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STATEMENT OF

GARY E. MOORE

DIRECTOR, DIVISION OF EMERGENCY READINESS AND OPERATIONS

AND

ACTING DEPUTY DIRECTOR

OFFICE OF EMERGENCY PREPAREDNESS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

BEFORE A FIELD HEARING OF THE

SUBCOMMITTEE ON NATIONAL SECURITY, VETERANS AFFAIRS

AND INTERNATIONAL RELATIONS

OF THE

COMMITTEE ON GOVERNMENT REFORM AND OVERSIGHT

U.S. HOUSE OF REPRESENTATIVES

March 27, 2000

Mr. Chairman and Members of the Committee,

Thank you for inviting me here today to discuss activities of the Department of Health and Human Services (DHHS) in responding to terrorist acts and other disasters. I am Gary Moore, Director of the Division of Operations and Readiness in the Office of Emergency Preparedness (OEP). At this time, I am also OEP's acting deputy director.

The first link in the response chain to any terrorist incident in the United States will be local in nature and will be supplemented by state and federal assistance. This is why local capability and capacity building is absolutely crucial to reducing preventable injuries and deaths caused by terrorist attacks. The critical issues, including the level of preparedness, rapidity of response, and the integration of all levels of government will determine either the success or failure of our nation's ability to respond to a major terrorist attack.

OEP coordinates the health and medical emergency preparedness activities with DHHS, and is the lead DHHS organization to coordinate disaster and emergency activities with other federal agencies, including the Federal Emergency Response Agency (FEMA) and the Departments of Justice (DOJ) and Defense (DOD). DHHS is the primary agency that provides the health and medical response under FEMA's Federal Response Plan (FRP). We also manage the National Disaster Medical System (NDMS). NDMS is a partnership between DHHS, DOD, FEMA, the Department of Veterans Affairs (VA), 7,000 private citizens across the country who volunteer their time and expertise as members of response teams to provide medical and support care to disaster victims, and more than 2,000 participating non-federal hospitals.

Our primary response capability is organized in teams such as Disaster Medical Assistance Teams (DMATs), specialty medical teams (such as burn and pediatric), and Disaster Mortuary Teams (DMORTs). Our 27 level-1 DMATs can be federalized and ready to deploy within hours and can be self sufficient on-the-scene for 72 hours. This means that they carry their own water, portable generators, pharmaceuticals and medical supplies, cots, tents, communications and other mission essential equipment. These teams have been sent to many areas in the aftermath of disasters in support of FEMA-coordinated relief activities. In addition, staff from OEP and our regional emergency coordinators also go to the disaster sites to manage the team activities and ensure that they can operate effectively.

Our mortuary teams can assist local medical examiner offices during disasters, or in the aftermath of airline and other transportation accidents, when called in by the National Transportation Safety Board (NTSB).

Since the beginning of FY 2000 in October, 1999, OEP has deployed to the Virgin Islands and Puerto Rico in the aftermath of Hurricane Lenny and along the entire east coast of the U.S. following Hurricane Floyd. Our mortuary teams and management support teams have deployed to Rhode Island and California to assist local coroner offices after airline crashes. And we have supported local and federal efforts during special events such as the World Trade Organization meeting in Seattle, and the State of the Union Address in Washington, D.C.

OEP and NDMS deploy to disaster sites only when invited. At this time, I would like to briefly discuss the conditions under which we deploy.

When there is a natural disaster - such as a hurricane, earthquake, or flood - the governor of the affected state will request that the President declare a disaster. Once that occurs, FEMA, as the Nation's consequence management and response coordinator, will task DHHS to provide critical services such as: health and medical; social, including services for children, youth and the elderly; veterinary services; mortuary activities; or any public health or medical service that may be needed in the affected area. OEP, as the Secretary's action agent, will mobilize NDMS, the Public Health Service's Commissioned Corps Readiness Force, and other federal agencies, such as DOD and VA, to assist in providing the needed services to assure the continued health and well being of the disaster victims.

