[House Hearing, 108 Congress]
[From the U.S. Government Publishing Office]
BIOTERRORISM PREPAREDNESS: PEOPLE,
TOOLS, AND SYSTEMS FOR DETECTING AND
RESPONDING TO A BIOTERRORIST ATTACK
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FIELD HEARING
BEFORE THE
COMMITTEE ON SCIENCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTH CONGRESS
SECOND SESSION
__________
MAY 3, 2004
__________
Serial No. 108-56
__________
Printed for the use of the Committee on Science
Available via the World Wide Web: http://www.house.gov/science
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______
COMMITTEE ON SCIENCE
HON. SHERWOOD L. BOEHLERT, New York, Chairman
RALPH M. HALL, Texas BART GORDON, Tennessee
LAMAR S. SMITH, Texas JERRY F. COSTELLO, Illinois
CURT WELDON, Pennsylvania EDDIE BERNICE JOHNSON, Texas
DANA ROHRABACHER, California LYNN C. WOOLSEY, California
KEN CALVERT, California NICK LAMPSON, Texas
NICK SMITH, Michigan JOHN B. LARSON, Connecticut
ROSCOE G. BARTLETT, Maryland MARK UDALL, Colorado
VERNON J. EHLERS, Michigan DAVID WU, Oregon
GIL GUTKNECHT, Minnesota MICHAEL M. HONDA, California
GEORGE R. NETHERCUTT, JR., BRAD MILLER, North Carolina
Washington LINCOLN DAVIS, Tennessee
FRANK D. LUCAS, Oklahoma SHEILA JACKSON LEE, Texas
JUDY BIGGERT, Illinois ZOE LOFGREN, California
WAYNE T. GILCHREST, Maryland BRAD SHERMAN, California
W. TODD AKIN, Missouri BRIAN BAIRD, Washington
TIMOTHY V. JOHNSON, Illinois DENNIS MOORE, Kansas
MELISSA A. HART, Pennsylvania ANTHONY D. WEINER, New York
J. RANDY FORBES, Virginia JIM MATHESON, Utah
PHIL GINGREY, Georgia DENNIS A. CARDOZA, California
ROB BISHOP, Utah VACANCY
MICHAEL C. BURGESS, Texas VACANCY
JO BONNER, Alabama VACANCY
TOM FEENEY, Florida
RANDY NEUGEBAUER, Texas
VACANCY
C O N T E N T S
May 3, 2004
Page
Witness List..................................................... 2
Hearing Charter.................................................. 3
Opening Statements
Statement by Representative Randy Neugebauer, Member, Committee
on Science, U.S. House of Representatives...................... 7
Written Statement............................................ 8
Statement by Representative Dennis Moore, Member, Committee on
Science, U.S. House of Representatives......................... 8
Written Statement............................................ 10
Witnesses:
Mr. Charles A. Schable, Director, Bioterrorism Preparedness &
Response Program, Centers for Disease Control & Prevention
Oral Statement............................................... 12
Written Statement............................................ 13
Biography.................................................... 17
Mr. Samuel H. Turner, Sr., Chief Executive Officer, Shawnee
Mission Medical Center
Oral Statement............................................... 18
Written Statement............................................ 20
Biography.................................................... 27
Financial Disclosure......................................... 28
Mr. Richard J. Morrissey, Acting Director of Health, Kansas
Department of Health & Environment
Oral Statement............................................... 29
Written Statement............................................ 30
Biography.................................................... 43
Ms. W. Kay Kent, Administrator/Health Officer, Lawrence Douglas
County Health Department
Oral Statement............................................... 43
Written Statement............................................ 45
Biography.................................................... 47
Mr. Brad Mason, Division Chief of Special Operations, Johnson
County Med-Act
Oral Statement............................................... 50
Written Statement............................................ 52
Biography.................................................... 53
Dr. Ronald J. Kendall, Director, The Institute of Environmental
and Human Health
Oral Statement............................................... 53
Written Statement............................................ 56
Biography.................................................... 69
Financial Disclosure......................................... 71
Discussion....................................................... 74
Appendix: Additional Material for the Record
Statement of Mr. Scott C. Voss, MPH, Public Health Emergency
Coordinator, Johnson County Health Department 98
BIOTERRORISM PREPAREDNESS: PEOPLE, TOOLS, AND SYSTEMS FOR DETECTING AND
RESPONDING TO A BIOTERRORIST ATTACK
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MONDAY, MAY 3, 2004
House of Representatives,
Committee on Science,
Washington, DC.
The Committee met, pursuant to call, at 10:00 a.m., in the
Shawnee Mission Room, Shawnee Mission Medical Center, 9100 West
74th Street, Shawnee Mission, Kansas, Hon. Randy Neugebauer
[Acting Chairman of the Committee] presiding.
HEARING CHARTER
COMMITTEE ON SCIENCE
U.S. HOUSE OF REPRESENTATIVES
Bioterrorism Preparedness: People,
Tools, and Systems for Detecting and
Responding to a Bioterrorist Attack
MONDAY, MAY 3, 2004
10:00 A.M.-12:00 P.M.
SHAWNEE MISSION MEDICAL CENTER
SHAWNEE MISSION, KANSAS
1. Purpose
On Monday, May 3, 2004, the House Science Committee will hold a
field hearing to receive testimony on state and local preparedness for
a bioterrorist attack, on the role of the Federal Government in
supporting local efforts to prepare for, detect, and respond to a
bioterrorist attack, and on the development and deployment of tools and
systems for detecting and responding to a bioterrorist attack.
2. Witnesses
Mr. Charles A. Schable is the Director of the Bioterrorism Preparedness
& Response Program at the U.S. Department of Health and Human Services'
Centers for Disease Control and Prevention (CDC). CDC's bioterrorism
and public health preparedness activities include support for
strengthening of regional and state laboratories' capacity to detect
different biological and chemical agents, upgrading of state and local
health agencies' capacity to detect and communicate different health
threats, and working with pharmaceutical companies and other partners
to create regional stockpiles of the drugs needed to treat
intentionally-launched disease outbreaks.
Mr. Samuel H. Turner, Sr. is the Chief Executive Officer of Shawnee
Mission Medical Center (SMMC). SMMC has mutual aid agreements with
local government agencies to monitor and respond to potential
biological events, and uses bio-surveillance software to coordinate and
communicate with other local hospitals to track outbreaks of diseases.
Mr. Richard J. Morrissey is Acting Director of Health at the Kansas
Department of Health & Environment (KDHE). The KDHE responds to
potential public health emergencies resulting from bioterrorism events
and natural disease outbreaks. The KDHE Bioterrorism Program includes
preparedness planning and response assessment, surveillance and
epidemiologic capacity, laboratory capacity, health alert network/
communications and information technology, risk communication and
health information dissemination, and education and training.
Ms. W. Kay Kent is the Administrator/Health Officer at the Lawrence-
Douglas County Health Department. Her expertise is in community health
nursing, and she serves on the Bioterrorism Preparedness Planning
Committee for the Kansas Department Health and Environment and Kansas
Association of Local Health Departments. Lawrence-Douglas County
experienced an outbreak of cryptosporidiosis in September of 2003, so
Ms. Kent has recent practical experience in disease/outbreak
management, treatment, and prevention, as well as in working with CDC
in outbreak response efforts.
Mr. Brad Mason is the Division Chief of Special Operations at Johnson
County Med-Act, where he directs the emergency medical services (EMS)
Special Operations Teams. He is responsible for EMS emergency planning
for mass casualty, mass fatality, incident management, hazardous
materials, and weapons of mass destruction incidents. He is also the
Chairman of the Mid America Regional Council Emergency Response
Committee, through which he has worked on regional incident response
and communications plans and metro-wide hospital diversion protocols.
Dr. Ronald J. Kendall is the Director of The Institute of Environmental
and Human Health (TIEHH) at Texas Tech University/Texas Tech University
Health Sciences Center. He is an expert in environmental toxicology.
TIEHH leads the Admiral Elmo R. Zumwalt, Jr. National Program for
Countermeasures to Biological and Chemical Threats, which includes work
on detection, biological mechanisms, physical and medical
countermeasures, modeling, and education, training, and outreach.
3. Overarching Questions
The hearing will address the following overarching questions:
How do first responders, Federal, State and local
governments, and health services providers work together to
prepare for, detect, and respond to bioterrorist attacks?
What tools and systems are used to detect and respond
to bioterrorist attacks? What tools need to be developed? Who
is developing these tools? Who is deploying them? What barriers
exist to their use?
How does preparedness for bioterrorist attacks affect
our ability to meet day-to-day health care needs and respond to
natural disease outbreaks?
4. Brief Overview
To be properly prepared to detect and respond to a
bioterrorist attack, numerous governmental and private entities
must coordinate their efforts and plan for targeted and
prioritized use of public health resources. Key players include
federal agencies, state and local health departments, first
responders, and hospitals.
Development and deployment of information technology
systems for the detection of bioterrorist agents or other
infectious diseases, the surveillance of unusual symptoms, and
rapid communication during incident management is significantly
improving capabilities to detect and respond effectively to
bioterrorist incidents and natural outbreaks of infectious
diseases.
After the anthrax attacks in the fall of 2001, the
Department of Health and Human Services (HHS) expanded its
programs to fund state, municipal, and territorial governments'
efforts to upgrade their bioterrorism preparedness and response
capabilities. In fiscal years 2002 and 2003, HHS distributed a
total of $2.5 billion.
Great strides in preparedness have been made.
However, a 2003 GAO report found that workforce shortages and
gaps in disease surveillance and laboratory facilities continue
to potentially limit state and local jurisdictions' ability to
response to a bioterrorist attack. Further strengthening public
health systems will not only improve bioterrorism preparedness,
but will also improve our capability to detect and respond to
natural outbreaks of infectious diseases.
5. Background
Vulnerability to Infectious Disease Crises
We live in a mobile, highly interconnected society. Infectious
diseases can be spread rapidly via people's movement across countries
and across oceans on planes, and hazardous substances can be spread
broadly via the mail system. The dangers and potential impact of a
bioterrorist attack can be seen in recent examples of intentional and
natural disease outbreaks--the anthrax attacks through the postal
system in the fall of 2001 and the severe acute respiratory syndrome
(SARS) epidemic experienced by China and internationally in 2003. These
incidents highlight the challenges inherent in identifying and
addressing gaps that could impair health systems' capacity to respond
to sudden infectious disease outbreaks. To be properly prepared for a
bioterrorist attack, plans for targeted and prioritized use of public
health resources must be made, and these plans will have the added
benefit of improving our capability to detect and respond to natural
outbreaks of infectious diseases.
Efforts to Improve Preparedness
After the anthrax attacks in the fall of 2001, Congress was
concerned that the Nation was not prepared to respond to a bioterrorist
attack that resulted in a major public health threat. Therefore,
several months after the incidents, Congress appropriated funds to
strengthen state and local bioterrorism preparedness. The Department of
Health and Human Services (HHS), through the CDC and the Health
Resources and Services Administration, provided funds through
cooperative agreement programs with state, municipal, and territorial
governments. These agreements were aimed at upgrading bioterrorism
preparedness and response capabilities at state and local public health
agencies, hospitals, and emergency medical service agencies, and the
participants were required to complete specific activities designed to
build public health and health care capacities. In fiscal years 2002
and 2003, HHS distributed a total of $2.5 billion toward this effort.
The General Accounting Office (GAO) has performed several studies
relating to the public health system's preparedness for bioterrorist
attacks and natural infectious disease outbreaks. In testimony last
year,\1\ GAO described how efforts of state and local public health
agencies to prepare for a bioterrorist attack have improved the
Nation's capacity to respond to infectious disease outbreaks and other
major public health threats, but also noted that gaps in preparedness
remain. For example, most hospitals reported participating in basic
planning activities for large-scale infectious disease outbreaks and
training staff about biological agents, but most hospitals also lacked
adequate equipment, isolation facilities, and staff to treat the large
increase in the number of patients that could result from a
bioterrorist attack. Not surprisingly, GAO found that jurisdictions
that have had multiple prior experiences with public health
emergencies, including natural disasters, demonstrated the highest
levels of preparedness. In another study, GAO also found that while
contingency plans for disease outbreaks or bioterrorist events are
being developed at the state and local levels, planning for regional
coordination that transcends state boundaries was lacking.\2\
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\1\ U.S. General Accounting Office testimony before the Committee
on Government Reform, House of Representatives on April 9, 2003; GAO-
03-654T.
\2\ U.S. General Accounting Office testimony before the
Subcommittee on Emergency Preparedness and Response, Select Committee
on Homeland Security, House of Representatives on September 24, 2003;
GAO-03-1176T.
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Information Technology for Disease Surveillance and Information Sharing
Information technology (IT) systems can play a critical role in
both detecting and responding to a public health emergency. Relevant
examples of IT-facilitated information gathering include systems for
environmental sampling and detection of bioterrorist agents or other
infectious diseases; surveillance systems that provide ongoing
collection and analysis of data related to behavior or symptoms
potentially associated with disease outbreaks; and systems that
facilitate the timely delivery of information to relevant responders
and decision-makers. Ongoing advances in the development and deployment
of sampling and surveillance systems are particularly critical, as
early detection of a bioterrorist attack or disease outbreak enables
public health officials to issue warnings and execute containment and
treatment plans to mitigate the potential effects of the incident.
A large number of surveillance and information sharing systems are
operational or planned throughout the country. In spring of 2003, a GAO
survey of just six federal agencies identified about 70 such
systems.\3\ One example is the Department of Defense's Electronic
Surveillance System for the Early Notification of Community-based
Epidemics (ESSENCE). This system is designed to support early
identification of infectious disease outbreaks among personnel using
military treatment facilities. The system works by gathering daily data
on symptoms reported by patients and alerting officials when data show
abnormal patterns. Another federal system is the CDC's Health Alert
Network, which is aimed at ensuring communications capacity at all
local and state health departments; ensuring that these departments
have the capacity to receive distance learning offerings from CDC and
others; and ensuring that the public health system has the capacity to
broadcast and receive health alerts at every level.
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\3\ U.S. General Accounting Office, Information Technology Strategy
Could Strengthen Federal Agencies' Abilities to Respond to Public
Health Emergencies, May 2003, GAO-03-139. The six agencies surveyed
were the Department of Defense, the Department of Health and Human
Services, the Department of Energy, the Department of Agriculture, the
Environmental Protection Agency, and the Department of Veterans
Affairs.
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6. Questions for Witnesses
Questions for Mr. Schable
How does the CDC work with State and local
governments on preparedness for a bioterrorist attack?
What tools and systems has the CDC developed, or is
in the process of developing, to assist State and local
governments in detecting and responding to a bioterrorist
attack?
If a bioterrorist attack occurred, what role would
the CDC play in the response and how would the CDC coordinate
with first responders, State and local governments, and health
services providers?
Questions for Mr. Turner
Please describe the elements of the Shawnee Mission
Medical Center (SMMC) bioterrorism response plan. How has the
plan been tested? Was the plan employed during last year's
cryptosporidiosis outbreak? What lessons were learned from that
experience and any other tests of the plan?
How would you compare the SMMC bioterrorism response
plan with the plans in place at similarly-situated hospitals
throughout the country?
How have Federal, State, and local governments
provided coordination and assistance in SMMC's efforts to
prepare for a bioterrorist attack? What could these governments
do to improve their efforts to help hospitals be better
prepared for a bioterrorist attack?
Questions for Mr. Mason
How does the current system for communication and
coordination between hospitals and public health officials
throughout the region work to facilitate overall first
responder performance? How has this system changed or improved
over the past several years?
How have recent technology advancements improved the
performance records of first responders?
What could the Federal Government do to improve its
efforts to help Johnson County be better prepared for a
bioterrorist attack?
Questions for Mr. Morrissey
What are the elements of the Kansas Bioterrorism
Preparedness Program? What level of readiness currently exists
in each of these elements, or ``focus areas''?
What systems have been put in place by the Kansas
Department of Health and Environment for early detection of a
possible bioterrorist attack? Is there clear integration and
coordination among the public health system, first responders,
and government officials about what to look for when trying to
detect an attack and how to track information that may be
useful for detection?
In Kansas, how do federal, state, and local officials
interact in developing bioterrorism preparedness plans? What
could the Federal Government do to improve its contributions to
support state and local preparedness?
Questions for Ms. Kent
What is the Lawrence-Douglas County Health
Department's role in regional preparedness for a potential
bioterrorist attack?
How have Federal and State governments facilitated
Lawrence-Douglas County's efforts to prepare for a bioterrorist
attack? What could these governments do to improve their
efforts to help the county be better prepared for a
bioterrorist attack?
Last summer, when the Kansas City area experienced an
outbreak of cryptosporidiosis, how did your department interact
with the CDC? Did the CDC offer the department and other local
organizations an appropriate level of support during that
outbreak?
Questions for Dr. Kendall
What tools and systems is the Institute of
Environmental and Human Health (TIEHH) working on to detect and
respond to a bioterrorist attack? What organizations provide
the funding to support this research and development? How are
the resulting technologies transitioned to users?
How does the TIEHH work with first responders and
State and local government organizations to understand their
needs for the technologies being developed at TIEHH? How do you
work with them on education, training, and outreach?
How can the Federal Government, particularly the
Department of Homeland Security, improve its efforts to help
communities be better prepared for a bioterrorist attack? Are
there specific areas that demand increased attention?
Mr. Neugebauer. We will call to order the Science Committee
hearing for Bioterrorism Preparedness: People, Tools, and
Systems for Detecting and Responding to a Bioterrorist Attack.
It's good to be here at Shawnee Mission Medical Center.
Mr. Turner, thank you for allowing us to have this hearing
here today. We appreciate that very much and it's good to be
with my friend and colleague, Congressman Moore from Kansas.
I want to say to the people in Kansas that you are well
represented by Mr. Moore and other great Members from the
Kansas delegation and so it's a pleasure to be in Kansas today.
Before I read my opening statement, I was thinking flying
here yesterday about this hearing and those of us that, I look
around the room, some of us grew up during the Cold War era and
we remember the threat of a nuclear attack and the drills and
the preparedness that we went through in our nation for a
different kind of attack. Today, we're going to be talking
about becoming more prepared for a different kind of threat to
our nation and how we begin to, as we did in the Cold War,
detect that threat, to respond to that threat and to mitigate
that threat.
And so I'm looking forward to today, and I know that we
have a very distinguished group of panelists and we're looking
forward to hearing from them.
So I'll read my opening statement. First, I'd like to thank
again my friend, Mr. Moore, Congressman Moore, for hosting this
field hearing, his home state of Kansas. And I'd like to thank
our panel of distinguished witnesses, Dr. Charles Schable; Mr.
Turner, our host; Mr. Richard Morrissey, Ms. Kent and Mr. Brad
Mason and my good friend, Dr. Ron Kendall, appearing before the
Science Committee today.
I'd like to recognize Dr. Kendall because he's from my home
town of Lubbock, Texas. Dr. Kendall is Director of the
Institute of Environmental and Human Health or what we like to
call TIEHH at Texas Tech University. He's an expert in
environmental toxicology. He leads the Admiral Elmo R. Zumwalt
National Program for Countermeasures to Biological and Chemical
Threats, which includes work on detection, biological
mechanisms, physical and medical countermeasures, modeling,
education, training and outreach. Thank you, Dr. Kendall, for
being here today. Thank you for taking time out of your busy
schedule.
At this time in American history, our national security has
become the most important issue facing our nation. The events
of September 11, along with our anthrax attacks in 2001, have
increased the Nation's concern about bioterrorism and our
ability to respond to those attacks.
Public health professionals play a vital role in preparing
and coordinating emergency personnel for such events. They are
responsible for detecting, investigating and identifying
disease outbreaks and simultaneously communicate effective
information for our first responders, the media and the public.
The capacity to fulfill these responsibilities depends on the
strength of the infrastructure that supports our public health
services. Today, we are going to receive testimony on state and
local preparedness for bioterrorist attacks and discuss the
role of our Federal Government in supporting local efforts to
prepare for, detect and respond to these attacks. We will also
talk about developing and deploying the necessary tools and
systems for detecting and responding to those attacks.
Again, I thank you for being here and I look forward to
hearing your testimony.
Mr. Moore.
[The prepared statement of Mr. Neugebauer follows:]
Prepared Statement of Representative Randy Neugebauer
First, I'd like to thank Mr. Moore for hosting this field hearing
in his home state Kansas; and I'd like to thank our panel of
distinguished witnesses, Mr. Charles Schable, Mr. Samuel Turner, Mr.
Richard Morrissey, Ms. Kay Kent, Mr. Brad Mason, and Dr. Ronald J.
Kendall for appearing before the Science Committee today.
I would also like to recognize Dr. Kendall as he is here from my
hometown, Lubbock Texas. Dr. Kendall is the Director of the Institute
for Environmental and Human Health, or what we like to call TIEHH, at
Texas Tech University. He is an expert in environmental toxicology.
TIEHH leads the Admiral Elmo R. Zumwalt, Jr. National Program for
Countermeasures to Biological and Chemical Threats, which includes work
on detection, biological mechanisms, physical and medical
countermeasures, modeling, and education, training, and outreach.
Thank you Dr. Kendall. And thank you all for taking time out of
your busy day to be here to talk about this important issue.
At this time in American history, our national security has become
the most important issue facing our nation. The events of September
11th along with the anthrax attacks in 2001 have increased the Nation's
concern about bioterrorism and our ability to respond to attacks.
Public health professionals play a vital role in preparing and
coordinating emergency personnel for such events. They are also
responsible for detecting, investigating and identifying disease
outbreaks and simultaneously communicate effective information with
first responders, the media, and the public. The capacity to fulfill
these responsibilities depends on the strength of the infrastructure
that supports public health services.
Today we are going to receive testimony on state and local
preparedness for a bioterrorist attack and discuss the role of the
Federal Government in supporting local efforts to prepare for, detect,
and respond to an attack. We will also talk about developing and
deploying the necessary tools and systems for detecting and responding
to a bioterrorist attack.
Again, thank you all for being here. I look forward to hearing your
testimony.
Mr. Moore.
Mr. Moore. Good morning. I'd like to thank my good friend,
Randy Neugebauer for being here from Texas this morning and all
of you, the witnesses and people who have attended this
hearing.
I want to invite all of you to participate in this
important hearing this morning and we're fortunate to have,
we're very fortunate to have the opportunity to hold this
hearing at the Shawnee Mission Medical Center and I thank my
friend Sam Turner for letting us use this great facility.
And Randy, thank you, for traveling up from Lubbock, Texas
to be with us here today. He does a great job in Congress and I
really appreciate his willingness to hold a hearing here in our
Congressional District.
I feel fortunate to serve on the Science Committee for
Republicans and Democrats who are able to work together in a
bipartisan spirit toward many common goals on issues that have
a day to day impact on the quality of an American's life.
We have assembled an impressive panel of witnesses. Mr.
Neugebauer has already introduced those, so I'm not going to
read all the names again, but I think each of them has a great
deal to contribute to the goals of our hearing here today. And
I want to thank each of the witnesses for taking their time out
of their busy schedules to come here and share their expertise
with us.
You will have an opportunity, and I'm going to ask the
Chairman for an opportunity, five days after the conclusion of
this hearing, for people to submit written statements, if we
can do that, Mr. Chairman?
Mr. Neugebauer. Without objection, so ordered.
Mr. Moore. Thank you, sir. I'll never forget my first visit
to the World Trade Center or actually, it was my second visit
to the World Trade Center, about two weeks after September 11.
I don't think any of us will ever forget the thousands of
people who died and the children who lost a parent that day.
Shortly after those vicious attacks at the World Trade Center
and at the Pentagon, another kind of terror was encountered in
Washington, D.C. and throughout our nation's postal system.
Anthrax was found to have killed two postal workers and the
contamination had spread through numerous federal buildings.
The containment and clean up following that event was
extraordinarily expensive, complicated and disturbing for all
those who were involved in the clean up process.
Since the months that followed those attacks of terror,
we've been confronted, both as a nation and as a community here
in the Kansas City area, with more naturally occurring, but
significant infectious disease outbreaks. Whether we're dealing
with vaccine shortages for an unusually tough strain of
influenza or something more disturbing like anthrax infections,
we know that our preparedness to deal with a bioterrorist
attack can have a positive bearing on overall public health and
infectious disease challenges.
In October of 2001, I co-hosted the Metropolitan Meeting on
Biological and Chemical Weapons. Three hundred law enforcement,
emergency response and health care professionals were invited
and we had a tremendous showing at that first meeting about two
weeks after September 11, excuse me, about a month after
September 11. In fact, we invited first responders. We invited
public health officials, law enforcement personnel,
firefighters, emergency medical service personnel, elected
public officials and people from various hospitals throughout
the greater Kansas City metropolitan area and again, we had a
tremendous attendance.
My objective in that first meeting was to find out, about a
month after September 11, where we were as a nation and
specifically, in the Kansas City metropolitan area, in terms of
being prepared to deal with a bioterrorist threat, attack in
the Kansas City area. At that time, we really discovered, I
think, and we listened. Karen McCarthy, Representative McCarthy
from right across the state line and myself were the co-hosts,
and we listened to the various people who appeared and
testified. And I think at that time, we were light years from
where we needed to be in terms of preparedness. And we have
come a long way since mid-October of 2001 in terms of being
prepared for something further in this area, but we still have
a ways to go.
And last June, I co-hosted the Homeland Security Forum in
the Greater Kansas City Area for additional follow-up. This
brought together regional stakeholders like each of you, to
assess how far our region has come in its efforts to promote a
regional response to homeland security issues. While throughout
the country as a whole, we still have room to improve on that
score, I am pleased that we have come a long way here in the
Kansas City metropolitan area.
Some of you may have experienced delays and difficulties in
obtaining funding that you need to provide the level of
preparedness that's needed by our communities. And I want to
learn about these roadblocks you may have experienced as you've
sought funding, as well as other difficulties you've had.
I also want to hear about success stories, and to remind
you that I'm available to support your efforts to request
grants, assist in grant searches and provide information about
potential funding.
Kansas City is one of the 30 cities to receive the High
Threat Urban Area Security Initiative Account Program funding.
In Fiscal Year 2003, the metropolitan area received $9.6
million and $13.2 million for Fiscal Year 2004. This federal
funding recognizes some of the serious needs and drastic
funding shortfalls created in the federal formulas for
distributing homeland security funding to communities most
vulnerable to terrorism, but there are still other problems.
We've read and heard a great deal about how state lines and
other jurisdictional boundaries have become unnecessary
obstacles and the efforts to achieve much needed communication
and cooperation between people and organizations. Yet, I think
in this area, particularly, I'm very proud of the fact that
we're working very well together, Missouri and Kansas residents
and the whole metropolitan area, in Kansas City to address this
very serious threat.
We hope that another attack never happens, but we have to
be prepared and expect the worse in case it does and make
provisions for that. Great strides are being made, yet local
public officials just like the panel before us today, continue
to report shortages of adequate medical equipment and work
forces to handle potential sudden surges from epidemic levels
of infection.
