Hearing of the Senate Homeland Security and Governmental Affairs Committee - Nuclear Terrorism: Providing Medical Care and Meeting Basic Needs in the Aftermath -- The Federal Response

Statement

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Thank you. Mr. Chairman, thank you for holding this hearing and for continuing the committee's important work on nuclear terrorism. I note as I look at the press tables today that they are not jammed with people, and yet, if we failed to do this kind of work, the consequences are so enormous. So I salute you for tackling a very difficult, a very consequential issue, and focusing the committee's work on nuclear terrorism.

Discussions of nuclear terrorism tend to overlook an important point. As Doctor Michael Robbins, a professor of radiation oncology at the Wake Forest University School of Medicine has cautioned, "The vast majority of general practitioners, emergency responders, and even many radiologists have little understanding of the health consequences of a radiological or nuclear event." As this committee considers the challenges of responding to a terrorist nuclear attack on an American city, his caution reminds us of the vast scale of these challenges. That is not only the general public, but also the medical community is ill prepared to face the terrible consequences of such an attack.

Our earlier hearings on this subject, not to mention the latest news stories on the activities of the Pakistani nuclear secret seller, A.Q. Khan, have left little room for doubt that technical and delivery options for such an attack are within the reach of terrorists. Previous witnesses have given us chilling testimony on the scale and nature of response challenges to a terrorist nuclear attack. They would include not only mass casualties and immense strain on local response capabilities, but also specific radiation related challenges, such as mass triage and burn care, decontamination, fallout plume modeling, and shelter or evacuate decisions.

One of the key recommendations that emerged from our prior hearings is the need for surge capacity for medical care for tens of thousands of injured people. Options for providing that surge capacity include field hospitals for triaging patients, as well as pre-positioning medications, supplies and equipment at large public facilities, such as convention centers or stadiums. If such a disastrous attack should occur, a well planned, vigorous, and coordinated, effective response by federal agencies will be critical to augmenting the local and state preparedness effort, as well as the nonprofit partners and the private sector organizations that would be involved.

Besides having access to resources throughout the country, the federal government can provide situational awareness and coordination that are critical to an effective response. Today's hearing gives us an opportunity to hear firsthand how the key federal agencies and departments are planning and preparing responses to a possible terrorist nuclear attack. I too, like the chairman, am particularly pleased that the panel includes Fire Chief James Schwartz of Arlington, Virginia.

His experiences in tactical command of the response to the 9-11 attack on the Pentagon and his department's training for possible nuclear incidents will be very valuable to this committee's deliberations.

Arlington is, of course, part of the national capital region and participates in extensive regional planning. Nonetheless, it was Arlington firefighters who were first on the scene at the Pentagon on 9-11. And today their plans assume no direct federal support for the first 24 to 72 hours after a catastrophe. This standard of preparation is commendable and should serve as a model for first responders in parts of the country where federal assets are less concentrated.

One of my concerns is that there is a misperception among many state and local responders that if there is a nuclear attack that somehow federal resources and federal first responders in the military will immediately be on the scene. But, in fact, regardless of the kind of disaster, it is always the state and local first responders who are first on the scene, and it always will be that way.

I'm very pleased with the improvements that we are making. I want to commend FEMA's administrator, Chief Paulison, for effectively implementing many of the reforms that the chairman and I authored as a result of our investigation into the failed and flawed response to Hurricane Katrina.

I'm going to put the rest of my statement in the record because I'm eager to hear our witnesses.

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Chief Paulison, one of the issues that came up in the previous hearings was the importance of communicating effective, accurate information about whether people should shelter in place or evacuate. And we learned at our previous hearing that in many cases, sheltering in place is the right decision. And I don't think that's intuitive to people at all. I think most people's first reaction is to flee.

Now we've talked a lot about the importance of the pluming modeling so that you know how to make an accurate decision in that regard. But what our witnesses told us in the previous hearing is that it wasn't clear who makes that decision and who should communicate that decision. Tell us what you think or what you're doing to clarify the confusion on the very essential communication piece of the strategy. Because accurate, believable, timely communication literally would make the difference in saving potentially thousands of lives.

MR. PAULISON: Well Senator, no question about it. The communication piece and all of our 15 scenarios is extremely important and we have laid out a communication plan for each one of those, particularly with a nuclear incident. Chief Schwartz accurately pointed out that the message has to be to shelter in place until your local first responders or local officials give you information of whether to evacuate or not. The difficulty is going to be quite frankly if you do have a large nuclear device such as a 10 kiloton bomb go off, communication systems are not going to be what they should be. We don't know are the radios going to work, we don't know. Are the telephones going to work, are televisions going to work, or what is going to work and what's not going to work. So it's really going to fall on those first few hours on the local community who has a responsibility for making a decision on evacuation to get that message out.

