MITIGATING CATASTROPHIC EVENTS THROUGH EFFECTIVE MEDICAL RESPONSE HEARING BEFORE THE SUBCOMMITTEE ON PREVENTION OF NUCLEAR AND BIOLOGICAL ATTACK OF THE COMMITTEE ON HOMELAND SECURITY HOUSE OF REPRESENTATIVES ONE HUNDRED NINTH CONGRESS FIRST SESSION OCTOBER 20, 2005 Serial No. 109–48 Printed for the use of the Committee on Homeland Security Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html U.S. GOVERNMENT PRINTING OFFICE 34–528 PDF WASHINGTON : 2007 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001 COMMITTEE ON HOMELAND SECURITY PETER T. KING, New York, Chairman DON YOUNG, Alaska BENNIE G. THOMPSON, Mississippi LAMAR S. SMITH, Texas LORETTA SANCHEZ, California CURT WELDON, Pennsylvania EDWARD J. MARKEY, Massachusetts CHRISTOPHER SHAYS, Connecticut NORMAN D. DICKS, Washington JOHN LINDER, Georgia JANE HARMAN, California MARK E. SOUDER, Indiana PETER A. DEFAZIO, Oregon TOM DAVIS, Virginia NITA M. LOWEY, New York DANIEL E. LUNGREN, California ELEANOR HOLMES NORTON, District of JIM GIBBONS, Nevada Columbia ROB SIMMONS, Connecticut ZOE LOFGREN, California MIKE ROGERS, Alabama SHEILA JACKSON-LEE, Texas STEVAN PEARCE, New Mexico BILL PASCRELL, JR., New Jersey KATHERINE HARRIS, Florida DONNA M. CHRISTENSEN, U.S. Virgin Islands BOBBY JINDAL, Louisiana BOB ETHERIDGE, North Carolina DAVE G. REICHERT, Washington JAMES R. LANGEVIN, Rhode Island MICHAEL MCCAUL, Texas KENDRICK B. MEEK, Florida CHARLIE DENT, Pennsylvania GINNY BROWN-WAITE, Florida SUBCOMMITTEE ON PREVENTION OF NUCLEAR AND BIOLOGICAL ATTACK JOHN LINDER, Georgia, Chairman DON YOUNG, Alaska JAMES R. LANGEVIN, Rhode Island, Ranking CHRISTOPHER SHAYS, Connecticut Member DANIEL E. LUNGREN, California EDWARD J. MARKEY, Massachusetts JIM GIBBONS, Nevada NORMAN D. DICKS, Washington ROB SIMMONS, Connecticut JANE HARMAN, California BOBBY JINDAL, Louisiana ELEANOR HOLMES NORTON, District of CHARLIE DENT, Pennsylvania Columbia PETER T. KING, New York (Ex Officio) DONNA M. CHRISTENSEN, U.S. Virgin Islands BENNIE G. THOMPSON, Mississippi (Ex Officio) (II) C O N T E N T S Page STATEMENTS The Honorable John Linder, a Representative in Congress From the State of Georgia and Chairman, Subcommittee on Prevention of Nuclear and Biological Attack: Oral Statement ..................................................................................................... 1 Prepared Statement ............................................................................................. 2 The Honorable James R. Langevin, a Representative in Congress From the State of Rhode Island, and Ranking Member, Subcommittee on Prevention of Nuclear and Biological Attack ........................................................................ 3 The Honorable Bennie G. Thompson, a Representative in Congress From the State of Mississippi, and Ranking Member, Committee on Committee on Homeland Security ......................................................................................... 41 WITNESSES Dr. Roy L. Alson, PhD, MD, FACEP, FAAEM, Associate Professor, Emergency Medicine, Wake Forest University School of Medicine: Oral Statement ..................................................................................................... 9 Prepared Statement ............................................................................................. 11 Richard Bradley, MD, Medical Director, Emergency Center—LBJ General Hospital, University of Texas Health Science Center at Houston: Oral Statement ..................................................................................................... 18 Prepared Statement ............................................................................................. 19 Jenny E. Freemen, MD, President and CEO, Hypermed, INC: Oral Statement ..................................................................................................... 28 Prepared Statement ............................................................................................. 31 Donald F. Thompson, MD, MPH&TM, Senior Research Fellow, Center for Technology and National Security Policy, National Defense University: Oral Statement ..................................................................................................... 23 Prepared Statement ............................................................................................. 