We can make great strides here. I'm really anxious to hear
all of you, so I'm going to stop talking now and again, thank
Congressman Neugebauer for coming here today to chair this
hearing in Kansas. Congressman Neugebauer has already indicated
that if you're not one of the witnesses or if you are a
witness, please if you have additional statements to submit
within five days of today's hearing, please do so and they will
be made part of the record.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Moore follows:]
Prepared Statement of Representative Dennis Moore
Good morning. Welcome to all of you who have come to listen and
participate in this important hearing today. We are fortunate and very
appreciative to have the opportunity to hold this hearing today here at
Shawnee Mission Medical Center, I extend my gratitude to you, Mr.
Turner as well as all of your staff here at SMMC, for making this space
available to us today. I also want to extend my warm welcome to my
Colleague, Mr. Neugebauer and to thank him for traveling to Kansas
today to preside at this hearing. I feel fortunate to serve on the
Science Committee, where Republicans and Democrats are able to work
together in a bipartisan spirit towards many common goals, on issues,
that have a day to day impact on the quality of life for all Americans.
We have assembled an impressive panel of witnesses with vast
expertise in many technical and administrative areas that bear upon our
readiness to face the challenges of preparedness for a bioterrorist
attack. I want to thank each of our witnesses for the time and energy
they expended in preparing for this hearing. Your carefully written and
informative testimony is a reflection of your commendable dedication to
your jobs and the people that you serve.
I will never forget my visit to the World Trade Center site shortly
after September 11th. None of us can ever forget the thousands who died
and the children who lost a parent that day. Shortly following those
vicious attacks at the World Trade Center, and at the Pentagon, another
kind of terror was encountered in Washington, and throughout our
nation's postal system. Anthrax was found to have killed two postal
workers, and that the contamination had spread through numerous federal
buildings. The containment and clean-up following that event was
extraordinarily expensive, complicated and disturbing for all those who
had been at risk of being exposed.
Since the months that followed those attacks of terror, we have
been confronted both as a nation and as a community here in the Kansas
City area with more naturally occurring but significant infectious
disease outbreaks. Whether we are dealing with vaccine shortages for an
unusually tough strain of influenza, or something more disturbing like
anthrax infections, we know that our preparedness to deal with a
bioterrorist attack can have a positive bearing on overall public
health challenges.
In October 2001, I co-hosted the Metropolitan Meeting on Biological
and Chemical Weapons; 300 law enforcement, emergency response and
health care professionals were invited. At that time, we discovered how
little coordination there was between local, State and federal
agencies. In June of last year, I also co-hosted the Homeland Security
Forum in the Greater Kansas City Area. This follow-up event brought
together regional stakeholders like each of you to assess how far our
region has come in its efforts to promote a regional response to
homeland security issues. While throughout the country as a whole we
still have room to improve on that score, I am pleased at how far we
have come here in the Kansas City metropolitan area.
Many of you have experienced delays and difficulties in obtaining
the funding that you need to provide the level of preparedness that is
needed by our communities. Today I want to learn about these roadblocks
you may have experienced as you have sought funding, as well as other
difficulties you may be having. I also want to hear some of your
success stories, and to remind you that I am available to support your
efforts to request grants, assist in grants searches, and provide
information about potential funding.
I am pleased Kansas City is one of 30 cities to receive High Threat
Urban Area Security Initiative Account program funding (UASI). In
fiscal year '03 the metropolitan area received $9.6 million dollars and
$13.2 for FY04 from UASI. This federal funding recognizes some of the
serious needs and drastic funding shortfalls created in the federal
formulas for distributing homeland security funding to communities most
vulnerable to terrorism. However, we know that it is not enough;
problems remain.
We have read and heard a great deal about how state lines and other
jurisdictional boundaries have become unnecessary obstacles in the
efforts to achieve much needed communication and cooperation between
people and organizations. Yet, everyone on both sides of a political
boundary or state line, face the same urgent challenge: to be prepared
for whatever bioterrorist or other wide-spread infectious disease
threats whenever they may strike. We of course all hope that we will
never be confronted with a bioterrorist attack. But after September
11th, we all have a stronger sense of the value of being prepared.
In conclusion, numerous governmental and private entities must be
effectively coordinated for a bioterror related event to be met with
the appropriate level of response. We have many new and impressive
technologies available to aid in the task of early detection,
containment and treatment for victims. We also have access to
sophisticated state-of-the-art communications equipment to aid in the
task of issuing early warnings to potential victims, and directives to
health professionals in the field. Great strides are being made. Yet,
local public health officials, just like the panel before us today
continue to report shortages of adequate medical equipment, and work
forces to handle potential sudden surges from epidemic levels of
infections. This is a challenge that we must be prepared to meet and I
believe that this hearing today will offer us some information to help
us in reaching toward that goal.
Mr. Neugebauer. What we'll do is we'll give each member of
our panel an opening statement, your statement, the written
testimony will be entered into the record as the gentleman
mentioned. And then if we ask you questions and you want to
submit some additional information, you have five days to do
that.
And we're going to start with Mr. Schable, and if you would
just kind of introduce yourself, a little bit about what
capacity you're in today.
Welcome, Mr. Schable.
STATEMENT OF CHARLES A. SCHABLE, DIRECTOR OF THE BIOTERRORISM
PREPAREDNESS AND RESPONSE PROGRAM, CENTERS FOR DISEASE CONTROL
AND PREVENTION, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Mr. Schable. Thank you, Congressman. Good morning,
everyone. I am Charles Schable and I am Director of the
Bioterrorism Preparedness and Response Program of the National
Center for Infectious Diseases, the Centers for Disease Control
and Prevention in Atlanta.
Thank you for the opportunity to join you to testify today
about CDC's bioterrorism preparedness efforts. I was last in
Kansas City in 2001 when the investigation of the anthrax
attacks through the mail led us to a mail sorting facility here
that was contaminated and I was part of the response team CDC
sent here to work with state and local officials. Fortunately,
no human cases occurred here, but the experience afforded me
the opportunity to witness an example of productive
collaborations between federal, state and local public health,
law enforcement and postal officials, under extremely trying
circumstances. These types of working relationships are part of
the foundation of a strong public health system that leads to
effective preparedness for and response to threats to health,
whether they be manmade or naturally caused.
With our partners, CDC continues to make vast strides
toward achieving optimal terrorism preparedness and emergency
response capacity at the federal, state and local levels and is
committed to strengthening the capacity of the public health
system to respond to both routine and emergent health threats.
In 1999, CDC began a program of providing technical assistance
and funding to state, local and territorial public health
departments to develop capacity to respond to terrorism events
and related public health emergencies.
In FY 2002, Congress appropriated a substantial increase in
funding for this preparedness effort and CDC's state and local
cooperative agreement program has grown rapidly as a result.
The resources provided through this program support 62 grantees
in the development of critical public health preparedness
capacities, including preparedness planning and readiness
assessment, surveillance in epidemiology, biological and
chemical laboratory capacity, communications systems and
information technology, health information dissemination and
risk communication and education and training.
States and localities have made substantial progress toward
achieving optimal levels of preparedness since the terrorist
attacks of fall 2001. For example, every state has developed an
emergency preparedness and response plan and nearly 90 percent
of states have trained public health practitioners to respond
to terrorism. Recent events such as the SARS, monkeypox and
avian influenza outbreaks, have underscored the essential role
early detection systems play in mobilizing rapid response.
Detection of a disease almost always occurs at the local level
where health care professionals encounter patients seeking
medical assessment or treatment. A clinician's ability to
quickly recognize and identify symptoms of unusual illnesses on
the front line has been critical to the CDC's ability to
recognize unfolding disease events and implement containment
measures to prevent further spread of disease.
For many years, CDC has made significant achievements in
building or enabling state and local health agencies to build
information systems that support the practice of public health,
however, many of these systems operate in isolation, not
capitalizing on the potential for a cross fertilization of data
exchange. The Public Health Information Network provides a
framework to better integrate these data streams.
Another tool in development to address the detection of
threats is the recently announced biosurveillance initiative,
which is part of an interagency effort that crosses multiple
sectors including food supply, environmental monitoring and
human health surveillance, and its benefits will be felt in all
state and local health departments. By integrating these
otherwise isolated data sources, potential public health
emergencies can be identified more rapidly.
In conclusion, CDC is committed to working with federal,
state and local partners to protect the Nation's health. Our
best public health strategy against disease is the development,
organization, and enhancement of public health disease
detection systems, tools, and the people needed to wield them.
While we have made substantial progress towards enhancing the
Nation's capability to rapidly detect disease within our
communities, improving our response and containment strategies,
and developing plans to recover from tragic events, much
remains to be done.
CDC is very grateful for the congressional support received
to date and looks forward to continuing to work with Congress
and Members of this committee as we strive to protect the
public's health from terrorism and other public health
emergencies.
Thank you for the opportunity to testify on this most
important topic. At this time I am happy to answer any
questions you may have.
[The prepared statement of Mr. Schable follows:]
Prepared Statement of Charles A. Schable
Good morning, Mr. Chairman and Members of the Committee. I am
Charles A. Schable, M.S., Associate Director for Emergency Response and
Preparedness, National Center for Infectious Diseases (NCID), Centers
for Disease Control and Prevention (CDC), and Director of NCID's
Bioterrorism Preparedness and Response Program. It is a pleasure to
testify before your committee. CDC's mission, as part of the Department
of Health and Human Services, is to protect the health and safety of
the American people through activities that range from terrorism
preparedness and response, to promoting worker safety, to preventing
birth defects and limiting the spread of infectious diseases. The
program I lead provides agency-wide coordination, with CDC's Office of
Terrorism Preparedness and Emergency Response, to prepare our nation
for and rapidly respond to a bioterrorism event anywhere in the United
States. Thank you for the opportunity to join you in Kansas to testify
today about CDC's bioterrorism preparedness efforts.
CDC continues to make vast strides toward achieving optimal
terrorism preparedness and emergency response capacity at the federal,
State, and local levels and is committed to strengthening the capacity
of the public health system to respond to both routine and emergent
health threats. To achieve this imperative, we must continue to prepare
the broader public health infrastructure to respond to a wide range of
public health emergencies. Today, I will address how CDC works with
state and local governments to prepare for a bioterrorist attack,
explain some of the systems and tools used by CDC to detect and respond
to a bioterrorist attack and describe CDC's role in response and
coordination with other state and local health officials, and other
health service providers.
State and Local Readiness
Today, as a result of the more than $3 billion investment Congress
and the Administration devoted over the past three fiscal years, the
front-lines of public health are better prepared to detect terrorism
and deal with its consequences, and there are specific initiatives
underway at CDC and in each state to make America safer.
While much progress has been made strengthening the Nation's
defenses against biological attacks, President Bush instructed his
administration to review its efforts and find new and better ways to
secure America. The result of this review is Biodefense for the 21st
Century, a recently approved presidential directive that builds on our
past accomplishments, specifies roles and responsibilities, and
integrates the programs and efforts of various communities--national
security, public health, law enforcement, etc.--into a sustained and
focused national effort.
In 1999, CDC began a program of providing technical assistance and
funding to state, local and territorial public health departments to
develop capacity to respond to terrorism events and related public
health emergencies. In FY 2002, Congress appropriated a substantial
increase in funding for this preparedness effort, and CDC's state and
local cooperative agreement program has grown rapidly as a result. The
resources provided through this cooperative agreement program support
62 grantees in the development of critical public health preparedness
capacities, including preparedness planning and readiness assessment;
surveillance and epidemiology; biological and chemical laboratory
capacity; communications systems and information technology; health
information dissemination and risk communication; and education and
training.
States and localities have made substantial progress toward
achieving optimal levels of preparedness since the terrorist attacks of
fall 2001. For example, every state has developed an emergency
preparedness and response plan and nearly 90 percent of states have
trained public health practitioners in responding to terrorism. In
addition, every state either has achieved or is moving toward around-
the-clock capacity to send and receive critical health information, and
42 states can transmit information among state and local public health
officials, hospitals, emergency departments, and law enforcement. CDC's
overarching goal in this arena is to have systems in place in each
community that protect citizens from infectious diseases, environmental
threats, and terrorism, and these achievements represent substantial
progress toward that end.
Commensurate with CDC's agency-wide emphasis on rigorous
measurement of programmatic impact, CDC will begin pilot testing
performance indicators in FY 2004 in an effort to better define and
establish a fundamental level of public health preparedness. The data
generated by these standardized indicators will provide a framework for
future cooperative agreement guidance, allow for accurate evaluation of
grantee progress, and enable more targeted technical assistance.
Moreover, these data will make an essential contribution toward
defining what it actually means to be ``prepared'' at the state or
local level. CDC anticipates incorporating the goals, objectives, and
measures of this performance indicators effort into the state and local
cooperative agreement guidance for FY 2005.
CDC's Role in Response
In the event of a bioterrorist attack in the United States, CDC
would provide public health advice to and support the Department of
Health and Human Services in orchestrating the public health response
to the attack. CDC would confirm that a biological agent had been
released, identify the agent, determine how the agent was or is
transmitted, and provide guidance in the development and implementation
of effective control measures. CDC would assist the state and local
health agencies in addition to the efforts described above, by
providing federal resources in support of critical health and medical
efforts, to include medical materiel housed within the Strategic
National Stockpile; deploying public health subject matter experts and
technicians to assist in managing efforts necessary to detect possible
additional bioterrorist attacks; and providing recommendations on
immunization and prophylaxis of the at risk population and guidance and
recommendations for the treatment, isolation or quarantine of infected
individuals. CDC would provide recommendations related to occupational
safety issues for first responders and work on risk communication
issues related to public health.
Systems and Tools
An important element to successful defense against any threat to
the Nation's public health, whether naturally occurring or deliberately
caused, continues to be accurate, early recognition of the problem.
Disease surveillance systems can prepare the Nation for potential
terrorist threats. ``Disease surveillance systems'' or disease
detection systems, address one important aspect of our nation's overall
public health preparedness. CDC, in collaboration with our federal,
State, and local partners is working to build systems that can: (1)
rapidly detect an event in our communities; (2) mobilize the
appropriate response to contain the event, and (3) ensure affected
communities quickly return to a sense of normalcy. These are what we
refer to as our foundations of public health readiness.
National disease detection can best be described as the ongoing
collection, analysis and dissemination of public health data related to
illness and injury. These ongoing data collection and analysis
activities enable public health officials to detect disease early, thus
resulting in faster intervention to control and contain the
consequences created by the causative agents. Without these early
detection systems, the consequences of outbreaks of infectious disease
and human exposures to agents such as chemicals and radiation would
take a much greater toll by way of increased illness, injury, and in
some cases death. Recent events, such as the SARS, monkeypox and avian
influenza outbreaks, have underscored the essential role early
detection systems play in mobilizing rapid response. Detection of a
disease almost always occurs at the local level where health care
professionals encounter patients seeking medical assessment or
treatment. A clinician's ability to quickly recognize and identify
symptoms of unusual illnesses on the front-line has been critical to
the CDC's ability to recognize unfolding disease events and implement
containment measures to prevent further spread of disease, thus
mitigating further harm to the public.
Awareness and diagnosis of a condition by a clinician or laboratory
is a key element of our current disease detection systems. Clinicians
and laboratories report diseases to state and local health departments,
which in turn share information with CDC. CDC works with its public
health partners to define conditions that should be reported
nationally. Health departments share these definitions and guidelines
with health care providers, infection control practitioners, emergency
department physicians, laboratorians, and other members of the health
care system to ensure accurate and timely reporting.
Many local reporters of disease incidence still report to public
health authorities on paper via facsimile. If a case of illness is
particularly unusual or severe (such as a case of anthrax), the local
health care worker may call the local health department immediately to
report the case. Current reporting systems are largely paper-based and
burdensome to both providers and health departments, often resulting in
reports which are neither complete nor timely. In addition to initial
detection, these detection and reporting systems play a pivotal role in
the detection of subsequent cases and help support the management of
the event once a response/investigation are initiated. Such information
is vital to coordinating response decisions, which ultimately lead to
the containment of an outbreak.
A comprehensive detection and reporting system requires a strong
foundation at all levels of local, State, and federal public health
agencies. CDC has been working with state and local health agencies for
many years to build the public health infrastructure to improve disease
detection and reporting systems.
Some examples of how states use their bioterrorism funding include:
Initiating implementation of a secure web-based disease
detection and reporting system to improve the timeliness and
accuracy of disease reporting.
Implementing a new hospital tracking system to detect possible
outbreaks by monitoring the number of patient admissions and
ambulance diversions at hospitals. This system provides a way
for hospitals to obtain instant messages and alerts.
Developing early warning systems based on symptom data from
emergency departments to detect unusual patterns of illness and
automatically alert hospitals and public health agencies when
the incidence of disease exceeds a critical threshold. Use of
such early warning systems might enable the earliest possible
response and intervention before an outbreak or epidemic
spreads.
Other related activities useful for early detection of emerging
infections or other critical biological agents include CDC's Emerging
Infections Programs (EIP). Through the EIP, state and local health
departments receive funds to conduct population-based surveillance that
goes beyond their routine function to develop ``next generation''
surveillance science, and often involves partnerships among public
health agencies and academic medical centers. In addition, CDC has
established networks of clinicians that serve as ``early warning
systems'' for public health by providing information about unusual
cases encountered in the clinical practices. As noted earlier, these
relationships, particularly between health care providers and local
health departments, are the foundation on which disease detection
systems operate.
Public Health Information Network
For many years CDC has made significant achievements in building or
enabling state and local health agencies to build information systems
that support the practice of public health. However, many of these
systems operate in isolation, not capitalizing on the potential for a
cross-fertilization of data exchange. A crosscutting and unifying
framework is needed to better integrate these data streams for early
detection of public health issues and emergencies. The Public Health
Information Network (PHIN) provides this framework. Through defined
data, vocabulary standards and strong collaborative relationships, the
PHIN will enable consistent collection and exchange of response,
health, and disease tracking data among public health partners.
Ensuring the security of this information is critical as is the ability
of the network to work reliably in times of national crisis. PHIN
encompasses four key components: (1) detection and monitoring; (2)
analysis and interpretation; (3) information dissemination and
knowledge management; and (4) public health response. Each of these
components is briefly described below.
Public health information systems must support functions that
include:
Early event detection--BioSense (described later in this
testimony) is being developed to support early event detection
activities associated with a possible bioterrorism threat.
Regional health data will be sent to authorized health
officials detailing health trends that could be related to a
possible bioterrorism attack.
Routine public health surveillance--The National Electronic
Disease Surveillance System (NEDSS) supports routine
surveillance activities associated with the rapid reporting of
disease trends to control outbreaks. The NEDSS platform allows
states to enter, update and electronically transmit demographic
and notifiable disease data.
Secure communications among public health partners--The
Epidemic Information Exchange, or Epi-X, technology allows for
the secure exchange of communications among participating
public health partners via the web by providing up-to-the-
minute information, reports, alerts, and discussions about
terrorist events, toxic exposures, disease outbreaks, and other
public health events.
Management and dissemination of information and knowledge--The
Health Alert Network's architecture upgraded the capacity of
state and local health agencies to communicate different health
threats such as emerging infectious and chronic diseases,
environmental hazards, as well as bioterrorism related threats.
Other functions include--Analysis and interpretation of
relevant public health data and public health response systems.
PHIN will provide the framework for these functions to serve as
part of an integrated and inter-operable network critical in
establishing a more effective public health system.
Since the majority of the data management needs come after disease
is detected, CDC through PHIN is investing in information systems to
support our public health response teams and our Director's Emergency
Operations Center (DEOC) in Atlanta and to assist state and local
health agencies in tracking and managing vital public health
information before, during, and after an event has occurred. CDC's
DEOC, which opened in 2003, serves as the centralized facility for
collaboration to gather and disseminate information to ensure a timely,
coordinated and effective public health response.
Biosurveillance Initiative
Recognizing the need to increase our current disease surveillance
and detection capabilities, the President, on February 3, 2004, issued
Homeland Security Presidential Directive 9 (HSPD-9), which states in
part:
``The Secretary of Homeland Security shall coordinate with the
Secretaries of Agriculture, Health and Human Services, and the
Administrator of the Environmental Protection Agency, and the
heads of other appropriate Federal departments and agencies to
create a new biological threat awareness capacity that will
enhance detection and characterization of an attack.''
CDC's role in this biosurveillance initiative focuses on human
health and involves three distinct but interrelated elements. The first
is BioSense, a state-of-the-art, multi-jurisdictional data sharing
program to facilitate surveillance of unusual patterns or clusters of
disease around the country. This data sharing effort will support early
detection of potential terrorism events while minimizing the reporting
burden for state and local health departments and clinical personnel.
The second element of the initiative centers on the addition and
expansion of quarantine stations at U.S. ports of entry and assigning
multi-disciplinary teams of quarantine officers, public health
advisors, epidemiologists, and information technicians to these sites.
This effort will assure effective monitoring of U.S. and international
regulatory requirements for travelers, rapid communication of disease
intelligence information to federal, State, local and international
partners, and consistent supervision of clinical and research material
movement through ports of entry.
The Laboratory Response Network, which serves as a point of
integration for federal, State, local and territorial laboratories to
ensure rapid and proficient laboratory diagnosis of emerging bioagents
and environmental contaminants, is the third and final component of the
biosurveillance initiative. Additional resources in FY 2005 will allow
the Laboratory Response Network to expand its reach into food safety
and animal diagnostic labs, thereby strengthening the Nation's
laboratory infrastructure for timely and accurate reporting of a
potential bioterrorism attack.
The biosurveillance initiative is part of an interagency effort
that crosses multiple sectors, including food supply, environmental
monitoring, and human health surveillance, and its benefits will be
felt in all state and local health departments. By integrating these
otherwise isolated data sources, potential public health emergencies
that may have gone undetected can be identified more rapidly. Through
the biosurveillance initiative and ongoing capacity-building efforts at
the state and local levels, the FY 2005 budget request will continue to
enhance front-line emergency preparedness.
Conclusion
CDC is committed to working with federal, State, and local partners
to protect the Nation's health. Our best public health strategy against
disease is the development, organization, and enhancement of public
health disease detection systems, tools, and the people needed to wield
them. The astute clinician remains the critical link in disease
detection and reporting. The first case of West Nile in 1999, and the
first case of anthrax reported in early October 2001, were identified
by astute clinicians. Training and education of these front-line health
protectors remain a high priority for CDC and will continue to be a
priority as we strive to improve all components of the Nation's disease
detection systems.
While we have made substantial progress towards enhancing the
Nation's capability to rapidly detect disease within our communities,
improving our response and containment strategies, and developing plans
to recover from tragic events, much remains to be done. CDC is very
grateful for the congressional support received to date and looks
forward to continuing to work with Congress and Members of this
committee as we strive to protect the public's health from terrorism
and other public health emergencies.
Thank you for the opportunity to testify on this most important
topic. At this time I would be happy to answer any questions.
Biography for Charles A. Schable
Mr. Schable is currently the Director of the Bioterrorism
Preparedness & Response Program at the U.S. Department of Health and
Human Services' Centers for Disease Control and Prevention, National
Center for Infectious Diseases. At CDC, Mr. Schable has also served as
Deputy Director (1998-2002), Division of AIDS, STD & TB Laboratory
Research, NCID; Chief (1984-1998), HIV Serology Section, Immunology
Branch, DASTLR, NCID; Chief (1976-1984), Serology Section, Hepatitis
Branch, DVRD, NCID, Phoenix, AZ.; Microbiologist, (1967-1976), Serology
Section, Hepatitis Division, NCID.
Mr. Schable received his B.S. in Microbiology in 1967 and his M.S.
in Microbiology/Immunology (1976) from Arizona State University, Tempe,
AZ. His honors include USPHS Commendation Medal (1986), Outstanding
Unit Citation (1989), Citation (1992), Outstanding Service Medal
(1994), Achievement Medal (1996); CDC Group/Professional Honor Award
(1982, 1994, 1998), American Society for Microbiology Elizabeth O. King
Award (1982).
Mr. Schable is a member of the Commissioned Officers Association,
the American Society for Microbiology, the National Registry of
Microbiologists, and Sigma Xi, National Committee for Clinical
Laboratory Standards. He is the author/co-author of 85 research and
review articles.
Mr. Neugebauer. Thank you, Mr. Schable. What we're going to
do is go through the entire panel and then we will come back in
for individual questions.
Our host, Mr. Samuel Turner.
STATEMENT OF SAMUEL H. TURNER, SR., CHIEF EXECUTIVE OFFICER,
SHAWNEE MISSION MEDICAL CENTER
Mr. Turner. Thank you, Mr. Chairman and Congressman Moore.
There are few things that scare a hospital administrator more
than the threat of bioterrorism. There are issues like staffing
shortages, reimbursement for patient care, capital needs for
aging facilities, the list is endless. However, many of these
issues are within our creative control and can be addressed
through diligent efforts to make change.
The threat of bioterrorism isn't so easily controlled. We
don't know when it will strike. It could be an hour from now or
10 years from now. We don't know in what form it will take
hold. It could be anthrax or smallpox. There's no way to
estimate the scope of the event. It could affect 10 people or
10,000 people. These are the thoughts that challenge us during
the day and keep us up at night.
I am pleased to have the opportunity to share information
with you today about the current situation at Shawnee Mission
Medical Center. We have the largest emergency department in
Johnson County serving nearly 50,000 patients annually. In the
entire State of Kansas, only three other hospitals report as
many visits.
Over the past several years, community demand for services
here has grown steadily, and as a result, we are substantially
expanding our facility. The expansion is desperately needed,
particularly to accommodate the estimated 60,000 emergency room
visits expected by 2007. As part of this effort, we also
believe it is incumbent on us to incorporate features to deal
with the very real issues of bioterrorism in any of its various
forms. We sit along Interstate 35 with a number of both truck
and auto traffic passing by with hazardous materials on a daily
basis. In addition, we are in close proximity to major rail
lines that can pose considerable threats to our region from
either deliberate or accidental causes. It is urgent that the
hospital be prepared for potential chemical accidents, natural
disasters and terrorist attacks.
Due to the projected high costs of our expansion, we will
not be able to incorporate many of the readiness proposals we
feel are needed without federal funding and partnerships. The
cost of incorporating bioterrorism readiness into the proposed
expansion is estimated to be at least a third of the emergency
department expansion costs. There are a number of design
modifications and requirements we feel are necessary to deal
with requirements of contamination mitigation or mass casualty
treatment that we would like to incorporate into the new
facility.
For instance, to plan for a more secure environment, we
need a long access road to allow hospital officials to detect
incoming threats. We need separate ambulance and walk-in
entrances so if one has to be shut down due to a biothreat, the
other entrances can be still usable. In addition, design and
equipment modifications must be incorporated into the air
handling mechanical systems to isolate the different air flows
so as not to contaminate the entire emergency department and/or
the hospital. We need to be prepared to stand alone for 48 to
72 hours. This includes vaccinations, antibiotics, chemical
antidotes, personal protective equipment and supplies.