The National Transportation Safety Board is charged with retrieving, investigating and providing identification and family assistance services after a major transportation accident. NTSB will request that DHHS provide additional mortuary and forensic expertise to assist local coroner offices when they are overwhelmed by the number of victims that need to be identified after an airline or train crash. NDMS mortuary teams include pathologists, forensic anthropologists, forensic dentists, and other specialists to assist in victim identification.

During a terrorist event, or even when a credible threat has been made, DOJ, through the FBI, is the lead federal agency in charge of crisis management. DHHS provides technical assistance to the FBI during all phases of threat assessment, and will frequently station a liaison at the FBI's strategic operations center. If a terrorist event does occur, FEMA becomes the lead federal agency in charge of consequence management. As in a natural disaster, FEMA would request DHHS to provide necessary health, medical and health related social services to the victims.

OEP's National Medical Response Teams (NMRTs) can provide medical treatment after a chemical or biological terrorist event. They are fully deployable to incident sites anywhere in the country with a cache of specialized pharmaceuticals to treat up to 5,000 patients. The teams have specialized personal protective equipment, detection devices and patient decontamination capability.

DHHS is committed to developing a strong local, state and federal capacity to respond to the health consequences of a terrorist attack. The effects of natural disasters, explosions and chemical attacks are usually immediately apparent. However, in a biological event, it is unlikely that a single localized place or cluster of people will be identified for traditional first responder activity. The initial responders to a biological attack will most likely include county and city health officers, hospital staff, members of the outpatient medical community and a wide range of response personnel in the public health system. DHHS, primarily through the Centers for Disease Control and Prevention, is supporting state and local governments in strengthening their surveillance, epidemiological investigation and laboratory identification capabilities, as well as continuing development of a national stockpile of critical pharmaceuticals and vaccines to supplement local and state resources, if needed. The National Institutes of Health has increased its research related to protecting against bioterrorism. And OEP is continuing development of local emergency health system capabilities to respond to the health consequences of a Weapon of Mass Destruction attack.

OEP is working on a number of fronts to assist local areas hospitals, and medical practitioners to effectively deal with the effects of terrorist acts. Some time ago, DHHS realized that the Nation was not prepared to deal with the health effects of terrorism, and that should a chemical, nuclear or bombing terrorist event occur, our cities and local metropolitan areas would bear the brunt of coping with its effects. In addition, we realized that the local medical communities would be faced with severe problems, including overload of hospital emergency rooms, medical personnel injured while responding, and potential contamination of emergency rooms or entire hospitals. Consequently, in FY 1995, DHHS began developing the first prototype Metropolitan Medical Response System (MMRS). These systems, which are components of local, city systems, would be called in to provide triage, medical treatment and patient decontamination. The city systems that we have been developing would then be able to transport "clean patients" to hospitals or other medical facilities for continued care. The hospitals are developing procedures to ensure that patients coming in would be decontaminated before entering the facility. To date, OEP has contracted with 47 of the Nation's largest metropolitan areas for MMRS development, and will initiate an additional 25 contracts during this fiscal year.

In FY 1999, Congress appropriated $3 million for OEP to renovate and modernize the Noble Army Hospital at Ft. McClellan, AL, in order for the hospital to be used to train doctors, nurses, paramedics and emergency medical technicians to recognize and treat patients with chemical exposures. An additional $1 million has been provided this fiscal year for curriculum development and to begin to train some health practitioners. In this way, we can train hospital staff and other medical responders from around the country to treat victims of terrorism.

We are also working with accreditation organizations, medical school curricula developers, and others to establish baseline knowledge and practices.

The Department of Health and Human Services is committed to assuring the health and medical care of our citizens. We are prepared to quickly mobilize the professionals required to respond to a disaster anywhere in the U.S. and its territories and to assist local medical response systems in dealing with extraordinary situations, including meeting the unique challenge of responding to the health and medical effects of terrorism

Mr. Chairman, that concludes my prepared remarks. I would be pleased to answer any questions you may have.