We are going to be providing and are providing information to them of what that should be. We've got protective action guidelines that are coming out very shortly that will give us a very clear direction on first responder decision making, on exposure guidelines, on clean up and decon procedures and things like that. And those will be coming out very, very shortly.

SEN. COLLINS: Is that the common alerting protocol also that the Chairman and I have written to you about?

MR. PAULISON: That's correct. And again that IPAWS system we're talking about in Arlington County has most of that already. They have the ability to activate Blackberries and cell phones. You know, I live in Arlington and, actually live in Florida but my -- (laughter) -- my wife says I live up here, I get reverse 91 calls all the time from them anytime there's a weather alert. So they've got a very robust system in place.

What we don't know is that system going to work after there is an explosion like that. And so that's the thing, we really don't have a handle on. I think your assumption is correct, most people intuitively will want to flee but quite frankly they should shelter in place until they're told what to do because we don't know, they may be going from a safe place into harm's way going through a plume.

SEN. COLLINS: But is it clear who has the responsibility for communicating that information?

MR. PAULISON: I think for the first several hours, it's the local community has a responsibility and the state if the local community's been decapitated. But very shortly after that, the federal government's going to have to step in and work with the state to provide those lines of communication.

SEN. COLLINS: Chief Schwartz, do you think it's clear who has responsibility for first of all making the decision on what the population should do and second communicating that?

MR. SCHWARTZ: I think in communities such as mine, it is. I think there is still more work to be done again through these collaborative processes so that everybody comes to that common understanding. Because as we said in part of our earlier comments, I'm not sure that many communities are even focusing on this kind of an incident as a reality, as a potential reality.

SEN. COLLINS: See I think you're very unusual. The level of planning that you've done, the preparedness, the experience, you're close to the Capital area, you're part of the Capital region, and I'm impressed with what you've done, extremely impressed, but I don't think you're typical.

MR. SCHWARTZ: I can appreciate that, Senator. One of the things that the IFC has done is and we are beta testing right now something we call the Fire Chief's Checklist for Terrorism. And one of the things that we're trying to do is get out to fire chief's all across this country their responsibility to ask these hard questions, work with their partners in their jurisdictions or in their regions, and come to some solutions around some of these problems. Because I appreciate that we may be unusual but we'd like to think too that we, along with some others that have advanced some of these concepts, that we can provide a kind of a way forward, some guidance for other communities that need to do the same thing.

And again, I would urge again that we consider just how real this threat is for even some metropolitan communities who are trying to make very tough resource decisions and how they're going to apportion their time around threats that they see as relatively small in probability.

SEN. COLLINS: Thank you.

MR. PAULISON: Senator, can I make one more comment?

SEN. COLLINS: Yes.

MR. PAULISON: Under Res 15 we really do have good solid communication plans in place and protocols laid out and what we really need to do I think based on what you're observing is that we need to do a better job of getting those protocols out to the local communities so that everyone understands how that system is going to fall in place.

But they are in place, we do have those. We've been working very hard to develop those since Katrina and to make sure that those, because I think what you said earlier is that communications is going to be extremely important. And people want to know what's going on, they want to know what to do and what the right thing is to do.

SEN. COLLINS: Thank you.

Doctor, you talked about your efforts to educate the medical profession and other healthcare providers about radiological issues and I was impressed that you're using specialized medical publications and on-line training course. Are you working with the AMA for example, the American Nurses Association, it seems to me that a way to educate healthcare professionals is through continuing education courses which all of them have to take as a condition of their licensure. When I was in state government, I oversaw the licensing boards, so I'm very familiar with that whole aspect.

Have you thought of developing and disseminating through state licensing boards a standard course that could be offered in states across this country for which medical professionals could receive continuing education credit?

MR. VANDERWAGEN: Well, specifically no.

SEN. COLLINS: Good idea, though.

MR. VANDERWAGEN: Yeah, good idea. (Laughter.) You know the fact of the matter is that part of the funding that went into public health emergency preparedness went through CDC, part of HHS, to schools of public health to develop these kind of curricula for various events. The curricula exists but we've not formally reached out to the credentialing organizations for instance and suggested to them that they make it a sort of a required part of licensure.

Easy enough to do through the federal licensure organization that brings together all the state licensure groups to do that. I've been impressed last week again and when I was up in New Jersey I went to Burlington Community College up there and their president is now president of the National Association of Community Colleges and I asked the question how do we utilize community colleges to more effectively outreach this kind of educational awareness of issues because 85 percent of first responder training occurs in a community college environment.

So we are exploring other means, but that's an idea that we hadn't pursued.

Could I comment on one or two things? One is NGA is working with us now to try and develop a non-classified briefing for elected officials so that we can help disseminate a greater understanding among elected officials, at least in a non-classified way, what the risks that they really have are.

