nation to panic and economic collapse, I believe we must do the following. Federal agencies must share all locally relevant information with the nearly 650,000 State and local police officers who

could be helping them today, but who for the most part are not.

Police chiefs should receive regular briefings on even highly classified information to help those chiefs better direct their own internal intelligence and counterterrorist efforts.

The Communications Assistance for Law Enforcement Act

[CALEA], which was passed in 1994, but has never been fully implemented, must be enforced. CALEA requires telephone companies

to ensure their systems and networks can accommodate Federal,

State and local wiretaps in the face of changing telephone technology. Right now, we can’t intercept certain digital telephone technologies, and that is keeping all of us dangerously in the dark.

In short, we must do all in our collective power not only to locate

the collaborators of last month’s hijackers, but also to deter all terrorists from operating against our still-vulnerable transportation

systems infrastructure and people. I think the threat is so great

that we should have every police officer in the America in this

fight.

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Like hundreds of firefighters in New York, my fellow officers at

the NYPD showed their willingness to give their lives to save others. My officers in Baltimore are ready to do the same. I think we

must be allowed to help. I believe the life of the Nation may depend upon it.

Mr. HORN. Thank you very much, Commissioner.

[The prepared statement of Mr. Norris follows:]

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Mr. HORN. We’re going to go through the next three and then one

more, and then we’ll go into Q&A.

Mr. Lynch is the Emergency Management Director, Shawnee

City and Pottawatomie County, OK, former Emergency Management Director, Oklahoma County, OK.

So, Mr. Lynch, we’re delighted to have you here. You went

through the experience of the Federal building that was wiped out

there.

Mr. LYNCH. Thank you, Mr. Chairman, and to Ranking Member

Schakowsky, to the other honorable members of this committee, it

is a great pleasure for me to come before you today to discuss the

preparedness efforts for chemical and biological terrorist attacks in

our country.

First, let me say that all Oklahomans, but especially my fellow

emergency managers and allied emergency services personnel extend our deepest compassion and prayers to the emergency workers, victims, family members and citizens of those communities affected by the attacks on September 11, 2001. Every emergency

worker in Oklahoma was ready to come to the aid of those communities impacted to repay in some way the support that you gave us

in the Murrah Building incident.

While we wanted to respond physically, we knew that our presence would create an unnecessary logistical burden on the community. Therefore, we have sent our support financially, spiritually

and emotionally to our brothers and sisters in New York, Pennsylvania and Virginia. We shall continue to do so as long as there is

a need. We will always remember the heroism displayed in those

communities.

I think it’s important to point out, as my colleagues on the panel

have done, that a lot of work has been done in the last 6 years to

prepare our communities. Among those activities are, State and

local emergency operations plans have been modified to include terrorism preparedness activities and mirror the Federal response

plan.

No. 2, State and local emergency exercises have been changed to

incorporate response forces working in and around terrorist activities.

No. 3, national, regional, State and local training programs have

been created which integrate personnel from all levels of government into private sector and voluntary agencies active in disasters.

And No. 4, communities have received limited Federal and State

support for equipment to use in response to these terrorist events.

The Nunn-Lugar-Domenici Act was a good starting point. However, somewhere along the way, the good intentions got slightly

skewed under the Federal bureaucracy. Both Oklahoma City and

Tulsa, OK, were on the list of the 120 cities to receive this training.

In my capacity at the time, I participated in activities for both communities.

The actual training itself was outstanding. It was relevant, it

was useful. However, getting there was inefficient. There were a lot

of meetings that were held prior to the actual training itself. In

fact, when it came down to doing the training and providing the

equipment caches, what was promised was not delivered. I think

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probably that’s because the money went toward meetings instead

of toward actual training programs.

All the quality training in the world, Mr. Chairman, as you have

heard from everybody here, all the plans that are prepared are not

valuable if you don’t have the tools you’ve trained on to respond

with, and if you don’t have the capability to sustain and augment

that training.

Both Oklahoma City and Tulsa were kind enough to include

their neighboring Federal, State and local jurisdictions in the training programs. This not only helped spread the training to additional communities, but it helped foster teamwork and continuity

of operations across jurisdictional boundaries.

Additionally, the FBI, the Federal Emergency Management

Agency, the U.S. Public Health Service have all sponsored outstanding training programs that have helped communities achieve

a higher-level of preparedness. Most of these programs have been

open to participants from all disciplines.

However, we need more equipment. I cannot emphasize this

enough. While Nunn-Lugar-Domenici provided some minimal

equipment and prior hazardous materials training encouraged larger communities to equip firefighters to respond to potential chemical emergencies, many communities across this country, and particularly in the heartland, simply do not have all of the equipment

that would be needed in a chemical or biological attack.

I have proposed the following recommendations: No. 1, funding

for assistance to the firefighters program of the Federal Emergency

Management Agency should be at least doubled for fiscal year

2002, and increased reauthorization for Federal fiscal years 2003

through 2007 of at least $1 billion per year should be passed.

No. 2, more pharmaceuticals are needed to be stockpiled. The

current stockpile maintained by the Department of Health and

Human Services is dangerously insufficient to handle more than

two simultaneous events. Local communities need to be able to

readily access these equipment caches within their jurisdiction. We

can’t wait for 8 hours or more for a supply to be flown in.

And the capability has to be developed at the local level. While

there is great technical expertise at the Federal level, waits of up

to 6 hours for a technical support team will not make it in those

critical first few hours. So we have to develop this capability across

our country.

In summary, Mr. Chairman, I believe that our communities

should not be characterized in terms of gloom and doom. We have

done a lot to help; the Federal and State governments have done

a lot to develop emergency management systems. Likewise, the situation should not be characterized as shipshape.

While the foundation has been laid, now is the time to buildupon

that foundation. The recommendations I have mentioned in this

testimony and in my written prepared remarks I believe will guide

us on a proper path to enhancing our preparedness and serving our

citizens.

We recognize that true emergency management requires a partnership between the Federal, State and local governments, business and industry, individuals and families, and voluntary organizations active in disaster. While we at the local level are ready to

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do all that we can to support the war against terrorism, we stand

firmly behind the President and the Congress and we eagerly anticipate your assistance in this war.

I thank you for your willingness to investigate this matter and

to help us with the task ahead. I thank you for the opportunity to

address this committee.

Mr. HORN. Well, thank you very much, Mr. Lynch. We’ll look forward to you in the question period.

[The prepared statement of Mr. Lynch follows:]

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Mr. HORN. We now have the Honorable Diana Bonta, the director

of the department of health services for the State of California. Before that she was director of the city of Long Beach’s excellent

health services, which is very rare for most cities in America.

So, Dr. Bonta.

Dr. BONTA. Good morning, Mr. Chairman and members. Thank

you very much for the opportunity to be here this morning.

In addition to serving as director of the California Department

of Health Services, I am the immediate past chair of the executive

board of the American Public Health Association as well.

And thank you very much, Congressman Horn, for your ongoing

support of local public health programs.

Since the tragic events of September 11th, national security has

been become our national concern. In California, Governor Gray

Davis has led the creation of the California Antiterrorism Center,

which will enable all law enforcement agencies to share information on terrorist threats and activities.

Additionally, the Governor’s Office of Emergency Services coordinates and responds to all types of hazards, including a biological

or chemical terrorism event. OES facilitates and coordinates statewide efforts in planning and response by bringing together Federal,

State, local, nonprofit organizations and key infrastructure officials

through various forums, such as the State Strategic Committee on

Terrorism and the Threat Assessment Committee of which the Department of Health Services is a member.

Also note, Governor Gray Davis has mobilized the California National Guard now to increase security at key airports.

In the aftermath of the terrorist attacks, there has been heightened awareness of potential biological and chemical threats to our

communities; and many have asked, ‘‘Is the Nation prepared for a

biological or chemical attack?’’ If such a horrific event were to

occur, the safety certainly of every man, woman and child would

depend on the public health system. This system must remain

strong.

Traditional public health activities have focused on preventing

the spread of communicable diseases and ensuring the safety of the

air that we breathe, the water that we drink and the food that we

eat. More recently, public health efforts have expanded to include

disease prevention activities to promote healthier lives. It’s a big

job and it has been done very well.

Now, in addition to all of our other responsibilities, the public

health system is faced with the intentional spread of disease. Public health resources would be significantly challenged following a

biological or chemical attack.

In recent years, public health systems in the Nation’s largest cities have become more involved in terrorism planning and preparedness use funds appropriated by Congress. Under this program, the

Nation’s 120 largest cities, including 18 in California, have received

funds for training, exercises and equipment to enhance their capability to respond to incidents involving weapons of mass destruction, including biological or chemical terrorism. The program trains

first responders, the firefighters, police, emergency management

teams and medical personnel who will be on the front lines in case

of any of these attacks occur in a U.S. city.

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In addition, this effort has been enhanced over the past several

years by funding from the Department of Health and Human Services, allowing for the development of the metropolitan medical response system in a dozen California cities. These funds have provided an essential first step in developing a coordinated response

to bioterrorism that involves enforcement, law enforcement, public

health and the medical communities.

In 1999, the Centers for Disease Control and Prevention [CDC],

developed the chemical and biological terrorism response and preparedness program. California and several other States and large

municipalities were awarded 5-year funding to develop responses

and preparedness plans concentrating on five areas, which I’ll summarize as preparedness and planning and readiness assessment;

surveillance and epidemiology capacity; laboratory capacity, both

for biological agents as well as chemical; and our health alert network/training system. These grants were intended to ‘‘kick start’’ all of this preparedness at both the State and local health department levels, and California received $2.5 million per year to develop the program. We were the only applicant to be funded in all

5 years in the country. And Los Angeles County, in addition, received $900,000 to assist them.

Since the start of this program, certainly California has made

great strides in preparation for both biological and chemical terrorism. I can tell you that we’ve recently had training, for instance,

in California. Just this week we had forums that involved hospitals, first responders, public health individuals, so that we would

have additional training.

I’ll summarize, then, that we need to continue to strengthen our

systems throughout the State, and first and foremost, we need additional resources to ensure that the Federal, State and local public

health infrastructure is strengthened.

Bioterrorism knows no State boundaries. With additional resources, we would do the following.

We would improve existing surveillance systems at the local

level, especially at the local level.

We would further coordinate State and local planning activities.

We would provide ongoing technical training for State and local

staff and for the primary care provider community in recognizing

symptoms, treatment protocols and prophylactics involving bioterrorism agents.

We would conduct response-readiness and risk-assessment of the

public health system through coordinated exercises.

We would expand the laboratory capability in chemical detection.

We would further develop prevention strategies. Risk-assessments must be conducted in many areas, such as food services, food

production, nuclear and chemical industries, and water supply systems. Currently California is developing a guidance document for

growers, food distributors and food service industry regarding a

hazard assessment.

And last we would evaluate the legal and regulatory statutes to

determine whether they provide sufficient authority for appropriate

action during an emergency.

Mr. Chairman, members of the subcommittee, I appreciate your

dedication to protecting the American public from these terrible

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threats and the opportunity that you’ve given me today. I encourage the subcommittee to do everything possible to support Federal

funding and assist us in these programs at the State and local

level.

Thank you.

Mr. HORN. Thank you.

[The prepared statement of Dr. Bonta follows:]

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Mr. HORN. Now we have Janet Heinrich, who is the director of

Health Care and Public Health Issues, U.S. General Accounting Office. Again, the General Accounting Office is the programmatic reviewer for the legislative branch. We’re delighted to have Dr.

Heinrich here.

Please proceed.

Dr. HEINRICH. Mr. Chairman and members of the subcommittee,

I appreciate the opportunity to be here today to discuss our ongoing

work on public health preparedness for domestic bioterrorist attack.

Last week we did release a report on Federal research and preparedness activities related to the public health and medical consequences of a bioterrorist attack on a civilian population. I’d like

to begin by giving a brief overview of the findings in our most recent report, and then address weaknesses in the public health infrastructure that we believe warrant special attention.

We identified more than 20 Federal departments and agencies as

having a role in preparing for or responding to the public health

and medical consequences after a bioterrorist attack. These agencies are participating in a variety of activities from improving the

detection of biological agents and developing new vaccines to managing the national stockpile of pharmaceuticals.

Coordination of these activities across departments and agencies

is fragmented. Our staff are struggling over there with a chart that

we have prepared that gives examples of efforts to coordinate these

activities at the Federal level as they existed before the creation of

the Office of Homeland Security.

I won’t walk you through the whole chart. Certainly, if you have

questions, we’ll try to answer them, but as you can see, a multitude

of agencies have overlapping responsibilities in various aspects of

bioterrorism preparedness. Bringing order to this picture will be a

challenge.

Federal spending on domestic preparedness for terrorist attacks

involving all types of weapons of mass destruction has risen even

310 percent since fiscal year 1998 to approximately $1.7 billion in

fiscal year 2001. Funding information and research preparedness

on a bioterrorist attack as reported to us by these Federal agencies

generally shows increases from year to year, but from a generally

low level in 1998.

For example, within HHS, CDC’s bioterrorism preparedness and

response program first received funding in fiscal year 1999. It’s

funding has increased from approximately $121 million to about

$194 million in fiscal year 2001.

While many of these activities are designed to provide support

for local responders, inadequacies in the public health infrastructure at the State and local levels may reduce effectiveness of the

overall response effort.

Our work has pointed to weaknesses in three key areas: Training

of health care providers; communication among the responsible

parties; and capacity of hospitals and laboratories.

Because physicians and nurses and emergency rooms and private

offices will most likely be the first health care providers to see patients following a bioterrorist attack, they need training to ensure

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their ability to make astute observations of unusual symptoms and

patterns and report them appropriately.

Most physicians and nurses have never seen cases of diseases

such as smallpox or plague, and some by biological agents initially

produce symptoms such as the ones I have today, of colds, influenza, other common illnesses that are very much like these other

virulent diseases.

In addition, physicians and other providers are currently underreporting identified cases of diseases to the Infectious Disease Surveillance Systems.

Because the pathogen used in a biological attack could take days

or weeks to identify, good channels of communication among the

parties involved is absolutely essential to ensure as rapid a response as is possible.

Once the disease outbreak has been recognized, local health departments will need to collect information, collaborate closely with

personnel across a variety of agencies, and bring in needed expertise and resources.

Past experiences with infectious diseases and the response have

revealed a lack of sufficient and secure channels for sharing information. Our report last year on the initial West Nile virus outbreak in New York City found that as the public investigation

grew, lines of communication were often unclear and efforts to keep

everyone informed were cumbersome.

We have also heard people speak to the need for laboratory capacity and hospital capacity. We have seen the patient load of regular influenza season—patients overtax regular care facilities and

emergency rooms in metropolitan areas are routinely filled and unable to accept patients in need of urgent care.

In conclusion, although numerous bioterrorism-related research

and preparedness activities are underway in Federal agencies, we

remain concerned about weaknesses in the public health and medical preparedness at the State and local levels.

And, Mr. Chairman, members of the committee, I would be

happy to answer any questions.

Mr. HORN. Thank you very much. I am going to have one individual who has a problem, and it is General Peake, who is the Surgeon General of the Army. And his presence in the answering and

questioning is very important for going through the panel that we

have just heard.

And so if the clerk can get a chair for the general over here at

the table. We will—OK, general, if you wanted to give us your presentation. And then we will start with our colleagues here on the

questions.