24 (III) MITIGATING CATASTROPHIC EVENTS THROUGH EFFECTIVE MEDICAL RESPONSE Thursday, October 20, 2005 U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON HOMELAND SECURITY, SUBCOMMITTEE ON PREVENTION OF NUCLEAR AND BIOLOGICAL ATTACK, Washington, DC. The subcommittee met, pursuant to call, at 1:03 p.m., in Room 1310, Longworth House Office Building, Hon. John Linder [chair- man of the subcommittee] presiding. Present: Representatives Linder, Dent, Langevin, and Thompson, ex officio. Mr. LINDER. The hearing will come to order. We are going to be very short on this end of the bench, because we finished voting an hour ago and everybody is on airplanes already, I suspect. I would like to welcome and thank our witnesses for appearing before this subcommittee today. There is an inordinate amount of attention focused on what went wrong during Hurricane Katrina. Today, instead, we are here to discuss what we must get right to prevent, mitigate and respond to a catastrophic biological or nuclear incident. As tragic as the loss of life was during the Katrina storm, imag- ine for a minute the consequence of a nuclear or bioterrorism event. The Atlantic Storm exercise showed us that a covert attack on key transportation hubs with smallpox can result in possibly 660,000 cases worldwide in just 30 days. A 10-kiloton nuclear de- vice detonated near the U.S. Capitol can result in 15,000 instant deaths and another 15,000 injured. Can our current medical response capabilities meet this chal- lenge? In 1979, President Carter established FEMA to centralize Fed- eral emergency functions. Five years later, the National Disaster Medical System was created within HHS to provide medical and related services in the event that a disaster overwhelms the local medical emergency capabilities. In the Homeland Security Act of 2002, NDMS was transferred to DHS and at present functions under the management of FEMA. Twenty years since their creation, both of these entities played a significant and crucial role in response to Hurricane Katrina. In December 2004, the Department of Homeland Security launched its National Response Plan, designed to coordinate the Federal Government’s efforts to prepare for and respond to a cata- strophic event. Under the NRP, DES would take the overall lead (1) 2 for responding to such events, with HHS tasked with coordinating the response of the public health and medical sectors. As the events of Katrina also highlighted, the Department of Defense played a vital role in providing both logistical and medical asset support for the victims. We have rearranged the deck chairs, come up with new plans, and Congress has committed substantial financial support to both Federal and local agencies. My question to you is very simple: Are our medical responders better prepared to mitigate a truly cata- strophic terrorist event? I can assure you that while Mother Nature often gives us warn- ing, we will not receive fair warning from terrorists. We will not have the luxury of ‘‘predeploying’’ our medical assets and per- sonnel. It is often said we have to use an all-hazards approach to any catastrophic event. I do not buy into this notion. There are unique requirements for both mitigating and responding to a nuclear or bi- ological event. We cannot continue to rely on lessons learned be- cause terrorists continue to plot and plan against us. It was my im- pression that the lessons learned occurred almost 4 years ago on September 11th. I look forward to your testimony, because each of you represents boots on the ground and not the bureaucratic apparatus. Your in- sights will be valuable to members of the subcommittee in con- structing legislation to fix problems. I recognize the ranking member of the subcommittee, Mr. Langevin of Rhode Island, for the purpose of making an opening statement. PREPARED STATEMENT OF HON. JOHN LINDER I would like to welcome and thank our witnesses for appearing before this Sub- committee today. There is an inordinate amount of attention focused on what went wrong during hurricane Katrina. Instead, we are here today to discuss what we must get right to prevent, mitigate and respond to a catastrophic biological or nuclear incident. As tragic as the loss of life was during the Katrina storm, imagine for a minute the consequence of a nuclear or bioterrorism event. The Atlantic Storm exercise showed us that a covert attack on key transportation hubs with smallpox can result in possibly 660,000 cases worldwide in just 30 days. A 10 kiloton nuclear device det- onated near the U.S. Capitol can result in 15,000 instant deaths and another 15,000 injured. Can our current medical response capabilities meet this challenge? In 1979, President Carter established FEMA to centralize Federal emergency functions. Five years later, the National Disaster Medical System was created with- in HHS to provide medical and related services in the event that a disaster over- whelms the local medical emergency capabilities. In the Homeland Security Act of 2002, NDMS was transferred to