Secondly Chief Schwartz's idea of regional dialogue is extremely important here. There are a number of active regional organizations in the Northeast to your state as a participant in that, they've already negotiated agreements for mutual aid with Nova Scotia and New Brunswick as well as U.S. states, we could use those regional organizations in a much more effective way I think and that's, those were ideas based on Chief Schwartz's recommendation which I support and I think ideas that you and the chairman have brought forth.

SEN. COLLINS: Thank you. Just so I clarify my comment, I wasn't suggesting that it be a condition of licensure, but it could be an available course under continuing education requirements, taking so many credits of some continuing education courses. I believe that if you developed a course in this area, that states would be very happy to have that as one of the offerings and that you would reach far more medical professionals.

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Secretary McHale, we talked earlier that those first responders are from the state and local level who first appear on the scene.

Right behind them is always the National Guard because the first thing the governors do when there's a catastrophic event, and that they would certainly do in the event of a nuclear terrorist attack, is to call up the National Guard. For the last year or so, the committee has repeatedly heard that that National Guard is seriously under equipped. General Blum, for example, testified that 88 percent of the Army/National Guard were quote, "very poorly equipped to perform a civil support function."

At a hearing that this committee held, we had the tags from a couple states including the adjutant general from Maine who said that we were at significant risk. A year later, I continue to hear troubling assessments about the current readiness of the National Guard to provide civil support services. You've talked a lot this morning and I agree with you that we've come a long ways when you look at the civil support teams or seaborne, but the National Guard's readiness is still an issue. Could you comment on where you think we are in terms of the role that the National Guard would inevitably be called upon to play and the preparedness of the Guard?

MR. MCHALE: In our strategy for homeland defense and civil support published in June 2005, we placed, quote, "a focused reliance," end of quote on our Reserve component forces for these kinds of missions with a particular emphasis upon the central role of the National Guard. So Senator, your question's quite appropriate in terms of how well-prepared is our central capability to execute the missions that are reflected in that strategy. We have pinned the rose on the National Guard, have we given the National Guard the resources, the capabilities that they require to execute the mission.

Even in the context of Hurricane Katrina, about 70 percent of our force that we deployed, which was the largest, fastest civil support mission in the United States, came out of the National Guard, about 70 percent, 50,000 of the 72,000 forces. I checked with the National Guard this morning and I guess the best summary I can give you is that there are indeed unmet resourcing requirements. And in my view there is a critical unmet requirement for integrated planning so that National Guard capabilities are correctly fused with state and local capabilities in the civilian sector, public and private, and the Title X capabilities that we would deploy under NORTHCOM command and control.

We do not have integrated planning yet at the state and local level. So let me back step just a moment. When I asked about personnel for the 10 kt nuclear mission I was informed by the (guard barrel ?) this morning that we have 88 percent of the people that we would need for the foreseeable mission requirements associated with a 10 kt nuclear response. I said that's fine but where do we stand in terms of equipment? We have the people, are they properly equipped? And the answer is not yet, and that's a truthful, candid answer to this committee. I'm sure it is not surprising for you to hear it.

The fact is we have made enormous progress. Steve Blum has shown terrific leadership. We've gone from a resourcing and equipment availability in the 50 percentiles up to about 62 percent at the present time, and under his leadership and with appropriate funding, hopefully from the Congress, it will move up to about 72 percent. That's the best equipped the Guard will ever have been both in terms of quality and quantity in the National Guard's history. But that does indicate that there are shortfalls that would need to be addressed in order to have an adequate response to a nuclear event.

So we have made progress but consistent with the plan that General Blum has laid out, we have further initiatives that have yet to be achieved.

On the second point, if I may very briefly. It is so important that we move from the strategic level down to the practical level of operational and tactical capabilities. And the concept that we are now pushing forward under the leadership of DHS is to create a taskforce for emergency readiness within each state where the adjutant general would play the leadership role along with other emergency managers to ensure that the plan, let's say in the state of Maine, to address a 10 kt nuclear detonation would be properly integrated into all state and local capabilities to include coordination with NORTHCOM and FEMA. We have not yet achieved that, we're pretty good at the poetry of strategy. We are not very good at the level of practical, tactical planning to deliver the capabilities in a timely manner.

And so with that candid recognition, I can also assure you we're on the cusp of achieving that integrated planning through the concept of the task force for emergency readiness which has received widespread support within the National Guard.

SEN. COLLINS: We are, however, going to have to get those planners down to the state level.

MR. MCHALE: Yes.

SEN. COLLINS: You and I have talked about that before. And the problem is that most National Guard bureaus at the state level simply do not have that capacity. DoD is awash with planners, that's what DoD does in addition to its obvious other responsibilities.

MR. MCHALE: The reason why the adjutants general like this approach is that we take DoD planners, we will have about 450 Reserve component DoD planners, officers who we trained in the planning process, who will as part of their monthly drill obligation serve alongside National Guardsmen under the immediate supervision of the adjutant general so that that DoD planning capacity can migrate to the state level. We are a helping hand, but the leadership, the authority, the accountability, must ultimately be vested in the state government.