LTG. PEAKE. Well, Mr. Chairman, Congresswoman Schakowsky,

distinguished members. On behalf of Dr. Clinton, I thank you for

the invitation to represent military medicine here today. The military health system really has a long history of supporting our Nation in time of domestic emergencies. That ability comes as a byproduct of our readiness to support our military in the defense of

our country and in the protection of vital interests.

That mission requires active, guard and reserve medical soldiers

trained to standard, prepared to work under austere and demanding environments, with an understanding of the spectrum of

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threats that can be faced on the battlefields of the world, endemic

diseases, trauma, chemical or biological or nuclear threats.

They train to work as teams in a task-organized manner with

leaders who not only have technical skills, but organizational and

planning skills that come through a progressive development process. They represent all of the skills of an integrated health care delivery system. They have equipment that can be moved as part of

a self-sustaining task force and still provide high-quality and reliable medical care in austere and harsh conditions.

They have the back-up of world class laboratory support, access

to unique capabilities such as aeromedical isolation teams, bioprotection for containment facilities, and world-class medical centers that are integrated through an air evacuation system that we

practice.

The written testimony that has been submitted by Mr. Duehring

describes in some detail the supporting role that we in the military

have to FEMA and the Federal response plan, and more particularly, to the public health service under Emergency Support Function 8.

We can smoothly integrate into the incident command structure

that is quite universally accepted in this country. We can task organize to bring individuals with special expertise, or teams with

special capabilities, preventative medicine, mental health, facilities

engineers or major units such as a hospital or a medical task force

such as we had at Hurricane Andrew, with medical helicopter evacuation, primary care, hospitalization, a logistics battalion, a major

military medical command headquarters commanded by a general

officer.

That joint task force, civil support, is now a standing organization that can serve as an integrator of military assets assigned to

include such medical units.

The most important thing that we bring, though, is where I

started. That is the dedicated, trained and motivated soldiers like

the National Guard soldier in New York who walked several miles

from her office to her home, changed into her uniform and then

went to where she knew her unit was supposed to go in emergencies. She did not have to be called. She was trained, and she

just went. Charlie Company 342nd Forward Support Battalion New

York Guard was part of the immediate set-up for emergency response because she lived there; she was part of that community.

The 101 Cav, New York Guard, was the first medical unit deployed at the disaster site on the 11th. They provided care to fellow

Guardsmen for things like respiratory distress and eye injuries,

keeping the rescue effort going.

And within 11 hours of the incident, one of our new, new New

York Guard civil support teams, under the control of the Governor,

had not only moved from Albany, NY, to New York City, but had

gathered and tested environmental samples from Ground Zero, coordinated with local, Federal, and State officials, and were able to

deem the site clear of nuclear, chemical, and biological contaminants. That sure made a positive impact on those that were working in that ongoing rescue effort.

At the Pentagon, active units were augmented by reserve units

working with the incident commander on the scene. Sergeant

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Delgado of the 311th Quartermaster Company from Puerto Rico

was at the Pentagon leading his squad by September 16th, absolutely professional in the tough duty of recovering remains.

I am proud of the trained and ready soldiers of all of our components, their professionalism, honed through training for support of

our wartime fighting mission provides an asset to augment the

local response, the State response, the Federal response, to chemical or biological attack here at home.

I must tell you that your support of a robust military medical

system is so important to keeping this capability. It is our direct

care system that provides the training platforms where these soldiers of all components get their initial set of skills. And it is in

that direct care system that skills are honed and maintained for

the active force. And it is in those research laboratories like these

you have already heard mentioned, USAMRIID, our Institute for

Infectious Disease, that world-class scientists can examine militarily relevant medical threats which unfortunately now are civil

relevant medical threats. And be available on a moment’s notice to

support this Nation.

So I thank you for the chance to be here today and for your support of military medicine. Thank you, sir.

Mr. HORN. Thank you, General.

I would like to know, for the record, in terms of the military hospitals, have we got compacts in any way where there would be, say,

the FEMA for the State Governor and then the FEMA—a smaller

one—is often there in a county such as Los Angeles with 10 million

people? And Los Angeles County as well as to have also Los Angeles City, and something like this happens. And there is veterans

hospitals, obviously.

In the case of Washington, you have a very fine hospital here in

the terms of Washington. But we also have a world-class hospital

known as Walter Reed Medical Center.

And then you also have the Navy’s Bethesda. Is there anything

we have worked out with the cities, with the counties, with the

States that are adjacent, so forth and would the military people

take in the individual civilians that are either ill or gassed or

whatever?

How are you going to work that out and have you worked that

out?

LTG. PEAKE. Sir, it works through, as was mentioned, through

the incident command center. So with the Pentagon as an example,

we had our injured taken to many hospitals throughout the Washington, DC, area. Some went to Walter Reed, some went to Washington Hospital Center, to Arlington, to Inova and so forth. They

were dispersed by the incident command center and the emergency

support.

Almost every place that we have an installation there is an integration with the local community in terms of how that community

would plan for dealing with an emergency or a disaster? I would

agree that it varies across the country about how good that planning is, and there is room for improvement in that.

But we are always integrated. As you know, under the Stafford

Act, the local installation commander can offer immediate response

while we are waiting for the rest of the system to kick in.

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Mr. HORN. Yeah, as I recall in California in 1906, the military

were there to help on that situation where you had an earthquake

and then fires, and then the gas pipes were broken and all of that,

and the military were there to help on that.

And the civilians, on this recent mess at the Pentagon where this

terrorist knocked out part of a wing, a lot of fire companies I am

sure went to help you.

LTG. PEAKE. They did, sir. And they were in charge of that operation and we subordinated ourselves within—I happened to be on

the cell phone with one of my officers en route to the Pentagon

when he saw the plane go in. I was able to contact Walter Reed.

We had surgical teams en route by the time the smoke was really

starting to billow.

But when we got there, the civilian response folks were there,

tremendously professional and we locked ourselves under them to

be a part of the team effort.

Mr. HORN. One of the problems is to get a proper laboratory to

know what is this toxic that is out there. Do we have that pretty

well in terms of your hospital system?

LTG. PEAKE. Sir, there are a couple of answers to that. One, this

civil support team that I referenced in my remarks has that kind

of capability. And it is a relatively new capability, and it worked

pretty well in this instance.

They are mobile, and they bring that equipment down. At the

Pentagon we brought from the Center for Health Promotion Preventive Medicine immediately we launched some folks down to

start sampling the air, soil and water in that—in the Pentagon environment so that we could know what was in the smoke, and reassure the 22,000 people that work there.

Regarding the laboratory business, we have committed ourselves

to integrate with the CDC’s network of laboratories around the

country. We are upgrading the laboratories in our medical centers,

in the six medical centers that the Army has to link in and be able

to do the diagnostics on things like anthrax and brucellosis and so

forth, and do that networked with the CDC.

Mr. HORN. Well, thank you. If you can stay with us for a while.

I want to yield to the ranking member, Ms. Schakowsky, the

gentlelady from Illinois.

Ms. SCHAKOWSKY. Thank you, Mr. Chairman. I would appreciate

the opportunity to make a short statement, and then to ask a couple of questions.

I really appreciate your holding this hearing today after the terrible events of September 11th. And the panel that has been put

together, and I am sure the next one as well, is really excellent.

Over the last couple of years, a national security subcommittee

on which I sit has participated in a number of hearings on this subject. But none has been more useful or more meaningful than the

one that we have heard today with the witnesses that we have had

the honor of hearing so far.

We have heard time and time again from experts in GAO and

HHS and elsewhere that we need a comprehensive threat and riskassessment for chemical and biological attacks.

Through this hearing today, we are developing a much clearer

understanding of the strengths and weaknesses of our defenses. It

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is my desire that we reach an understanding that both reassures

the public that they are safe and provides us clear guidance of the

appropriate Federal role in responding to the chemical and biological threats that may exist.

Earlier this week, the Secretary of Health and Human Services

assured the public that our country was, in fact, prepared for any

threat to our Nation’s health. But, I am not sure that I share his

confidence.

As some of our witnesses have explained, our public health system, good as it is, could have difficulty responding to a significant

biological or chemical attack, not to mention even a major flu-like

outbreak.

The capacity of our public and private hospitals is strained each

year during flu season. A disaster with 10,000 injuries that requires hospitalization could be very difficult for that system to handle. We must question whether our system could handle such a situation.

The front lines in most disasters as we have heard so eloquently

today, and I thank Dr. Smithson and Mayor O’Malley and all of the

other witnesses for pointing this out so poignantly, is local government and local health care providers as well as State.

We see this again and again as towns and cities are struck by

hurricanes, tornados and even disasters like we saw last month.

The first there to tend to those in need are the local firemen, police

officers, emergency medical personnel.

Any response we develop now as you have said as our witnesses

must keep that fact in mind. Training and communications are key

to disaster response and should be a major part of our planning

and investment. We heard you.

The majority of that investment should be made at the State or

local level with an appropriate level of coordination and assistance

from the Federal Government.

Past experience has also shown that the public health system is

the second line of response. Once the disaster scene is surveyed,

the injured are moved to hospitals, it is often the case that the hospital capacity is reduced by the same disaster.

We have taken our public health system for granted for some

time now. It has suffered as a result. Community cooperation is the

third line of response. Once the level of damage is assessed, those

hardest hit will have to call upon their neighbors for assistance. As

we saw after the events of September 11th, every one wants to

help.

We need to develop a network of community organizations, much

like that under development by the Office of Emergency Preparedness at HHS. The goal is to provide every community with the

preparation and resources to respond to a disaster. Those are just

some of the many critical issues that we will need to assess, and

many others you outlined for us today as we move to improve the

emergency response infrastructure in this country so we are able

to address the current shortfalls and the possibility of future

threats to our health and security.

I would really appreciate being able to ask a few questions, Mr.

Chairman. I want to make sure, Dr. Smithson, I heard you clearly.

Were you saying in terms of crop dusters, because there was some

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evidence that one of the terrorists at least was looking into the use

of crop dusters that the particles that would be distributed really

are too big to cause any kind of health risk?

Dr. SMITHSON. Yes. You have got me exactly right. This is a very

closed community. There are small businesses. One of the things

that isn’t being discussed today is really the fact that Atta didn’t

even get a peek inside the cockpit. These are people that are required to have a 1-year apprenticeship just to learn how to fly

these things and operate the sprayers behind them. And the sprayers would be suitable for chemical agent dispersal, I won’t joke

with you about that.

But for biological agent dispersal, you would have to go in there

and change everything around. You can’t even dial them down to

the particle size required, very, very small particle size required for

effective biological agent dispersal.

Ms. SCHAKOWSKY. But it can be useful for some sort of chemical?

Dr. SMITHSON. That is what crop dusters do. But again, if you

just fly low a regular light aircraft, and the assumption is that

somebody is going to jump into one of these things and get it successfully off the ground, it would be the difference between driving

a little Miata sports car and driving a couple of 18-wheelers

hitched together fully loaded. Things handle differently.

And there is no assurance that they will crash, but they are not

going to be able to operate these things automatically and cause

the havoc that seems to believe the assumption working in press

circles today.

Ms. SCHAKOWSKY. No, but if they were able to get the training

and were to load it with some sort of deadly chemical, and then fly

it over some of—a densely populated area, it could, in fact, be a

problem; is that not true?

Dr. SMITHSON. I would agree with you in that, but again the assumption is that it would be effective. In cities, there is micrometeorology that is going to come into play.

These crop duster pilots are trained to go way down and lay

something right on the Earth and be effective in what they do. We

are making several leaps of logic right now, and everything appears to be very frightening. I would encourage you, just as I have

done, to spend time with people who have actually made these

weapons so that you understand how technically difficult it is, with

people who actually fly crop dusters so that you have an appreciation about this.

One of the things that is happening in this country is our citizens are getting their wits scared out of them by what they are

hearing over the airwaves, often from people that don’t seem to

know their technical stuff.

Ms. SCHAKOWSKY. You did mention hazardous chemical facilities?

Have you looked at all into nuclear power plants as a potential

danger for a terrorist attack?

Dr. SMITHSON. No, ma’am. My jurisdiction is chemical and biological. However, in the survey of 33 cities that I took, talking with

individuals just like this; the locals are very aware, in fact, I defy

you to find a HAZMAT captain who does not know off the top of

his or her head how many of these facilities are in their communities. In most of the locations where I went, they had already a

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great appreciation of what these facilities were in terms of a danger to their citizens.

Listen, the chemical industry takes the security of these sites

very seriously. But so do the local responders around them. And in

many cases, they have already begun working with these facilities

and other locations like sporting arenas and major buildings, landmarks, to enhance the security of those sites.

So there are things that are happening across this country in

spots that will definitely protect Americans. What needs to be done

here in the mindset that needs to be adjusted inside the Beltway,

is that the preparation needs to be nationwide.

And that you need to institutionalize the training, not just train

here and there. The Federal Government’s role is mid to long-term

recovery assistance, not rescue. Because right now you cannot fit

any more rescuers on top of the rubble pile in New York City.

If you threw every Federal asset at it, it just wouldn’t work.

Ms. SCHAKOWSKY. Then finally, speaking of Federal assets. All of

you have spoken about the need for Federal assistance at the State

and local level. If we were with—with our finite resources to put—

to make a Federal investment, what would you think is the most

important thing? Let me just kind of—if we can quickly go down

the panel—the most important investment that we could make to

guarantee the safety of our citizens against chemical and biological

threats.

Mr. HORN. We are going to be three amendments to these questions.

Dr. SMITHSON. Institutionalization of the training in the Nation’s

fire academies, police academies, medical and nursing schools as

well as in public health training. That is the only way you are

going to raise the standard of readiness and preparedness across

this country.

Mr. O’MALLEY. I mentioned before, yes, about Federal dollars. It

is going to take Federal dollars. I really still do believe that for all

of the other things we are talking about, that the disconnect in

criminal intelligence is the biggest threat right now and the most

dangerous one.

But I would piggyback on that just to add that protective equipment and the additional vaccinations and stockpiles around.

Mr. NORRIS. I agree with everything. Preventative equipment,

stockpiles of vaccinations, but I can’t stress enough that all of these

things are carried out by human beings. What is missing right now

is human intelligence. While these things are very, very important

to mitigate once a disaster strikes, I think we need to just as seriously take the intervention before they strike and be tracking down

the people that are trying to deliver whatever may come in this

country. And that is really lacking.

I think most of the discussion I have heard at the top levels regarding equipment, the biochem. threats, nuclear threats and the

like, the choice of terrorists around the world is still bullets and

bombs. The World Trade Center was done with a very low-tech operation and we seem to be losing sight of that.

We are missing human intelligence and we need much more coordination with our Federal counterparts to arrest the people out

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there right now who have been in this country for over a decade

preparing to do this.

Mr. HORN. Let me add to that, and that is, some people are out

getting gas masks and all of the rest of it. It has happened in

Israel sometimes. But also there have been deaths when the individual didn’t pull the cord for oxygen. What is your advice on that.

Mr. NORRIS. Very important. Just as the mayor was saying, one

of the most important things is to be prepared when an attack occurs because a lot—Dr. Smithson said it best. People are being terrified. If air raid sirens go off in cities around America and people

start to leave their homes when in fact maybe they should stay in

place and things like that, people are buying gas masks, gas

masks, well, we have them, police departments and fire departments. They have to be tested to OSHA specifications for seal.