Emergency department associates must be trained to handle
bioterrorism response and hazmat.
There are also needs for space and equipment to perform
triage, decontamination, mass vaccination and a temporary
mortuary. Development needs to occur to make the equipment that
is available on the market applicable to the health care
environment.
For years, the Kansas City metropolitan area has been
performing city-wide disaster drills; however, guidelines and
best practice recommendations from the Federal Government are
needed to ensure efficiency and that all communities are as
prepared as they can be. We have put countless resources into
upgrading our preparation, but a wide gap still exists.
In 2002, software was made available at no cost to local
hospitals that already operated Cerner lab information systems.
The HealthSentry tracking tool gets information from the
existing systems without extra technical work and cost. Most
importantly, health department officials are able to see the
data two to three days earlier than they would without this
technology.
The data made available through this system could be one of
the first signals that a bioterrorism event has occurred.
Through automated systems like this and the constant vigilance
of our front line providers, trends can be identified and more
appropriately responded to in order to minimize the potential
loss of human life.
According to Solucient, the leading source of health care
business intelligence, the median profitability for community
hospitals like Shawnee Mission Medical Center is only 3.64
percent. Although here at Shawnee Mission we reinvest all
profit back into the hospital for the benefit of the community,
there simply isn't enough money to make all of the needed
improvements and preparations while maintaining a financially
viable organization.
Nationally, hospitals are being asked to improve overall
quality, including reducing clinical errors and infection
rates. The solutions that are in place to help with this effort
come at no small price. For instance, we are currently in the
process of implementing a comprehensive clinical informatics
system that will launch next year at a cost of $4.5 million.
Clearly, in this time of real threats, we must be prepared for
possible attack.
We firmly believe that our new facility could greatly
assist in overall emergency preparedness for our area by
designing the emergency department to provide the space,
equipment and trained personnel that are needed to ensure that
our first responders have been given every opportunity to save
precious lives.
I'll defer the rest of my statement for further questions.
I see I've run out of time.
[The prepared statement of Mr. Turner follows:]
Prepared Statement of Samuel H. Turner, Sr.
INTRODUCTION
There are few things that scare a hospital administrator more than
the threat of bioterrorism. There are issues like staffing shortages,
reimbursement for patient care, capital needs for aging and undersized
facilities, specialty hospitals. . .the list is endless. However, many
of these issues are within our creative control and can be addressed
through consistent and diligent efforts to make change. The threat of
bioterrorism isn't so easily controlled. We don't know when it will
strike. It could be an hour from now or 10 years from now. We don't
know in what form it will take hold. It could be anthrax or smallpox. .
.or any other number of destructive agents. There's no way to estimate
the scope of the event. It could affect 10 people or 10,000 people.
These are the thoughts that challenge us during the day and keep us up
at night.
THE SITUATION
I am pleased to have the opportunity to share information with you
about the current situation at Shawnee Mission Medical Center. To give
you some perspective, Shawnee Mission Medical Center is located in a
southwestern suburb of the Kansas City metropolitan area. There are
roughly three million people in the metropolitan area with about one
million in Shawnee Mission Medical Center's primary service area. We
have the largest emergency department in Johnson County serving nearly
50,000 patients annually. It is the third-busiest emergency department
in the entire metropolitan area behind only two designated Trauma
Centers that are located on the Missouri side of the metropolitan area
(Truman Medical Center and North Kansas City Hospital). In the entire
state of Kansas, only hospitals in Topeka and Wichita record as many
visits as Shawnee Mission Medical Center. This volume is particularly
impressive when taking into consideration that the current Emergency
Department is one-third the size recommended by current planning
standards to accommodate this volume.
Over the past several years, community demand for services at
Shawnee Mission Medical Center has grown steadily and as a result, the
hospital is substantially expanding its facility. The mission of this
expansion project is to create a state-of-the-art medical services
destination point in an optimal environment for healing and whole-
person health. Improving the patient experience and provider workflow
is being integrated in every aspect of design along with the concepts
of adaptability and continual collaboration. The new Emergency
Department will feature a hub-like triage station that is surrounded by
disease specific treatment pods and decentralized waiting areas. It is
our desire to implement a number of bioterrorism readiness features
into this expansion.
CURRENT FACILITY CHALLENGES & FUTURE SOLUTIONS
In 2002 and 2003, Shawnee Mission Medical Center was forced to go
on diversion for 60 and 40 days respectively. Diversion means that the
hospital cannot accept any additional ambulance traffic. All
operational efficiencies have been investigated and implemented. The
best hope is to maintain the 2003 diversion days and not increase days
on diversion. The lack of an adequate number of telemetry beds
contributes greatly to this forced diversion. Currently less than 30
percent of the Medical-Surgical beds have monitoring capability.
Without this $84.2 million expansion, there will continue to be times
when we cannot meet the community need for our services, particularly
emergency services. And in the case of a disaster situation, we would
be even less able to accommodate the community's needs without this
expansion in its entirety.
The expansion is desperately needed, particularly to accommodate
the estimated 60,000 visits by 2007. As a part of this effort, we also
believe it is incumbent on us to incorporate features to deal with the
very real issues of bioterrorism in any of its various forms (i.e.,
biochemical or biological). Shawnee Mission Medical Center sits along
Interstate 35 with a number of both truck and auto traffic passing by
with hazardous materials on a daily basis. In addition, we are also in
close proximity to major rail lines that can pose considerable threats
to our region from either deliberate or accidental causes. It is urgent
that the hospital be prepared for potential chemical accidents, natural
disasters and potential terrorist attacks.
Due to the projected high costs of our expansion, we will not be
able to incorporate many of the readiness proposals we feel are needed
without federal funding and federal partnerships. The cost of
incorporating bioterrorism readiness into the proposed expansion is
estimated to be $4.5 million of the entire $12 million Emergency
Department expansion. The following information outlines a number of
design modifications and requirements we feel are necessary to deal
with the requirements of contamination mitigation or mass casualty
treatment that we would like to incorporate into the new facility.
Security
-- Long access road to allow hospital officials to detect
incoming threat
-- Dedicated security vestibule with metal detectors and
security guard station
Bioterrorism Readiness
-- The Emergency Department must be built next to a flat
parking area that can allow for rapid expansion of the
facility. If a bioterrorism threat is detected, the hospital
can accommodate First Responder/National Guard/Emergency
Services personnel to quickly locate temporary treatment units
next to the hospital. The design will allow us to quickly turn
our parking areas into extra treatment areas for mass
casualties.
-- Separate ambulance and walk-in entrances must be built. If
one entrance has to be shut down due to a bio-threat, the other
entrance can still be useable.
-- A treatment pod system must be incorporated into the design
to allow for flexibility and containment of an infectious agent
that would not necessarily force us to shut down the entire
Emergency Department. In other words, a contaminated patient
will be able to enter from the outside into an isolated room
that provides privacy for decontamination. After becoming
decontaminated, the patient will then be able to directly enter
the Emergency Department. In addition, design and equipment
modifications must be incorporated into the air handling
mechanical systems to isolate the different airflows so as to
not contaminate the entire Emergency Department and/or
hospital.
-- A triage area made up of a large area and treatment rooms
needs to be positioned adjacent to the Emergency Department to
rapidly distinguish medical cases.
--
* The Emergency Department should occupy the first floor and have
the capability to completely contain itself and be under lockdown from
the rest of the hospital if needed.
-- The various medical technology labs must be located in
close proximity and within the containment space.
-- The patient areas must be directly above the Emergency
Department for easy access for other hospital personnel in case
of terrorism events.
-- Dedicated security stations, including screening stations
and restricted access areas must also be incorporated into the
design and construction.
ADDITIONAL PREPAREDNESS NEEDS
Infection Control Concerns
Infection Control specialists, although always important, have
become indispensable in the post-9/11 environment. These experts fully
understand the impact of bioterorism threats and how quickly, if
implemented, they could have a significant impact on our society.
Following are some of the concerns of Infection Control staff and the
needs that exist to be as fully prepared as possible for possible
attack.
Resist contamination of the hospital environment by
staging triage of incoming suspect patients at a point outside
of the hospital.
Mechanical/equipment resources are needed
(ventilators, negative air flow rooms, masks, gloves, and
gowns) which could take 24 to 48 hours to access, and may
deplete vendor supplies in a short period of time.
Prophylaxis of healthy individuals coming to the
hospital must be carried out away from contaminated areas, but
will require staffing.
Trained Infection Control personnel to monitor
wearing of Personal Protective Equipment (PPE) and placement of
patients in negative air isolation rooms. SMMC currently has 14
isolation rooms.
Educating staff about the signs and symptoms of
bioterrorism agents must be ongoing. Additional staffing and
educational funding is needed for this purpose.
Communication among hospitals, health departments and
emergency personnel must be standardized so that the same
definitions and control techniques are put into place. With
standardization, help from staff can be distributed where it is
needed and at any facility. Ideally, this would come from the
federal level so that if help is needed, anyone from around the
country could be called in to help.
Emergency Planning Integration
There has been a citywide initiative to coordinate efforts for
emergency preparedness and these efforts have served the city well.
There needs to be continued planning integration between our hospital
and other community resources to ensure that the community will be
adequately served in a time of need. Good guidelines and best practice
recommendations from the Federal Government are needed to ensure
efficiency and that all communities are as prepared as they can be.
Locally, there have been great strides in this area and an EMS system
supports hospital coordination. However, not every hospital has access
to the Hospital Emergency Administrative Radio system due to cost
constraints, so again our ability to be most effective for our
community is jeopardized due to lack of funding.
Self-Sustaining Protection
Funding is needed to allow Shawnee Mission Medical Center to stand-
alone for 48-72 hours before help arrives. This includes vaccinations,
antibiotics, chemical antidotes, personal protective equipment and
supplies.
Additional Space and Equipment Needs
Although we feel that we are addressing many of the space needs in
our expansion planning, there are additional needs for space and
equipment to perform triage, decontamination, mass vaccination and a
temporary mortuary. In addition, the current personal protective
equipment is either not protective enough or so cumbersome it inhibits
our provider's ability to provide care to patients. Development needs
to occur to make the equipment that is available on the market
applicable to the health care environment.
The Best Laid Plans
The best laid plans are just that without trained personnel to
carry out the actions. Additional funding is needed for training
Emergency Department associates including bioterrorism response and
Hazmat.
Increased Security
Shawnee Mission Medical Center has increased its security efforts
since 9/11, but there is so much that is still at risk. Funding is
needed to improve access control and security for prevention through
increased surveillance and tighter access and preparedness for a
response to a terrorist attack.
PRACTICE, PRACTICE, PRACTICE
For years the Kansas City metropolitan area has been performing
city-wide disaster drills. Only a couple days before the drill and in
the midst of our preparation for the drill in 2001, we all sat in shock
at the horror we were seeing on television the morning of September 11.
Since that time, the drills have taken on a whole new meaning and there
is a greater sense of reality. We have put countless resources into
upgrading our preparation, but a wide gap still exists. We have
upgraded our emergency preparedness manual to include bioterrorism. We
have changed our Medical Staff bylaws to give temporary status to
physicians in a disaster situation. We have created a large notebook
that is utilized in the lab so they can be vigilant in their efforts to
swiftly identify any trends as they are occurring. Unfortunately, our
day-to-day operations limit our preparation. There are several hundred
patients who need the attention of our caregivers on a daily basis. The
``what ifs'' are endless and it is almost overwhelming to think about
all that needs to be done and know that there is no way with our
current financial resources to accomplish all that we want to.
In addition to the citywide disaster drills, we also conduct
periodic table top drills. Before and after all drills, citywide or
tabletop, we conduct preparation meetings and then following the drill,
critique our performance. Everyone involved in the drills are included
in the critique, not just Shawnee Mission Medical Center associates.
The Merriam Fire Department noticed that our incident command process
needed some improvement and offered to conduct a training session. This
type of cooperation has contributed greatly to the improvements our
hospital and other community resources have been able to make.
In addition to the drills, there are periodic ``live'' situations
that help us think through our preparedness for something bigger. In
the past two years, we have had a severe ice storm that left us without
our normal power supplies and there was a major water main break that
left us without running water supplies. Although we were pleased with
our overall preparedness for these situations, there are things we have
been able to tweak in the plans that will be valuable for similar
situations or even more severe ones. In addition, last fall there was a
local outbreak of cryptosporidiosis that gave an opportunity for the
state to communicate an outbreak and keep everyone abreast of the
situation. Because of the media coverage, we encountered a large number
of patients coming to the Emergency Department for fear of having this
parasite. There were some confirmed cases, but many others were not.
This gave both the lab and the providers in the Emergency Department an
opportunity to be aware of possible patients with a condition.
We believe that we are virtually as prepared as we can be with our
current resources, but the limitations we are aware of and do not have
the ability to overcome are terribly concerning. Our constraints are
not vastly different than other hospitals in the area, the region or
the country. We all are faced with many of the same challenges and it
is clear that federal assistance is needed to address these issues for
the good of our country.
THE COMPETITION FOR CAPITAL
According to Solucient, a the leading source of health care
business intelligence, the median profitability for community hospitals
like Shawnee Mission Medical Center is 3.64%. Although Shawnee Mission
Medical Center reinvests all of its profit back into the hospital for
the benefit of the community, there simply isn't enough money to make
all of the needed improvements and preparations while maintaining a
financially viable organization.
Nationally, hospitals are being asked to improve overall quality
including reducing clinical errors and infection rates. The solutions
that are in place to help with this effort come at no small price. In
2005, Shawnee Mission Medical Center will be installing a comprehensive
clinical informatics system. Utilizing this system, Shawnee Mission
Medical Center will be able to gather a wide variety of clinical and
financial data. This will provide a solid data baseline in which to
compare with after the project is completed in 2008. This state-of-the-
art system will provide the opportunity to allow health care providers
more time at the patient's bedside and less time locating and
maintaining paper records. In addition, Shawnee Mission Medical Center
will be able to deliver enhanced care more quickly with this system in
case of a disaster. This system is expected to cost the medical center
approximately $4.5 million.
SILENT PROTECTION
If only there were more safeguards in place that like that of
HealthSentry. In 2002, the Cerner Corporation launched a software
application as a pilot program in the Kansas City area. Cerner
estimated that the startup investment over a five-year development and
rollout period would cost approximately $2 million. This software was
made available to the local hospitals that already operated Cerner lab
information systems at no cost, however. The HealthSentry tracking tool
gets information from the existing systems without extra technical work
and cost. The program automatically operates in the background and is
monitored and maintained through connections to Cerner's data center. A
data file of each provider's lab information is sent daily through a
secure network with encryption processes to protect patient identity to
Cerner. After the file arrives at Cerner, the data are analyzed and
released in a series of reports and regional maps that are made
available to the health department the next morning. Less than a day
later, public health officials can log onto a secure web site to view
which diseases were reported in the field. Health department officials
have reported that through this system, they are receiving information
2-3 days earlier than without this technology.
The data made available through this system could be one of the
first signals that a bioterrorism event has occurred. Through automated
systems like this and the constant vigilance of our front-line
providers, trends can be identified and more appropriately responded to
in order to minimize the potential loss of human life.
IN SUMMARY
Clearly in this time of real threats we must be prepared for
possible attack. We firmly believe that our new facility could greatly
assist in the overall emergency preparedness for our area. Again, due
to the location of the hospital, our Emergency Department sees
significant volume and is strategically located to provide community
support in the event of a terrorist attack. Therefore, we must design
the Emergency Department to provide the space, equipment and trained
personnel that are needed to ensure that our first responders have been
given every opportunity to save precious lives. However, we know that
we cannot do this alone. We will continue to make our best efforts to
prepare our facility, physicians, nurses and staff to the best of our
ability. We will continue to work proactively with other local health
care providers and emergency services providers to ensure the most
coordinated effort should an incident occur. And we will continue to
ask for the Federal Government's support in these efforts. The
residents of our community, and others across the Nation, deserve
nothing less.
Biography for Samuel H. Turner, Sr.
Samuel H. Turner, Sr., presently serves as President and Chief
Executive Officer of Shawnee Mission Medical Center. Mr. Turner has
nearly 20 years experience in the industry having served as a health
care consultant as well as a hospital executive.
His career began with a position as General Attorney at Aluminum
Company of America in Pittsburgh, Pa. After eight years in that
position, he decided to enter the health care arena. Mr. Turner became
the General Vice President at Hyde Park Hospital in Chicago, Ill.
Within several years, he was recruited to be a Senior Vice President
and Chief Operating Officer at Lakeshore Health System, Inc., in East
Chicago, Ind. In 1993, Mr. Turner became President and Chief Executive
Officer at St. Vincent Charity Hospital in Cleveland, Ohio. From there,
he entered private law practice offering consulting for physicians and
hospitals. Mr. Turner also started his own company, Custom Title and
Settlement, Inc., during that time. He joined Shawnee Mission Medical
Center in 2000.
Mr. Turner received his Bachelor's degree from Tennessee State
University in 1974, and three years later earned a law degree from
Vanderbilt University School of Law. Mr. Turner served in the United
States Army from 1969-1971 and received a Bronze Star for Valor and a
Bronze Star for Merit during his tour in Vietnam.
Mr. Turner is active in the community serving on various boards
including the American Heart Association, Boys & Girls Club of Eastern
Jackson County, Midwest Bioethics Center, the Johnson County Community
College Foundation, Country Club Bank, Shawnee Area Chamber of
Commerce, United Way of Johnson County and Kansas City's public
television station KCPT.
He is also a member of the Overland Park Rotary Club and the
Northeast Johnson County Chapter of NAACP.
He and his wife, Sharon, reside in Leawood, Kansas.
Mr. Neugebauer. Thank you, Mr. Turner.
Mr. Richard Morrissey.
STATEMENT OF RICHARD MORRISSEY, INTERIM DIRECTOR, DIVISION OF
HEALTH, KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT
Mr. Morrissey. Thank you, Mr. Chairman and Congressman
Moore for this opportunity to testify on bioterrorism
preparedness and response from the state perspective. I'm Dick
Morrissey and I currently serve as the Interim Director of the
Division of Health for KDHE and in that role I'm also the
Executive Director of the State's Bioterrorism Program.
The current operating budget for the Kansas program is
approximately $17 million. KDHE has worked closely with the
associated local health departments and Kansas Hospital
Association to develop and implement the State's program and
plan of work related to public health and hospital
preparedness. $6,125,000 for public health funding is being
directly distributed to local health departments in the current
fiscal year to support their implementation of the state work
plan. And $4 million is allocated directly to community
hospitals for that purpose.
The Hospital Bioterrorism Program required regional
planning to provide a minimum level of surge capacity. For that
purpose, the program adopted the same regions used for the
State Trauma Program and used by the Kansas Hospital
Association for those purposes. The Public Health Bioterrorism
Program, on the other hand, did not have a requirement for
regional planning and development, but the large number of
small health departments in the State necessitated an approach
that would foster shared planning and a mechanism for sharing
resources locally.
Approximately $800,000 was made available in incentive
grants to local health departments that participated in a
regional collaboration. To date, 104 of 105 counties have
chosen to participate in one of 15 regional groupings that they
developed. The hallmarks of this process were that it was
voluntary and it was bottom up. Local health departments
decided the regions that they would participate with.
Kansas is focused on technology in the bioterrorism program
in really three separate areas. The first was the development
of an automated disease reporting system called HAWK. At the
present time, 36 counties containing approximately 90 percent
of the Kansas population now submit information regarding their
cases of reportable disease through HAWK, which is a secure
web-based disease reporting system. About 90 percent of all
case reports from local health departments are received via the
system.
The Public Health Information Exchange or PHIX, was
developed with bioterrorism funding as part of the National
Health Alert Network. That system provides a secure web and
pager based two-way communication medium for exchange of alert
messaging among public health, hospital and laboratory
officials as well as partners in law enforcement, military,
emergency management and so forth. Local health departments
serving all 105 Kansas counties and more than 90 percent of the
State's community hospitals participate in PHIX.
The State Public Health Laboratory has been upgraded to a
biosafety level 3 and can now return confirmatory testing
results on biological agents more safely, securely and rapidly.
With the second year of federal funding, the focus in the
laboratory has shifted to chemical agents in focus area D and
we are now in the process of upgrading the laboratory for
testing of chemical agents.
In the area of coordination, Governor Kathleen Sebelius has
focused on coordinating Homeland Security efforts in the State
since first taking office in January of 2003. In June of 2003,
she created the Governor's Homeland Security Council, charged
with coordinating policy for Homeland Security efforts and
assuring that Homeland Security funds are being used to maximum
effect. The Governor's objectives are to coordinate existing
and federally required agencies and advisory groups, to reduce
duplication, and to work toward assuring the highest possible
level of preparedness and response capability at both the state
and community levels.
Finally, funding for restoring public health and hospital
capacity has long been needed. The neglect of many years has
not been corrected with two years of funding. We have public
health departments and hospitals still working to develop the
capability to respond to disasters and to meet the surge
capacity requirements.
We are grateful for the significant federal support you
have provided, but it is critical that funding continue in
order to further develop and sustain the local public health
and hospital infrastructure.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Morrissey follows:]
Prepared Statement of Richard J. Morrissey
Bioterrorism and First Responders: How Can Biosurveillance Technologies
Help Front-line Public Health Facilities and First Responders?
Introduction
Thank you Chairman Neugebauer and Representative Moore for this
opportunity to testify on ``Bioterrorism and First Responders: How Can
Biosurveillance Technologies Help Front-line Public Health Facilities
and First Responders.'' My name is Richard Morrissey. I serve as
Interim Director of the Division of Health for the Kansas Department of
Health and Environment (KDHE). I also serve as the Executive Director
of the Kansas Bioterrorism Program.
Background
The current operating budget for the Kansas Bioterrorism Program is
approximately $17.1 million, which is received from the federal
Department of Health and Human Services in two separate grant awards.
The first bioterrorism grant received by KDHE was the Public Health
Preparedness and Response to Bioterrorism Cooperative Agreement,
administered at the federal level by the Centers for Disease Control
and Prevention (CDC). KDHE has received funds under the CDC program
since it began in 1999. Between 1999 and 2001, Kansas received
approximately $850,000 per year to meet state public health
bioterrorism needs. In 2002, a total of $12.3 million was awarded to
Kansas and another $12 million in 2003.
The second federal bioterrorism grant administered by the Kansas
Bioterrorism Program is administered at the federal level by the Health
Resources and Services Administration (HRSA). Kansas was awarded $1.3
million for FFY 2002 and $5.1 million for FFY 2003 under this program.
KDHE has worked very closely with the Kansas Association of Local
Health Departments and Kansas Hospital Association to develop and
implement the Kansas Bioterrorism Program's plan of work related to
public health and hospital preparedness. In 2002, $5,350,000 in grant
funds was provided directly to local health departments throughout
Kansas. An additional $6,125,000 is being directly distributed to the
local health departments in the current federal fiscal year to support
their implementation of the work plan related to the federal focus
areas. Attachment A summarizes the activities for each of the seven
focus areas in the CDC grant, and shows the allocation of grant funds
for Federal Fiscal Years 2002 and 2003.
In FFY 2002, the Kansas Bioterrorism Program provided $945,000
directly to the state's six hospital regions and in FFY 2003,
$4,000,000 is being provided directly to hospitals and other providers
for implementation steps to improve surge capacity. Attachment B
summarizes the planned activity by established federal priority areas.
Program Highlights:
A statewide bioterrorism plan has been established
and all local health departments have submitted local
bioterrorism preparedness and response plans, including a
smallpox annex. State and local response plans were tested and
evaluated during six regional exercises in October 2003.
The smallpox vaccination program implemented during
fiscal year 2002 has resulted in the creation of 46 smallpox
response teams in 23 counties. Development and training of
these teams will be ongoing, with planning and development of
additional response teams occurring at the local level.
Training on smallpox vaccination has been conducted at six
locations throughout Kansas using a live satellite uplink at
the Bob Dole Media Center at Kansas State University. Pre-event
vaccination of public health and health care response team
members continues while the program's focus shifts toward post-
event smallpox planning.
Thirty-six counties (containing approximately 90
percent of the Kansas population) now submit information
regarding their cases of reportable disease through HAWK, a
secure, Web-based disease surveillance reporting system. About
90 percent of all case reports from local health departments
are received via the HAWK system.
The Public Health Information exchange (PHIX), was
developed with bioterrorism funding as part of the Health Alert
Network (HAN). The system provides a secure, web and pager
based two-way communication medium for exchange of alert
messaging among public health, hospital and laboratory
officials, as well as partners in law enforcement, military,
and emergency managers. Local health departments serving all
105 Kansas counties and more than 90 percent of the state's
community hospitals participate in PHIX.
The state public health laboratory has been upgraded
and can now return confirmatory testing results on possible
biological agents much more safely, securely and rapidly. These
upgrades are direct outcomes of Bioterrorism Program funding.
The laboratory is currently implementing similar upgrades to
establish capacity for testing of chemical agents.
A toll-free telephone hotline has been established
for 24/7 disease reporting. A phone bank of volunteer staff has
been recruited and trained to respond to calls from the public
during widespread outbreaks.
High-speed Internet connections are being provided to
one third of the county health departments through the Health
Alert Network (HAN) and funded by the Bioterrorism Program
grant. All 105 Kansas counties participate in HAN.
In October 2003, ``Oktoberfest: An Exercise in
Terror!'' a regional bioterrorism exercise was conducted in
each of the six hospital regions. Individuals from hospitals,
public health departments, law enforcement, fire service,
emergency management officials from each county and several
state and federal officials participated. The two-day exercise,
which included instruction on incident command and posed both
chemical and biological scenarios was well attended, including
112 of 128 Kansas community hospitals. A total of 1,035
individuals participated in the exercise.
Through regional hospital planning meetings, the lack
of facilities in Kansas hospitals for patients requiring
airborne isolation was recognized as the greatest need. Funds
distributed to the regions were used to purchase portable
equipment that allows Kansas to boast the availability of at
least one airborne isolation room in each community hospital.
This equipment will also be used to increase the state's
ability to properly care for patients with tuberculosis and
other infectious respiratory diseases.
Focus on Regional Planning and Development
The Hospital Bioterrorism Program required planning on a regional
basis to provide a minimum level of surge capacity. The program adopted
the same regions used for the State Trauma Program and by the Kansas
Hospital Association for this purpose. Attachment C displays the six
regions. Each of these regions developed a plan during the first year
and is coordinating implementation activities during the current year.
The Public Health Bioterrorism Program did not have a requirement
for regional planning and development, but the large number of small
health departments in the state necessitated an approach that would
foster shared planning and a mechanism for sharing resources.
Approximately $800,000 was made available in incentive grants to local
health departments that participated in a regional collaboration. To
date, 104 of 105 counties have chosen to participate in one of 15
regional groupings that they developed. Hallmarks of this process were
that it was voluntary and bottom up. Regional structures are
contractual arms of local health departments that maintain the
responsibility and authority of local health officers and county
commissions. Attachment D displays the 15 local health department
regions.