And so we want to be as helpful as we can be without being intrusive in that process. And the Task Force for Emergency Readiness creates that kind of integrated planning capability.

SEN. COLLINS: And when do you see that actually going into effect? I think it's a great plan. I think it makes a great deal of sense but as far as states actually seeing DOD planners working side- by-side with them.

MR. MCHALE: Again, we're in a supporting role. Dave and I spoke about as recently as 10 minutes before this hearing. I've also been working very closely with Harvey Johnson, Dave's deputy, to make this a reality. We -- we, in fact, have developed a pilot program. And I would anticipate that DHS would announce that the pilot program later this year would be initiated in approximately a half dozen states where frankly, we're going to bend over backwards to make sure it's a success in those states, because if it is, it'll be much like the civil support teams. We had nine of them back in September of 2001. We have 55 of them authorized today.

If the first half dozen or so Task Forces for Emergency Readiness work in those five states, I have no doubt that the adjutants general and emergency managers will spread the gospel.

SEN. COLLINS: Thank you. Chief Schwartz, my final question is for you. The Metropolitan Medical Response System program, MMRS, is a small grant program at DHS and FEMA compared to many of the other Homeland Security Grant Programs. But it is a program that's directly relevant to the issues we're talking about today.

It's my understanding that it provided just $300,000 to 124 urban areas that it covered this year, including Arlington County. It's a program that gives a great deal of discretion to local communities about how exactly they use it, which I think is a strength. But give us your assessment of the MMRS program. How valuable is it to you? Should it be expanded? Are we underfunding it at $300,000?

MR. SCHWARTZ: I would tell you that it's probably some of the -- as meager as the funds are, they are some of the best spent funds in all of our efforts around homeland security.

I think that -- I would note that it is the only federal program that creates a bridge between what government is going to do in a crisis and what the private health care community is going to do. We don't have anything else that facilitates a collaboration between the private health care community as a full partner in a response to something like the events we're talking about today and many others that we could envision. And what those of us in the -- you know, represented at this table are also going to do. So it has great strength, great value there.

I am one, and this may be a controversial comment, but I am one that would have taken a program like UASI, and I -- the Urban Area Security Initiative, and I would have placed it under a framework like MMRS, as opposed to the other way around. We've got UASI, and then we tell UASI cities to go work with their MMRS partners. Whereas the framework of MMRS, the goals that it set out, however they need to be adjusted at the local level, I think is a far better approach to the kinds of issues that we're discussing today.

In its original form, it was geared towards the human health consequences that result from a weapon of mass destruction. I think that whether it is a weapon of mass destruction or a naturally occurring crisis, as we said before in an all-hazards environment, the problems are all virtually the same.

My job as a fire chief is to come to work in my community every single day and focus on the health and well-being of the citizens and visitors to Arlington County. That may be because the threat is from a fire or an EMS type incident. It may be because it's a public health outbreak, and then my role is slightly different but no less important to support my partners in public health.

And if we have not done a job -- a good job of integrating our capabilities in that response, then we're all going to be going in different directions, and I think that ill serves our citizens. So I think that the way MMRS is structured, I think that the goals that it lays out provide us with a far better approach to managing problems like we're talking about today. And -- and I often times say, it isn't about the MM. It's about the RS, okay. It's about building a better response system, and as a part of that, you know, we obviously focus on the medical well-being of those we serve.

SEN. COLLINS: Thank you. Thank you, Mr. Chairman.

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I can't imagine a greater turnaround than we've seen with FEMA. It doesn't mean that there aren't still problems. It doesn't mean that there aren't still issues and challenges that need to be addressed.

But the change in leadership combined with the extensive reforms that this committee put in place are paying dividends, and we've seen it. And thank goodness we did do all of the reforms and such capable new leadership was brought in, because our country has been challenged with natural disasters the like of which I've never seen before, including my home state of Maine where we had flooding this spring in northern Maine that was unlike anything in the state's history.

So I want to second your praise and thanks to Chief Paulison and to all of the rank and file FEMA members who are working so hard each and every day. As I listened to this panel, it helps me be confident that we have so many people who are working so hard for our nation. And you don't get thanked often. There's so much anti-bureaucracy, anti-Washington feeling in this country.

And I think if the people of this nation could all have heard this hearing and the seriousness and dedication that's represented by each of our panelists and by all the people that you represent, the men and women who are working hard each and every day to protect this country, it would be very heartening to the people of this nation.

We may not get the headlines and the attention, and that is typical when you're doing a good job, as all of you are. But in fact, I want you to know that this committee does pay attention to your work, and we do appreciate it, and you are making a difference each and every day. So thank you.

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