You could put on a gas mask and still get killed if you run out

the door, because they don’t fit properly. And people are misleading

themselves giving them some sense of comfort. But representing

my city as the police chief, I still say we need to intervene in these

acts before they occur.

You concentrate as much of our efforts that way as you are to

the rescue efforts afterwards.

Mr. O’MALLEY. I can tell you that all 36 of the gas masks on

stock in stores in the Baltimore area have sold out immediately,

and none of them would do much good anyway when it comes to

a biological attack.

Dr. SMITHSON. This is one of the aspects of the aftermath of September 11th that has saddened me the most. Americans have

rushed to do things that they think will serve their interests, when

in fact that may not be the case. If this gas mask that you purchased is not fitted, and if you are not instructed in how to use it

and understand the changing of the canisters and how to make

sure that it fits when you are running, then you have bought yourself some false protection.

Let us use common sense. If you do see a crop duster overhead,

get inside, shut the windows, shut the doors and you will have provided ample protection for yourself. If you are still nervous about

it, go jump into a shower. Ask fire folks. One of the most effective

decontaminants is water.

In terms of stockpiling antibiotics, I am sure that Scott

Lillibridge will touch on this in just few minutes. That is also false

security. It could backfire on Americans.

If they start self-medicating themselves with the first dose—in

the case of the sniffles that they get, the after affects could be that

the medications won’t work for them later when they really, truly

need them.

So, I know Scott will get to this, too. I hope that America’s physicians will get better educated on what is happening in the country

and stop writing prescriptions right now.

Mr. HORN. Would any others like to respond?

Ms. SCHAKOWSKY. Any others want to respond? I also wanted to

thank Mrs. McHale for that very dramatic testimony and sharing

that information and to say how happy I am. I was waiting to hear

about your child being born healthy.

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Dr. BONTA. Mr. Chairman, I would like to address a question if

I can. It is really difficult to pinpoint down the one single actual

thing that if we had to eliminate it to just one, because all of the

suggestions that have been here are good and we all have ideas

that we think are important.

But if I had to narrow it down, I would say making sure that

we get the right equipment for response into the hands of the local

first responders. It is imperative that we have that. We have to

have good communications equipment. We have to have good detection of surveillance equipment. We have to have good personal protective equipment for those folks too if we expect them to be able

to do their job.

Mr. HORN. Let me ask one question before I turn to Mr.

Cummings. That is that in the case of Baltimore, what was the

toxin? And did you know how much—when did you first know

which toxin it was, and had those individuals had violated the

rules of the Department of Transportation to note on the storage

there with the toxins so that the firemen going in would know, particularly under tunnels and so forth?

Tell us a little bit about what was the toxin and were they terrorists or were they just incidental accidents?

Mr. O’MALLEY. Well, on your last point we have yet to have a

cause determined by the NTSB. So we don’t know what the cause

of it was at this point.

Recently we did arrest a person of Middle Eastern descent coming out of the tunnel with camera equipment and a knapsack and

a hood. And whether that person was a probe or a kid that didn’t

get enough love from his dad early in life or what that was, we

don’t know.

But when this incident actually broke out and a fire was happening inside this tunnel, keep in mind this tunnel, it was built in the

1890’s. It bankrupted the B&O Railroad. It was their last and

greatest public works project. It is almost like a mile and a quarter-long brick oven with two entrances. We found a third one only

because of memory.

So we knew right away from the manifest what was on the train.

You can’t be 100 percent sure that the people recording it on the

manifest didn’t make a mistake. So you really don’t know what you

are dealing with until you get inside and the order of things.

And the other curious thing was that although we knew what

was on the train, without being able to get up inside the tunnel,

we couldn’t tell you where the fire was on the train.

In retrospect, we were fortunate in that the people assembling

the train had indeed put buffers between some of the chemical cars

so that there was not a chain reaction. I mean, there was, of

course, a chain reaction in that the chemical fire was adjacent to

a car containing trash and garbage and packed paper, so there was

a reaction, but not the sort of combustible reaction there would

have been had all of the chemicals been tied together.

I forget, the one that actually exploded was. And that was the

one that had caused the fire. It ruptured an adjacent car that had

hydrochloric acid in it. That basically ran out, diluted or was

burned. The other car whose polysyllabic chemical name escapes

me at this time, ‘‘methylethylbadstuff’’ we will say for the sake of

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this hearing, was fortunately at the other end of the car. And our

great fear—it was some sort of a chlorine agent. Our fear was that

would rupture, that would somehow be in gaseous form and become

a deadly gas.

And that was fortunately at the other end. There has been an

uncoupling of the cars, so the cars that had jumped off the rail

where the fire happened, you know, kind of came to a rest quickly.

The other half of the car continued to roll a little bit on the back

of the engine and so there was a separation of space.

But, keep in mind, when all of these suckers were pulled out of

that tunnel late at night in front of our fire department and a very

nervous mayor at about 2 a.m., they were all charred and looked

like a bunch of hot-dogs being pulled out of a fire.

So I am sorry, I can’t tell you exactly what the bad one was. But

it was some sort of chlorine agent.

Mr. HORN. What is the situation of that particular tunnel or

whatever?

Mr. O’MALLEY. Not unlike other tunnels, including one—you

know, not unlike other tunnels in cities up and down the East

Coast or rail yards or the tracks that go through them, those tracks

are very much open. They are open to pedestrians. I mean, fortunately, thanks to Commissioner Norris and our assessment of

vulnerabilities, the reason we apprehended the individual coming

out of that tunnel was because we were keeping an eye on that

tunnel and had additional security, had spoken to CSX.

But there is very little security around any of these rail yards.

While it is true, as the doctor said, that the chemical companies

take the security of their chemicals very seriously, they take it so

seriously that most of the dangerous tankers are left out open on

the yard instead of coming inside their plant, inside the chained

gates. So this is a serious vulnerability for a lot of cities, Baltimore,

Philadelphia and many other—industrial cities along the corridor.

We have identified it. Obviously, it is going to cost a bit of money

to do the proper fencing, to do security cameras. The gentleman

from the train company, as I asked him about great, simply security measures like that, said we have 23,000 miles of track in the

United States, to which I answered, I am sure you do. And which

percentage of that track runs through America’s 20 largest population centers?

Mr. HORN. We thank you very much.

And now I want to yield 3 minutes to the gentleman from Maryland, Mr. Cummings.

Mr. CUMMINGS. Thank you very much, Mr. Chairman, for your

courtesy. And I certainly am very pleased to welcome the mayor of

Baltimore, Mayor O’Malley, and certainly our police commissioner.

Mr. Chairman, Mayor O’Malley has done an outstanding job. I

think his testimony today indicates that Baltimore is as prepared

as we can be, and we can always use some help. And I think the

mayor would agree with me on that. We can use resources, as we

debate in the Congress about how we are doing, with these pocketbooks open and dealing with these emergency circumstances, I

think it is very important that we keep in mind, that as Mayor

O’Malley has said, we are indeed on the frontline of this.

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Mr. Chairman, one of the things that I find so interesting, coming from our police commissioner, Commissioner Norris, who, too,

is doing an outstanding job in our city, and the crime rate has gone

down dramatically, it is shocking to the conscience that the cooperation that he talked, a lack of cooperation between our Federal

agencies and our local police.

And, you know, when we think about all that we have heard, and

all of the concerns that we have heard in the news media about

how the FBI, DEA and all of the other Federal agencies, CIA, trying to track down the criminal element, the terrorists involved in

this matter, and to not be working closely with our local police is

very—I mean it should concern every single American who may be

listening to this.

And so one of the things that we will do, Mr. Chairman, and the

committee, subcommittee of this committee which I rank on, Criminal Justice, is I have asked Chairman Souder, and I hope that you

will help me with this, to convene a subcommittee hearing or with

the chairman of our overall committee, Congressman Burton, to

ask the FBI to ask the other agencies, Federal Government law enforcement-type agencies, why don’t people like Commissioner Norris have the kind of cooperation that he wants to have?

And so I think that while we have got great police and we saw

it in New York, and we see it all over the country, people work

every day, they knew their territories, just like Commissioner Norris said, they knew the people, they know every square inch of

their cities, it seems logical to me that we would try to have that

maximum cooperation.

Finally let me say this. I think that when, as I have listened

today, I hope that we understand—it sounds like when I listen to

the mayor, what he is basically saying is, look, you know, let us

not put a blinder up to our eyes and then listening to Dr.

Smithson, let us not put a blinder up to our eyes and act like one

thing is going on, when actually it is another.

And let’s be practical and deal with these things. And I think

that is what—I hope that we in the Congress will listen to them

very carefully, because what they bring to us are the practical—

first of all, the information that is accurate, and then the practical

solutions to the problem so that we will not be fooled.

Americans, I think, after September 11th, they thought that they

had a level of security, which we quickly found out that we didn’t.

So the kinds of things that are coming forth today, Mr. Chairman,

again, I thank you. It is the kind of information that we need to

address the problems that we are confronting.

Again, I thank you for your courtesy.

Mr. HORN. I thank the gentleman. And as I said earlier today,

Mrs. Maloney, the gentlewoman from New York has helped us on

this, as many other things. And so I now yield 3 minutes. We are

going to just have to keep going, because we want the second-tier

to come and we would love you to have your role after you hear

some of the second-tier.

So, Mrs. Maloney.

Mrs. MALONEY. First of all, I want to thank all of the panelists,

particular to welcome my friend, Mayor O’Malley, with whom I

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have had an opportunity to work on other important issues before

this Congress.

I agree very much with the theme that many of you have put forward that all emergencies are local and the number of lives that

will be saved is very much due to a local response. In New York

it was New York’s bravest and finest that were the first at the

scene.

And on Monday, when I was at Ground Zero, it was still fire that

was in charge of the scene. Yesterday, a member of what we call

in New York the ‘‘Bucket Brigade,’’ was in my office. This is the

group of volunteers that supported the fire in removing debris by

hand in buckets trying to look for lives.

And they told me that even when there was a notice to evacuate,

because they were afraid a building was going to fall, that the firefighters and officers refused to leave the site. They kept looking,

trying to save people and responding. To me they are the greatest

heros in our country.

Later today we will be authorizing the intelligence committee.

And I will certainly be bringing to the floor in my statements the

items that you brought on better coordination. We definitely need

to invest and strengthen our intelligence.

I would like to ask about smallpox. Many people who are experts

in this have told me that there is a universal agreement that the

smallpox virus is the single most dangerous raw material for a

non-nuclear terror attack. One expert said it is almost like a smallpox and then everything else.

We eradicated it in 1978. It is supposed to exist, the virus, in two

places, the CDC in Atlanta and in Russia. But I am told by some

experts that they believe that many of these smaller countries have

the smallpox virus. We know that it could kill, or in the past has

killed up to a third of those infected. And the World Health Organization is trying to speed up responses.

Our own government has roughly 15 million doses of smallpox

vaccine; has ordered 40 million more for delivery by the end of the

year 2004. Many of my constituents in New York have called my

office and asked for the smallpox vaccine.

I have called the National Institute of Health. They have told me

that it is not available. Many experts believe that it is a threat.

Russia apparently developed weapons that could put the virus on

the tip of it and send it to our country.

And we have not really had a great control of some of their weapons after the cold war. I would like to ask some of our experts

whether you think we should be developing more vaccine? Should

our citizens have access to it? Even though we don’t have enough

for everyone, shouldn’t some of the people that are asking for it be

able to have access to it?

As a child, I was vaccinated, but I am told that anyone who was

vaccinated many years ago is no longer covered or immune to a

smallpox virus. I would like anyone on the panel who would like

to comment on what we should be doing. Should we be developing

more vaccine? Should we be distributing it? What should we be

doing?

Dr. SMITHSON. A few years ago, I spent several weeks in the

former Soviet Union interviewing the weaponeers who did this,

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who figured out how to turn diseases into weapons of war. And the

Soviet Union did that with over 50 diseases, including Marburg. It

is true. They did weaponize smallpox. They manufactured tons of

it, along with plague and anthrax.

And they put it on top of ICBM’s aimed at Western populations

centers. I think it would be foolhardy to assume that smallpox seed

cultures only exist in one place in the former Soviet weapons complex, which consists of over 50 centers that were involved in the research, development testing and production of these weapons.

However, when I talked with the weaponeers there was one

thing that they understood very clearly. Terrorists, they kept on

telling me, are our common enemies, because Moscow has had its

own encounter with terrorism.

Also, before that even happened, Aum Shinrikyo, the cult in

Japan, had knocked on the National Health Institute doors for both

chemical and biological weapons knowledge. I don’t want to feed

you a line here. I did interview weaponeers who knew colleagues

who had gone to help Iraq and Iran and China and North Korea.

They had been invited to teach. But let us not make the assumption that is not all that they did. Let us also not make the assumption that these governments would automatically share something

like smallpox with a terrorist group, because if it is anything that

a weaponeer understands, it is the consequences of unleashing

something like that on a population, even if it is the population of

your enemy. Because that is something that goes around the world

and would be very, very difficult to contain.

Let us also not make the assumption that smallpox is for sale on

the streets of Moscow or any other place. In today’s environment,

there are so many rumors that are floating around. If I were to

give you a remark on the other aspect of your question, it would

be that if anybody should be getting smallpox vaccines in an emergency; it has to be the very people who are going to be there. We

are expecting them to save our lives.

The medical personnel, both in hospitals and the paramedics and

other technicians as well as the firefighters and police.

Mrs. MALONEY. Should we be vaccinating them now, in your

opinion?

Dr. SMITHSON. I think I will leave that judgment call to others.

It is not for me to advocate that. I don’t feel that there is imminent

danger that smallpox is going to be released on this country. I

think before we go doing a lot of knee-jerk things, this is an atmosphere that breeds knee-jerk reaction, we need to carefully think

through these matters.

And, by the way, I agree with what Governor—excuse me, I just

promoted you, Mayor O’Malley said—— Mr. O’MALLEY. Thank you. I accept your nomination.

Dr. SMITHSON [continuing]. With what Mayor O’Malley said. It is

not just the frontline personnel, it is also their families, because

they have to be assured that their family is going to be OK if something bad happens.

Mr. O’MALLEY. I think the long-term issue of prophylaxing your

emergency responders, though, it is just that—it is slightly longerterm issue, but it is a very important issue. We assume that when

the calls go out, everybody goes and they do their duty. And we

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have seen the courage. And many and most probably will. But ask

people to—in these sorts of things, to leave their families behind

is a tough thing to ask human beings to do in these times of emergency.

But I would think that given the level of vaccinations that we

currently have, that go doing them all over the country in a kneejerk way would not be a wise use of the limited vaccines we have

on smallpox.

Dr. SMITHSON. Right. The thing is, we need to assure these people now what the priorities are going to be, that they would be the

first to receive these medications, simply because they will have to

save us.

Mrs. MALONEY. Can I ask one brief show of hands on one brief

question, Mr. Chairman.

Mr. HORN. Yes.

Mrs. MALONEY. I would like a show of hands, because we have

to get on to other people, as the chairman said, of how many people

agree with Secretary Thompson’s statement that he stated on 60

Minutes on Sunday? ‘‘We are prepared to take care of any contingency, any consequence that develops for any kind of bioterrorism

attack.’’ Do you agree with this statement of being prepared? Raise your

hand if you agree you are prepared for all of this.

Raise your hand if you think we are not prepared.