Federal, State, Local Partnerships
Partnerships have built the foundation for a successful,
coordinated Bioterrorism Program in Kansas. As mentioned above, KDHE
works hand-in-hand with the Kansas Association of Local Health
Departments and Kansas Hospital Association in developing and
implementing the CDC and HRSA Cooperative Agreements. Program
priorities are developed collaboratively and implemented locally,
regionally, and at the state level to assure a consistent approach at
Bioterrorism planning and preparedness. Additionally, KDHE has built a
very solid working relationship with the Kansas Division of Emergency
Management (KDEM) and Kansas Highway Patrol (KHP), the two lead state
partners in relationship to terrorism planning and preparedness. The
KHP is the State Administrative Agency for the Office of Domestic
Preparedness (ODP) grant program, while KDEM manages all Federal
Emergency Management Association (FEMA) funds in Kansas. Through this
ongoing collaboration, funds disbursement at the local level is
coordinated to assure non-duplication of effort and integration of
resources to build our state's capacity to protect Kansans from
terrorism and other emergency situations.
Our direct federal partners are the Hospital Bioterrorism
Preparedness Program in the Health Resources and Services
Administration and the Public Health Preparedness and Response to
Bioterrorism Program at the Centers for Disease Control and Prevention.
Both of these programs have struggled to meet the great demands of
getting these programs organized and have provided us with strong
support and technical assistance. In doing so, they have to overcome
the inherent fragmentation involved in the multiple federal programs
providing support and guidance to the overall response to terrorism.
Early Detection Systems
KDHE's Bioterrorism Program considers development and expansion of
epidemiologic and surveillance capacity at all levels among its highest
priorities. Funding support for HAWK, a secure, Web-based disease
surveillance reporting system, has allowed for further system
development and an expansion of the user base over the past two years.
Thirty-six counties (containing approximately 90 percent of the Kansas
population) now submit information regarding their cases of reportable
disease through HAWK, a secure, Web-based disease surveillance
reporting system. About 90 percent of all case reports from local
health departments are received via the HAWK system. In addition,
funding is provided to local health departments to further develop
their own surveillance capacity, with ongoing training on epidemiology
and other surveillance issues provided by the state.
KDHE has placed renewed priority on recruiting and retaining an
expanded staff of physicians, other health officers, and experienced
epidemiologists to enhance our communicable disease management and
bioterrorism detection capacity. Additionally, a team of seven Medical
Investigators is being developed to provide regional epidemiology and
surveillance support to local health departments across the state.
These staff members will be the lead on our regional rapid response
teams and will work with local health care professionals to manage
outbreak situations. At the same time, local health departments are
using bioterrorism funding to develop their capacity to support
statewide surveillance and communicable disease control efforts,
working within their newly established bioterrorism regions.
Kansas has not elected to invest bioterrorism funding in the
development of new technologies for syndromic surveillance, but we have
closely monitored those activities in other parts of the country. KDHE
staff has been directly involved in the discussion at national levels
about the usefulness of biosurveillance monitoring systems. While some
of these systems look promising, their role in public health
surveillance remains unclear, particularly in a predominantly rural
state like Kansas. Important aspects (such as the presence of
appropriate response plans when the system detects a potential
abnormality) need to be addressed before such systems can be deployed
on a large scale. Most importantly, the conditions under which these
systems can be useful to assist in the detection of and response to a
bioterrorism event or another public health emergency still need to be
clearly understood and demonstrated. We do envision the opportunity in
the future to participate in or implement systems that have been
demonstrated effective in development efforts funded in other states.
Integration & Collaboration
As noted earlier, KDHE works closely with Kansas Highway Patrol
(KHP) and Kansas Division of Emergency Management (KDEM) to assure
integration and collaboration at all levels for terrorism preparedness
planning in Kansas. KDHE's Director of Health serves as the Executive
Director for Bioterrorism in Kansas, and represents the agency on the
Governor's Bioterrorism Coordinating Council, Governor's Homeland
Security Council, and Commission for Emergency Preparedness and
Response. Through these avenues, KDHE has an opportunity to link with
all members of the emergency preparedness and response community,
including health care/mental health, law enforcement, fire, emergency
management, elected officials, advocacy groups, and others.
KDHE's Bioterrorism Program Director serves along with the KHP's
ODP Administrative Lead and KDEM's Administrator on a working committee
to coordinate all terrorism-related activities funded by ODP, FEMA,
CDC, and HRSA. This threesome meets weekly to discuss ongoing projects
and issues, and to develop new and innovative methods of collaboration.
Additionally, they facilitate communication between the cabinet-level
representatives of their respective agencies related to policy making
and consensus building.
Governor Kathleen Sebelius has focused on coordinating Homeland
Security efforts in the state since first taking office in January of
2003. In June of 2003, she created the Governor's Homeland Security
Council, charged with coordinating policy for Homeland Security efforts
and assuring that Homeland Security funds are being used for maximum
effect. The Homeland Security Council includes representatives of all
the involved state agencies as well as representatives of the Kansas
Association of Counties and the League of Municipalities. The
Governor's objectives are to coordinate existing and federally required
advisory groups, to reduce duplication, and to work toward assuring the
highest possible level of preparedness and response capability at both
the state and community level. Attachment E displays the Homeland
Security organization for the state.
Federal Assistance
We have appreciated the funding and technical assistance received
thus far from the federal bioterrorism programs. We have also worked,
as noted above, to coordinate the program efforts with those of our
sister Homeland Security agencies in the state. For example, we have
allocated Office of Domestic Preparedness funding to support an
integrated system of exercises that will support the needs of health
agencies, emergency preparedness agencies, and first responders across
the state. While the challenges to coordinating these programs at the
federal level have been formidable, all that can be done to facilitate
future coordination of federal guidance and policy can only enhance the
ability to collaborate effectively at the state and local levels.
Funding for restoring public health and hospital capacity has long
been needed; the neglect of many years has not been corrected with two
years of funding. We are grateful for the significant federal support
you have provided, but it is critical that funding continue in order to
further develop and sustain the local public health infrastructure.
Accountability is a shared concern and we have worked to build into
our programs, assessment and evaluation measures that monitor our
progress against specified grant expectations and requirements. If
there are to be other performance measures established at the federal
level, it is critical that state and local officials have the
opportunity to participate in the process of their development. To the
extent that federal policy expectations are articulated across Homeland
Security programs, it will enhance the process of setting functional
performance expectations.
Conclusion
The Kansas Bioterrorism Program continues to improve the capacity,
at both the state and local level, to prepare for and respond to public
health emergencies. Coordination and collaboration with partner
organizations and federal funding agencies will remain a priority, and
is required for continued progress toward our share goals.
Thank you for the opportunity to provide testimony on this critical
issue for the Nation.
Attachment B
HRSA Bioterrorism Hospital Cooperative Agreement
Priority Area
1. Administration
Full-time staff in the Hospital Bioterrorism Program include a
program manager, who has experience in local Kansas hospitals, and a
program assistant with expertise in chemical emergency management.
Additionally a contract pharmacist, shared with the public health
bioterrorism program will be hired this year as will a new medical
director. Technical assistance is provided to the program through a
contract with the Kansas Hospital Education and Research Foundation.
2. Regional Surge Capacity
In 2002 the six hospital regions prepared a regional hospital
bioterrorism plan which included plans for the care of 500 additional
acutely ill patients in the region. The plans included methods to
acquire more space to care for patients, methods and resource lists for
transportation of patients both within and outside the region. In 2003
the regions will continue the planning process and the revised plans
will address protocols for triage of patients relative to available
resources, including patients with infectious diseases and placement
and transportation of patients with diseases requiring airborne
isolation. Assessment of both intra- and interstate personnel
credentialing problems will also be a part of the plan.
During 2003, grants of $25,000 are being provided to community
hospitals to purchase personal protective equipment to be used during
chemical, radiological and biological emergencies. Additionally
facilities are using these funds to purchase systems for
decontamination, medical supplies, education, training, and terrorism
related exercises. Once facilities make these personal protective
equipment purchases, employees in Kansas hospitals will be afforded the
minimum level of protection in case of a chemical emergency.
3. Emergency Medical Services
This priority was not directly addressed in FFY 2002. In the
current year, planning for EMS needs will be initiated. An assessment
of the current capabilities of EMS agencies with regard to pediatric
trauma and life support equipment and training will be undertaken.
Priorities for purchase of equipment will be established and as
available implementation funds targeted for FFY 2004. Each hospital
planning region will establish a medical triage subcommittee as a part
of its planning structure to address EMS and triage issues which could
arise as a result of a large surge of patients. This subcommittee will
be responsible for establishing triage, patient transfer, and admission
guidelines for patients needing hospital services. These guidelines
will be prepared in cooperation with the State Trauma Planning regions
and local medical care providers.
4. Links to Public Health Departments
Development of a sentinel network of health care providers who
would assist KDHE in collection of syndromic surveillance data is an
integral part of the hospital linkage to local health departments.
Establishment of a sentinel network composed of a variety of health
care provider types including hospitals, health departments, and
federally qualified health centers is a task currently underway.
Hospital bioterrorism program staff are currently assisting the Bureau
of Epidemiology and Disease Prevention in locating sentinel sites for
monitoring of disease. Hospital infection control practitioners serve
as a significant link to KDHE and the local health departments with
regard to both disease reporting and disease investigation.
An increase of laboratory capacities for microbiology testing for
Category A Agents and chemical terrorism in at least 10 hospital
laboratories strategically placed throughout the state is being
implemented. Funding of up to $10,000 per laboratory is being provided.
This will increase the overall capacity and decrease the length of time
for analysis of results based on geography and travel time.
5. Education and Preparedness Training
Several large scale terrorism preparedness educational programs
will be undertaken during the coming year. Training for clinical
providers and other appropriate volunteers to assist in caring for both
those individuals who have been exposed to terrorist acts and those
individuals who have behavioral manifestations of terrorism generated
fear. This training will be useful in assisting the hospital regions in
developing a cadre of trained workers who can assist in the assuring
that mental health needs are met at a local level during terrorism
related and other disasters. Training for non-clinical hospital workers
in basic infection control procedures with special focus on CDC
Category A Bioterrorist agents will be conducted using a variety of
methods including the use of web-based media or ``webinars'' and CD-ROM
materials. In addition to the on-site trainings, development of a
manual of appropriate templates for mutual aid agreements, memorandum
of understanding, memorandum of agreement, and contingency based
contracts will also be prepared. These materials will be developed in
cooperation with the Kansas Hospital Association using legal council
and will be distributed to all community hospitals, local health
departments and local emergency planning committees.
6. Terrorism Preparedness Exercises
During fiscal year 2003, KDHE is planning two regional hospital
bioterrorism exercises. The first of these exercises, ``Oktoberfest: An
Exercise in Terror!'' occurred in October 2003 the second is scheduled
to occur in March 2004. The October full-day exercise was a functional
tabletop exercise that occured at different times in each of the six
hospital regions and tested each region's capabilities to respond to a
biological event. The March 2004 full-day exercise is planned to be
another functional tabletop exercise which will occur in each of the
six regions. The purpose of this exercise will be to assess whether
cross-regional coordination planning is sufficient to assure that any
large scale event could be handled appropriately within the state. Both
of these events include elements which will test the response systems
plans and ability to care for children and the frail elderly as well as
other types of special needs populations including those with limited
English proficiency. Planned simulations include weather conditions,
citizen/victim reports, massive pediatric and adult illness and trauma,
deaths, the worried well, media interaction and movement and
prioritization of resources.
Biography for Richard J. Morrissey
2003-Present--Interim Director, Division of Health, Kansas Department
of Health and Environment, Curtis State Office Building, 1000
SW Jackson, Suite 300, Topeka, KS 66612-1365
1992-2003--Director, Office of Local and Rural Health, Kansas
Department of Health and Environment, Topeka, Kansas
1989-1992--Deputy Director, Division of Health, Kansas Department of
Health and Environment, Topeka, Kansas
1983-1989--Director, Bureau of Adult and Child Care, Kansas Department
of Health and Environment, Topeka, Kansas
1981-1983--Special Assistant to the Secretary, Kansas Department of
Health and Environment, Topeka, Kansas
1979-1981--Director, Health Resources, Kansas Department of Health and
Environment, Topeka, Kansas
1974-1979--Planning Consultant and Associate Director, Office of Health
Planning, Kansas Department of Health and Environment, Topeka,
Kansas
EDUCATION
Graduate of the University of Iowa (B.A.), 1971.
PERSONAL BACKGROUND
1. Attended elementary and high school in Davenport, Iowa
2. Served in the U.S. Army from 1965 to 1968 (First
Lieutenant)
3. Married; two children
4. Presently living in Lawrence, Kansas.
Mr. Neugebauer. Thank you, Mr. Morrissey.
Ms. Kay Kent, welcome.
STATEMENT OF W. KAY KENT, RN, MS, ADMINISTRATOR/HEALTH OFFICER,
LAWRENCE-DOUGLAS COUNTY HEALTH DEPARTMENT, LAWRENCE, KANSAS
Ms. Kent. Good morning. My name is Kay Kent. I'm the
Administrator/Health Officer of the Lawrence-Douglas County
Health Department in Lawrence, Kansas. Thank you for the
opportunity to address you today regarding state and local
preparedness for a bioterrorism event.
Detection and response to bioterrorism generally happens
first at the local level. The capacities needed to effectively
respond to bioterrorism are also the capacities needed by local
public health agencies to respond to all hazards. In Douglas
County, we have worked to integrate bioterrorism detection and
response with systems public health already uses to detect and
respond to more common, naturally occurring disease outbreaks.
The Lawrence-Douglas County Health Department has had a
leadership role in bringing together response partners to work
on preparedness and response plans for public health
emergencies.
Local preparedness efforts are ongoing. A critical step was
to delegate and delineate our roles and responsibilities among
response partners, both at the local level and state level.
Participation in local and state exercises helps to identify
critical gaps in our response readiness.
The most significant assistance from the Federal Government
has been new dollars passed through the Kansas Department of
Health and Environment to address preparedness for a
bioterrorism attack and other public health emergencies.
The federal bioterrorism funding is used primarily to
address staffing, training and infrastructure needs. In
addition, we have recently received federal funding for the
development of a Douglas County Medical Reserve Corps. These
federal dollars focus on our significant need for developing
surge capacity in the area of personnel. Resources from the
Kansas Department of Health and Environment have included the
template for writing a preparedness and response plan,
exercises that allow local health departments to exercise their
plans across county lines, and training on surveillance, risk
communication and epidemiology.
In 2003, Douglas County and several surrounding counties
were involved in an outbreak of Cryptosporidium. The first case
was reported on July 24, 2003. The outbreak was considered over
on October 24, 2003. I would like my written testimony to
reflect that that's 2003, not 2004.
On August 22nd we made a request for assistance from the
Centers for Disease Control and Prevention and on August 25th,
three days, staff from CDC arrived and stayed on-site at our
health department for five weeks. Kansas Department of Health
and Environment epidemiology staff was also available on site
during the first week of the CDC investigation and by telephone
throughout the investigation.
Although this was not a disease perpetrated by terrorists,
the size of the outbreak and the complexity of transmission
constituted a public health emergency for our health department
and our community. Our ability to meet our public health
responsibilities in responding to this emergency was greatly
enhanced by the preparedness work done over the previous 18 to
24 months. And these preparedness activities included enhanced
relationships with key community response partners, key contact
information and lists available in usable format for rapid
dissemination of information, improved infrastructure including
surge computer network capacity and surge capacity of agency
staff.
Our experience with working with state and federal staff on
an outbreak investigation was very positive. In an outbreak,
strong leadership at the local, state and federal levels is
critical. In addition to the staff that came on site, daily
conference calls were held with Kansas Department of Health and
Environment staff in Topeka and CDC staff in Atlanta to work on
technical issues and strategies for the intervention.
In order to assist local health departments, state and
federal agencies also need resources, particularly surge
capacity for laboratory and epidemiology staff. We found lab
support for the investigation at both the state and federal
levels to be critical. It was vital to the investigation that
we were able to have a large volume of tests run timely. The
number of hours contributed by CDC and Kansas Department of
Health and Environment staff was significant. Had there been
another disease outbreak to deal with elsewhere in the State,
the Kansas Department of Health and Environment staff would not
have been able to provide the level of support needed in
Douglas County.
Progress has been made related to preparedness and
responses to public health emergencies. Federal funding has
been an important part of that progress. Ongoing federal
funding is essential to sustain public health response
readiness at the local level. The added responsibility placed
on local public health agencies is great, but it is part of our
mission and public health has a unique role to play.
Thank you for holding this hearing and for your support of
public health and I'll be happy to respond to any questions.
[The prepared statement of Ms. Kent follows:]
Prepared Statement of W. Kay Kent
Good morning. My name is Kay Kent. I am the Administrator/Health
Officer of the Lawrence-Douglas County Health Department in Lawrence,
Kansas. Thank you for the opportunity to address you today regarding
State and local preparedness for a bioterrorism attack.
To put my comments in context, I will start with a brief
description of Douglas County and the Lawrence-Douglas County Health
Department. Douglas County, with a population of just over 100,000
residents, is located in northeast Kansas, 30 minutes from the Topeka
state capital to the west and 30 minutes from the Kansas City metro
area to the east. We are a city-county health department with
governmental public health responsibilities. A five-member health board
appointed by city and county commissioners is the policy making body
for our agency. We currently have a staff of 42 and a total budget of
$2.7 million. We provide a full range of public health services.
Program offerings include disease control and prevention, clinic
services for the maternal and child health population (ranging from
child health assessments to family planning to nutrition services to
child care licensing), case management services for the frail elderly,
teen parents and at-risk families, community health activities, and
environmental health.
The major points I will address are our health department's role in
preparedness for a potential bioterrorism attack and how federal and
state governments have facilitated those efforts. I will talk about my
experience with an outbreak of cryptosporidiosis in Douglas County in
2003 and how preparedness efforts for bioterrorism helped us deal with
this naturally occurring disease outbreak. Finally, I will discuss what
State and Federal governments could do to improve their efforts to help
us be better prepared for the next pubic health emergency.
Local role in preparedness
Detection and response to bioterrorism generally happens first at
the local level. Local public health preparedness is a fundamental
building block of our nation's overall readiness. The capacities needed
to effectively respond to bioterrorism are also the capacities needed
by local public health agencies to respond to all hazards. In Douglas
County we have worked to integrate bioterrorism detection and response
with systems public health already uses to detect and respond to more
common, naturally occurring disease outbreaks.
The Lawrence-Douglas County Health Department began working in
earnest on a bioterrorism preparedness and response plan in January
2002. Our agency has had a leadership role in bringing together local
response partners to work on a preparedness and response plan for
public health emergencies. This process involved forming new
relationships, particularly with local law enforcement jurisdictions,
fire and emergency medical services and emergency management. We also
strengthened and enhanced our relationships with physicians, the
hospital, university and urgent health clinics, and pharmacies.
Local preparedness efforts are ongoing; we continue today to
update, expand and exercise our local public health emergencies plan.
Our health department collaborates regionally with four other Kansas
counties to provide staff training. A critical step during initial
planning was to delineate roles and responsibilities among response
partners, both at the local level and state level. Since then we have
been working to further refine plans that would allow us to provide
mass distribution of vaccines or prophylaxis through the deployment of
the Strategic National Stockpile. Participation in local and state
exercises helped to identify critical gaps in our response readiness.
We continue to have a significant need for staff with specialized
skills in risk communication.
State and federal role in assisting with our efforts
The most significant assistance from the Federal Government has
been new dollars passed through the Kansas Department of Health and
Environment (KDHE) to address new or expanded public health
responsibilities related to preparedness for a bioterrorism attack and
other public health emergencies. About half of the $11 million in
federal funding that came to Kansas in FY 2003 was distributed to local
health departments. Our health department received $111,000 in FY 2003
and $149,000 in FY 2004.
Bioterrorism funding is used primarily to address staffing,
training and infrastructure needs. Staffing was increased by 1.75 FTE
to address new responsibilities for local public health emergency
preparedness and response activities and assure improvement in critical
capacity areas. State-sponsored training on surveillance, epidemiology,
risk communication, and the Incident Management System was made
available to select health department staff. Because we must continue
our day-to-day work while staff is being trained, grant funds pay for
replacement staff during the trainings. We expanded our computer
network to address surge capacity needs and put in place security
enhancements. These activities required additional time for contracted
IT assistance.
Other resources from Kansas Department of Health and Environment
(KDHE) include a template for writing a preparedness and response plan
that was made available to local health departments early in the
planning process. KDHE also organized exercises that allow local health
departments to exercise their plans across county lines.
We expect the state health agency to provide technical assistance
on issues where capacity has not yet been developed at the local level
or, in some cases, would not be effective or practical to implement at
the local level. For example, the state should provide laboratory
services and high level technical expertise in epidemiology that can be
expanded if circumstances warrant.
Outbreak of Cryptosporidiosis
In 2003, Douglas County and several surrounding counties in
northeast Kansas were involved in an outbreak of Cryptosporidium.
Although this was not a disease perpetrated by terrorists, the size of
the outbreak and complexity of transmission, constituted a public
health emergency for our health department. Our ability to meet our
pubic health responsibilities in responding to this emergency was
greatly enhanced by the preparedness work done over the last 18 to 24
months.
Cryptosporidium is a diarrheal illness caused by a chlorine-
resistant parasite. Individuals become infected by swallowing the
parasite after coming in contact with fecal-contaminated surfaces or
recreational water. The first case was reported on July 24, 2003; the
outbreak was considered over on October 24, 2003. During this time
period, there were 89 laboratory-confirmed cases among Douglas County
residents plus seven cases among residents in neighboring counties
linked to exposures in Douglas County. There were more than 600
probable cases. During the course of the disease investigation and
implementation of prevention and control measures health department
staff logged an additional 863 hours, distributed more than 9,000 fact
sheets, made more than 5,000 telephone calls in search of probable
cases, and issued 365 stool collection kits.
On Friday, August 22 we made a request, through the Kansas
Department of Health and Environment (KDHE), for assistance from the
Centers for Disease Control and Prevention (CDC). On Monday, August 25
an EIS officer arrived at our health department and stayed for five
weeks. She was joined by a second EIS officer and four other CDC staff
who rotated through. KDHE epidemiology staff was also available on-site
during the first week of the CDC investigation and by telephone
throughout the investigation.
Preparedness activities that assisted us in our response efforts
included established relationships with key community response
partners. These partners included local physicians, university health
center, school district, and hospital infection control. Because these
individuals or entities had been involved in planning with the health
department for a bioterrorism incident, we already had built a level of
trust and familiarity with public health work.
We also benefited from our current infrastructure. High-speed
Internet capability was essential as was a functioning computer network
and phone system. Transforming a conference room into an operations
center capable of handling several computer and printer connections had
been tested prior to the outbreak. Earlier preparations such as
preprogrammed fax numbers for physicians and school nurses, mailing
labels for child care facilities, and e-mail addresses for key contacts
assisted with rapid communications.
The health department had begun to address the need for surge
capacity in response to a bioterrorism event and this proved useful
during the outbreak of Cryptosporidium. Individuals previously
identified as potential workers were contacted and asked to assist. In
addition, current staff, some of whom are part-time, worked flexible
hours to meet the need. Nearly all current staff participated in
response efforts. Had the outbreak been much larger, additional surge
capacity would have been necessary.
Future efforts from State and Federal Governments
Ongoing federal funding is essential to sustain public health
response readiness at the local level. Ongoing preparedness efforts to
respond to a bioterrorism incident (linkages made, training received,
exercises held), improve skills that are also needed for responding to
a naturally occurring disease. Local health departments do not have the
luxury of hiring staff and creating systems exclusively for
bioterrorism preparedness. Agency staff and systems are multi-purpose
in providing essential public health services.
Since last year's outbreak, the health department has received
federal funding for the development of a Douglas County Medical Reserve
Corps. These federal dollars focus on our significant need for
developing surge capacity to address public health emergencies.
Our experience with working with state and federal staff on an
outbreak investigation was very positive. In an outbreak, strong
leadership at the local, state and federal levels is critical. Those
involved in the Douglas County outbreak had previous experience in
partnering across the various levels of government which facilitated a
good working relationship and an effective investigation. CDC was able
to bring to us locally, expertise in epidemiology. We were able to
provide expertise about our community. And together, we problem-solved
about the source of the infection and what interventions to put in
place to bring the outbreak under control.
By having access to local incidents as they unfold, CDC is able to
improve understanding of new and emerging diseases and test better
methods for disease identification. For example, one segment of
research done in Douglas County was for the purpose of finding an
alternative to stool samples as a means for disease testing.
In order to assist local health departments, state and federal
agencies also need resources, particularly surge capacity for both
laboratory and epidemiology staff. We found lab support for the
investigation at both the state and federal levels to be critical. It
was vital to the investigation that we be able to have a large volume
of tests run timely. The number of hours contributed by CDC and Kansas
Department of Health and Environment (KDHE) epidemiology staff to the
Cryptosporidium outbreak was significant--during a public health
emergency the work is really 24/7. Had there been another outbreak to
deal with elsewhere in the state, KDHE would not have been available to
provide the level of support needed in Douglas County.
In addition to the staff that came on-site, daily conference calls
were held with KDHE staff in Topeka and CDC staff in Atlanta to work on
technical issues and strategies for the investigation. Materials
developed as part of the investigation were reviewed by CDC and KDHE
epidemiology staff as well as significant contributions from the KDHE
public information office. We worked to have consistent messages
conveyed to the public across county lines because communicable disease
does not know county boundaries.
Responding to bioterrorism or any other public health emergency is
more than just learning the specifics of a new disease. There are new
functions throughout the agency and local health department staff need
strong analytical, communication and technology skills to be
successful. Such staff development requires someone to do planning,
assessment, leadership and monitoring.
Progress has been made related to preparedness and response to
public health emergencies and federal funding has been an important
part of that progress. The added responsibility placed on local public
health agencies is great, but is part of our mission and public health
has a unique role to play. Ongoing, adequate resources from the federal
level are needed to address gaps identified through local planning and
public health emergency exercises.
Thank you for holding this hearing and for your support of public
health. I'll be happy to respond to any questions you may have.
Biography for W. Kay Kent
EDUCATION:
Master of Science in Community Health Nursing, Boston University,
Boston, Massachusetts, January 1973.
Bachelor of Science in Nursing, University of Kansas, Kansas City,
Kansas, June 1966.
Diploma, Trinity Lutheran Hospital School of Nursing, Kansas City,
Missouri, August 1964.
PROFESSIONAL CREDENTIALS:
Licensed to practice as a Registered Nurse in Kansas.
PROFESSIONAL EXPERIENCE:
Administrator/Health Officer: Lawrence-Douglas County Health
Department, Lawrence, Kansas, June 1973 to present. First non-
physician Health Officer in Kansas.
Public Health Leadership Institute, Centers for Disease Control and
Western Consortium for Public Health, 1992-1993 (Year 2
Scholar).
Instructor, Community Health Nursing: University of Kansas School of
Nursing, Kansas City, Kansas, January 1973 to June 1973.
Instructor, Psychiatric Nursing: Faulkner Hospital School of Nursing,
Boston, Massachusetts, September 1970 to September 1971.
Instructor: Mendota State Hospital, Madison, Wisconsin, January 1967 to
August 1970.
Staff Nurse: New England Deaconess Hospital, Boston, Massachusetts,
June 1966 to January 1967.
Staff Nurse (Part-time): Trinity Lutheran Hospital, Kansas City,
Missouri, August 1964 to June 1966.
PROFESSIONAL ORGANIZATIONS:
Public Health Leadership Society.
American Public Health Association.
Kansas Public Health Association.
American Nurses Association.
Kansas Association of Local Health Departments.
Kansas Nurses Association.
District 17 of the Kansas Nurses Association.
CURRENT ACTIVITIES:
Board of Directors, Kansas Health Institute.
Kansas Public Health Systems Group.
Bioterrorism Preparedness Planning Committee for the Kansas Department
Health and Environment and Kansas Association of Local Health
Departments.
Douglas County Community Health Improvement Project Leadership Group.
Legislative Committee, Kansas Association of Local Health Departments.
PAST ACTIVITIES:
Chair, Board of Directors, Kansas Health Institute.
Lawrence Partnership for Children and Youth, Inc., Board of Directors.
Supreme Court Task Force on Permanency Planning and Children's Justice
Act Task Force.
Governor's Public Health Improvement Commission Task Force on Effective
Public Health Organizations.
Lawrence Memorial Hospital Board of Directors.
Kansas Master of Public Health Degree Program Advisory Committee.
Douglas County Health Care Access Board of Directors.
Kansas Department of Health and Environment Strategic Planning
Committee.
Douglas County Area Health and Human Services Needs Assessment Steering
Committee.
Kansas Public Health System Study Committee Co-Chair.
Douglas County Visiting Nurses Board of Directors.
Jayhawk Area Agency on Aging, Inc., Tri-County Advisory Council.
Douglas County AIDS Project Advisory Committee.
American Public Health Association/American Academy of Pediatrics
Health and Safety Organization and Administrative Technical
Panel of the Child Care Performance Standards Project.
Kansas Coalition on Medical Indigency.
Kansas Advisory Committee to the Coordinating Council on Early
Childhood Development Services.
Emergency Planning Committee for Douglas County.
Kansas University School of Nursing Ad Hoc Nursing Curriculum
Committee.
Kansas Long Term Care Advisory Committee.
Kansas Department of Health and Environment P.L. 99-457 (Handicapped
Infant and Toddlers) Grant Review Committee.
Kansas Hospital Association Human Services Alternative for Rural
Hospitals Grant Advisory Committee.
Douglas County Teen Pregnancy Task Force.
President, President-Elect, Secretary-Treasurer, District
Representative, and Legislative Chair, Kansas Association of
Local Health Departments.
Board of Directors and Secretary of Health Systems Agency Board, Health
Systems Agency of Northeast Kansas.
Chairman, Project Review Committee of Northeast Kansas Health Systems
Agency.
Chairman, Nominations Committee, Health Systems Agency of Northeast
Kansas.
Board of Directors, Douglas County Planning Council On Services for the
Aging.
Chairman, Health Committee, Douglas County Planning Council On Services
for the Aging.
Kansas Public Health Association Legislative Committee.
Kansas Public Health Association Program Committee.
University of Kansas Biohazards Committee.
Douglas County Citizens Committee on Alcoholism.
Douglas County Heart Unit.
Douglas County March of Dimes.
Douglas County Emergency Medical Services Council.
Kansas State Board of Nursing Subcommittee on Communication between
Nursing Service and Nursing Education.
Chairperson, Fourth Annual Governor's Conference on Aging Health
Program.
HONORS AND AWARDS:
Kansas Health Foundation Leadership Fellow, 1999.
First Recipient of Kansas Health Foundation Community Health Leadership
Award, 1994.
Kansas Public Health Association Special Services Award, October 1992.
Kansas Public Health Association Samuel J. Crumbine Medal for
Outstanding Service in Public Health, May 1987.
Kansas State Public Health Association Certificate of Merit, October
1982.
District 17 of Kansas State Nurses Association Certificate of Merit,
May 1982.
Sigma Theta Tau National Honor Society for Nursing, 1966.
Florence Nightingale Award, Trinity Lutheran School of Nursing, 1964.
PUBLICATIONS AND NATIONAL PRESENTATIONS:
``Mumps Outbreak in a Highly Vaccinated Population,'' Bradley S. Hersh,
M.D., M.P.H., Paul E.M. Fine, V.M.D., Ph.D., W. Kay Kent, R.N.,
M.S., Stephen L. Cochi, M.D., Laura H. Kahn, R.N., B.S.N.,
Elizabeth R. Zell, M. Stat., Patrick L. Hays, Ph.D., and Cindy
L. Wood., M.D., M.P.H., The Journal of Pediatrics. August 1991.
Co-presenter of The Health of Children in Day Care, a Public Health
Challenge, American Public Health Association meeting, 1986.
``An Integrative Approach to Child Care Licensing by a City-County
Health Department,'' co-authored with Peggy Scally, R.N.,
Health of Children in Day Care, Public Health Profiles, Kansas
Department of Health and Environment, 1986.
``A Multi-Service County Health Department,'' Dynamics of Aging,
Forrest J. Berghorn and Donna E. Schafer, and Associates,
Boulder, Colorado: Westview Press, 1981.
Mr. Neugebauer. Thank you, Ms. Kent.
Mr. Brad Mason.
STATEMENT OF BRADLEY C. MASON, DIVISION CHIEF OF SPECIAL
OPERATIONS, JOHNSON COUNTY MED-ACT, JOHNSON COUNTY, KANSAS
Mr. Mason. Good morning, Mr. Chairman, Congressman Moore.
Thank you for inviting me here today.
I am Brad Mason. I'm the Special Operations Chief for
Johnson County Med-Act. Also I serve as the Chairman of the Mid
America Regional Council Emergency Response Committee, commonly
known in these parts as MARCER. MARCER is an emergency medical
services committee serving the eight county MARC region. It
covers both sides of the state line. I am also a member of the
Regional Homeland Security Coordinating Committee and a number
of its operational subcommittees.
I was asked to come here today to provide testimony on how
current and future technology investments provide for
coordinated communication among the public health, hospital and
emergency response community within Johnson County and the
Kansas City region.
MARCER has always been in the forefront of providing voice
communications infrastructure to link EMS providers in the
field to base hospital physicians in the emergency departments
of all metro area emergency rooms. A recent upgrade to the
MARCER system was completed in 2003. Presently, a wireless
voice radio system links all providers in the area. Public
Health agencies in the metro area have a minimal role in the
MARCER radio system on a day-to-day basis. It is important to
note that the radio system has the ability to expand to meet a
need for public health radio communications, should such a need
be demonstrated. At this time the need for day-to-day metro-
wide access for our public health agencies is not required.
The use of internet-based communications is becoming more
and more commonplace in metro Kansas City. One such application
is called EMSystem. MARCER led the deployment of EMSystem
throughout the region in 2001. While EMSystem was initially
implemented to facilitate disaster communications and hospital
diversion information between hospitals and EMS providers, a
side benefit was discovered in helping public health agencies
communicate among EMS providers and emergency departments.
Public health agencies have leveraged the rapid messaging
ability of EMSystem to provide yet another means of instant
access to health alerts and other critical information
pertaining to disease outbreaks, reporting, etc.
Based on the success in the Kansas City region with
EMSystem, the State of Missouri implemented EMSystem
statewide starting in 2002. This brought obvious benefits for
the state health agencies in providing another communications
conduit for the dissemination of public health alerts and
advisories. Utilizing grant funding, the State of Missouri has
covered all of the annual expenses for EMSystem users
statewide, including users from Kansas that serve the metro
Kansas City region. EMSystem combined with other public health
information systems provides for an adequate means of
information alerts to the response community. I also understand
the State of Kansas is considering a statewide implementation
of the EMSystem as well.
As is widely reported, public health agencies need to have
an early detection system in order to properly respond to
potential infectious disease outbreaks. I understand that this
is an area where quite a bit of improvement can be made, not
only locally, but nationally. Johnson County presently uses the
First Watch program. Public Health grant funding from the CDC
has helped fund the deployment of this program in Johnson
County. First Watch is an internet-based system at our
Emergency Medical Systems dispatch center. The program looks
for spikes in certain EMS call activity. Once a spike is
recorded the system automatically notifies public health
officials, who then in turn start an investigation into the
matter. For instance, if there was an increase in respiratory
distress calls that EMS ran in a given period of time, public
health officials would be notified of that alert. The same
First Watch system is used in Kansas City, Missouri at the
MAST ambulance system. Presently, there is no compilation of
the two systems data to obtain a better ``metro'' picture of
alerts.
While computer based programs have streamlined the sharing
of information, much more can still be done to get a broader
picture of the metro area when it comes to surveillance of the
medical community. The shortcomings of only performing
syndromic surveillance of CAD data are several. More detailed
surveillance could occur by developing applications that mine
the data of the EMS systems electronic medical record systems.
Patient records are much more detailed in terms of reporting
patient signs and symptoms compared to the very basic
information found in CAD systems. The same could be said for
the electronic patient records in hospitals and other health
care settings in the metro area such as pharmacies. While the
metro area has been making positive strides towards the
information sharing and coordination needed for adequate early
warning, more work still needs to be done.
Critically important to the progress being made on the
aforementioned programs in place for the Johnson County and
metro Kansas City area is federal funding. Funding from such
programs as the Department of Homeland Security's State
Homeland Security Grant Program and the Urban Area Security
Initiative have started the ball rolling in the right direction
with Johnson County and in our region. Continued funding at or
above current levels will help move our region closer to the
goal of a solid early warning network for public health
emergencies.
As we progress into the future years, sustainment funding
is also necessary for the new resources obtained through the
grants. Often times, equipment is perishable and requires
replacement in a matter of a few years. For example, Johnson
County is considering stockpiling antibiotics to provide
prophylaxes treatment of our first responders. However, we
assume the risk that these medications will expire and we need
funding to replace them in three to five years.
These are but a few of the representative issues we are
dealing with locally and regionally. We are on the front lines
and our community expects us to respond accordingly to their
local emergency. I appreciate you taking the time to listen to
your local first responders. I look forward to our continued
dialogue on this matter.
[The prepared statement of Mr. Mason follows:]
Prepared Statement of Bradley C. Mason
Mr. Chairman and Members of the Committee, I thank you for inviting
me to testify today.
I am the Division Chief of Special Operations for Johnson County
Med-Act, the county paramedic service here in Johnson County, Kansas. I
also serve as the Chairman of the Mid America Regional Council
Emergency Response Committee or MARCER. MARCER is a Metro Kansas City
EMS committee serving the eight county MARC region. I am also a member
of the MARC Regional Homeland Security Coordinating Committee.
I was asked to provide testimony on how current and future
technology investments provide for coordinated communication among the
public health, hospital and emergency response community within Johnson
County and the Kansas City region.
MARCER has always been in the forefront of providing voice
communications infrastructure to link EMS providers in the field to
base hospital physicians in the emergency departments of all hospitals
in metro Kansas City. A recent upgrade to the MARCER system was
completed in 2003. Presently a wireless voice radio system links all
providers in the area. Public Health agencies in the metro area have a
minimal role in the MARCER radio system on a day-to-day basis. It is
important to note that the radio system has the ability to expand to
meet a need for public health radio communications, should such a need
be demonstrated. At this time the need for day-to-day metro-wide radio
access for our public health agencies is not required.
The use of Internet based computer applications is becoming more
commonplace in metro Kansas City. One such application is called
EMSystem. MARCER led the deployment of EMSystem throughout the region
in 2001. While EMSystem was initially implemented to facilitate
disaster communications and hospital diversion information between
hospitals and EMS providers, a side benefit was discovered in helping
public health agencies communicate among EMS providers and emergency
departments. Public health agencies have leveraged the rapid messaging
ability of EMSystem to provide instant access to health alerts and
other critical information pertaining to disease outbreaks, reporting,
etc.
Based on the success in the Kansas City region with EMSystem the
State of Missouri implemented it's use statewide starting in 2002. This
brought obvious benefits for the state health agencies in providing
another communications conduit for the dissemination of public health
alerts and advisories. Utilizing grant funding the State of Missouri
has covered all of the annual expenses for all EMSystem users
statewide, including users from Kansas that serve the metro Kansas City
region. EMSystem combined with other public health information systems
provide for an adequate means of information alerts to the response
community. I also understand that the State of Kansas is considering a
statewide implementation of EMSystem.
As is widely reported, public health agencies need to have early
detection systems in order to properly respond to potential infectious
disease outbreaks. I understand that this is an area where quite a bit
of improvement can be made, not only locally but also nationally.
Johnson County presently uses the First Watch program. Public Health
grant funding from the CDC have helped fund the deployment of the
program in Johnson County. First Watch is an Internet based
application that mines the data in the computer aided dispatch (CAD)
system at the EMS dispatch center. The program looks for spikes in
certain EMS call activity. Once a spike is recorded the system
automatically notifies public health officials, who then in turn start
and investigation into the matter. For instance if there was an
increase is respiratory distress calls for EMS, beyond a predefined
threshold, public health officials would be automatically notified by
the First Watch system. The spikes in calls at our 911 centers, urgent
care center and emergency departments that are often the first real
indicators of a potential biological incident. The same First Watch
system is in use in Kansas City, Missouri at the MAST ambulance system.
Presently there is no compilation of the two systems data to obtain a
more ``metro'' oriented perspective of the data.
While computer based programs have streamlined the sharing of
information much more can still be done to get a broader picture of the
metro area when in comes to surveillance in the medical community. The
shortcomings of only performing syndromic surveillance of CAD data are
several. More detailed surveillance could occur by developing
applications that mine the data of the EMS systems electronic medical
record systems. Patient records are much more detailed in terms of
reporting patient signs and symptoms compared to the very basic data
found in CAD systems. The same could be said for the electronic patient
records in hospitals and other health care settings. While the metro
area has been making positive strides towards the information sharing
and coordination needed for adequate early warning, more work needs to
be done.
Critically important to the progress being made on the
aforementioned programs in place in the Johnson County and metro Kansas
City area is federal funding. Funding from such programs as the
Department of Homeland Security's State Homeland Security Grant Program
and the Urban Area Security Initiative have started the ball rolling in
the right direction within Johnson County and in our region. Continued
funding at or above current levels will help move our region closer to
the goal of a solid early warning network for public health
emergencies.
As we progress into the future years, sustainment funding is also
necessary for the new resources obtained through the grants. Often
time's equipment is perishable and requires replacement in a matter of
a few years. For example, Johnson County is considering stockpiling
antibiotics to provide prophylaxes treatment to our first responders
until Federal Response Plan resources are made available. Such
medication has a two to five year shelf life and will eventually need
replaced. If continued federal funding is not maintained, where will
our local community find the needed dollars to maintain what we have?
These are but a few of the representative issues we are dealing
with locally and regionally. We are on the front lines and our
community expects us to respond accordingly to their local emergency. I
appreciate you taking the time to listen to your local first
responders. I look forward to our continued dialogue on this matter.
Biography for Bradley C. Mason
Has worked for Johnson County EMS: Med-Act since 1984
Division Chief of Special Operations since 1997
Directs EMS Special Operations Teams which include:
Emergency Operations Team
Disaster Response Team
Hazardous Materials Medical Support Team
Tactical Medic Team
Bike Medic Team
Responsible for EMS emergency planning for Med-Act
and for Johnson County Government. Plans include Mass Casualty,
Mass Fatality, Incident Management, Haz-Mat and Weapons of Mass
Destruction (WMD)
Presently the Chairman of the Mid America Regional
Council Emergency Rescue (MARCER) Committee.
Through MARCER Brad has led:
A major overhaul to the radio
communications system that links EMS providers
in the field with hospital emergency
departments in metro Kansas City
Revisions to the Regional Mass
Casualty Incident (MCI) Response Plan
Revisions to the Regional Disaster
Communications Plan
Development and implementation of the
EMSystem in Metropolitan Kansas City
Development of metro-wide hospital
diversion protocols
Member of the Regional Homeland Security Coordinating
Committee and numerous related homeland security subcommittees.
Recipient of the Mid America Regional Council's
``2004 Regional Leadership Award''
Mr. Neugebauer. Thank you, Mr. Mason.
Dr. Ron Kendall.
STATEMENT OF DR. RONALD J. KENDALL, PH.D., DIRECTOR, THE
INSTITUTE OF ENVIRONMENTAL AND HUMAN HEALTH, TEXAS TECH
UNIVERSITY
Dr. Kendall. Chairman Neugebauer, Congressman Moore, thank
you for the invitation to be here and to sit with these
distinguished guests. I was presented a letter from the Science
Committee to address some of the research underway in our
Institute at Texas Tech University and I'm pleased to be here
to represent the University and the District and your support,
Congressman Neugebauer, and thank you very much for that
support.
The activities that we have related to biological and
chemical terrorism countermeasures date back to July 1998. We
were, at that time, contacted by Admiral Elmo R. Zumwalt, Jr.,
previously Chief of Naval Operations in Vietnam. He had
interactions with the National Security Council, identified our
program as a place upon which we could interact in
toxicological research and information leveraging related to
biological and chemical terrorism. We worked closely with the
Admiral to set up a briefing and subsequently an initiative by
which we were funded in 2000 by the United States Congress to
appropriate funding for Texas Tech University system, the
University of Texas at Austin and the University of South
Florida to support research and technology development,
training and education for countermeasures to biological and
chemical threats. This funding was critical to establishing the
Zumwalt Program which is implemented through the Institute of
Environment and Human Health at Texas Tech which I oversee and
this Institute is the joint venture of our medical school, law
school and university and I think reflects the multi-
disciplinary cooperation that's critical.
In terms of purpose, we were to coordinate and facilitate
multi-disciplinary, basic and applied research and to provide
education and training programs in cooperation with the
Department of Defense to enhance various operational military
capabilities to more effectively and efficiently identify,
prevent, mitigate and eliminate biological and chemical threats
and other weapons of mass destruction.
Our focus has been to integrate and expand the multi-
disciplinary pool of expertise, technologies and collaborations
necessary to remain a premiere internationally recognized
leader in the scientific research and proliferation of
information pertinent to military, and now civilian,
countermeasures to biological and chemical weapon threats. This
was not done irrelevant to other needs in the country,
particularly as those identified previously by the National
Research Council.
Our current research focus areas which are identified in
great detail in my appended testimony today are to develop and
test advanced modeling and simulation capabilities to predict
and preclude the dispersion of biological and chemical agents
inside buildings and in urban and rural environments within and
including livestock and wild animal populations. Secondly, to
study and identify and quantify as well as qualify emerging
foreign animal disease and re-emerging zoonotic disease threats
and their potential uses as biological terrorism weapons;
develop and test advanced composite non-woven fabrics for use
as personal protective equipment against ballistic, biological
and chemical insult and as I speak, we have several patents
emerging, already one in place and moving forward to others; to
develop and test novel approaches to detect and remediate
biological and chemical agent exposures through therapeutic and
genetic approaches, and to test existing and develop new
generations of sensors to detect and identify biological and
chemical weapon agents.
This work has involved extraordinary collaboration. It has
involved many multi-disciplinary research projects at Texas
Tech that have engaged more than 60 faculty scientists
addressing modeling, textiles, chemical engineering,
atmospheric science, electrical engineering, plant and soil
sciences, pharmacology, physiology, microbiology and
toxicology.
The Zumwalt Program has used and embraced this expertise in
a multi-disciplinary format to bring this level of expertise to
the focus of transferring the information to the scientific
literature and to first responders. We have patented,
published, as well as presented more than 60 professional
scientific presentations not only in this country, but
internationally. This research has been sponsored by the United
States Army Research, Development and Engineering Command and
continues to be sponsored through that process.
We have interacted with the first responders by developing
scientific expertise and state-of-the-art technologies through
our collaborations in the Zumwalt Program and leveraging that
success to now the establishment of the Texas Emergency
Analysis and Response Program, TEARP, operated through our
program. This gives us an opportunity to integrate scientific
and technical expertise with state-of-the-art computing,
communications, information systems and visualization
technologies to create an immediately responsive and highly
accurate operational capability to save lives and protect
property. This also employs the engagement and deployment of
our mobile platforms known as the VIPER systems.
The federal funding that we have received has been
predominantly through the Department of Defense. However, we
encourage through the Department of Homeland Security and other
entities becoming involved in the bioterrorism directive issued
by President Bush to increase research focus on the development
of more rapid biological pathogen recognition and
identification capabilities for use in both active and passive
surveillance systems, particularly in high population density
areas such as this area; to create regionally focused research
labs to assess and develop technologies to address the growing
threat of emerging and resurging pathogens that may have also
the potential for the use as biological terror agents; an
increased focus on the establishment of training and education
facilities to provide the most up-to-date information and
technologies to emergency responders, their leadership, as well
as elected officials, on the preventive and response procedures
for biological weapon agents.
In July of 1998, as a toxicologist, and having the
opportunity to visit with Admiral Zumwalt, this is an area we
were concerned about. Now, it is an area that I think is a part
of our reality. We must get ready. We must get ready as soon as
possible. I think the threat is imminent.
Thank you.
[The prepared statement of Mr. Kendall follows:]
Prepared Statement of Ronald J. Kendall
Overview and History of The Institute of Environmental and Human
Health:
In 1997, Texas Tech University and Texas Tech University Health
Sciences Center established, as a joint venture, The Institute of
Environmental and Human Health (TIEHH) to bridge their ability to
assess the impacts of toxic chemicals on the environment and on human
beings. This initiative employs a medical school and health sciences
center interfaced with a comprehensive university, including the Texas
Tech University School of Law, and represents an opportunity to address
environmental and human health issues from a multi-disciplinary
perspective. Research members have been recruited based on experience
in the field of environmental toxicology, as well as the diversity of
their research. Dr. Ronald J. Kendall, a prominent leader in the
international toxicology community, was hired as the founding director
of TIEHH to direct this team and recruit the best scientists and
personnel in this field.
TIEHH research assesses human exposure to chemicals in the
environment associated with symptomologies that can be determined to
enhance and standardize the diagnostic process. TIEHH builds upon
analytical methods of elements from human exposure to enhance
quantitation of chemicals in association with environmental exposures.
TIEHH also builds upon population-based epidemiological studies,
including both humans and wildlife, to begin to better define the
``Canary in the Coal Mine'' concept from a more quantitative and
rigorous scientific basis. TIEHH is developing new innovative
approaches to assess human health consequences in the environment.
In a very short time, experts at TIEHH have created a one-of-a-kind
program working to find answers to real-world issues. Incorporating a
multi-disciplinary group of scientists, scholars, business leaders and
government agencies, TIEHH personnel have assembled the best minds in
the country to research environmental issues and provide solutions.
Located in Lubbock, Texas, on the former Reese Air Force Base which is
now Reese Technology Center, TIEHH occupies six buildings and more than
150,000 sq. ft. Over $15 million was invested through several state and
federal agencies, as well as support from Texas Tech, for the building
and laboratory renovation and capital improvements. This includes over
$3 million for the renovation of facilities and purchase of a high
performance computing system and virtual reality theater equipment that
is housed in TIEHH.
As of Fiscal Year 2002-2003, TIEHH has facilitated approximately
$50 million in grants and contracts awarded to Texas Tech University
since TIEHH's establishment in 1997. Active grants facilitated by TIEHH
core and research faculty and collaborators include the following
sponsors: Strategic Environmental Research and Development Program,
U.S. Army Soldier and Biological Chemical Command, Environmental
Protection Agency, National Institute of Health, U.S. Department of
Agriculture, National Institute of Environmental Health Sciences,
National Science Foundation, and U.S. Army Corps of Engineers.
Admiral Elmo R. Zumwalt, Jr. National Program for Countermeasures to
Biological and Chemical Threats
For almost five years The Institute of Environmental and Human
Health at Texas Tech University has been the home of the Admiral Elmo
R. Zumwalt, Jr. National Program for Countermeasures to Biological and
Chemical Threats (Zumwalt Program), which is a multi-disciplinary
research, education, and service consortium composed of more than 60
research scientists. The Zumwalt Program was formally established in
1999 with the primary mission of defining, investigating, mitigating,
and furthering the understanding and ability of operational military
forces to prevent the threats associated with biological and chemical
weapons. Inspired by the leadership of the late Admiral Elmo R.
Zumwalt, Jr., the former Commander of Naval Operations during the
Vietnam War, Dr. Ronald Kendall, Director of TIEHH, took the steps
necessary to begin a countermeasures research program at Texas Tech
University (TTU). He and others judiciously selected a team of multi-
disciplinary intellectual and technological experts from the Texas Tech
University System and charged them with developing effective
countermeasure strategies that would improve the Nation's understanding
of biological and chemical weapons. By late 1999, these efforts
culminated in a large research consortium that submitted a white paper
designed to meet the critical needs of the National Research Council. A
short time later the U. S. Congress appropriated funding to the Texas
Tech University System, the University of Texas at Austin, and the
University of South Florida to support research and technology
development, training and education for countermeasures to biological
and chemical threats, the Zumwalt Program received funding from the
U.S. Army Soldier Biological and Chemical Command (SBCCOM) to establish
and implement the research initiative (in October 2003 the SBCCOM was
re-organized and renamed the U.S. Army Research, Development and
Engineering Command (RDECOM) ).
The administrative and support functions to facilitate all elements
of the Zumwalt Program are headquartered at TIEHH. Once established and
initiated, the Zumwalt Program used SBCCOM funding to expand and branch
out to recruit scientists and conduct research in more than 12
different departments within the TTU System. Each research project is
peer-reviewed to insure it complements the overall Zumwalt Program and
SBCCOM/RDECOM mission, which is to develop, acquire, and sustain
soldier support and nuclear, biological, and chemical defense
technology, systems, and services. The start-up funding enabled
individual scientists within the Zumwalt Program to bring their
individual expertise and laboratory resources to bear on the threats of
biological and chemical weapons and threat agents. The Zumwalt Program
at Texas Tech is part of the National Consortium for Countermeasures to
Biological and Chemical Threats (National Consortium), which represents
efforts contributed from Arkansas State University, Florida Atlantic
University, Kansas State University, Oklahoma State University,
University of Central Florida, University of Kansas, University of
South Florida, University of Texas System, and the Texas Tech
University System.