Mr. HORN. Well, wait a minute.

Mr. O’MALLEY. I think it is all a matter of degrees. I don’t think

that we are prepared for many, many things. And I think, depending on the degree of it, we would quickly find that preparation outstripped by about—— Mr. HORN. I remember where the previous administration had

warehouses all over the place on the flu and nobody ever used

them. And that is why we need doctors to know, and chemists to

know if any of this is—otherwise, I don’t believe in sort of scaring

the living daylights out of people. Because—I would like Ms. Bonta

to respond.

Dr. BONTA. I think it is dependent upon degrees. Because certainly we have experience in the United States where some local

public health departments are still in buildings that were made for

the polio epidemic.

In 1988 when I was with the city of Long Beach, we were in just

such a building. We had a rotary telephone and we had two computers that staff were even not fully trained in how to use. We

have moved a long way throughout the country, and certainly in

California we have the advantage of having years and years of preparing for earthquake preparedness and other natural disasters.

But this is a unique situation in which we need more work on communication, on training, on laboratory preparedness and having

disease surveillance and epidemiology.

LTG. PEAKE. I would just say, ma’am, you know, I am a doc. And

so you are the one doc in the ER, and three or four people come

in, that is a mass casualty. It is a matter of degree. And the issue

is having the systems back-up that can pull the things together

where you need it, when you need it, to be able to make that response.

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And I think that has sort of been a consistent theme as I have

heard here.

Mr. HORN. Thank you. And we thank you. And our last questioning goes to Mr. Kanjorski, the gentleman from Pennsylvania, 3

minutes.

Mr. KANJORSKI. Thank you very much, Mr. Chairman.

I want to make a few observations to the panel, because I have

been sort of monitoring the channels over the last several weeks

on television. It seems that if anybody has written a book lately,

in the extreme has been a guest. And they make all of those proposals. And then I have been talking to constituents that have a

legitimate reason to try and make an analysis and a judgment of

how they should carry on their daily lives.

And what I am most interested in is the lack of our system for

having a central clearinghouse operation to adequately inform people as to what the risks and various categories are, some—what

the symptomologies are and what disadvantages of taking

proactive action.

One member of the health community made a great point the

other day. Vaccines, for instance, have a percentage of detrimental

effects on society. If you were to inoculate the entire country, even

though it may be one half percent a negative effect, you are talking

about a million and a half people that may suffer irreparable injury

as a result of just taking the shot itself.

A lot of people aren’t aware of that. They think that it is a sure

cure. The other things that they aren’t aware of is the difficulty of

delivering the longevity of life of some of those biotechnology methodologies that would be used in germ warfare and also in gas warfare; what the chances are of getting the proper nozzles on a crop

duster.

I guess what I am most interested in, and the observation I

would make over the last 3 weeks, is that we in government and

in leadership have a tendency to underestimate the intelligence

and rationale of the American people. They don’t want, even the

Secretary of HHS, to come out and make a pronouncement. They

want to know the basis on which his pronouncement was made so

they can analyze in their own mind what their chances of having

an exposure would be.

In order to bring the level of that type of understanding up, are

you aware of anything that we are doing to create a national institute of reliability, if you will, for this information, whether it be on

the Internet, should we do it in the national broadcast—what is the

educational factor here?

Because we just have entirely too many people that are in a

State of anxiety that shouldn’t be there, are giving up their normal

course of life and business and having a major impact on our economy and other things.

I just came from a session, Mr. Chairman, where we talk about

security. And after we got to $25 or $30 billion in expenses of

changing railroad lines and doing all kinds of things, which are

probably intelligent things to do, I realized that we could on our

way to spending ourselves into bankruptcy in trying to take care

of every contingency that could happen knowing fully well, the

open country that we are, we can’t accomplish that.

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So do you have any ideas? I’ll just ask the panel: What could we

do to provide a level of intelligence and information that would

meet the needs of the average American who wants to be informed

as to what to do and do away with the rumor mills that are out

there that are paralyzing us?

Mr. O’MALLEY. Your point is—I think it is an excellent point.

One of things we have tried to do through the conference of mayors

is inform each other and try to encourage well informed local officials to talk about these things.

We had a teleconference with about 200 cities that chimed in,

and our guests—and the first one was last week. And it was done

with—on bioterrorism, going through the likely agents. I mentioned

the Hopkins Center for Civil Biodefense Studies. It is

www.hopkins-biodefense.org, I think.

And we are going to be doing one next week on chemical readiness. So it would probably be a good idea to have some sort of 800

number or something in cities that people could call. But fortunately, I think the Internet, I think you are right. I think a lot of

Americans are educating themselves.

But we need to do a better job. And I don’t think it does any of

us any good to not discuss it. I know there are some local elected

officials who feel like, ‘‘Oh, my goodness, if I go on camera or talk

about this, I might make it worse.’’

Indeed if they are uninformed they may make the hysteria

worse. So I think it is incumbent on us locally to get the word out

and do it through our local affiliates.

Mr. HORN. That is very well answered.

I would like to now play musical chairs where the group in the

back, our panel two, and if some of you could stay around, we

would like that.

Let us start here with Scott Lillibridge, special assistant to Secretary Thompson. Second one is Bruce Baughman, FEMA. Craig

Duehring from the Department of Defense. Mr. Fogg, New Hampshire Office of Emergency Management. Mark Smith, Washington

Hospital Center, and Kyle Olson, vice president and senior associate.

We will start with Mr. Scott Lillibridge, M.D., special assistant

to the Secretary for National Security and Emergency Management

Department of Health and Human Services which is headed by one

of the best cabinet members I have ever known, that is Mr. Thompson. He is on top of it. And I am delighted to have one of his special

assistants here.

So, Mr. Lillibridge, proceed to give us a summary of your excellent—all of you had wonderful papers, and that automatically goes

in the record. But we would just like to see an overview from you

at this point.

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STATEMENTS OF SCOTT R. LILLIBRIDGE, M.D., SPECIAL ASSISTANT TO THE SECRETARY FOR NATIONAL SECURITY AND

EMERGENCY MANAGEMENT, DEPARTMENT OF HEALTH AND

HUMAN SERVICES; BRUCE BAUGHMAN, DIRECTOR, PLANNING AND READINESS DIVISION, FEDERAL EMERGENCY

MANAGEMENT AGENCY; CRAIG DUEHRING, PRINCIPAL DEPUTY ASSISTANT SECRETARY OF DEFENSE FOR RESERVE AFFAIRS, DEPARTMENT OF DEFENSE; WOODBURY FOGG, DIRECTOR, NEW HAMPSHIRE OFFICE OF EMERGENCY MANAGEMENT, CO-CHAIR, TERRORISM COMMITTEE, NATIONAL

EMERGENCY MANAGEMENT ASSOCIATION; MARK SMITH,

M.D., WASHINGTON HOSPITAL CENTER, REPRESENTING THE

AMERICAN HOSPITAL ASSOCIATION; AND KYLE B. OLSON,

VICE PRESIDENT AND SENIOR ASSOCIATE, COMMUNITY RESEARCH ASSOCIATES

Dr. LILLIBRIDGE. Thank you, Mr. Chairman and members of the

subcommittee. I am Scott Lillibridge, special assistant for the Secretary of Health and Human Services, Tommy Thompson, for National Security Issues and Emergency Management.

I appreciate the opportunity to appear before you today to discuss the issues and the role in State and local government preparedness to respond to acts of terrorism, including biological terrorism and chemical terrorism. I would like to take heart in the

comments that I have heard today from plain-speaking Amy

Smithson about preparedness, the comments from Dr. Bonta about

State and local preparedness in the public health sector, and of

course, Baltimore for taking matters into their own hands, once

again. Thank you.

At any rate, I would like to acknowledge that our State and local

public health programs comprise the foundation of an effective national strategy for preparedness and emergency response. Preparedness must incorporate not only the immediate responses to

threats such as biological terrorism, it must also encompass the

broader components of public health infrastructure which provide

the foundation for immediate and effective emergency responses.

These components include, one, a well-trained, well-staffed, fully

prepared public health work force. Two, a laboratory capacity to

produce timely and accurate results for diagnostics and public

health investigations.

Three, we need epidemiology or disease detective work including

surveillance for infectious diseases which provide the ability to detect health threats urgently.

Four, we need secure accessible information systems that can

help us analyze essential information, communicate it rapidly, and

analyze trends and interpret data.

And last, of course, we need an effective communication system.

I believe several members today spoke to the issue of important

public health information and relating that accurately to the public.

Currently States lack an optimum public health infrastructure at

both the State and the local level. We will need to discuss and

make planning on the long-term as part of our overall preparedness effort.

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I would like to begin talking about HHS activities and preparedness and response, and start with the Centers for Disease Control

activities.

The HHS CDC has used funds provided—has provided funds for

the past several years from Congress to begin the process of improving expertise, facilities and procedures of State and local

health departments to respond to biological and chemical terrorism

and other acts of terrorism.

For example, over the past 3 years the agency has awarded more

than $130 million in cooperative agreements to 50 States, one territory and four major metropolitan health departments, and has created a bioterrorism preparedness response program and other components that anchor as part of that overall program, including

stockpiles, chemical preparedness, health information, and a health

alert network.

We must continue our work with our State and local public

health systems to make sure that they are more prepared. This requires interaction of State departments of health with State emergency managers to fully integrate the States’ capacity to effectively

distribute life-saving medications to victims, whether it be a biological or a chemical attack.

The HHS Office of Emergency Preparedness is also working on

a number of projects to assist local hospitals and medical practitioners to deal with the effects of biological, chemical and other terrorist acts.

Since fiscal year 1995, for example, the Office of Emergency Preparedness has been developing local metropolitan medical response

systems [MMRS]. Through contractual relationships with local

communities, MMRS uses existing emergency response systems,

emergency management, medical and mental health providers,

public health departments, law enforcement and public health departments, to provide an integrated unified response to a mass casualty event.

As of September 30, 2001 the OEP, Office of Emergency Preparedness has contracted with 97 municipalities to develop MMRS

systems.

The fiscal year 2002 budget includes funding for an additional 25

MMRS systems. MMRS contracts require the development of local

capacity, capabilities for mass immunization, prophylaxis in the

first 24 hours following an identified disease outbreak, and the capability to distribute material deployed to the local site from the

National Pharmaceutical Stockpile.

Local medical staff are trained to recognize disease symptoms so

that they can initiate treatment, and the local capability to manage

the remains of the deceased are also included in this effort. We

have important lessons learned from the recent September 11th activities.

First of all, I would like to talk about the response and just highlight a few things that I think are quite exciting. Second, we were

able to respond to two sites with medical emergency teams in a

matter of hours and provide assistance onsite and some cases minutes to hours. And involved on-the-ground assistance in both Virginia, near the Pentagon, and in New York City.

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Our stockpile became operational for the first time in terms of

deployment, and with a timeline of 12 hours or less we actually got

it there in 7 hours. That was one of the few things able to fly and

move during that time of crisis with complex coordination with the

Federal Aviation Administration and the national security community of the United States.

We had teams in place. Shortly surveillance was enhanced, particularly in New York City. Our disease detectives from the Centers for Disease Control were onsite amplifying surveillance, and

working with State and local communities, building on the infrastructure, largely since West Nile, to enhance local public health

capacity.

A number of important activities have been undertaken by the

Secretary of Health and Human Services since September 11th.

And they include meeting with pharmaceutical agents, accelerating

vaccine production, and taking aggressive steps to accelerate the

development of—long-term development of our national pharmaceutical stockpile.

On the long-term overview, as an indication of the Nation’s preparedness for bioterrorism, I would like to review a little bit about

the lessons learned from the Top Off 2000 exercise in May 2000.

This national drill provided scenarios related to weapons of mass

destruction, to a mass destruction attack against our population. It

involved the cooperation at the State and local level, FEMA, Department of Justice, HHS, Department of Defense, and many other

vital community sectors that would play a role in an actual response.

While much progress has been made to date, the number of important lessons that have been, from that event have begun to

shape our overall views of preparedness. And they are as follows.

It is clear from the health perspective, and there are many ways

to look at this, but from the health perspective, improving the public health infrastructure, both at the statute and local level remain

a critical focus of our terrorism preparedness and response efforts.

Such preparedness is indispensable for reducing the Nation’s vulnerability to terrorism from infectious agents and from other potential emergencies through the development of these broad public

health capacities, again, State and local capacities.

Second, it would also be extremely important to link emergency

management services and health decisionmaking at the most local

levels for the purpose of rapidly addressing the needs of larger population, particularly a population affected by bioterrorism or other

chemical terrorism events.

I would like to conclude and say a few things on behalf of our

department, that the Department of Health and Human Services

is committed to ensuring the health and medical care of our citizens, and we have made substantial progress to date in enhancing

the Nation’s capability to respond to a bioterrorism event.

But there is more we can do to strengthen our readiness. I was

glad to see through a show of hands that people were neither convinced that we were ready nor not ready. I think that is an important indication that the issue of preparedness is a long-term endeavor and will require us to broaden the depth and the breadth

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of our preparedness activities along all fronts in this war against

terrorism.

Priorities include strengthening our local and State public health

surveillance capacity, continuing to enhance our national pharmaceutical stockpile, and helping our local hospitals and medical professionals better prepare to respond to a biological or a chemical attack.

Mr. Chairman, that concludes my prepared remarks, and I would

be pleased to answer any questions that you or members of the

subcommittee may have. Thank you very much.

Mr. HORN. Thank you very much.

[The prepared statement of Dr. Lillibridge follows:]

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Mr. HORN. And our second presenter is Bruce Baughman, Director of Planning and Readiness Division of the Federal Emergency

Management Agency [FEMA].

Mr. BAUGHMAN. Good morning, Mr. Chairman, members of the

subcommittee. I’m Bruce Baughman. I’m Director of Planning and

Readiness for the Federal Emergency Management Agency. It’s my

pleasure to represent Director Allbaugh at these important hearings on biological and chemical terrorism.

The mission of FEMA is to reduce the loss of life and property

and assist in protecting the Nation’s critical infrastructure from all

types of hazards. When disaster strikes, we provide a coordination

and management framework to responding Federal agencies and a

source of funding for State and local governments.

The Federal Response Plan is the heart of that management

framework. It reflects the labor of an interagency group that meets

in Washington and in all 10 of our FEMA regions to develop an

interagency capability to respond as a team. This team is staffed

by 26 departments and agencies and the American Red Cross, and

is organized into interagency functions based upon the authorities

and expertise of the member organizations and the needs of our

counterparts in State and local government.

Our plan is designed to augment, not supplant, the response systems of State and local government. Since 1992, the response plan

has been a proven framework for managing major disasters and

emergencies regardless of cause. It works. It worked in Oklahoma

City. It worked at the World Trade Center. We’re basically coordinating the responding teams of 14 agencies responding to that

event.

However, biological and chemical attacks present a unique challenge. Of the two, I am more concerned about biological terrorism.

A chemical attack is very similar to a large-scale HAZMAT incident. Through the National Response Center, the National Contingency Plan, the Environmental Protection Agency and the Coast

Guard, managed systems that can act, local, State and Federal responders, and the chemical industry, these systems are used routinely in HAZMAT incidents. EPA and the Coast Guard are also

the primary agencies for hazardous material function under our

plan.