Vision, Objectives, and Collaborations: Created by the best and
brightest of the TTU System, the Zumwalt Program envisioned that its
efforts would result in a long-term and much- needed biological and
chemical weapon and threat agent research program. Initially envisioned
as a means for creating professional jobs for West Texans, this program
is now positioned to significantly contribute to improving national
security. In an effort to minimize start-up costs and maximize
research, the Zumwalt Program is permanently housed at TIEHH where an
Administrative Support Team has been continually utilized to ensure
solutions were provided to the problems associated with biological and
chemical threat agents. The initial prime objective of the Zumwalt
Program was to develop and lead collaborative efforts with other
academic institutions involved in countermeasures research. This
objective was achieved. In fact, after three years, intercollegiate
collaborations continue to be developed with other academic
institutions which now include the University of South Florida's Center
for Biological Defense, the University of Texas, Oklahoma State
University, the University of Kansas, Texas A&M University, and the
Johns Hopkins Applied Physics Laboratory. Evidence of these successful
collaborations was displayed when Texas Tech hosted the 2003 Consortium
of Biological Defense Research Meeting (CBDR) where more than 80
scientists presented over 30 technical presentations concerning the
detection, mitigation, and prevention of biological and chemical weapon
and threat agents.
Specific Questions Addressed:
1. What tools and systems is the Institute of Environmental and Human
Health (TIEHH) working on to detect and respond to a bioterrorist
attack? What organizations provide the funding to support this research
and development? How are the resulting technologies transitioned to
users?
The Zumwalt Program continues its focus of coordinating and
integrating all expert, multi-disciplinary intellectual and
technological resources available to design, develop and field
effective and efficient strategies, devices and therapeutics to combat
biological and chemical weapons of terrorism or of mass destruction.
The Zumwalt Program team at TTU is composed of more than 60 research
scientists collaborating to meet our mission. The focus of our
endeavors remains the leveraging of previous successes, advancement and
continuity of our multi-disciplinary team to exploit all identified and
novel opportunities to meet the Nation's biological and chemical threat
countermeasures research and development needs as identified by the
Institute of Medicine's National Research Council:
Pre-incident communications and intelligence
Personal protective equipment
Detection and measurement of chemical and biological
agents
Recognizing covert exposure
Mass-casualty decontamination and triage procedures
Availability, safety, and efficacy of drugs, vaccines
and other therapeutics
Computer-related tools for training and operations
Specific ongoing research efforts being conducted by scientists
under the auspices of the Zumwalt Program to protect against and
respond to potential bioterrorism incidents, are focused upon four
areas, including: (1) The modeling, simulation and visualization of how
biological threat agents may disperse through an environment following
release. (2) Developing and refining technologies for agent detection,
remediation and therapeutic intervention strategies. (3) Developing new
and assessing existing technologies to create sensors and personal
protective devices for biological and chemical threats. And (4), the
design and development of technologies to protect buildings and the
environment from biological and chemical weapons. During fiscal year
2003, the outstanding team of research scientists working as part of
the Zumwalt Program successfully completed research in these four focus
areas, as detailed below:
Focus Area I: Modeling, Simulation and Visualization
Modeling and Simulation of Scavenging Degradation and
Deposition of Chemical and Biological Contaminants in the Urban
Environment--While most modeling and simulation projects have
concentrated efforts upon determining and predicting the dispersive
characteristics of chemical and biological agent plumes or clouds
around buildings in an urban environment, this project seeks to
understand the effects that vegetative canopy, scavenging contaminants,
degradation of the chemical and biological agents as they interact with
ambient radiation and urban pollutants or deposition and potential
resuspension or re-evaporation of contaminants have on plume or cloud
dispersion within the urban environment. Most currently-used models do
not account for these post-release factors that are believed to
profoundly affect the dispersion and concentration patterns, possibly
leading to large errors in simulation accuracy. A primary focus of this
program is to formulate and test boundary conditions that account for
these post-release phenomena for codes that predict contaminant
transport and dispersion. An understanding of the vegetative canopy
flow is fundamental to improving the accuracy and ability to
characterize urban dispersion patterns, including the street-level
patterns. For this reason, investigators have gone to great lengths to
study and understand data unique to vegetative canopies, including tree
type, leaf size, and tree-stand arrangement. Models have been created
that show particle movement and deflection around vegetative canopies
and are proving to be very useful for estimating the risk that response
teams may face when attempting to rescue casualties or entering and
cleaning-up contaminated areas. Collaboration between TIEHH and the
Atmospheric Sciences Group has lead to significant leveraging
opportunities with the Governor of Texas Homeland Security Office and
Division of Emergency Management of the Texas Department of Public
Safety.
Modeling Airborne Transport of Hazards Using Advanced
Atmospheric Monitoring Systems and Numerical Techniques--The objective
of this project is to evaluate the capabilities and limitations of
mesoscale (10-100 km range) atmospheric models for chemical and
biological agent airborne transport prediction. It is critically
important to understand how biological and chemical agents are
physically dispersed and transported in the atmosphere. Accurate
simulation or near real-time assessments of chemical and biological
threats depend upon accurate interpretations and forecasting of
atmospheric conditions. Work conducted during 2002 has allowed
investigators to develop and deploy portable field meteorological data
sensor and recording platforms. Optimizing and enhancing the
meteorological data handling of current DOD models will allow for
accurate simulations of potential scenarios in advance of chemical/
biological attacks, the determination of where and when specific
populations or targets would be at risk given specific criteria,
determination points of release and environmental conditions, and allow
the tracing back of the trajectory of detected airborne agents in order
to locate and neutralize its release point. These platforms were tested
under severe weather events, included hurricane Lilli and tropical
cyclones Fay and Isadore. The high-resolution atmospheric data gathered
during these storm events can be used to better predict biological and
chemical agent dispersion in the atmosphere. Additionally, significant
leverage opportunities have resulted with the Texas Division of
Emergency Management, as well as the testing of these capabilities
during a training event held in the Houston Shipping Channel. Future
leverage opportunities appear likely with atmospheric research groups
in Oklahoma and New Mexico.
Determining Spread Pattern of Microbial Food Toxins in
Agricultural Systems--Agriculture-related terrorism is a real and
present threat to our country's food supply and economic stability. The
primary objective of this project is to determine and follow the spread
pattern of ricin/ricinine from the point of contamination on the soil
surface to its ultimate detoxification/ degradation. Investigators have
identified and characterized a ricin-contaminated test-site within an
existing field. This field has been used to grow castor beans for many
years and investigators have detected a significant ricin gradient
within the soil. Innovative techniques have been developed and
implemented to qualify and quantify ricin levels in the soil. Abiotic
factors including soil types, mineralogy, pH, salinity, moisture as
well as biotic factors, fungi and bacteria, are primary factors in the
capacity of the soil to sequester or mitigate the ricin/ricinine. From
data resulting from studies of spread patterns during 2001,
investigators are focusing on determining or developing new ways to
mitigate the spread of this dangerous toxin. Recent discoveries of
direct links between the al-Qaida network and the Iraqi military, and
plans to utilize ricin on the battlefield, heighten the need to find
means to mitigate the toxin.
Focus Area II: Agent Detection, Remediation and Therapeutic
Intervention Strategies
Cellular Transduction Mechanisms Involved in Latent
Neurodegeneration of Motor And Cognitive Central Nervous System Sites--
Chemical warfare agents, particularly organophosphate-based agents and
biological toxins pose a significant threat to both military and
civilian personnel and have the potential to both acutely and
chronically impact the human nervous system. Long term consequences
associated with intermittent or continued exposure to these toxicants
appear to arise from excessive levels of glutamate and activation of
AMPA-preferring glutamate receptors. There is some evidence to suggest
that syndromes such as the Gulf War Syndrome experienced by Desert
Storm veterans is the latent result of chemical exposure. Broadly,
there needs to be a scientific basis for understanding and preventing
acute and delayed neuronal cell death. Specifically this study was
initiated to determine whether AMPA-receptor-induced dark cell
degeneration (DCD) in Purkinje neurons is associated with the
translocation of Bax, cytochrome C release from the mitochondria and
activation of representative initiator and executor caspases that
include caspase-9, caspase-3, and caspase-7. Investigators have
concluded that stress-activated kinases are instrumental in mediating
AMPA-induced DCD, and allow for the assumption that AMPA-induced
toxicity is pharmacologically ameliorated with MAP antagonists.
Developing therapies to control cell death in a programmed manner may
prove beneficial in mitigating long-term effects of exposure to various
chemical agents.
The Isolation and Characterization of Combinatorial Peptides
for the Detection and Neutralization of Bioagents--Isolation and
characterization of high affinity peptide ligands is a useful and
possibly a more economical means for detecting and neutralizing
biological warfare agents. Using principles of combinatorial peptide
chemistry along with affinity maturation of phage display peptides,
this project will continue to investigate peptide ligands with high
binding affinity for ricin, cholera, tetanus, and shiga toxins. During
2002, investigators identified peptide display phages with binding
affinity for ricin and cholera toxin. These discoveries were critical
in gaining the ability to detect ricin and cholera toxins in very low
concentrations. Additionally, a capillary bio-panning apparatus was
developed that can be used for automated bio-panning of phage display
libraries.
Microsystems for Detecting Liquid and Gaseous Hazards--
Fluorescent Spectroscopy is used to identify and quantify trace
contaminants by looking for their characteristic optical
``fingerprint.'' This spectrophotometric sensing approach is a
cornerstone of analytical chemistry and increasingly finds applications
for monitoring biological and chemical agents. This project is focused
on the development of enabling technologies needed for next generation
sensors and integrating optic spectroscopic techniques into a compact
biological and chemical agent warning device. Investigators have
fabricated a hybrid mini-fluorescence/absorption spectroscopy system,
the materials for a UV light emitting diode, microfluidics, and an
analysis and deconvolution system. Liquid core waveguide technology has
also been used successfully to improve this project. The hybrid-
integrated mini-fluorescence/absorption system incorporates mostly
small and discrete parts and is under computer control that uses a
laptop for data output.
Combinative Toxicity of Biotoxin Mixtures--Biotoxins are
naturally occurring toxic agents produced by bacteria, cyanobacteria,
fungi and some species of plants or marine fish and are etiological
agents for a variety of animal and human toxicoses. Several biotoxins
such as aflatoxin, T-2 toxin, anatoxin, botulinum toxin, microcystins,
ricin, saxitoxin, staphylococcal enterotoxin, and tetrodotoxin are
known to be potential biological weapons. Synergistic and potentiation
effects of biotoxin mixtures may enhance casualties and cause long-term
effects in affected human populations. The objective of this study is
to investigate the mechanisms of combinative toxic effects on animals
and humans to facilitate the development of protective strategies
against potential use of these mixtures as biological warfare threat
agents or terrorist attack agents. Investigators tested the acute
toxicity of four biotoxins, including aflatoxin B1, T-2 toxin,
microcystin-LR and fumonisin, in rats and fish. The respective toxic
index for these toxins was developed. Additionally, antibody-based
immunoaffinity methods, enzyme-linked immunosorbent assays, and
radioimmunoassay were established for measuring these biotoxins in the
laboratory as well as for a small number of environmental samples.
Investigators also optimized the experimental conditions, including
parameters such as cell numbers, incubation times, substrate
concentrations, and biotoxin solubilities. Significant leverage
opportunities have already been demonstrated with cancer research
centers in China. Future research collaborations include environmental
research in Vietnam.
Counter-Terrorism Measures to Combat Yersinia pestis with
Selenium Pharmaceuticals--The primary objective of this research is to
produce selenium-labeled peptides and phage (bacterial viruses) that
can selectively bind to the surface of pathogenic bacteria and
inactivate them through the generation of superoxide radicals on their
surface. Initial results have demonstrated that selenium could be
covalently bonded to organic molecules and would continue to retain its
ability to kill bacteria. Additionally, investigators identified
specific peptide sequences for high specificity and affinity for
Yersinia pestis. Some of these sequences have been synthesized and
labeled with selenium display phages. Most importantly, investigators
have demonstrated that using the selenium-labeled phage, bacteria can
now be killed in 30 minutes, as opposed to 36 hours. Plans have been
initiated with members of the DOD to test the in vivo efficacy of these
phage on Y. pestis.
Focus Area III: Sensors and Personal Protective Devices
Development of Lightweight Nonwoven Protective Clothing for
Chemical and Biological Warfare Protection--Non-woven substrates are a
novel and promising approach for use in the development of protective
clothing substrates because they are lightweight, breathable, and
comfortable. The purpose of this project is to use state-of-the-art
non-woven technology to produce fabrics capable of providing chemical
protection. Researchers have produced non-woven substrates with high
tensile strength and have incorporated an activated carbon layer that
is thought to provide a significant amount of chemical absorbency.
Additionally, the research team was able to use thermal bonding
technology to incorporate chemical sensor prototypes into wall
coverings. This project has generated substantial scientific, industry
and media attention and has been featured in local and regional
coverage. Results from this project has led to the filing of two
patents and has significantly increased public and industry awareness
for TIEHH, TTU, and TTU's Office of Technology Transfer and
Intellectual Property.
Development of a Fluid-Based Fluorescent Bioaerosol
Detector--The primary objective of this research is to meet the
immediate need for an inexpensive, low power, robust trigger to alert
inhabitants of an increase in biological aerosol activity, thereby
allowing the triggering of more sophisticated systems to determine the
identity and source of the pathogen. During 2002 this project resulted
in the development and testing of a novel and inexpensive sensor device
capable of detecting airborne biological agents. The first three months
of the project were dedicated to defining the parameters for sample
media such as liquids, aerosols, and solid surfaces. A considerable
amount of time was spent in the design and testing phase, as well. The
prototype instrument utilizes a recently developed and proven aflatoxin
biosensor which utilizes a flashlamp and photomultiplier tube, coupled
with miniaturized fluidics to repeatedly sense small amounts of
fluorescence in a two-minute cycle and a high-flow, aerosol
concentrator into a single integrated unit. Although there was some
experimentation involved in the construction of the detection device,
the final test results of the prototype bio-aerosol detector revealed
the relationship between the bacterial agents and the intensity of the
fluorescence emissions. This prototype device will be improved and
refined in 2003 and tests in full-scale building models will be
completed.
Development of Near Real-Time Sensors for Chemical Warfare
Agents in Indoor Environments--The potential use of chemical weapon
agents represents a growing global threat and has brought to focus the
need for instrumentation that can rapidly detect these compounds at
very low levels. The objective of this project is to develop an
inexpensive, concealable sensor for monitoring the release of the
chemical warfare agents Sarin and Soman in indoor and outdoor
environments. Using liquid core waveguide technology and a molecular
imprinted polymer designed specifically for recognition of chemical
agents, investigators have built a chemical sensor capable of detecting
chemical warfare simulants in near real-time. The proof of concept was
successful and efforts in 2003 will seek to improve on limiters of
detection and timing. Significant leveraging opportunities for this
project exist, including the possibility for future collaborations with
ITT Industries and the United States Air Force.
Focus Area IV: Building Protection Strategies
Modeling and Simulation of Chemical and Biological Fluid
Dispersion within a Building Envelope--The Modeling and Simulation
(M&S) project has developed an integrated computer model and simulation
of the release of chemical and biological agents in urban terrain,
including releases within an office building. Along with the ability to
predict chemical and biological particle dispersion, these models
provide predictions of the relative toxic effects on military and
civilian personnel. These simulations should prove useful to the
military for training operations designed to test response time for an
offensive or terrorist use of chemical and biological weapons.
Additional future leverage opportunities exist with both tactical and
operational war-gaming and virtual battlefield technologies.
Each of these research projects was very successful in meeting its
planned objectives and milestones, as well as generating significant
information and novel findings to enhance the knowledge base and
approaches to countering biological and chemical weapons and threats.
Measures of the successes of these research efforts by the Zumwalt
Program include the issuance of one patent and two are pending with the
U.S. Patent Office, more than 35 peer-reviewed publications are either
in print or in press, and 60 professional scientific presentations have
been presented in 13 states and five foreign countries as a direct
result of this research program to date.
Specific areas of research to be addressed by the Zumwalt Program
researchers at Texas Tech during fiscal year 2004 will include:
Focus Area I: Modeling, Simulation and Visualization
Modeling the Transport of Aerosols in the Urban Environment:
Real-time Updating of Dispersion Predictions Using Sensor Data--Near-
real time dispersion codes based on Gaussian Puff and Plume models are
essential to the direction of responses to chemical, radiological and
biological releases. Aerosol dispersion predictions are currently based
on Second Order Integrated Puff (SCIPUFF) algorithms. One of the major
sources of uncertainty in the predictions provided by such codes lies
in source characterization. In many cases, it will be difficult or even
impossible to directly assess the exact characteristics of a source
during the critical early stages of a release, and further uncertainty
results from the effects of source location (elevation, position
relative to obstacles) on downstream transport. It is sought to develop
techniques to integrate sensor data to improve dispersion predictions
in real time during the evolution of a release event. It is anticipated
that future generations of sensors will provide a spatial concentration
field during the evolution of a release event. The proposed research
will develop techniques to use this data to develop refined estimates
of source characteristics and updated dispersion predictions. The
reverse-diffusion problem is inherently ill-posed, eliminating the
possibility of direct analytical solution. To address this problem, a
neural net algorithm is to be developed to characterize the source from
the evolving concentration field. The algorithm will then be applied to
evaluate the effect of sensor deployment strategies on the accuracy of,
and time taken to achieve, source characterization. The proposed
research will be closely integrated with the development of the Texas
Emergency Analysis and Response Program (TEARP) operations center. The
dispersion modeling tools used in center operations will provide
scenarios for use in the evaluation of sensor deployment strategies.
The operations center will benefit by using scenario development for
both the training of center personnel and the cooperative development
of operational strategies with TIPC. The evaluation of sensor
deployment strategies provides another opportunity for cooperation with
the TEARP center and TIPC, both with regard to strategies for use in
emergencies and in the design of permanent sensor arrays to protect key
elements of the infrastructure of the State of Texas. As source
characterization algorithms are developed, methodologies will be
developed to implement the algorithms in conjunction with the Gaussian
modeling codes used by TEARP. The algorithms may be tested in an
operating environment, and, once successfully validated, implemented
for use in emergency operations. Research currently funded enhances
understanding of aerosol transport in the urban environment by
characterizing the interaction between aerosols and vegetative
canopies. While the vast majority of the research effort will be
devoted to the research described above, an effort is to be made to
pursue elements of the current investigation into the interaction
between aerosol species and vegetative canopies to completion. A
methodology is to be developed to introduce the local effects
associated with vegetation into larger scale Gaussian dispersion
models. Further investigation is needed to determine the residence of
time of the entering streams within the canopy and the rate at which
aerosols entering the canopy can be expected to deposit out on the
surfaces of the canopy. These elements may then be combined with
previously obtained results to formulate a sink/source term
representing vegetation in Gaussian Puff models. An investigation into
the effect of wind velocity on the aerodynamic drag force exerted on
trees is also to be undertaken in order to establish a framework for
adjusting canopy parameters in response to varying wind velocities.
Use of Prognostic Wind Fields and GIS-based Software for
Surface-Layer Atmospheric Diffusion Computation--This project is a
follow-up to the past three years of our work, which has focused on
combining meteorological field platform development, mesoscale
meteorological models and diffusion modeling technologies to
investigate, develop, evaluate the accuracy and effectiveness of, and
improve codes simulating the airborne dispersion of chemical/biological
agents or other hazardous substances. Past results have indicated that
nudging the meteorological models with surface-based data alone appears
to have only a limited impact on mesoscale weather and dispersion
forecasts: it appears that data from vertical profiles and probes of
the atmosphere may be needed for true improvement of model
prognostications through data assimilation. A model providing the best
tools for evaluation of a dispersing airborne chemical/biological event
must provide a balance between complexity, timeliness, and accuracy,
and should be able to display results overlain with urban topography in
a Geographic Information Systems (GIS) setting. The proposed project
will strive to implement these needs, and will represent a partnership
with Army Research Laboratory (ARL) scientists. The ARL has been tasked
to develop a real-time operational system for short-term weather
forecasting for chemical/biological-emergency response applications,
and has sought out the expertise of this project's Principal
Investigators to assist them towards this goal. This project will
include the development of interactive software between the MM5
meteorological model and the CATS-JACE GIS-based software, including
the HPAC dispersion model, in order to display airborne dispersion
calculations in a GIS environment. A microscale wind model will be
developed or acquired, and will be interfaced with the aforementioned
dispersion model to provide a fast but sufficiently accurate and
detailed wind flow prediction in the event of an attack or accidental
release. This project utilizes the field facilities of Texas Tech's
Wind Science and Engineering Research Center and West Texas Mesonet,
leveraged with other ongoing experiments supported by other agencies,
to acquire high-resolution surface and upper air wind flow
measurements. The MM5 meteorological model will then be ``nudged'' with
these data to determine whether vertical (above-surface) meteorological
information improves short-term local forecasting and dispersion
calculations and provides a more accurate prediction of the
consequences of a chemical/biological release. Finally, a new-
generation mesoscale model will begin to be tested to determine whether
it can replicate MM5's ability to provide inputs to the HPAC dispersion
model. This project will represent an improvement to models of weather
and airborne dispersion, supporting the Army's need to rapidly and
accurately adjust high-resolution meteorological and dispersion model
forecasts to actual observations at a meso (10 to 100 km) scale, as
related to the Integrated Meteorological Support System concept. The
results of the proposed research will improve the ability not only of
the armed forces but also civilian authorities and first responders to
use locally-collected weather data to gain a tactical advantage,
whether it be on the battlefield or in a civilian emergency.
Focus Area II: Agent Detection, Remediation and Therapeutic
Intervention Strategies
Mechanistic Studies of Combinative Toxicity of Biotoxin
Mixtures--The long-term goal of this research project is to investigate
mechanisms of combinative toxic effects of biotoxin mixture(s) on
animal and humans and develop prevention strategies against potential
use of these mixture(s) as biological warfare threats (BWT) or
terrorist attacks. Biotoxins are naturally-occurring toxic agents
produced by bacterial, cyanobacteria, fungi, and some species of plants
and marine fish, which have caused the tremendous economic loss
worldwide and are etiological agents of a variety of animal and human
toxicoses. Many biotoxins, such as aflatoxin, T-2 toxin, anatoxin,
botulinum toxins, microcystins, ricin, saxitoxin, staphylococcal
enterotoxins, and tetrodotoxins, are known to be weaponized or to be
available for use as terrorist attack(s). For many years, our research
efforts have been only focused on study of single toxin, and a great
deal of data regarding individual toxins are well documented. However,
little attention has been paid in study of combinative toxic effects of
biotoxin mixture(s), which may be more potent and cause more damage to
human and animal health. The great challenge currently faced in the
field of anti-BWT is how to deal with the attack(s) of toxic biotoxin
mixture(s). It is logical to raise the concern because a large quantity
of single biotoxin is ready, available for use and our knowledge about
the combinative toxicity of toxin mixture(s) is very limited.
Therefore, there is an urgent need for understanding the mechanism of
combinative toxicity of biotoxin mixture(s), developing rapid and
sensitive methods to detect multiple biotoxins in the field and body
fluids of animal and humans, and as a long-term shot, developing
prevention strategies against possible use of these toxin mixtures. The
general hypothesis for this FY04 research proposal is that the
combinative toxic effects found in our studies with biotoxin mixtures
may be molecularly controlled by the critical gene or gene products for
metabolism and detoxification and modulate the process will, to a
certain degree, reduce the damage and mortality caused by these toxin
mixture(s). The specific aims in this project include: 1) to study
molecular mechanisms of combinative acute toxic effects of biotoxin
mixtures in rat and fish models. 2) To study molecular mechanisms of
combinative cytotoxicity induced by biotoxin mixture in targeted human
liver and lung cells. 3) To continue development and validation of
rapid and sensitive monoclonal antibodies based method(s) for detecting
multiple biotoxins exposures in animals and humans, and 4) To continue
screening safe and nontoxic chemicals for detoxifying or antagonizing
the combinative acute toxic or cytotoxic effects caused by these toxin
mixtures. Biotoxins and their mixtures selected in the project
represent most toxins of interest both in the field of anti-BWT and in
the scientific community of public health. Through the completion of
the proposed study, the mechanisms of combinative acute toxicity and
cytotoxicity of selected mixture of biotoxins will be thoroughly
explored. The rapid and sensitive method(s) for detecting multiple
biotoxins in field and body fluids of animals and humans will be
developed and validated. A series of chemicals possessing antagonistic
effects against acute toxicity of biotoxin mixture(s) will be
identified and studied. This proposal seeks the continuing support from
RDECOM for FY 2004. The research project titled ``Combinative toxicity
of biotoxin mixtures'' was funded by SBCCOM in FY 2001 (DAAD13-00-C-
0056), in FY 2002 (DAAD13-01-C-0053), and in FY 2003 (DAAD13-02-C-
0070). The proposed studies for the first two years have been completed
and the annual report for each year has been delivered. The delivery
arrangement for the FY 2003 will be fully met by the end of this
funding year. A large database regarding toxicity and cytotoxicity of
individual toxin, combination of two toxin mixtures, and combinations
of three toxin mixtures in F344 rats, mosquitofish, human HepG2 and
BEAS-2B cells has been set up based on our previous studies. Research
proposed will be follow-on from previous research findings with the new
specific aims and new methods.
Proteomics and Latent Neurodegeneration Triggered by Warfare
Agents: Development of a Novel System for Comprehensive Assessment of
Candidate Protein Mediators Using an Array Chip--The objective of this
proposal is to utilize a protein array chip to develop a novel model
system that permits a comprehensive and efficient qualitative
assessment of candidate proteins involved in latent neurodegeneration
triggered by radiological, biological and chemical warfare agents. The
ultimate objective is to identify molecular substrates, define
prominent transduction pathways and describe relevant cellular
pathophysiology mediating latent neurodegeneration to be able to
rationally develop therapeutic interventions that prevent catastrophic
life-long neurological problems following exposure to non-lethal
amounts of warfare agents by targeting proteins identified as major
contributors to neuronal programmed cell death in selected brain
regions. Retrospective epidemiological studies document higher
incidences of neurodegenerative and other diseases in personnel from
the Viet Nam conflict and Gulf War however potential causes and
mechanisms are entirely unknown. Chronic neurodegenerative diseases
have been mechanistically linked to excitotoxicity, a process that
occurs when glutamate abusively activates various glutamate receptors
including the AMPA and NMDA subtypes leading to a plethora of
intracellular events that are capable of triggering multiple
constitutive programmed cell death enzymatic cascades that remain
poorly characterized. Moreover, particular cell death mechanisms are
likely dependent on many concomitant factors including the physiologic
context of the cell and the regional location in the brain. This year
we propose to develop a model system using a protein array chip that
directly identifies proteins that mediate the pathology of cellular
neural degeneration. Protein array technology is a successor to gene
micro-array technology and represents an innovative and new, ``state-
of-the-art'' approach that targets many relevant proteins at once and
excludes irrelevant proteins by casting a wide net, allowing
identification of potential players at the exclusion of others.
Proteins are the molecular machinery (work horses) of the cell
responsible for all physiologic and pathologic processes.
Identification of relevant proteins by traditional methods is
particularly problematic since the number of these proteins and
enzymatic cascades associated with cell death is rapidly expanding
making it impractical to singularly probe each candidate protein.