The model we will use, it is our intent to use this model in the

event of a chemical attack. However, to make this model robust

and functional, we need to provide additional training for first responders at the State and local level and equipment.

In an undetected biological attack, first responders would be doctors, hospital staff, animal control workers, instead of police, fire

and emergency medical personnel. Connections between nontraditional first responders and the larger Federal response is not routine. The Department of Health and Human Services is the critical

link between the health and medical community and the larger

Federal response. FEMA works closely with the Public Health

Service as the primary agency for health and medical under the

Federal Response Plan. We rely on them to bring the right expertise to the table when we meet to discuss potential biological events

and how they will spread and the sources and techniques that will

be needed to control them.

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We are making progress. As Scott mentioned, Exercise TOPOFF

in May 2000 involved a chemical attack on the East Coast followed

by a biological attack in the Midwest. We have incorporated these

lessons learned in the exercise into our response procedures. This

process is active and ongoing. It takes time and resources to identify, develop and incorporate changes into the system.

In January 2001, the FBI and FEMA jointly published the U.S.

Government’s Interagency Domestic Terrorism Concept of Operation, or CONPLAN. The Departments of Health and Human Services, Defense, Energy and the Environmental Protection Agency

were part of that plan. Together, the CONPLAN and the Federal

Response Plan provide the framework for managing the response

to the causes and consequences of terrorism.

On May 8th, the President asked that the Vice President oversee

the development of a coordinated national effort regarding domestic

preparedness. The President also asked that the Director of FEMA

create an Office of National Preparedness to coordinate Federal

programs dealing with preparedness for and response to terrorists’

use of weapons of mass destruction. In July, the Director formally

established the office at the FEMA headquarters and had staff elements in each of the 10 FEMA regions.

On September 21st, in the wake of the horrific terrorist attack

at the World Trade Center and the Pentagon, the President announced the establishment of the Office of Homeland Security and

the Office of the—in the White House to be headed by Governor

Ridge of Pennsylvania. The office will lead, oversee and coordinate

the national strategy to safeguard the country against terrorism

and to respond to the attacks that may occur. It is our understanding that the office will coordinate a broad range of policies and activities related to the prevention, deterrence and preparedness and

response. The office includes the—a Homeland Security Council

comprised of key Federal departments and agencies, including the

Director of FEMA.

We expect to provide significant support to this office in our new

role as the lead Federal agency for consequence management.

Mr. Chairman, you convened this hearing to ask about our preparedness to work with State and local government agencies in the

event of a biological and chemical attack. Terrorism presents tremendous challenges. We rely heavily on the Department of Health

and Human Services to coordinate the efforts of the health and

medical community to address biological hazards. We also rely on

the Environmental Protection Agency and the Coast Guard to coordinate the efforts of the hazardous material community to address chemical hazards. They need your support to increase the national inventory of response resources and capability. FEMA needs

your support to ensure that the system that the Nation uses 65

times a year to respond to major disasters has the tools and the

capacity to adapt to a biological and chemical attack on any other

weapon—or any other weapon of choice.

Thank you, Mr. Chairman. I would be happy to answer any questions at this time.

Mr. HORN. Well, I thank you.

[The prepared statement of Mr. Baughman follows:]

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Mr. HORN. We have a little problem here as usual. We’re sent

here to vote, and we’re now down to the 10-minute bit. And that

is the 10-minute warning. And so we’re going to go into recess until

12:35, 12:40, and right below us in the basement is the splendid,

fine, wonderful restaurant known as the Rayburn cafeteria. So

we’ll be glad to see you back here, and we’ll get to work at 12:35.

[Recess.]

Mr. HORN. The agriculture bill now passed in the House of Representatives, and we are out of recess, and at 12:35 we will start

now with Craig Duehring, the Principal Deputy Assistant Secretary of Defense for Reserve Affairs of the Department of Defense.

Mr. Duehring, we’re glad to have you here.

Mr. DUEHRING. Good afternoon, Mr. Chairman. Thank you for

the invitation to testify before you today on the Department of Defense’s continuing efforts to ensure a strong national defense

against domestic terrorists using weapons of mass destruction, or

simply WMD. America’s National Guard and Reserves are critical

to our Nation’s capability to support an enhanced and integrated

Federal, State and local response to incidents involving weapons of

mass destruction.

We’re going to use the term ‘‘consequence management’’ quite

often. At DOD we define WMD consequence management as emergency assistance to protect public health and safety, restore essential government services and provide emergency relief to those affected by the consequences of an incident involving WMD agents,

whether they are released deliberately, naturally or accidentally.

DOD normally provides such assistance only in response to requests from the appropriate lead Federal agency to support specific

State and local authorities in mitigating the consequences of a domestic, nuclear, chemical, biological, radiological or high-yield explosive incident.

My testimony today will provide a brief description of DOD’s role

in Federal response preparations, as well as an overview of the initiatives we have undertaken to better prepare us to provide the

support requested. Presidential decision directives established 3

years ago directed the U.S. Government to enhance its plans and

policies to protect against unconventional threats to the homeland

and Americans overseas. Since then there has been a concerted effort to identify and streamline Federal agency coordination mechanisms to address the growing possibility of asymmetrical assaults

on U.S. vulnerabilities at home and abroad.

These efforts focus primarily on establishing policies and programs to enhance the Nation’s preparations to thwart and, if that

fails, respond to terrorists’ use of weapons of mass destruction or

cyber-warfare. Federal agency consequence management responsibilities and the need for extensive interagency coordination and

response to a significant terrorist incident here or at home have

been delineated in the documents that were presented 3 years ago,

but which today still serve as the basis for all current Federal disaster response plans.

Today Federal response to a WMD incident in the United States

will likely involve many agencies of the U.S. Government, each

bringing specialized talents and expertise honed in the execution of

larger programs designed for purposes other than terrorist attacks.

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No one agency possesses all the talents, but a few such as the FBI,

FEMA and HHS know they have lead responsibilities to coordinate

our Federal response to national emergencies.

The Federal Response Plan articulates that distribution of the responsibilities and authorities for cooperation and coordination for

disaster response. In the event of an incident, we recognize that

those closest to the problem are going to be the first to respond,

but the presumption is that in the event of a catastrophic incident,

those State and local capabilities may be quickly overwhelmed. If

a civilian authority requests Federal support, the lead Federal

agency, FBI, or FEMA, for example, is likely to request support

from many other Federal agencies including the Department of Defense.

We have undertaken a number of steps within the department

to address how we will support the Nation in responding to incidents involving weapons of mass destruction. First, we have sought

to define more clearly what the department’s role should and

should not be. We do not call consequence management homeland

defense, but refer to it rather as civil support. This reflects the fundamental principle that DOD is not in the lead, but is there to support the lead Federal agency in the event of a domestic disaster

contingency.

Four principles guide DOD’s response in the event of a domestic

WMD contingency. First, there will be an unequivocal chain of accountability and authority for all military support to civil authorities. Second, DOD’s role is to provide support to the lead Federal

agency. Third, though our capabilities are primarily war-fighting

capabilities, the expertise that we have gained as a result of the

threats that we have faced overseas can be leveraged in the domestic arena as well. DOD also brings communications, logistics, transportation and medical assets, among others, that can be used for

civil support. And fourth, our response will necessarily be grounded

in the National Guard and Reserves as our forward-deployed forces

for domestic operations.

The National Guard and Reserves will play a prominent support

role for State and local authorities in consequence management.

DOD has assigned full-time National Guard WMD civil support

teams in 27 States to provide as part of a State emergency response capability the first wave of support to overwhelmed local incident commanders in dealing with incidents involving weapons of

mass destruction. We will soon announce the stationing of five new

teams authorized by Congress last year in five additional States,

bringing the total to 32 civil support teams.

These teams are comprised of 22 highly skilled, full-time, welltrained and equipped Army and Air National Guard personnel.

These teams provide specialized expertise and technical assistance

to the local incident commander in, first, facilitating on-scene communications and command and control among the different responding agencies; second, exchanging technical data and information with military laboratory experts on weaponized chemical and

biological agents; and finally, helping to shape or revise the local

incident commanders’ response strategy based on the specific chemical, biological or radiological agents found at the scene.

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The WMD civil support teams are unique because of their Federal-State relationship. They are federally resourced, federally

trained, and expected to operate under Federal doctrine, but they

will perform their mission primarily under the command and control of the Governors of the States in which they are located. Operationally they fall under the command and control of the adjutants

general of those States. As a result, they will be available to respond to an incident as part of a State response, well before Federal response assets would be called upon to provide assistance.

During fiscal year 2002, DOD will also continue to train and sustain 100 chemical decontamination and 9 reconnaissance platoonsized elements in the Army Reserve. Medical patient decontamination teams in the National Guard and Air Force Reserve will receive additional training in domestic response, casualty decontamination. They will be provided with both military and commercial off-the-shelf equipment and will receive enhanced training in

civilian HAZMAT procedures.

I have more information dealing with the domestic preparedness

program and also with WMD advisory panel.

Mr. HORN. Why don’t we put it in the hearing, without objection,

so it can be distributed.

Mr. DUEHRING. Yes, sir. And I’ll be happy to answer any questions that you have.

[The prepared statement of Mr. Duehring follows:]

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Mr. HORN. Well, I have one right now. I noticed in the paper this

morning that Deputy Secretary of Defense Wolfowitz is the—mentioned the Posse Comitatus situation, and I wonder, was the Reserve involved in that particular situation?

Mr. DUEHRING. I’m not aware of what that particular situation

is. I am aware of the Posse Comitatus, and when the National

Guard operated in a State setting, in a call-up by the Governor, of

course, then their rules are different than if they were Federalized.

So I’d have to give you kind of a general answer. I can’t be specific

because I don’t really know what it was they were referring to.

Mr. HORN. Well, I can understand that, but I think it said he

had a 71-page memo on the subject.

I happen to agree with him. I read that 30 years ago. So it isn’t

new to me, but I would like to have anything you have to put at

this point in the record.

Mr. DUEHRING. Yes, sir.

Mr. HORN. Thank you.

We’ll go to Mr. Fogg, who is the director of the New Hampshire

Office of Emergency Management and co-chair of the Terrorism

Committee, National Emergency Management Association. Mr.

Fogg.

Mr. FOGG. Mr. Chairman and members of the subcommittee,

thank you for the opportunity to appear. I am here today representing the National Emergency Management Association,

NEMA, whose members are the Directors of Emergency Management for the States and territories. We’re the ones responsible to

our Governors for disaster mitigation, preparedness, response and

recovery. This includes responsibility for terrorism, consequence

management and preparedness in each of our States. We each

serve as the central coordination point for our State’s response activities and interface with Federal agencies.

I serve as the current co-chair of NEMA’s Terrorism Committee

along with Peter LaPorte, the director from the District of Columbia Emergency Management Agency. NEMA’s Terrorism Committee has been actively engaged for a number of years on this topic.

I also serve as chairman of the Northeast States Emergency Consortium [NESEC], comprised of the Emergency Management Directors for the six New England States, plus New York, plus New Jersey.

And I’d like to begin by thanking you all for recognizing the importance of preparing for acts of terrorism. We need and appreciate

your support for what we must accomplish.

We’ve taken an all-hazards approach to disaster preparedness,

and I want to emphasize that, all-hazards approach, and, therefore,

we’re able to integrate into our domestic preparedness efforts those

proven systems we already use for dealing with natural and technological disasters. We also recognize clearly the value of prevention and mitigation in minimizing the consequences of disaster, and

we incorporate those considerations in all our planning.

NEMA has developed a list of recommended enhancements to be

incorporated into a nationwide strategy for attaining better preparedness for catastrophic events. The full text of these recommendations is included in the attached NEMA white paper for

your reference.

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I’d like to highlight the highest priority items in my testimony

today, and before I do that, I’d just like to make the point that the

lessons learned from the September 11th attacks are not brand

new ideas. Many are concepts we’ve been working on for years and

just have not yet had the resources to fully implement.

Now is the time for Federal, State and local governments to take

action. It is not the time to prepare reports or criticize past actions

or issue sweeping new directives. You have our detailed written

testimony, which is fairly comprehensive, but the committee asked

us to focus on how the Federal Government can best work with

State and local governments to deal with chemical and biological

terrorist attacks, so I’ll limit my comments to that issue.

There are four main points. No. 1, our Nation requires an overall

national, not Federal, national domestic preparedness strategy that

is developed collaboratively with full involvement by local, State,

Federal and private partners, and it is built upon existing all-hazards plans and systems. This national preparedness strategy must

be a pillar of our national and homeland security strategy; that is,

the preparedness component and the law enforcement component

together comprise our all security strategy. We should base that

strategy on tried and proven all-hazards systems, particularly the

Federal Response Plan, the Incident Command System and our

Emergency Management Assistance Compact [EMAC], that 41 of

our States and territories have adopted, with others in process.

We need the Federal Government to be a catalyst, an enabler,

not a controller, and we also need to use the system. Don’t bypass

the States in their role in coordinating statewide and regional

plans. Oftentimes we hear about going directly to the municipalities, and that is great. It gets money where it needs to go, but it

leaves the States out of their coordinating role, and we need to be

very careful with that.

Two, our Nation’s preparedness for catastrophic events would be

well served by strengthening our regional capabilities. Strong consideration should be given to developing that strategy by strengthening our regional capabilities to provide a rapid, flexible response

capable of dealing with multiple mass casualty events occurring in

different places at the same time. If we put all our resources in one

place, we could get in trouble real quick.

Our Federal agencies can help by delegating decisionmaking authority to their regional offices. Some do that quite well now. Director Allbaugh at FEMA is pushing that concept, and that has

worked well in the past.

Mr. HORN. Let me ask at that point, is that the Federal Government regional areas? There are about 10 they’ve blocked out over

the last 30 years, and you want to operate within that area?

Mr. FOGG. That’s correct, sir, that’s correct. Delegate the authority to make decisions and make plans to that level. And what that

does is develop those relationships, that trust and credibility that

is so important in crisis situations, and understanding each other’s

resources, constraints, methods of—modus operandi, if you will,

and it eliminates the who’s in charge in the turf, and we found that

out. That was one of the major lessons learned from our TOPOFF

Exercise. And we hosted one of the venues in New Hampshire.

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Those agencies who had developed those relationships and used

them succeeded. The others did not.

We would encourage broader use of existing regional relationships, and I will just cite NESEC as an example, at Northeast

States Emergency Consortium. The details are in the written testimony, but it’s been done at very little incremental cost. We expanded on existing structure, and it’s a good use of Federal support.

The other thing we should do is develop our international relationships. I think we’ve overlooked that in the Federal emergency

management field.

Three, medical surge capacity is the main key to dealing with

mass casualty events, regardless of cause. The most noticeable hole

in our system is our limited ability to access and deliver surge capacity rapidly to the site of a mass casualty event. We have some

impressive national capabilities, but we need more local and regional capacity close to home to deal with true mass casualties

until a cavalry can get there. We need one of those disaster and

medical assistance teams widely dispersed. There are some parts

of our country that now are not covered very well by that system.

We need to fill those gaps, and we need faster access to military

reserve medical units with their own deployable equipment. And I

really want to wave the flag on that one.

We need to assist the health care industry in restoring a surge

capacity to our hospitals. The pressures of managed care have virtually eliminated that surge capacity, and we need to work together to restore some of it.

Four, the other real key to preparedness is timely sharing and

dissemination of critical intelligence information to those who really need to know. Commissioner Norris said it very well this morning. But don’t leave the State police and the county sheriffs out. All

levels have got to be involved in sharing of pertinent intelligence.

Again, for the same reason, the State folks need to be able to sort

that out on a statewide level and work with their local counterparts and Federal counterparts to direct resources where they need

to go.

And the other main issue about the intelligence issue is—and it

is about—it lets the health care system and the other first responders have a heightened awareness about the potential symptoms. It

gives them a heads-up, gives them a little warning, and it lets

them avoid being second victims and to contain the spread and effect of the agent.

And last, on sharing the intelligence, use the compartmented

need-to-know system that the military uses. It works quite well.

But we need to have greater reciprocity of security clearances between Federal agencies. Right now if you’ve got a FEMA clearance,

you can’t see DOD stuff. If you’ve got a DOD one, you can’t see

Health and Human Services stuff. We need to clean that up so we

can share intelligence effectively.

Let me summarize. No. 1, we need a clear national domestic preparedness strategy built collaboratively at all levels, local, State,

Federal and private. Two, we need to consider strongly strengthening our regional capacities. Three, we need to increase our mass

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casualty surge capability, especially regionally and locally. And

four, we need to improve intelligence-sharing across the board.

I want to end by emphasizing—— Mr. HORN. That has been the suggestion, and I think we’re going

to have to go to your two other colleagues to—— Mr. FOGG. OK. I just have one more sentence here. I want to end

by emphasizing that we should buildupon the proven systems that

we have in place and not reinvent the wheel. Add a spoke or two,

maybe even combine some, and definitely make the wheel turn

faster, but please, let’s not come up with a new wheel. And remember, this is not just about terrorism. It is about all-hazards preparedness. Thank you.

Mr. HORN. Well, thank you. That was very lucid.

[The prepared statement of Mr. Fogg follows:]

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Mr. HORN. Dr. Smith, Mark Smith is from the Washington Hospital Center, very distinguished institution in Washington, representing the American Hospital Association. Dr. Smith.

Dr. SMITH. Thank you, Mr. Chairman. I’m Mark Smith, the chair

of emergency medicine at Washington Hospital Center in Washington, DC, and I’m here today on behalf of the American Hospital Association’s nearly 5,000 hospitals, health systems, networks and

other health care provider members. We appreciate the opportunity

to present our views on hospital readiness for a potential terrorist

attack utilizing chemical, biological or radiologic weapons, as well

as explosives, incendiaries and other more traditional means of destruction.

The special responsibilities of hospitals in a terrorist attack is to

treat, manage and mitigate the acute medical consequences that

occur, and as this great Nation enters into a war on terrorism, the

American people and government officials need to have confidence

in our hospitals and our systems of health care, and I have no

doubt that American hospitals will rise to the occasion just as they

did on September 11th, hospitals in New York and New Jersey,

Virginia and Washington, DC, who relied on their training, their

experience and their prior disaster planning. They performed outstandingly. The hospital system worked.

Here at Washington Hospital Center, the regional burn center

for Suburban Maryland the District of Columbia and Virginia, we

treated 15 survivors from the Pentagon. Many of the victims were

severely burned. On September 11th, we were all part of a seamless single system of rescue, fire, police, EMS, hospital, and it was

not only those hospitals that directly cared for the victims. Our region’s vast network of hospitals responded. At Washington Hospital

Center that morning, we received offers of aid and assistance from

Malcolm Grove Medical Center, University of Maryland Medical

Center, Johns Hopkins, and MedStar Health’s Baltimore hospitals,

offers of personnel, ventilators, medical supplies and hospital beds,

whatever was needed.

America’s hospitals were ready for the foreseeable, but now we

must plan for what once seemed extraordinary. To date the AHA

has created a disaster readiness site on its Web page, engaged in

frequent communication about biological and chemical preparedness with hospitals across America and sent out two advisories on

hospital readiness. Preparedness work that had occurred quietly

behind the scenes during the past several years is coming out at

the public view, such as the District of Columbia Hospital Association’s Mutual Aid Plan led by Dr. Joe Barbera, or the ER–1 Readiness Project at the Washington Hospital Center to develop the design specifications for an all-risks emergency department, one that

has national capability built into it to manage the medical consequences of these terrorism disasters and epidemics.

To meet the new challenges that we now face, our recommendations include the following: First, integration of hospitals with police, fire, EMS and public health needs to occur to a much greater

level than exists today. Although not traditionally thought of as

such, hospitals are, in fact, one of the core elements of a community’s public safety infrastructure. Hospital is the final destination

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of every public service agency when injury, illness or acute exposure occurs.

Two, hospitals need to increase inventories of drugs, antibiotics

to combat the effects of chemical and biological weapons such as

anthrax, nerve gas.

Hospitals need to increase reserves of ventilators, monitors,

stretchers, all the basic equipment and supplies needed to treat victims of a mass disaster event.

Hospitals need much more robust systems for communicating in

real-time with other hospitals and with public service agencies in

order to better coordinate care for victims. Information provides

light, and we are often in the dark.

Hospitals need improved systems of surveillance detection and

reporting in order to identify potential biologic outbreaks as early

as possible.

Hospitals need backup water supplies or auxiliary power sources

and adequate fuel storage. We need our hospitals to be secure and

safe under all conditions.

Hospitals need to be able to utilize nurses and health care personnel who are not licensed locally, but who are licensed in other

parts of the country.

Hospitals need enhanced stability that currently exists to decontaminate contaminated patients and then to expeditiously care for

them.

In order to implement those recommendations, we need people,

health care workers, and right now American hospitals are facing

a severe work force shortage. Hospitals nationwide have 126,000— this shortage cuts right to the heart of communities across America

and to our ability to be ready for any need. Legislation has been

introduced to address the work force shortage, and we urge its passage.

Our Nation’s nurses, doctors and health care workers answered

the call on September 11th and stand ready to do so again, whenever and wherever it comes. But let me leave you with my final—

the summation thought, which is that America’s hospitals need to

be considered and treated for what they, in fact, really are, an integral part of our public safety infrastructure.

Thank you.

[The prepared statement of Dr. Smith follows:]

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Mr. HORN. Can you give us that nurse estimate? Is it 128,000?

Dr. SMITH. 126,000.

Mr. HORN. 126,000. Thank you very much.

And now we go to—maybe Mrs. Maloney would like to introduce

him—Kyle Olson, vice president, senior associate, Community Research Associates.

Mrs. MALONEY. His resume is quite long, quite distinguished.

He’s been at the head of this issue for many decades. Many of you

may have already met him, as I did, originally from his many

statements on television, 60 Minutes, Dateline, Frontline. He’s

been on the front- line on this issue, and I’m pleased that he’s been

a constituent of mine, and I am very delighted that he was able

to join us, and I thank you, Mr. Chairman, for allowing him to be

part of the panel. I always find his insights incredibly important

on this important issue. Thank you for coming.

Mr. OLSON. Thank you, ma’am.

Mr. HORN. Mr. Olson, you’re vice president and senior associate

to the Community Research Associates. Is that sort of a consulting

firm to hospitals?

Mr. OLSON. Well, by way of disclosure, I will acknowledge that

I have been, am now, and hopefully after my remarks today will

continue to be a scum-sucking government contractor. My firm has

worked with the Department of Justice, Department of Defense,

State and local governments for a number of years, particularly in

the area of WMD training, preparedness and other support. I will

also acknowledge that my remarks today have not been reviewed,

probably a mistake on my part, by any of those entities.

Again, I want to thank you for the opportunity to speak today

and offer my thoughts on the biological and chemical terrorism

problem to this committee. In the aftermath of the tragic events of

September 11th, the specter of terrorists’ use of weapons of mass

destruction has gone from being a remote possibility that is probably worth planning for to one more aspect of what has become a

national nightmare. Many have looked at the threat posed by

chemical and in particular biological weapons for the very first

time in the last few weeks, while others, including many of today’s

witnesses, have been working on this problem for a long time.

Today you, me, all of us are being asked by the American public

for an answer that will put, frankly, this grim genie back into the

bottle and let us get back to our lives. Unfortunately, there is no

silver bullet that is going to slay this monster, nor ensure that it

is going to stay in the grave once it’s put there. Even as we focus

on Osama bin Laden and his organization, we have to confront the

truth. He is not the first nor will he be the last man to covet weapons of mass destruction. After we run him to ground, we will still

have to deal with the potential that these weapons, created in the

middle of the last century, will wreak havoc on the new. To that

end, it is important that the answers be simple, that they be complete.

It has been suggested that the efforts made to ready cities of this

Nation to respond to WMD terrorism have been lacking. They’ve

been characterized as a mile wide and an inch deep. This much is

true. We could have done more. We can always do more. Navy exercises could have been more demanding. Maybe the training could

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have been more complete. Yet it is also true that the Nunn-LugarDomenici training and exercise program introduced thousands of

first responders to a threat that they had never even thought

about. New problems demanded new responses and new ideas from

police, fire and emergency managers, and they worked those problems in the context of that program. As a result, there is no doubt

we are far better prepared today than we were 5 years ago, particularly for potential chemical use.

On the other hand, the argument has been made all too convincingly that our health establishment is still ill-equipped to deal with

bioterrorism. I don’t argue that point. Over the course of the last

4 or 5 years, the element of emergency services that has been most

consistently a no-show at these integrated training and exercises

has been the medical community. For whatever reason, time constraints, budgetary limitations, skepticism, in many cities the doctors have not been in the tent, and now we are seeing evidence

that this is changing. Yesterday’s news out of Florida suggests that

this foxhole conversion comes none too soon. Serious work remains

to be done.

For example, while it is true that we have Federal stockpiles of

drugs, we do not have plans that have been tested for distribution

of those drugs in the event of a major biological event. We have

plans on paper that have not been field-tested by and large.

But before we join those who fully discount our preparations,

consider this. When the World Trade Center fell, New York City

activated an emergency response system that had for years deliberately tested itself against the darkest WMD scenarios, chemical,

biological, even radiological. New York’s leaders understood perhaps better than the rest of us that the world’s first city was terrorism’s potential primary target, and so they prepared themselves.

They took advantage of Federal training, exercises, equipment,

funding and other help. They pushed, they grabbed, they shook the

money tree. They played Federal agencies against each other. They

enjoyed using those duplicative programs that everybody complains

about, and at the end of the day, after a lot of work and a lot of

soul-searching, the city’s emergency management system was

structured to deal with an event that could leave 5,000 or more

New Yorkers dead.

New York’s planners invented ways to work around the loss of

power, communications, transportation. They even confronted the

possibility of losing scores of men and women from the city’s now

legendary fire and police departments. Because they did all these

things and thought their way through all these horrible ideas, New

York City was better prepared than any city on Earth when those

towers fell. Observers have noted that the city didn’t quit. It wept.

We all wept. But New York got up and fought, and I believe beyond

the spirit of the city’s people that the training helped. No, september 11th was not sarin, and it wasn’t smallpox, but it was mass destruction. The responders in New York had been encouraged to

think about the unthinkable, and when it became real, those same

responders’ actions saved more than 20,000 lives.

A similar story played out here in Arlington, VA, where the capital-area responders after years of preparation managed an efficient, professional response in the attack on the Pentagon.

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As we discuss where the Nation must go in the days ahead, as

Congress and the administration consider how to invest our hope

and our treasure, I hope we can appreciate that the efforts of the

past 5 years have not been wasted. They haven’t been perfect.

What government program ever has been? But they have not been

wasted.

Much of the criticism directed against the current hodgepodge of

Federal agencies arrayed against terrorism is, I would argue, a little bit out of date. There truly has been a shake-out over the last

couple of years with a broader understanding of the way things are

supposed to work. It is a little bit wider appreciated now. It’s not

a streamlined system, but its functions have become more sophisticated and better targeted over the last several years. We still have

overlaps, there are still food fights at budget time, but responder

agencies at the State and local level have in many cases a pretty

good idea of where to go to get help.

A major restructuring in the middle of everything else that is

going on right now holds out the potential for confusion rather

than clarity. I don’t know that the best course for this government

is to pursue a single homeland defense counterterrorism agency

that tries to do everything well and ends up doing many things

poorly. I actually tend to believe that competition among competing

ideas is a pretty good idea.

I’ve seen the wiring diagrams. I know there’s urgency to rearrange the deck chairs, but I also know that the small successes of

the first few days of the last few weeks in this bizarre, necessary

twilight world we are embarking upon stemmed from earnest to

frequently clumsy efforts to make a difference. As you consider the

path forward, as we all wrestle with the unimaginable, let’s remember the instructions given to physicians when they enter into

practice: First, do no harm. Thank you.

Mr. HORN. Thank you.

[The prepared statement of Mr. Olson follows:]

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Mr. HORN. Let’s start the questioning. I’m going to take 5 minutes, and I’d like to know from Mr. Lillibridge and Mr. Duehring,

Mr. Fogg and Mr. Olson in particular in educating people through

professional conferences that go on all over America, are we giving

training from the Federal side and having people at these conferences so they can bring people up to the level that they ought

to be if they’re going to really be useful? I just wondered how we’re

using the grant money.

Dr. LILLIBRIDGE. Thank you, Mr. Chairman. I would also ask

after a few minutes that I be dismissed, I have some other pressing

engagements, but I’d like to answer that question as best we can.

We could always do more, but let me tell you what’s in progress

and what’s been done along that avenue.

First, we’ve worked with both the Department of Defense to do

satellite broadcasts to reach as many as 18,000 health providers at

a time. These have been highly successful and have dealt with both

chemical and biologic weapons response on the health and medical

sector.

The second thing is that we’ve also partnered with the major

guilds, professional organizations, and there are a huge number of

preparedness efforts in terms of training at these annual and regional meetings, and those are ongoing.

Recently we’ve also looked forward to the partnership at HHS

with FEMA on linking emergency management and training at the

State, local level in terms of integrating our capacities in those

areas.

Mr. HORN. Well, we’ll just go down the line. Mr. Baughman, any

thoughts on this as to grants and how we get that—people across

the country, be it hospital administrators, doctors, also in our medical schools and our public health schools, and I suspect the—I

would hope the public health schools in America would certainly

have a course on terrorism and all the rest?

Mr. BAUGHMAN. I think one of the things we do need to do is to

work closer with our public health partners at the State and local

level. At the Federal level—and we can talk about the State level—

we work at that level, but what is lacking right now is guidance,

guidance to put out to State and health providers, local health providers on what they ought to be doing.

An example is right now. What—the word that we ought to be

putting out to the American public on what should we be doing as

far as protection and guidance. As a matter of fact, we had a dialog

with HHS the day before yesterday on this, but I think what State

and local health providers are hungry for is a lot more guidance on

what they ought to be doing to make their health care network

more robust in light of a WMD-type scenario.

Mr. HORN. Mr. Duehring.

Mr. DUEHRING. Well, sir, the training that the Department of Defense does is oriented pretty much toward practical hands-on application for our own people, and that is continuing. That is ongoing.

We have, of course, wartime commitments that parallel the threat

that you have here in the United States, and I addressed that very

briefly in my opening comments.

Now, in addition to that, under the 1997 defense authorization

bill, called the Nunn-Lugar-Domenici Act, we were tasked initially

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to go out and conduct training with communities, and there has

been references today about the training that had gone on in New

York. That was part of that program. We actually trained leaders

of these various cities and 105 communities. But the provisions of

that bill have now expired. So, to my knowledge, the only other

agency that is involved now would be the Department of Justice,

and they may have a little more to add, if they are here.