Protein array methodology has the advantage over DNA genomic technology
because it directly identifies complexes of proteins that work in
molecular ensembles to carry out the pathophysiologic events.
Furthermore, this technology translates to more efficient discovery of
cellular processes, fostering rapid progression and development of
rational therapeutic interventions for field applications. Our major
goals/milestones for year 4 continue to be to define potential novel
therapeutic approaches that target destructive enzymatic cascades to
prevent radiological, chemical or biological warfare agent-induced
excitatory neurodegeneration in exposed individuals. The overall intent
of our research is to develop a model system to expedite discovery of
various proteins that contribute to signal transduction pathways that
are common final process responsible for neurotoxicity and
neurodegeneration regardless of the nature or type of initiating
insult. These studies will identify universal intracellular mediators
of neurodegeneration and thereby identify relevant target proteins/
enzymes on which to focus development of prophylactic and therapeutic
treatments to prevent latent neuropathology in individuals at risk from
non-lethal exposures to neurotoxic warfare agents.
Fluorescence based detection of single spores--The goal of
this project is to combine recent advances in ultraviolet light sources
and results of experiments with gated fluorescence detection to prepare
a microsystem capable of detection of a single spore. Under past
funding from SBCCOM we have developed deep ultraviolet light emitting
diodes operating at 280 nm that are an enabling component of new
fluorescence-based spore detection systems. We have also developed the
microfluidic components using sophisticated electronics needed to
realize a practical detection system. The current implementation uses a
chelation reaction of terbium with dipicolinic acid (DPA), a unique
chemical component of spores, to provide an efficient and long-lived
fluorescence signature specific to DPA. This detection method greatly
reduces the problem of false positives. The fluorescence efficiency of
Tb(DPA)3 is 10,000 times higher than that of native Tb(III). Our
current system, based on gated photomultiplier detection, has a
sensitivity limit equivalent to 10 spores. This already exceeds the
best published results by more than a factor of 70. Higher power LED
sources and improvements in the photodetection electronics will reduce
the limit of detection to a single spore. The construction and testing
of the new system requires an interdisciplinary team of scientists with
expertise in Electrical Engineering, Chemistry, and Physics. Such a
team, consisting of Profs. H. Temkin (Electrical Engineering), S.
Dasgupta (Chemistry), S. Nikishin (Electrical Engineering), and M.
Holtz (Physics), has been assembled and proven under the past SBCCOM
funding. A simple, compact, and reliable spore detection system would
be of great interest to a number of our partners in the Admiral Elmo R.
Zumwalt, Jr. National Program for Countermeasures to Biological and
Chemical Threats.
Development of Combinatorial Peptides for use in the
Detection of and Countermeasures against BWAs--Many bioassays and
biosensors depend upon antibodies as recognition reagents. While
antibodies frequently have the desired sensitivity and selectivity,
there can be problems with antibody reagents. In some cases, antibodies
may be unobtainable due to the non-antigenic nature of the analyte or
the target of interest and need to be analyzed in a sample matrix not
compatible with antibody function. This later limitation can be
especially important in environmental testing applications, where
compounds must be extracted from soil or groundwater with organic
solvents. Antibodies are also relatively expensive to produce in large
quantities, are susceptible to a variety of environmental agents and
conditions, have a relatively short shelf life and require
refrigeration or freezing for storage and transport. Recent technology,
however, can address these limitations and includes the use of peptides
as reagents for sensors. Single -chain peptides are much more robust
and have much longer shelf-lives than do more complex proteins such as
antibodies. They do not require refrigeration for storage or transport,
can be produced in very large quantities inexpensively and are more
amenable to a variety of diagnostic and therapeutic formats than are
antibodies. For these reasons high affinity, target-specific peptides
offer an obvious advantage over the use of antibodies in the detection
and/or neutralization of biowarfare agents (BWAs). A program is
proposed to develop Phage-Display technology for the isolation and
characterization of high affinity peptide ligands which can be used for
the identification, simulation, and as countermeasures against of BWAs.
For this study, and on the advice of RDECOM, we will target Y. pestis,
vaccinia virus, B. anthracis spores botulinum toxin (BoNT) for
identification and simulation and cholera toxin (CT) for countermeasure
studies.
Counter Terrorism Measures to Combat Yersinia pestis and
Cholera Toxin with Selenium Pharmaceuticals--Objective: During the last
year a selenium-peptide was designed and synthesized that can kill over
three log units of bacteria (99.9 percent) in 15 minutes and kill all
of the bacteria in two hours. This seleno-peptide is specific for only
bacteria that express the Yersinia pestis F1 antigen on their surface.
Thus, the peptide has no effect on other bacteria. This represents the
first of a new type of antibiotic that kills by a mechanism for which
bacteria cannot develop resistance and that is specific for a single
bacterial type. The objective for the next year is to complete the
design of this new antibiotic by testing its half-life in vivo. The
seleno-peptide will then be modified to extend its half-life and test
it on the bacteria in living animals. In addition, we will extend this
technology to develop a drug that will inactivate cholera toxin. This
will utilize a peptide that was developed by Dr. Joe Fralick on a
different SBCCOM project which targets and binds quite well to cholera
toxin. Methods: 1. To determine and improve the half-lives of newly
selected seleno-peptides and seleno-peptidomimetics in vivo. The
peptides will be labeled with tritium and then injected into mice.
Half-lives for the existence of the peptide in the blood will then be
measured. The same peptides will also be synthesized with attached
polyethylene glycol residues to improve their half-life in vivo. 2. To
continue to synthesize peptides and peptidomimetic selenium containing
compounds that were selected for increased binding to Yersinia pestis
and increased stability in vivo. While testing for the half-life in
vivo, additional seleno-peptides will be synthesized based upon
molecular modeling studies for binding to the F1 protein. These
peptides will then be tested by BiaCore binding studies for the ones,
which bind best to the F1 protein. 3. To test for the ability of the
seleno-peptide or seleno-phage to kill Y. pestis in vivo. The best
candidates from the half-life studies will be tested for their ability
to kill the Y. pestis bacteria in vivo. 4. A seleno-peptide that binds
to cholera toxin will be synthesized and tested for its ability
inactivate the cholera toxin. Significance: This research represents
the design and synthesis of a new type of antibiotic that can target a
specific bacterial species, and then kill that bacteria by a mechanism
for which the bacteria cannot develop a resistance. In addition this
same technology, which works extremely well on bacteria, will be
extended to the design of a drug that can inactivate a toxin. Both of
these new drugs have significance as medical countermeasures for the
protection of combat personnel.
Focus Area III: Sensors and Personal Protective Devices
Liquid Crystal Technology Based Diagnostic Sensor for
Detecting Nerve Agents--Threats of use of Chemical and Biological
agents during peace time and warfare have drawn considerable attention.
For purposes of countering such threats, it is necessary to detect a
variety of synthetic organic chemicals at low concentration levels.
Highly sensitive laboratory-based methods of detection (like Gas
Chromatography and Liquid Chromatography) for specific chemical
compounds do exist. However, these methods are not suited for
measurement of personal exposure due to their size, weight and power
requirements. Further, many of these techniques require demanding user
input for obtaining reliable analytical results. Hence, it becomes
imperative that we find an inexpensive, easily-constructed, low weight
alternative that requires minimal user input for detecting presence of
chemical warfare agents for the protection of personnel in danger of
being exposed. To meet this challenge, several approaches have been
designed. In the first approach, a pre-treated solid surface presents
an array of immobilized chemical receptors that weakly bind LC
molecules to orient it in a well-defined direction. Upon exposure, the
receptors will selectively bind targeted analytes (driven by
competitive H-binding ability) more strongly than they bind the
molecules forming the LC. This will release the LC molecules. Since the
surface will be pre-treated to define a nanometer-scale topography, the
freed LC molecules will be forced to assume a predictable and visually
distinct orientation in the absence of receptor-mediated-anchoring of
the mesogen at the surface. In the second approach novel liquid
crystalline molecules will be designed and synthesized that form LC
phase through weakly bonding with each other. These molecules will be
placed in an electric/magnetic field which orients the molecules in a
well-defined direction. The target molecules, due to their competitive
H-bonding ability, will release the LC molecules from each other. This
will induce a visually-distinct phase in the liquid crystalline
material. This release will also trigger a change in the applied
electric field which in turn will be amplified and used for detection.
In this approach, the LC molecules will double up as receptors for
target analyte molecules. This approach will also allow the flexibility
to tuning/designing target specific liquid crystalline molecules. The
above will lead to the construction of a detection system that will be
sufficiently simple to be easily incorporated into a sensor for
personal monitoring. Such a sensor, with low power requirements and
production cost will be of diagnostic utility for detecting nerve
agents such as Tabun (GA) Sarin (GB) Soman (GD) or VX or their
hydrolytic products.
Development of Highly Efficient Nonwoven Chemical
Countermeasures Substrates--The overall goal of the project is develop
nonwoven based chemical countermeasures protective substrates that are
multi-functional and highly efficient. Immediate objectives are: 1) to
develop ``next-to-skin'' friendly adsorbent chemical decontamination
wipes and liners for chemical protective suits and 2) to develop highly
efficient and multi-functional destructive adsorbent nanofiber webs.
The proposed project will utilize the ``state-of-the-art'' H1 needle-
punching non-woven technology to develop a multi-layer adsorbent
substrate. In addition, a through-air thermal bonding technology will
be effectively utilized to develop base substrates with enhanced
strength and smoothness. The combined use of the needle-punching and
the thermal bonding technologies will result in non-woven base
substrates that have improved mechanical and surface properties. The
project will also focus on a new and unexplored territory to develop
destructive adsorbent nanofiber webs. These specialized nanowebs will
have catalytic degradation action against certain chemical warfare
agents and also adsorbency. This multi-functional web will
significantly enhance the overall protection and filtration
efficiencies of chemical protective substrates. The RDECOM funded
chemical protective non-wovens research at TTU has been extremely
successful in delivering products on time. A three-layered non-woven
chemical protective substrate has been developed. The chemical
protective non-woven composite substrates were evaluated for their
protection and adsorption characteristics at the U.S. Army Natick
Soldier Center. Results have been very successful and have shown that
the non-woven composites are good enough to serve as lining materials
for JS-LIST chemical protective suits. Overall, the project has
tremendous pay-back potential to the U.S. DOD and the society by
developing new technologies that enhance the protection efficiencies of
currently available chemical countermeasures substrates. The continued
support of the RDECOM will help to sustain graduate students to
continue their research activities resulting in their intellectual
growth and development.
Development of a Field-Deployable, Remotely-Monitored, Area-
Wide, Biological Pathogen Detection System--Zoonoses, or diseases of
wild and domestic animals that can cross over into humans, have shaped
history and influenced mankind's social and cultural behaviors. Many of
these naturally-occurring zoonotic pathogens are known to have been
weaponized and are classified as potential biological terrorism threat
agents. Diseases such as hantavirus, plague (Yersinia pestis) and
tularemia (Francisella tularensis) exist and are maintained in wild
rodent and arthropod hosts throughout most of the western United
States. These enzootic foci of disease are most often unknown until a
human case of disease occurs and field surveillance operations are
conducted. Current technologies to identify the reservoirs or vectors
of these disease agents involve capture of wild rodents, collection of
blood or tissue specimens from the animals, and serological assay,
culture growth or polymerase chain reaction methods. These processes
and techniques are extremely labor-intensive, expensive and require
from days to weeks for definitive results to be obtained. The primary
objective of this project is to develop a remotely monitored, near-real
time, highly accurate biological agent detection system that can be
easily deployed into any environment to detect and report the presence
of disease pathogens and infection in a suspect rodent population. The
initial step to acquiring our objective will be to develop a
molecularly imprinted polymer (MIP) or liquid crystal (LC) absorbence
sensor that is sensitive to Yersinia pseudotuberculosis (a pathogenic
species in rodents very similar to Y. pestis). The MIP/LC sensing
element will then be integrated into a rodent bait matrix and offered
to a rodent known to harbor Y. pseudotuberculosis. The fluorescence
response signal of the MIP or absorbency response of the LC will be
monitored, measured and transmitted to a remote event recorder.
Successful development and follow-on enhancement of this biological
pathogen detection system will significantly improve public health,
preventive medicine and Homeland security response capabilities in the
civilian and military environments.
Focus Area IV: Environmental Protection Strategies
Generation and analysis of dust particles potentially
containing plant toxins and bacterial spores--The objective of this
proposal is to identify the relationships between soil materials and
the generation of dust particles that contain plant toxins and
bacterial spores. Inoculation of soil with a toxic agent would be a
simple mechanism to contaminate large military reservations through the
dust raised by wind action. The plant-toxin, ricin, and peanut lectin,
a non-toxic surrogate for ricin, will be evaluated. The spores of the
bacteria Bacillus cereus, a surrogate for Bacillus anthracis, will
initially be evaluated. Characterization of ricin sorption to and
desorption from natural and anthropogenic materials has been achieved
by our team. Also, the sorption of both ricin and Bacillus cereus
spores on raw fruits and vegetables has been examined. The potential
detachment of dusts containing these toxins or spores has not been
evaluated. A local USDA-ARS research facility that examines wind
erosion has developed a laboratory apparatus to generate dust particles
from soil samples. This technology will be utilized in this research
project. A series of experiments to quantify the amount and fraction of
dust particles that contain toxins and bacterial spores is to be
conducted. Soils are unique materials that are heterogeneous and vary
both spatially and temporally. Soils with the same soil texture can
exhibit radical differences in dust loss depending on whether the soil
is wet or dry. Temperature might also have an effect on dust
production. This will be the first year of a multi-year proposal. The
relationship between soil properties, dust generation, and wind
transport of toxins and spores is complex and cannot be easily or
rapidly evaluated.
Leveraging of Successes
Specific examples of ongoing efforts to leverage the successes and
expand the momentum of the Zumwalt Program into additional research
areas to address highly vulnerable human health protection and economic
stability include: (1) Coordinating the development and establishment
of a multi-disciplinary project with the Director of Homeland Security
for Texas to provide near real-time surveillance, monitoring and
predictive modeling of disasters or biological and chemical incidents.
(2) Developing and coordinating a multi-disciplinary project to provide
near real-time surveillance of livestock and field crops for disease
indicators to combat agricultural terrorism. (3) Exploiting the
successful completion of research and development of a near real-time
biological aerosol detector device. (4) Conducted preliminary studies
and analysis for the development of multi-discipline, multi-agency
projects to quantify and characterize zoonotic diseases classified as
potential biological weapon agents occurring in Texas. New research
initiatives being pursued as a result of the capabilities, expertise
and successes of the Zumwalt Program team include:
Enhanced sensitivity and specificity of biological
and chemical agent sensors.
Emergency operations support through total visibility
and modeling of biological and chemical threats in the
environment.
Active surveillance and monitoring of pre- and post-
harvest agricultural production systems.
Non-woven fabrics technology for protection against
and detection of biological and chemical threat agents.
Adaptation of biological and chemical agent sensor
technologies to more directly support homeland security needs.
Development of integrated medical system/health care
surge capacity models to assess biological and chemical
terrorism incident response capabilities.
Expansion of non-wovens materials technology research
to improve health and safety of military forces, as well as
emergency first responders in diverse environments.
Design and development of novel approaches to
military medical force protection.
Development of biological and chemical environmental
threat recognition, prediction and mitigation technologies.
Dynamics of zoonotic pathogens and their potential
use as biological terror agents.
2. How does TIEHH work with first responders and State and local
government organizations to understand their needs for the technologies
being developed at TIEHH? How do you work with them on education,
training, and outreach?
Through the scientific expertise and state-of-the-art technologies
available through the collaborations among the Zumwalt Program team
members and through leveraging of our successes, an operational
capability to augment and supplement emergency response assets in the
State of Texas was created. This capability, the Texas Emergency
Analysis and Response Program (TEARP), integrates scientific and
technical expertise with state-of-the-art computing, communications,
information systems, and visualization technologies to create an
immediately responsive and highly accurate operational capability to
save the lives and protect the property of Texans during accidental or
intentional incidents involving biological, chemical and radiological
threat agents.
The TEARP at Texas Tech University is composed of four primary
components: (1) A continuous Operations Center which coordinates the
gathering and initial assessments of ``raw'' information, disseminates
analyzed information, and maintains communications with supported
agencies and services. (2) The Center for Dispersive Processes which
utilizes data received from numerous sources to develop predictive
plume/cloud/threat dispersion models. (3) Wind Science and Engineering,
which utilizes meteorological and other weather information resources
to evaluate and predict atmospheric influences at an incident site. (4)
Biological and Chemical Threat Assessment, which collects and analyzes
epidemiological, epizoological and toxicological data to develop
predictive models of biological pathogen threats, chemical hazards and
their dispersion. This operational platform will provide Texas law
enforcement and emergency response leadership, as well as on-site
personnel, the information technologies and capabilities needed to
dramatically improve their abilities to safely, effectively and
efficiently respond to emergency situations. We are a multi-
disciplinary team combining scientific and technical expertise, as well
as operational experts with an understanding of emergency incident
response and support operations. This operational understanding coupled
with highly accurate weather and hazardous dispersion prediction
technologies will provide on-site emergency responders with what is
needed to help save lives and property.
The TEARP will provide a wide variety of technical and relevant
information and consultation to on-site authorities and the Governor's
emergency response team through the development and interpretation of
predictive models of hazard (plume/cloud) movement in the environment
for 1, 2, 3, 6, 12, 24, 48 and 72 hours in the future, thereby ensuring
highly accurate, near-real time situational awareness for the Texas SOC
and on-site first responders. TEARP utilizes all available U.S.
National Weather Service observations, near-real time satellite
imagery, and forecast information combined with sophisticated high
speed computing capabilities (SGI Super Computer) to provide weather
forecasts covering Texas at resolutions ranging from 1-15 km.
Additionally, the TEARP can deploy mobile platforms called Vehicular
Instrumentation Platform for Emergency Response (VIPER) systems
outfitted with biological, chemical, meteorological, and radiological
sensors into hazardous areas and environments, to relay near-real time
data to decision-makers. The TEARP will maintain a full remote
computational backup and satellite distribution network for its
products and results to ensure uninterrupted service. Finally, the
superior technologies and operational and scientific expertise brought
together by the TEARP will make available unprecedented resources to
provide training to emergency responders, as well as local and state
elected officials, in all aspects of biological, chemical and
radiological incident response activities.
Operational Capabilities:
Deliver rapid, accurate data and predictions to
government officials, emergency responders, and emergency/
incident site commanders; information to make insightful and
knowledgeable decisions.
Provide real-time dissemination of analysis results
through secure communications to prepare for and mitigate an
emergent event.
Continuously deliver accurate, high-resolution,
timely weather predictions covering the entire state of Texas.
Provide state-of-the-art dispersion predictions of
pollutants, biological and chemical agents as a result of
adverse atmospheric conditions, industrial and transportation
accidents, and terrorism-related incidents.
Provide mobile platforms called Vehicular
Instrumentation Platform for Emergency Response (VIPER) systems
for deploying biological, chemical, meteorological, and
radiological sensors into hazardous areas and environments, to
relay near-real time data to decision-makers.
Ensure dispersion and weather predictions are
visualized using leading edge technologies.
Provide support for local and state emergency
response training exercises.
Provide technical support on the latest in
meteorological and particle dispersion modeling and simulation
capabilities. Modeling results (complemented with insights and
analysis from subject matter experts in biological, chemical,
and radiological materials and their relationship to
environmental toxicology and epidemiology) will be utilized
before, during and after all operational events. These highly
accurate assessments will be communicated in user-friendly
language to enable use by all facets of governmental
infrastructure.
Maintain a full remote computational backup and
satellite distribution network for its products and results to
ensure uninterrupted service.
3. How can the Federal Government, particularly the Department of
Homeland Security, improve its efforts to help communities be better
prepared for a bioterrorist attack? Are there specific areas that
demand increased attention?
The following areas require increased attention from the Department
of Homeland Security to ensure the American people are protected from
the threat of bioterrorism:
1. An increased research focus on the development of more
rapid biological pathogen recognition and identification
capabilities for use in both active and passive surveillance
systems, particularly in areas of high population density.
2. The creation of regionally-focused research laboratories to
assess and develop technologies to address the growing threat
of emerging and resurging pathogens that may also have the
potential for use as biological terror agents, particularly
those pathogens specific to or enzootic in geographic regions.
3. An increased focus on the establishment of training and
education facilities to provide the most up-to-date information
and technologies to emergency responders, their leadership, as
well as elected officials, on the preventive and response
procedures for biological weapon agents.
Biography for Ronald J. Kendall
Founder and Director of The Institute of
Environmental and Human Health (TIEHH) at Texas Tech University
(1997-Present); Founding Chair and Professor, Department of
Environmental Toxicology, Texas Tech University (Institute
Faculty, Adjunct Faculty, Staff, Graduate Students--130;
150,000 square feet Physical Plant and multi-million dollar
annual budget)
Founder and Director of The Institute of Wildlife and
Environmental Toxicology (TIWET) at Clemson University (1989-
1997)
Founding Department Head (1989-1995) and Professor
(1989-1997) in the Department of Environmental Toxicology at
Clemson University
Founding Director, Institute of Wildlife Toxicology,
and Professor of Environmental Toxicology, Huxley College of
Environmental Studies, Western Washington University (1980-
1989)
Past-President of the Society of Environmental
Toxicology and Chemistry (SETAC), and has served on its Board
of Directors and Executive Committee, as well as being Vice
President, on the SETAC Foundation for Environmental Education
Board of Directors, and was the Annual Review Editor and
currently Terrestrial Toxicology Editor of the journal,
Environmental Toxicology and Chemistry
Authored more than one hundred refereed journal and
technical articles, and published or edited several books
including, Toxic Substances in the Environment, Wildlife
Toxicology, Wildlife Toxicology and Population Modeling:
Integrated Studies of Agroecosystems and Principles and
Processes for Evaluating Endocrine Disruption in Wildlife
Made more than 170 public and scientific
presentations in the field of wildlife and environmental
toxicology
As Principal Investigator have received 136 research
grants totaling more than 42 million dollars
Graduated thirty students at the graduate level,
including M.S. and Ph.D. degrees
Authored ten courses in environmental toxicology and
wildlife toxicology
``Award of Appreciation'' from United States
Environmental Protection Agency for service related to
Chairmanship of the EPA Scientific Advisory Panel for
implementation of the Federal Insecticide, Fungicide and
Rodenticide Act and the Food Quality Protection Act of 1996,
January 2004.
Received an Outstanding Researcher Award, College of
Arts & Sciences, Texas Tech University, 2003.
Received the 1996 Alumni Research Award for
outstanding faculty research at Clemson University
Received the 1987 Paul J. and Ruth Olscamp Research
Award, from Western Washington State University
In 1996, addressed the United Nations Committee on
Sustainable Development, United Nations, New York
Awarded a Fulbright Fellowship in 1991
Served as an environmental advisor to the United
States Justice Department, Environmental Enforcement Section
National Board/Committee Appointments (representative
past and present)
National Research Council Committee on Superfund Site
Assessment and Remediation in the Coeur d'Alene River Basin
(November 2003 to present)
United States Environmental Protection Agency's,
Science Advisory Panel (Member, 1995-December 2002; Chair
January, 1999-December 2002)
United States Environmental Protection Agency's,
Joint SAB/SAP Review on ``Data from Testing of Human Subjects''
served as Chairman (1998-2000)
United States Environmental Protection Agency's,
Science Advisory Board, Mercury Review Subcommittee (1997)
The National Academy of Sciences', Ecological Risk
Assessment Subcommittee, Committee on Risk Assessment
Methodologies (1990-1991)
The Endocrine Disruptors Screening and Testing
Advisory Committee (EDSTAC) of the USEPA (1996-1998)
Board of Research Directors of the Canadian Network
of Toxicology Centers for the Canadian Government (1993-1999)
Consulted with many foreign countries on
environmental issues (e.g., Russia, Costa Rica, Canada, the
Netherlands, France, United Kingdom, Portugal, Switzerland)
Graduated with honors from the University of South
Carolina, received M.S. degree in Wildlife Ecology from Clemson
University, Ph.D. in Fisheries and Wildlife Sciences/Toxicology
from Virginia Polytechnic Institute and State University, and
received a United States Environmental Protection Agency post-
doctoral traineeship at the Massachusetts Institute of
Technology
Discussion
Mr. Neugebauer. Thank you, Dr. Kendall, and I'm going to
yield to my friend from Kansas, Mr. Moore, for the first
questions.
Mr. Moore. I'd like to direct my first questions to Mr.
Schable and also to Sam Turner, Mr. Turner. And the question is
that the President has set a goal of assuming, I'm sorry,
assuring that most Americans have electronic health records
within the next 10 years. This would seem to impact detection
and monitoring, analysis and interpretation, as well as
knowledge management.
My question to you is what do we need to do to meet the
President's goal of assuring that--and is this something that
we should do, that most Americans have electronic health
records in the next 10 years? What do we need to do to make
that happen?
Mr. Schable, first, if you would, please?
Mr. Schable. Electronic medical reporting and medical
records would be a useful tool in monitoring events, get
knowledge of something that might be happening on a local
level, but to also see over a long period of time what the
baselines are for particular events. That is like we track
influenza over long periods of time. We know when a peak
occurs, something has occurred, when the peaks for influenza
should be or they shouldn't be. How exactly to handle that is a
little out of my expertise. I would defer to the person from--
Mr. Turner, from the hospital system to answer that a little
more at the local level.
Mr. Moore. Very good.
Mr. Turner. We're currently in the process of implementing
electronic medical records here at the hospital and we think
we'll have it done within the next 14 months, the first phase
of it, which will go a long ways toward being able to really
take care of our patients adequately and it certainly will
increase the medication, reduction of medication errors, safety
of patients in the hospital. I think that any time you can have
that much information readily available to parties that need
the information, it will certainly increase, not only our
ability in-house, but as well as community-wide and nationwide
to get demographics out, disease categories information that
needs to be done to really address some of the issues that
we're talking about today.
The problem is that it's millions of dollars for each
hospital to implement it. And you don't get reimbursed for
that. So the ability for all hospitals to be able to implement
this mandate is problematic. It really is, and I think that 10
years, certainly for some hospitals is realistic, but for most
hospitals without funding, it's impossible.
Mr. Moore. Thank you, Mr. Turner. I guess I'd ask the same
question to Mr. Morrissey with the Kansas Department of Health
and also Ms. Kent, if you have comments on that, and any other
witness, frankly, if you have comments on that, let me hear
from you.
Mr. Morrissey. Congressman Moore, I think Mr. Turner's
focus on the potential benefits with patient safety and drug
interaction, whole range of things, have been an issue that the
whole industry has focused on for some time and clearly would
benefit from that. We've talked and you've heard several of us
talk about early detection systems and the potential for new
technology and common patient medical records to enhance those
and I think there's no question that going that direction makes
sense from the technological standpoint.