Mr. HORN. Mr. Fogg.

Mr. FOGG. From a State level, I would say that the National Governors Association, FEMA, through the Emergency Management

Institute, all of our other Federal partners have been providing

good training, and we’ve been delivering it. The problem—and

we’ve been getting a lot of guidance in terms of planning, you

know, how to do planning, and of course we have a pretty good—

we know how to do that ourselves, but the problem is we need to

link and coordinate those various offerings from all the different

agencies and coordinate them so we get the best bite at a local responder’s limited time. Most of them are volunteers. There’s plenty

of training out there, but focusing it, coordinating it so they get the

best use of their time so we can attract them is an important thing.

And last, I would say the place we really need to concentrate

some effort is on exercising. We can have great plans, we can have

great training, but if we don’t exercise them, you know, to get people used to working with each other and understanding what is

going on, we’re missing the boat, and we’re not spending enough

money and enough time exercising.

Mr. HORN. I’m going to recess that question. I see Mr. Lillibridge

does have a chance to get away and do certain things, but could

you tell me on what’s apparently yesterday’s news about an anthrax case in Florida? Was there one? Do we know? Is CDC looking

at it or what?

Dr. LILLIBRIDGE. Thank you, Mr. Chairman. Let me update on

that and give you an indication of how the public health system

works, where we are in that case, and what we know today.

As you know, yesterday the press reported there was an apparent anthrax case in a single individual who was thought to be noncommunicable and thought to be sporadic in nature. That means

one of those cases that occur from time to time.

We have a robust State and local health department, and many

accolades to the department—the Florida Department of Health in

their early response. Remember, they’re into a 3-year preparedness

effort with their lab and their surveillance activity, and as we hone

our surveillance activity, we’re going to be more aware of these

outlier kinds of cases.

What we know is that the case was entered into the hospital on

October 2nd, and within 24 hours the State had done some preliminary investigation, was able to confirm laboratory testing on this,

and confined this to a single case at the local facility in—near

Miami. The prognosis of that person is unclear at this time; however, the test was reconfirmed at CDC in a partnership with our—

according to our plans, with our State and local partners.

CDC, disease detectives and laboratorians are working with the

State health department to see if there is any additional cases or

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any additional facts that would help determine where this case

came from.

As of this morning—and I talked with the people on the ground

just before coming to this hearing and asked if there was any indication that there was a widespread outbreak or any other information that might relate to this hearing, because we might be asked,

and the answer was no. But I will assure you disease detectives are

on the ground from both the Florida State Health Department and

the Centers for Disease Control, and we’ll keep you updated as information is developed.

Mr. HORN. At this point, there’s no second case.

Dr. LILLIBRIDGE. At this point we are advised by the FBI that

this does not seem to be a biological agent attack. We are not finding secondary cases. This person was—became ill nearly a week

ago, and by that time we certainly should see additional cases if

this was going to be a widespread problem.

Again, we’ll keep you updated and keep the public updated as information is known.

Mr. HORN. When was the last anthrax case in this country?

Dr. LILLIBRIDGE. Well, we have information from 1955 to 1978.

We have a total of 11 cases that were documented. Now, remember,

as you enhance surveillance, we don’t find all these cases until you

begin looking, but at any rate we have information on 11 cases,

and the last 1 in 19—clearly 1978, and recently this case in Florida. Most of these are occupational or related to something you’re

doing with animals, hides and that sort of thing, but, again, those

occurred in the absence of a bioterrorism attack.

Mr. HORN. Thank you.

Dr. LILLIBRIDGE. Thank you, Mr. Chairman.

Mr. HORN. You’re quite welcome.

Let’s pick up here now with Dr. Smith on——

Dr. SMITH. Training and education.

Mr. HORN [continuing]. How we educate and train people.

Dr. SMITH. I think what is important to understand is that training and education, medical training, medical education, it’s not a

one-time affair. It occurs in multiple venues, national meetings,

grant rounds. In fact, 2 days ago the Washington Hospital Center

department of medicine put on a grant rounds on biological agents.

It was standing room only, and I suspect a similar thing is happening in hospitals across the country.

What we need are resources, knowledge, material, and I must

say, the CDC has done a terrific job on its Web site. The material

that is there is outstanding and has been a resource for many of

us, as well as the material that the military has put out with its

little handbooks on bio and chemical agents. So I think what we’re

going to see is that there’s going to be an explosion of courses and

talks on this subject.

Mr. HORN. Is anybody on public television doing a, say, 1-hour

on it or something like that?

Dr. SMITH. I don’t know, but I suspect they probably are.

Mr. HORN. You ought to head in their direction.

Dr. SMITH. Thank you.

Mr. HORN. Mr. Olson, anything else on this?

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Mr. OLSON. Mr. Chairman, just a couple of thoughts. First of all,

there is a robust or a fairly robust training program that did indeed migrate from the Department of Defense to the Department

of Justice, and, again, by way of disclosure, my firm has a small

part of that, but that doesn’t mean it’s not any good.

And the program is designed to reach out to carry the training

to the people when they’re in the States, local jurisdictions in recognition to the point that’s been made abundantly clear throughout

the day, that the first responders are the first line of defense, and

that is absolutely true.

But I also just want to point out my very real appreciation of the

fact that the medical community in Washington, DC, led by George

Washington University Medical Center and the Washington Medical Center, those are actually a couple of institutions that are right

out there in the lead. They have taken the point on this thing. I

think they point a very important direction for the medical community in this country.

However, I do go back to my initial point, which is that I do not

believe that is representative, unfortunately, at this point, of where

the Nation’s medical communities—they’re just a little bit behind

the power curve at this point.

Mr. HORN. Thank you.

I now yield to the ranking member, Ms. Schakowsky, the gentlewoman from Illinois.

Ms. SCHAKOWSKY. Thank you, Mr. Chairman.

I’m sorry that Dr. Lillibridge left. And I was pleased with his

comments that there was still much more to do, because while I

think it’s important for us not to unnecessarily alarm people and

to overreact, at the same time I think it is not a good idea. I know

that the Secretary of HHS has been assuring the public that our

country is perfectly prepared and sounded as if in all instances for

any threat to our Nation’s health, and I think we have to take a

very clear and thoughtful look at this approach to it, and I appreciate all of your comments.

Two of you—and I don’t remember—mentioned Nunn-Lugar and

the funding that it provides for the domestic work to defend

against weapons of mass destruction and provide training, not to

mention securing the Russian stockpile of nuclear weapons. My understanding is that in this budget, in the defense authorization bill,

that there is a $40 million cut in Nunn-Lugar. Even at the same

time as we have about an $8 billion increase in national missile defense, there’s been a cut. Clearly, this bill was crafted before this

threat.

How important is this program and is this funding stream to the

work that you’re doing? Anyone can answer.

Mr. Olson.

Mr. OLSON. Congresswoman—and I don’t want to speak too far

on this because I wasn’t involved in the agency perspective in these

things—but the cut in Nunn-Lugar, the program was essentially

designed to reach out to the 120 or so largest cities. That program

is actually pretty well completing that cycle of work. It was a cycle

of training followed by a series of chemical and biological exercises.

With the goal of completing the 120 cities, that training program

and that exercise program, again, was transitioned from the DeVerDate 11-MAY-2000 08:46 Sep 24, 2002 Jkt 000000 PO 00000 Frm 00162 Fmt 6633 Sfmt 6633 C:\DOCS\81522.TXT HGOVREF1 PsN: HGOVREF1
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partment of Defense to the Department of Justice. And has been

rolled into other training initiatives which are being managed by

that agency. Now those programs are still, frankly, under development to some extent at this point. Nunn-Lugar is continuing, I believe through the next year or so. All of the cities that were promised training will receive that training, and then, if you will, the

next generation of training and exercises will follow. Exactly what

shape that is, I think is still under development, though. But there

is a commitment within DOJ to continue training and exercise

work.

Ms. SCHAKOWSKY. So there is no loss of actual implementation

due to the reduced funding? Just seems to me, if we’re looking at

where we most usefully put our resources, that kind of effort does

need to continue. I want to be assured, then, that it is.

Mr. OLSON. My understanding and—again, as a scum-sucking

contractor, my hopes are that this level of effort will continue. I

would probably direct you to get a better sense of the detailed planning from the Department of Justice’s Office for Domestic Preparedness, which has the mandate for continuing that training and

exercise program.

Ms. SCHAKOWSKY. I wanted to quickly ask about our public

health infrastructure; and while I applaud the response that there

was, it seems to me that had there been—and we all wish there

were, actually—more injured than there were dead, whether or not

our system could respond.

But what I’m concerned about, New York I think was, as you

said, Mr. Olson, probably more prepared than anyone else. Had it

been elsewhere, it seems that there are many public health offices

that are without even some of the basics. The doctor from the State

of California was saying that her local office, before this job, was

like that, unequipped with fax machines and computers and not

updated.

How big a problem is that around the country, that we don’t

have this kind of infrastructure? And do we have the communications systems nationally that can transmit information about an

anthrax case, or this or that, that would be needed to coordinate

a response?

Anybody respond to that?

Mr. OLSON. I will just offer one thought, ma’am.

Penicillin and streptomycin pretty much killed the public health

service. Once we shifted to an antibiotic-based approach to medicine, we tended to walk away from any of the things that we had

done back in the era of polio, tuberculosis, smallpox. At that time

we had a very robust system, because our only options were to

identify outbreaks early and then rely upon techniques like quarantine to control them.

Once we found we could defeat these diseases, we essentially— I won’t say we dismantled, but we tended to ignore. The phrase ‘‘benign neglect’’ comes to mind. I think it became a less pressing

investment in terms of public infrastructure.

We are now, I think, recognizing that we have to reconstitute

that. I’m not suggesting that we’re going to go back to having armies of public health nurses. There are new technologies, new ways

of doing things; and I know the medical community is addressing

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those surveillance technologies. The Internet is a powerful tool. But

the public health system is not what we would like to think it is.

Ms. SCHAKOWSKY. And, Dr. Smith, how do we increase the numbers to the extent that we need to in terms of nursing shortages,

etc?

Dr. SMITH. It’s part of the legislation that has been introduced,

support for nursing schools, scholarships, all the different ways you

encourage people to go into a profession that is the backbone of our

health care system. And like most things, it’s going to require a

multiplicity of efforts.

Mr. HORN. Go ahead. We have all the peace and quiet now.

They’re all adjourned.

Dr. SMITH. I think that we have to look at the reasons why there

has been such—there is now a shortage. It really is going to become one of the great health care crises in this country. If you look

at the age spectrum of nurses right now, the ones who are working

are slanted toward the older age group. We do not have the younger nurses coming in that we are going to need to sustain all of us

when we get to an age where we’re going to need them even more.

Ms. SCHAKOWSKY. Thank you.

Mr. HORN. Mrs. Maloney, the gentlewoman from New York.

Mrs. MALONEY. I want to thank all of the panelists, particularly

Mr. Baughman, and publicly acknowledge for my constituency,

New York City, and express our appreciation for the ongoing leadership, assistance, help that FEMA is giving to New York City. Director Allbaugh has spent a great deal of time there. We appreciate, really, all of your professional expertise and assistance and

help.

I appreciate the comments of all of the panelists. I particularly

want to thank you for the comments about how well New York responded to the crisis that we had. The command central for emergencies was completely destroyed in the attack on the World Trade

Center. It was in one of the buildings that later collapsed. And

within 3 days, the city totally rebuilt an alternative command center down at Pier 92, which I think speaks well for the resourcefulness and strength and determination of the American people.

I’d like to ask any of the panelists to comment on this question.

It’s my understanding that if there was an anthrax outbreak in one

of our cities and it turned out to be widespread, that the Federal

Government would immediately get involved and would tap the

emergency medical warehouses at one of the eight sites—at one of

the eight sites around the country. How quickly could these supplies be distributed and how coordinated are the various governments to ensure quick delivery as well, since we know that different people would possibly be getting sick at different times?

And if anyone would like to respond to that question, I would——

Mr. BAUGHMAN. There are now 10 caches, there were 8. We’ve

just beefed that up to 10.

Mrs. MALONEY. There are 10.

Mr. BAUGHMAN. The caches can be to the city, or cities, in a matter of hours. The problem we found in Top Off, that I think still

exists is, the ability of the local government to do the distribution

and inoculation, the local health care system. That was a problem

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if you saw the GAO report in Top Off. So that is what I think is

the long pole in the tent right now.

Mrs. MALONEY. Would anyone else like to comment on how we

address this problem?

Mr. BAUGHMAN. By the way, in addition to that, we work with

HHS. We are surging the national stockpile as far as pharmaceuticals in addition to that.

Mr. HORN. I might add on Mrs. Maloney’s question, if there is

anyone from the first panel and if they’d like to comment on any

of the testimony here of the second panel, please come forward and

just read your name into it, so the reporter of debates will be able

to know who said it—if you’re still around.

So go ahead.

Mrs. MALONEY. Anyone else care to comment?

Dr. SMITH. The distribution is a real issue. Most jurisdictions are

only now thinking about how to do it. And they have very little experience in doing something similar. And if you look—one of the tenets of response in a disaster is the doctrine of daily routine. You

try to do in a disaster extensions of what you do in your day-today job because that’s how you’re going to perform the best. If

we’re trying to do something that is totally new and totally different, it’s going to be much more difficult to effect, and——

Mrs. MALONEY. Earlier, Dr. Smithson responded to my request

about buying antibiotics and possibly a gas mask by saying that it

was totally unnecessary. And I have to ask if it gives people a

sense of security and buys them peace of mind, what’s wrong with

having antibiotics in your medicine cabinet that some doctors say

could be helpful in case of a chemical or biological attack?

And I ask anyone to respond.

Mr. OLSON. Mrs. Maloney, Congresswoman, this is when it actually hits close to home. I’ve been working in this area for about 15

or 16 years. And I can sit back and look at this thing very rationally and very calmly and say, well, OK, the best strategy is to rely

on the public health system, to count on the surveillance system to

be heightened to a higher level, you know, to recognize that there

are those, now, 10 caches of pharmaceuticals. Yet when I go home

at night, my wife is asking me, what can I do to protect my daughters? What can I do—I need to do something.

And given that, I guess I’ll take exception with my good friend,

Dr. Smithson, from the earlier panel. I don’t necessarily see anything wrong, if it makes you feel better, go out and buy a gas

mask, why not—$50, $100, if it makes you feel better that you’ve

got that on the shelf? Odds are you’re never going to pull that

thing down, but you’re never going to hurt yourself with it either.

If you go to your doctor and get a prescription for antibiotics, if

he knows you and gives you a meaningful prescription and gives

you some good advice on what and when, why not? There are very

few things that an individual can do. This is a mission for government and collective response.

But I tend to fall on the side of those people who are saying, you

know, look at the Israelis. They have been living on the edge for

50 years and they do these things. We’ve been on the edge for 3

weeks. If it buys us a little peace of mind in these very uncertain

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times, I’m not sure I’m going to stand up and tell somebody don’t

do it.

Mrs. MALONEY. What I find somewhat troubling from the presentations we’ve heard today is, everyone says, ‘‘Don’t worry, be calm,’’ and yet the testimony is saying that we have these caches, but we

don’t have in place a way to distribute it, or antibiotics or vaccines,

in a quick way; and we don’t really have the surveillance or the intelligence.

We don’t have the coordination between the FBI and the local response people. And you’re telling us basically that we don’t have

the health care workers that are trained, and they’re not vaccinated yet for certain things that some people are saying may happen? And yet you’re telling us not to be concerned.

So the question that I get asked the most when I go home is the

question that Mr. Olson’s children are asking him and his wife is

asking him, ‘‘What can we do for civil defense?’’ When I go home

to my community meetings, people know we’re at risk. It’s common

sense.

Who would ever have dreamed that anyone would fly and turn

our airplanes into a weapon of mass destruction against our own

Department of Defense and our own financial center? Absolutely

unbelievable. They even had one man who was saying, ‘‘Just train

me to fly a plane; I don’t want to know how to land, I don’t want

to know how to take off.’’ That was reported, and no one knew

what to do with it because no one could ever imagine that this

could happen.

So I think that we have to imagine or think that something horrible may happen. And my question is, what can we do for civil defense back in our own homes?

Mr. Olson mentioned Israel. Israel has trained for many years

for civil defense, having had many terrorist attacks in their own

country. Are there programs or models that they have that we

could implement here in our own country? And what can we tell

our constituents when they say, what can we do back in our own

city or our own farm or wherever they are to protect ourselves in

the event of one of these terrible attacks?

Mr. BAUGHMAN. I think there’s a couple of things. First off, one

of the things that we’re working on right now is to set up a joint

information center with all of the agencies that have expertise in

this particular area to talk about what we need to be telling the

American public and when we ought to be telling the American

public. A lot of it is just information. But how do we get the information down to folks like Woody and the fire chief to get that information out? Right now, we don’t have real good dissemination systems.

For example, while in the law enforcement arena you do have a

means of passing law enforcement sensitive data, there is no

means that we have readily available to pass it down to the firefighter on the street that needs that information.

So how do we get that out? That is one of the things that has

been pointed out that has caused problems in past disasters. We,

right now, have got some things in the works to look at some shortterm fixes for that. But that is a long-term pole in the tent that

I think we need to come up with a solution to.

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Mrs. MALONEY. But before you even get to the firefighter or fire

officer in a real disaster, many people will not have the opportunity

to talk to anyone except their immediate family. And my question

is, what do we say to these people who are saying, what do we do

for our own defense, that we can do ourselves to protect ourselves,

because we don’t have enough police or firemen out there in the

event that—if something happened quickly?

Mr. BAUGHMAN. There is a list of protective action guides that

many hospitals have, many health care systems have, that we

could quickly put together to deal with a situation like this. In

some cases, we have already done that.

Mrs. MALONEY. We should be getting that out now to the public.

Mr. BAUGHMAN. That is correct. We should.

Dr. SMITH. I think it’s a very real question. And the answer has

got to be based on facts, and the answer may turn out to be something we’re going to do, things we never did before.

The truth is the—a number of the bioagents have an incubation

period. And during that incubation period where you are asymptomatic, if you were to take a simple antibiotic you can prevent

yourself from getting the disease. It’s a reasonable question to ask

when you’re in a high-risk area, whether you should have a supply

of doxycycline, which is the drug, around.

There are always problems with taking antibiotics—with side effects, with outdated drugs. That’s why the answer is not simple.

But it definitely has to be considered. Quite frankly, many of my

health care colleagues have personal stocks of doxycycline and

ciprofloxacin. If you abide by the Golden Rule that you should do

unto others as you do unto yourself, we should be considering this.

Mr. OLSON. I’ve been watching the news over the last couple of

weeks. I would much rather see people out there buying some antibiotics than buying guns. It’s going to make a much bigger impact.

Ms. SCHAKOWSKY. Thank you. I thank the gentlelady for yielding.

I think that individuals do want information. We do it for planning escape routes from our own home in case of fire, evacuation

plans from buildings and those kinds of things. But I think, and

I would recommend—and I don’t know if it’s up to FEMA or to

HHS. I think people are also looking for collective ways of what to

do, and there may be a nongovernmental organizational infrastructure that people could be plugged into in an effective way, that we

might want to make suggestions to people, ways that we can help

our local fire departments or ways that we can get involved in— we have it for fighting crime neighborhood watch groups, communications systems.

I’m not really sure. But I think some thought is useful. Because

people are lining up to give blood; people want to do something. I

think there may be constructive ways that ordinary people in their

communities can play a really constructive role, who would welcome those suggestions and would even implement them themselves at a local level if they were good ideas.

Mrs. MALONEY. Reclaiming my time, I have just one last, brief

question. I’d like every panelist to answer it.

And it’s, what is the No. 1 thing you think we should focus on

in preparing for chemical and biological attacks? What’s the No. 1

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thing we should focus on? Just go down the line and give us your

thoughts.

Mr. OLSON. Medical community. We need to train doctors to recognize these things; we need to teach them what to do when they

recognize them. And we need to ensure that the systems that exist

in the very best hospitals for surveillance and communication are

present across the board.

Dr. SMITH. Creation of a much more robust information and communication infrastructure that will permit integration across agencies, among hospitals, people.

Mr. FOGG. Sharing of intelligence, that’s the best way to prevent

it, minimize it, in the first place.

Complete implementation of the health alert network, that’s a

great idea. We’ve got well—gotten well down the road, but we need

to get the rest of the way. We need buy-in from everybody. That’s

something the public should be informed about and supportive of.

And last, medical surge capacity at the local and regional level.

Mr. DUEHRING. From a defense angle, if you want just one issue,

training. Training is a very perishable commodity, because you can

train one person today and that person may be gone tomorrow.

With such a large program like this, we have to always make sure

we are organized and funded to be able to train our people and continuously train them so that whenever the next crisis occurs, wherever it occurs, that we’re there to help them.

Mr. BAUGHMAN. I’m going to voice my organizational bias. I

think we’ve got to have a strong emergency management system

from local government to State government, up. Our system and

Woody’s system at the State level integrates all the State agencies.

Responding to a situation like that is not a single agency. In New

York City, we responded with 14 Federal agencies to that one incident. So you’ve got to have HHS, you’ve got to have EPA, Coast

Guard, DOD, and the other agencies integrated in that process.

Down at the State and local level, you need to have fire, hazmat

and public works integrated in that response. Right now, we are

putting very little money into emergency management at the State

and local level.

Mr. HORN. I’m glad you mentioned that, because the Comptroller

General of the United States has a very good crew in the GAO,

General Accounting Office; and we’re looking just at those to see

if those places—by State and region. And we’ll be doing that over

the next 2 months to—there are the pieces there, but again, the

communications sometimes are lacking.

Let me ask my last question, I’m sure, and that’s—Mr. Duehring

is the Principal Deputy Assistant Secretary of Defense for Reserve

Affairs. And I note here in Dr. Smithson’s testimony on the New

York City terrorist attacks, she said that the New York State National Guard’s civil support team did not reach the site until 12

hours after the collapse of the Twin Towers. What caused the

delay?

Mr. DUEHRING. There were a couple of things that happened. No.

1, they were notified and alerted immediately. Within 90 minutes

they had moved to a staging area and were ready to go. Of course,

as a lot of people know with the things that happened after 90 minutes, the communications were destroyed and the people who were

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tasked to actually call out the team were killed. So there was a bit

of confusion.

And they were summoned eventually. They responded. They did

their work, I believe, in a 17-block area searching for possible contaminants of some type. They determined the area was free and

clear.

They withdrew and actually were recalled two other times to assist in communications, because the teams have some unique

equipment installed in their vans which allows them to actually

marry together various communications systems that the fire department or the EMT’s or whoever happens to be there might have;

and when they can’t talk to each other, they can through this unit.

So they were very valuable. It was a unique situation driven by

the events of the time.

Mr. HORN. Have any of you had a role for the AmeriCorps? A lot

of us pushed that 10 years ago, and it came out of a group of university presidents, that we thought this was a good idea. Have any

of you used it? And should they be used?

Mr. FOGG. Yes, we have. We’ve used AmeriCorps folks rather extensively in the State of New Hampshire—not specifically for biological/chemical preparedness, but all-hazards preparedness—by

having them work with some engineers, do review for critical facilities in the State and assess their vulnerability and measures we

can take to improve their survivability, not only to man-made

issues, but to natural disasters, hurricanes, earthquakes, snowstorms, ice storms, that sort of thing as well.

They have been extremely valuable in that process.

Mr. BAUGHMAN. Likewise, we use AmeriCorps too on natural disasters. We haven’t worked out a role for them in this type of environment.

Mrs. MALONEY. Will the gentlemen yield for one quick question

on September 11th? I want to respond to your comments on communications.

On September 11th I drove home and went to what was then

command center at One Police Plaza. The No. 1 thing they said

they needed was communications, all communications were down.

They really couldn’t talk to each other.

And one of the things I did was call Chairman Young and his

staff because he was involved with defense; and I know he shipped

a load of satellite phones down, which is what they were asking for.

So my question to you, learning from the World Trade Center

disaster and your comments earlier that the response time—the

early days are when you save people, each day that goes by, the

opportunity to recover someone diminishes. One of the things the

rescue workers have told me is that what really strapped them for

days was the inability to communicate, that you literally had to

walk to a person to communicate with them. There was very little

communication.

And I just ask—maybe not for this panel, but maybe to get back

to the chairman—your ideas of what we could do to improve communications. Did the satellite phones work? Were they—is that

what we should have ready at FEMA to deliver quickly?

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You know, I just didn’t know how to get them, so I called Chairman Young; I thought, if anybody has got them, defense has got

them.

In other words, how do you respond to that one problem that you

were mentioning? And really I heard at Ground Zero the night of

September 11th one of the biggest challenges was the inability to

communicate. And it went on for days, weeks, that the communication system wasn’t working.

Mr. BAUGHMAN. The problem was, cell phones were useless, as

they normally are in any major disaster, because the usage goes— on the cells goes up to saturate. The public switch network was affected, so it was sporadic at best. Satellite communications and

high-frequency radio were the only means of communications at

the time.

We do, and if a request comes to us, we can tap into any 1 of

the 26 agencies. DOD is one of those national communications systems, and their national communications center has about 27 agencies that have telecommunications assets that can be brought to

bear. Satellite communications or sat phones, getting that to the

area, shouldn’t have been a problem. If the request is put in the

right channels, we can get in there.

Mr. HORN. On that point, the Army, as you know, over the last

few years, has started moving communications and generally computing different things that a soldier does. And it does that with

one person on the battlefield. And it seems to me, some of the domestic agencies might want to look at the communications side of

that, because I have heard a lot of complaints about the 999’s, and

either we ought to have more operators or more satellites or something.

I remember at my university in Long Beach we had an exercise

there and nobody could talk to each other—and in all of L.A. County. Now, that’s 10 million people there, and no other part of the

United States has 10 million within that particular jurisdiction.

And they were told, well, all the licenses are on the East Coast.

And I don’t know how much that has been changed, because nobody’s brought it to me if they have. But we need some linkage

there in terms of getting that.

I don’t know if FEMA is familiar with that. If not, let’s all go to

the FCC.

Mr. BAUGHMAN. Yes, sir. As a matter of fact, one of the things

we’re doing is, we are in the process of doing some catastrophic

planning. Terrorism is one of the scenarios. We are putting a lot

of time and effort into that in the upcoming year, primarily in five

scenario areas. The L.A. Basin is one of those to take a look at,

each 1 of our 12 functional areas, and what we need to do to enhance telecommunications, health and medical, in that particular

area following a catastrophic event.

Dr. SMITH. Would you permit me 90 seconds to respond to one

of the points of my colleague to the left about the lack of involvement of the medical community in this planning, because I think

it’s an important issue?

I think it’s important to realize where there has been—why it

has occurred. In my view, it is not because of the disinterest of

physicians to participate. In many cases, the medical community is

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simply not asked. We have been excluded by the public safety

agencies because we’re not considered a public safety agency. It’s

all police, fire and EMS.

The second point is that hospitals have lots of things on their

plate. Their primary mission is taking care of individual patients.

That’s their job. And that’s actually what they get paid for. No insurance payer pays for emergency preparedness. We’re sort of at

the margins.

In fact, Ms. Schakowsky asked about, why the nursing problem?

Part of the problem is money. Because we don’t have money to pay

maybe the salaries that we need to pay to attract people. So that

we have to figure out a way to support hospitals, which are really

the only private sector in this quadrant of police, fire and EMS.

The other three are all in the public sector.

Mr. HORN. Yes. Mr. Olson.

Mr. OLSON. We’re going to step outside and drop the gloves in

a second. But whereas that may, in fact, be the case in some locals,

there have certainly been other opportunities where the public

health sector, the private health community, was specifically invited and again opted not to participate. There are no simple answers.

I’m not even suggesting that there is a lack of desire to do something. I acknowledge every one of the structural problems that was

identified by Dr. Smith just now. I think that, nonetheless, the bottom line for all of us now—and I heard it down the way here—it’s

not to go back and beat each other up over what we didn’t do in

the past, it’s to identify what we need to do together in the future.

Mr. HORN. Yes. Mr. Fogg.

Mr. FOGG. I would have to say that our experience has been extremely positive. Once—and I guess we did it from the emergency

management profession. But in New Hampshire, we asked and actually our three States Maine, Massachusetts and New Hampshire,

together, as a result of the Top Off exercise, reached out to the

medical community. And I’ve been very pleased with the response

we’ve received.

We recognize that there are gaps there. We recognize the economic concerns. And we’re trying to work together in spite of those

constraints to improve the medical surge capability.

I’ve been very impressed at the response and the progress we’ve

made already. But can we do it without additional help? No. We

need help.

Mr. OLSON. I would indicate that I think Top Off is an example

of one case where it definitely worked with the medical community

in not only the Northeast, but also in Colorado and Denver and

others did come together and did play well. But that was a very

high-profile, very long-term effort that took a lot of effort to make

that happen.

Again, that’s in the past. Let’s move forward.

Mr. HORN. Whatever happened to Vermont? You didn’t seem to

mention Vermont.

Mr. FOGG. I’m glad you asked, because right now the best cooperation we’re getting, once we started that after Top Off, has

been our upper valley in New Hampshire that actually reaches up

into Vermont in the watershed along the Connecticut River. The

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cross-coordination between the Vermont medical community and

the New Hampshire one, spearheaded primarily by Dartmouth

Medical Center in Hanover, right on the border, has been astounding. We have reached out to public health services on a national

level.

I feel really good about what we’re doing there. We just need

time and a little more resources to get where we want to go.

Mr. HORN. Well, thank you. Any other thoughts before we gavel

this down?

Well, if not, I’m going to thank the staff that put this hearing

together, and the hearings about to come all over the country. J.

Russell George, staff director and chief counsel; Matt Phillips, on

my left, is the professional staff member that put all the pieces together for this hearing; Mark Johnson, our clerk; Bonnie Heald,

communications director; and Jim Holmes, our intern. And the minority staff: David McMillen, professional staff; Jean Gosa, minority clerk, and two faithful, hard-working court reporters, namely

Julie Thomas and Mark Stuart. And we thank you all. It’s a tough

one.

So we are now going to recess the committee until we go to New

York.

[Whereupon, at 1:58 p.m., the subcommittee was adjourned.]

[The prepared statement of Hon. Elijah E. Cummings and additional information submitted for the hearing record follow:]

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