Probably the concern I would raise is that Kansas is also a
rural state with many very small hospitals. We have a large
number, in fact, the largest in the country of critical access
hospitals and I'm not sure that the priorities statewide are
going to be as focused on that kind of technological change as
they are on for us walking before we run and having on the
ground communication and basic surveillance capability to
respond.
So I think it's both. We have an urban situation and
capacity to deal with. We also have a very rural situation and
it's going to require addressing both, both directions.
Mr. Moore. Ms. Kent, do you have any comments?
Ms. Kent. During our disease outbreak, when CDC came and we
were trying to get a handle quickly on what the extent of the
outbreak was, we wanted to look at physician records,
electronic records and so we called all of our physician groups
in the community and were truly handicapped by the fact that I
think we only had two medical practices that had electronic
records. And so we were not able to get a handle on that as
quickly as we could have, had we had electronic records to be
able to access. So I think that it has tremendous potential in
terms of when you have disease outbreaks, but I do think in a
state as rural as Kansas, it's going to be very difficult to
achieve.
Mr. Moore. Mr. Mason or Dr. Kendall, any comments?
Mr. Mason. Well, as I mentioned in my testimony, we use an
electronic medical record system. We basically implemented it
about a year ago and spent probably about a half a million
dollars of our funds of capital improvements to implement the
project. So yes, it's costly. I can only imagine what it would
be like to implement it in a hospital.
I think an important part is we're looking to the future to
have electronic medical records to surveil, but let's don't
forget those that we already have in place. As an example, the
MAST system of Kansas City is implementing an electronic
medical record system. And if you combined our EMSystem and
MAST EMSystem, you're looking at probably about three-fourths
of the metro area's emergency medical response system through
hospital. You could data mine an awful lot of this medical
surveillance from that. While we need to look at future
implementation, let's look at leveraging what we have in place
right now as well.
Dr. Kendall. I'd like to make a comment, Congressman Moore.
Mr. Moore. Yes.
Dr. Kendall. In Lubbock, Texas, we're blessed with multiple
hospitals and a medical school at Texas Tech. Just this past
year, the flu epidemic alone saturated our beds to the point
where if we had had an additional problem like a biological
attack, we would have been at capacity already. Therefore, the
concept of the best medical records possible as applied to
individual patient care could do much more for us to identify
how serious a level of potential an individual patient may be
of succumbing to a disease threat and so on.
And also, I want to comment that once we have people
entering the hospital, we are way down the road on a biological
or chemical event. In other words, can we do a better job at
providing the platforms necessary to provide real time
information to assist our first responders in reducing
exposures or getting people out of toxic or hazardous zones. I
think that's going to be one of the great challenges because
already, this minute, the fine people that are running our
hospitals are already in near capacity, in order to make their
budgets work as well as provide the kind of comprehensive care
necessary in today's health care needs.
Thank you.
Mr. Moore. Thank you, Dr. Kendall.
Mr. Morrissey, about a third--and I'll direct this really
to anybody on the panel who thinks they have something to
contribute here, because a lot of these transcend your
individual testimony, I think, and apply to Kansas and
Missouri.
A third of the population of Kansas lives near Missouri in
this northeast section of Kansas and I guess my question to you
is how are we coming along in coordinating efforts to protect
the population of Kansas and Missouri with the State of
Missouri?
Is there coordination efforts going on there, Mr.
Morrissey?
Mr. Morrissey. Congressman, there is ongoing communication
between the two state programs and the two state health
departments and in fact, in this federal region, the four
bioterrorism programs have a meeting scheduled, really, the
first one to get all of the staffs together and to begin that
discussion.
Mr. Moore. When does that happen? Do you recall?
Mr. Morrissey. It's in June. I'll have to get you that
exact date. I think that's an area where we recognize there's
significant need. The metropolitan area really has been the
focus of the metropolitan medical response system with first a
program that was funded through Kansas City, Missouri and
covered the Kansas side and now one as well in the Wyandotte
County area. And so a good deal of that coordination has
occurred locally through those mechanisms and through the focus
of MARC and their regional partnership.
Mr. Moore. Anybody else want to comment on this?
Ms. Kent. I would just say that I think we're beginning,
counties that are a little further removed from the
metropolitan area, but would be impacted such as Douglas
County, beginning to have closer relationships with the Kansas
counties that are part of the metropolitan area, but I think
there's still a lot of work that needs to be done in that area.
Mr. Moore. Mr. Schable, and this is not intended as a
criticism of anybody, this is simply an acknowledgement, I
think, that we had a horrible event here in September 2001 and
we've got a huge challenge to try to prepare our nation to
respond to something in the future similar to make sure
something like that doesn't happen to the extent that we can.
My question, I guess, is if you can answer this or any
other panel member can answer this, with regard to the
Department of Homeland Security, how are efforts to coordinate
among the 50 States and I just--I think this is the first time
I've heard about this regional meeting that's coming up in
June, maybe. And I'm glad to hear that because my concern is I
don't know what's really being done by the Department of
Homeland Security to coordinate efforts with the 50 States and
my feeling is, and maybe this is correct, maybe it's not, that
the Department of Homeland Security and the federal agencies
would have a lot more background and experience in dealing with
bioterrorism than some of the states would.
Is there an effort to try to coordinate the information
that they could use, the 50 States, to protect themselves and
our citizens or is each state kind of just left on its own to
develop their protection as best they can?
Mr. Schable. Well, the Department of Homeland Security, of
course, is a new federal department that is still organizing
itself, but I assure you, Congressman, that the Department of
Health and Human Services is actively working with the
Department of Homeland Security on these bioterrorism efforts.
Many of the people that I know that are now in the Department
of Homeland Security are long-time public health people that I
personally know and have a lot of experience with and then we
do try to coordinate what we are doing.
The Department of Homeland Security has some very specific
mission for the Nation's defense against terrorism and CDC
knows what it needs to do and we do try to coordinate.
Could we coordinate better? Certainly, sir. And we are
making every effort to try to do that. As I said, I know almost
everyone in DHS that deals with terrorism and we constantly are
trying to make sure that the right hand and the left do know
what they're doing. Do they always know what they're doing? No,
sir, but we're trying very hard to make sure they do know what
they're doing.
I am firmly convinced that if an event occurs, it will be
at the local level and those people are the ones that are going
to have to respond first. When something happens, they're not
going to call me first. These people are going to be responding
and we are going to be right behind them helping them respond.
Mr. Moore. Thank you, Mr. Schable. I do want to again state
this is not intended as a criticism of anybody. We're kind of
all struggling through this together and I appreciate the
efforts that are being made on the national level and I just
want to make sure that the states, each of the states has the
same opportunity and experience and information level that the
Federal Government has.
Does anybody else have a comment on that?
Mr. Chairman, I've got some other questions, but I
certainly would like to yield back to you.
Mr. Neugebauer. Sure, we'll bounce back and forth here.
Dr. Kendall, one of the things that is certainly an
important part of our efforts on biological attack is
detection. And then once we've detected, determining how broad
that threat is and to disseminate that information, obviously,
to our first responders and our health officials.
Could you kind of go into a little bit of detail of the
TEARP and the VIPER program that you all have developed at the
Institute and how that fits into the detection scenario?
Dr. Kendall. Yes, sir, I will. Through the Governor's
office there is a strategic plan to deal with homeland security
in the State of Texas, including biological and chemical
terrorism countermeasures. Included in that are operational
centers that are located throughout the state that employ
largely our Department of Public Safety, but in our case, there
are discussions to engage research and knowledge-base
information that can be transferred to our first responders.
What I mean there, as I mentioned earlier, the Department
of Defense has funded us for a number of years to develop
information for military readiness, yet it was highly
transferrable to domestic security. And in that concept, we
developed the TEARP, the Texas Emergency and Analysis Response
Program which involves our high performance computing systems,
virtual reality center and multi-disciplinary expertise to
engage questions of how would one look at a hazardous waste--I
mean a hazardous substance or toxic cloud or release into our
water systems, etc., and work through that question through
virtual reality simulation as we could then assist in
identifying the threat level and the dispersion zone and at
what point and what level of protection would be needed to
enter those zones. That's going to require a lot of expertise
and quick response. Not hours, minutes. Okay?
In addition to that, one of the areas that we have worked
with and I wanted to emphasize cooperation is the key. Multi-
disciplinary cooperation among our federal agencies, our states
and then down to our regions and communities.
One of the areas that we've worked with with our wind
engineering research team, a world-renown group at Texas Tech,
is the VIPER platform, is the Vehicular Instrumentation
Platform for Emergency Response. Basically, this is a system
that we can deploy either with human operated capability or in
the future robotics that can engage toxic zones to provide us
with critical weather information, wind information, humidity,
barometric pressure as well as deploy our sensors to determine
what substances at what concentrations and the dispersion zone.
This information can be transferred immediately in real
time via wireless internet as well as cell phone technology
back to the operations center so the high performance computer
can model the event and determine dispersion characteristics
and how widespread the toxic zone will be. Those are some of
the things we are doing within the State of Texas and this will
be provided--this kind of data will be provided immediately to
our first responders. We provide demonstrations to leaders in
our community and the state level, including the Office of
Homeland Security leadership in the state. And I think it's a
model that could have applications in other regions, including
this region.
Mr. Neugebauer. I think I can speak for Dr. Kendall, I
think he would invite you to come and see the capability that
they have developed there for helping our first responders in
other agencies to begin to model a particular event and I think
it's important that we share the information that we're
gleaning from the research money that we're spending because
there's not an endless supply of that money available and so I
think--Mr. Schable there is nodding his head, yes. And so I
think it's important that we do that. So I would encourage you
to do that.
One of the things we talked about and we focused this
morning a little bit is about the attack on our direct--attack
on our citizens in an event of something like that, but what we
really haven't talked about in some of the opening testimony
was attacks on our food supply which could be as catastrophic
as attack directly on our population.
I'd like to kind of just hear from some of you as you're
incorporating into your plans and detection and monitoring,
what you're doing in that respect also. Mr. Schable.
Mr. Schable. Yes sir. We are working diligently with the
Food and Drug Administration, the U.S. Department of
Agriculture, the Food Safety Inspection Service, FSIS. Indeed,
their Acting Director is coming next week to discuss this
because food safety, it really is extremely important, yet many
people don't realize how hard that is to do. There are
tremendous numbers of processing plants. CDC historically keeps
an eye on outbreaks associated with food processing plants, but
in this day and age, we want to make sure that those terrorism
type of events don't occur. We don't want to have to go
investigate. We would prefer to investigate nothing. But we are
working with those groups to try to make food safety much
better. Indeed, in Georgia, at the U.S. Department of
Agriculture associated with one of the universities, they just
opened a new research laboratory to detect outbreaks or threats
to the food safety very quickly. And again, that is something
we need to do a good deal more work on. We've as you said, sir,
been working more on people, but now we're going to start
backing that up with work on not only food supply, but the
animal industry itself.
Mr. Neugebauer. Any others?
Mr. Morrissey. Mr. Chairman, recently, the state has
allocated funding from its grant funds from the Office of
Domestic Preparedness to conduct a statewide assessment of food
security in the state and I would echo Mr. Schable's concern
that this is a difficult problem to get your arms around. The
farm to fork idea here in terms of agriculture and the whole
food chain is a huge task when you think of it from a security
perspective and changing. From a public health perspective, our
basic response has still got to be dealing with food borne
disease and the systems that we already have in place to detect
and respond to food-borne illness.
Mr. Neugebauer. Dr. Kendall.
Dr. Kendall. Congressman Neugebauer, a good example of a
model for a biological terrorist attack would be West Nile
Virus, as an example, moving from the northeast to the
southeast and across the country. We in Lubbock, Texas, get
about 16 inches of rain a year. You wouldn't think there would
be many mosquitos there, but last year we had the largest per
capita outbreak in the country with children dying and older
individuals dying.
What does this mean is that the animals were telling us
something, birds, horses, etc. Therefore, although I was asked
to focus predominantly on human health today, we cannot
separate them. The animals were already telling us the virus
was moving in. Our institute had the data and was showing these
mosquitoes were infected, birds were dying, etc. I think we've
got to learn to have good surveillance epidemiology to look for
signals before humans start dying.
In addition, I think it gives us tools to better apply
early warning systems that will help us better save lives.
Mr. Neugebauer. Thank you. Anybody else want to--I think
particularly, this is going to be an issue for Texans and
Kansans alike because when you look at the contribution that
these two states, for example, make to the food supply in our
country, particularly I think about the cattle industry, it's a
major issue.
This is a question to all of you, but disease surveillance
we've been talking about is an important facet of public
health, especially in early detection of seasonal diseases and
outbreaks. Have you or your office detected seasonal diseases
earlier, more rapidly through the use of disease surveillance
and I guess has the CDC been an integral part of that
surveillance in the past and presently?
Mr. Schable. Well, since he asked, the Chairman asked about
have we been of any help, I hope that the state would say yes.
(Laughter.)
Mr. Morrissey. Kay just did actually, in her earlier
comment talking about the Cryptosporiosis outbreak that Douglas
County suffered through last summer and the significant help
from CDC and from the state and the partnership that worked on
that. But to the question about early detection systems, I
don't think that I can say that we've had the experience of
having detected disease using those electronic systems. And my
understanding is that's not occurred nationally. We really
haven't gotten to the point yet of having a system that's
worked to the extent that we can say yes, we identified this
disease early because of that and I think in my testimony, I
made the point that we're looking at developing more basic
systems across the state and assuring that we can function
doing more rudimentary, I guess, surveillance.
It's not that we don't recognize the very potential
advantages of the technology interventions with surveillance,
but we're looking to others to make the investments to develop
that and frankly, we're looking to take advantage once those
systems are better tested and in place.
Mr. Turner. I think there are, with the HealthSentry
software package I mentioned in my testimony, there are
beginnings of having viable software packages and tools to help
us with early detection. And CDC has always been an important
part of helping hospitals out, but we are very vulnerable as
was evidenced by the influenza outbreak this past winter when a
lot of us ran out of the vaccinations. It's just some things we
just have to get--we're going to have to get better and better.
That's something that really caught a lot of us by surprise.
The full scope of it. But there are software packages that are
being implemented that are being discovered that will help us
in the future.
Mr. Neugebauer. I think an important aspect of this
question is and it's somewhat what Dr. Kendall mentioned was
like for West Nile Virus, it's important that information
transfer begin very quickly, particularly West Nile because
early treatment of that disease is very important and I think
as we look at some of these other threats, identifying them
very quickly and making sure that we help, and particularly, I
think the question was brought up about or a statement was made
that in Kansas and in West Texas, we're urban and we're rural.
And in some of those early detections, we always assume
that those are going to begin in a metropolitan area, but you
know that may not necessarily be the case. So we've got to
build a network where our detection and identification is done
on a relatively quick basis.
Mr. Moore. Mr. Chairman, may I follow-up on one of your
questions?
Mr. Neugebauer. I yield back to you.
Mr. Moore. Thank you, sir. Thank you. I thought the
Chairman asked a really good question and I wanted to follow up
a little bit and that deals with the food supply and the
infection of a food supply. And we saw in the last several
months disastrous results when one animal in Canada apparently
came to this country infected and we--it has a tremendous
adverse effect on our economy. Kansas, Texas and I think there
are a few cattle in Texas, right, Mr. Chairman?
Mr. Neugebauer. One or two.
Mr. Moore. And really, I'm very serious here, this could be
a tremendous economic, just devastation for many places that
are cattle producers around this country.
What, if anything, can we, should we do to protect the food
supply, namely cattle, but expand from there and I'm asking Mr.
Schable, Dr. Kendall, anybody who wants to comment on that, Mr.
Morrissey?
Mr. Schable. It's actually a very good question,
Congressman.
What can we do to protect the food supply? I think we have
worked with our colleagues in the U.S. Department of
Agriculture as they are the ones that have the legal
responsibility for the food supply, along with the Food and
Drug Administration and HHS. We have to look at what vaccines
are available, what systems are available, how can we make sure
something doesn't move into this country from other parts of
the Nation, other parts of the world. The borders between us
and Canada and us and Mexico, I don't know how easily herds
move back and forth, but I don't think they worry--they worry a
little bit about that, but they're starting to pay more
attention to that type of thing.
I think that's what we need to do, is to start putting as
much effort into animal and plant safety in many of these cases
as much as we are for human safety because you're right, sir,
is that the economic impact of this would be tremendous if say
there was a significant cattle problem and look what happened
in the U.K. That was a lot of people who suffered a lot from
that particular event.
Mr. Moore. Others? Dr. Kendall.
Dr. Kendall. Congressman Moore, thank you for the
opportunity to comment on this, but to a large degree how we've
concentrated our agriculture, say corn production, cotton
production, beef cattle, concentration, chickens, other
poultry, makes them vulnerable and easily attacked. Therefore,
the need for surveillance capability, I think is critically
important now.
I continue to emphasize we cannot separate ourselves from
our food supply. The need for fiber and food is critical to our
survival as well as our monetary health and for that reason I
think increased cooperation between multiple federal agencies,
as well as our states and regions will be critical as we
continue to work through these problems and how to detect them
early.
Mr. Moore. And let me just ask one additional question
which may elicit further comment from any of the people who
have already talked, but to Mr. Morrissey as well. How are we,
right now, in terms of readiness, preparedness to deal with
this? Are our people protected? What do we need to do to get us
there? My uneasy feeling is we're not really close yet. Maybe
I'm wrong, I hope I'm wrong.
Mr. Morrissey. Congressman, if I can touch on the question
about foreign animal disease first, that's not our principal
focus in the Department of Health and Environment. It is a
shared responsibility across a number of agencies and the
Department of Animal Health, Commissioner Teagarten has that
responsibility. They're working toward enacting--they have in
place an active statewide planning process. They're working
toward an animal identification tracking system and they're now
I think looking forward to participating in a national effort
to better be able to electronically track animals for things
like BSE and the whole range of concerns.
I think that's in the early stages and like the public
health system and the health care system, they have the same
kinds of problems with surge capacity. And in fact, we have
some plans, but our ability to implement those in a very short
time frame is I think very limited and those are issues they're
going to continue to struggle with.
Mr. Moore. I guess that's the uneasiness I feel about this
and I think it's just an acknowledgement that we still have a
ways to go, we need to get through. That's one of the reasons
for the hearing today, Mr. Chairman. As you know, sir, I really
appreciate your coming in for this, but there are a lot of
areas where I think our country and our people are still
vulnerable. We need to number one identify those and find a way
to coordinate giving information to all the different, the 50
states and homeland security. I know this is a huge, huge
challenge. So I'm not pointing a finger to anybody. I'm saying
we're all in this together. We've got to work together and I
think we're doing the best job we can right now, but boy, we've
got a ways to go to make sure that our nation is protected in
the future. Because what we saw as a result of September 11 was
not just the horrible fact of 3,000 plus people died there, but
there were tremendous economic implications for the rest of the
Nation after that as well. So it's a question of lives and our
commerce, the airline industry was hurt very, very badly as a
result of September 11.
Mr. Chairman, do you yield back?
Mr. Neugebauer. I think the President's directive, I think
they're calling that Project Bioshield and I think that's--when
we talk about multi-disciplinary, I think we've got to put the
food supply into that initiative because it's equally
important.
One of the things I'd like to hear from some of the first
responders because you have other folks in the room that
probably need to hear this, but what are some of the
information--we heard a lot of you talk about the need for
vaccination and equipment and stuff like that, but from an
informational standpoint where do you feel like the information
void is that you need today to be on the front line,
particularly the first responders diagnoses, symptoms,
remediation?
Mr. Mason, I'll start with you.
Mr. Mason. For us, the--as the responders you said the word
response, basically react. We don't spend a lot of time in the
detection and surveillance piece in and of ourselves, we just
respond to the 911 calls and start tracking those trends--hm,
something has consistently been going on here--and then we pull
in our friends in public health in the process.
Through the exercises we participate in in the county and
the state, as an example, I think one of the frustrations for
the response community isn't the lack of information from our
public health community, it's the speed at which it comes. And
that's just a matter of science. It has little to do with
problems in communicating on the human side. It's laboratories
are few and far between. Their ability to do high end
analytical work in the State of Kansas, I think, is limited to
one lab that's been recently upgraded. So that slows the
process down in terms of identifying what it is that we're
dealing with. Once the identification has occurred, the
treatment plans and what we can do to respond to that are I
think pretty well known and very easily disseminated from top
to bottom, so really, it's probably more of a time delay in
determining what it is we've dealt with. In terms of my
personal frustration in exercises, thankfully, nothing in the
real world has hit us yet. But in the exercises, it's certainly
been that delay in what is this thing? We've got to narrow it
down to five possibilities and we can start some things, but it
certainly is that delay.
Mr. Neugebauer. And that concerns me, quite honestly. If
you're called to a building, for example, this afternoon and
people are either sick or you find people that have died in
that building, as you go into that building, do you have
detection equipment that would help you begin to identify the
environmental conditions of that building?
Mr. Mason. We do. When we're talking about detection
equipment, it's a broad spectrum from like the chemical
detection through the biological detection. The biological
detection clearly is the one that takes some time to get a true
analysis of what goes on and we can certainly defer to the
experts on exactly what I'm referring to here, but we can go in
today with monitors that tell us if there's an oxygen deficient
atmosphere, if there are certain chemical agents, VX, saran and
so on and so forth that are part of those environments. We can
walk in today with those things off of the fire trucks which
traditionally don't carry items like that on our first response
ambulance, but my hazmat medics carry those kinds of detection
equipment so we can look at the signs and symptoms of patients
and do they fit a certain profile for a chemical agent. Those
kind of are the things, walks like duck, quacks like a duck,
it's a duck. Very simple things up front in the chemical
environment.
It's the more incipient biological thing that we're not
going to know about. It's going to be we're all of a sudden
seeing a spike in calls and maybe it's an evocative thing and
maybe it's a more rapid food-borne illness that we're seeing a
grouping of people come in, but today, I think, going back to
just universal precautions. The books from the CDC tell you to
wash your hands and wear your gloves. Our paramedics do that
every day. So going into a building today with the detection
equipment we have, I feel safe that our people are going to go
in there. They're not going to get themselves hurt. They're
going to identify the problem and they're going to treat the
injuries and give them transport to the hospital.
It's again that long-term identification of what is this
biological piece that we're dealing with. We can through the
grant money, the Homeland Security grant money, they bought a
nice fancy piece of equipment that can tell us today off one of
our hazmat trucks is it coffee creamer or is it anthrax? They
can do a little bit of that stuff in the field now which is
nice. So we're making some of these technological advances to
give to that rapid assessment of what the problem may be, so
we're getting there in terms of biological, but I think there's
still a lot more needs to be done and I'm very intrigued with
this VIPER system that I'm hearing about.
Mr. Neugebauer. I was going to say so, Dr. Kendall, if Mr.
Mason calls you and has a reading on this device and he's got a
five story building or a warehouse or something like that, what
kinds of information could you give him back to help his first
responders?
Dr. Kendall. First of all, there would need to be structure
in a way that we would need the relevant data on atmospheric
conditions or humidity, etc., so we can get a better feel, if
it's in a building, outside of a building, how materials may
move or flow.
Once you get into the biological area, that gets into--we
can do quick analyses on chemicals. A lot of the real time
chemical problems, the equipment right in our building we can
do it. It's the biologicals as Mr. Mason mentioned, that
require a little bit more screening. Although we can get it
down to certain, at least certain potential areas.
I think one of the--I was just sitting here thinking,
Congressman, but one of the areas that I think we're
underestimating is we're talking about whether anthrax or
botulism and so on, we know a good bit about them, relatively
speaking. It's the techniques and current technologies of
molecular biology, we're going to probably be seeing in the
future genetically engineered organisms that we don't
necessarily have the technology yet to deal with and I think
our techniques in the future are going to have to be robust,
they're going to have to be encompassing and at least get them
information: is this an acute toxin or a chronic toxin or
whatever else? And so that's a challenging area. We don't have
as quick a response capability as I would like to see, but this
is what I'm saying. We need to develop further techniques to at
least get the first responders the information on just how
hazardous is this. Subsequently, of course, we can be seeing
the human health effects if they aren't adequately prepared.
Mr. Neugebauer. Ms. Kent?
Ms. Kent. Yes, I just wanted to say on the biological
agents and referring back to my testimony, this is where having
lab surge capacity that we can really get quick results and
that is where epidemiology is critical, where we really are
getting on it right away and following up and who has had
contact with whom, but laboratory surge capacity will be
critical in these biological events.
Mr. Neugebauer. I yield back.
Mr. Moore. Thank you, Mr. Chairman. A couple of questions
and I'll throw them out to anybody who feels they have
something they want to contribute, I'd like to hear from you.
One, I guess is, with response, and the Chairman asked this
earlier, kind of as a collateral question here about the VIPER
system or somebody mentioned the VIPER system, I guess, Mr.
Mason did. So it sounded like a great system.
Are there efforts to find out where a state has come upon
something that really may benefit the other 49 states to
distribute that information to make sure that not just Texas
has it? That's one question I have.
Another question and this is an uneasy feeling again and I
hope you can say well, that shouldn't be a concern, you don't
have to worry about that. I have walked past on sidewalks in
Washington, D.C. and the same thing here, huge buildings where
several hundred or a thousand people work and I've seen not far
from the sidewalk this huge air intake and I just wonder what
would happen if somebody were to put a biological agent in
there that would be distributed through the air ventilation
system throughout the building.
Are we dealing with anything like that? Is that just
science fiction or is that something that really could be
damaging to people?
Mr. Turner.
Mr. Turner. I don't know that we are dealing with that and
some of these opportunities that terrorists would have are so
scary that you don't even want to mention them on record
because there are so many opportunities.
Mr. Moore. I guarantee you, if we thought about it, they
have too.
Mr. Turner. I know. As I mentioned in my testimony, one of
our concerns that we have, even at this facility is if our
inability to isolate air duct systems, those systems that would
just spread it throughout the hospital, so we could be really
good at what we're doing even in the emergency department, but
it then infiltrates the whole hospital. So I don't see from a
public facility standpoint that we are doing anything to
address that and it is something to be concerned about.
Mr. Morrissey. Congressman, we have done statewide threat
assessments, now in the second version we're into, in looking
at that and I think it's as indicated, safe to say that we have
a lot of buildings that are vulnerable in a variety of ways and
the process of re-engineering those is probably overwhelming in
a number of cases, not just from the situation you describe,
but even from protecting them from explosive attack. I think
it's a big problem and I sure don't have an answer.
Mr. Moore. I'm sure, Mr. Schable has an answer.
Mr. Schable. Well, we have, obviously, that is something,
sir, that we have looked at. Since Mr. Turner is sitting next
to me, we'll use his hospital as an example. I mean the air
intakes usually do not blow directly into the hospital without
some type of filtration system embedded in them. They're not
HEPA filters which would filter all organisms, but there are
things in there that would substantially reduce the amount of
particles that do make it through.
But as Mr. Morrissey said, to re-engineer these types of
buildings so that air intakes would truly get rid of all
biological agents as they go through it would be an
astronomical cost. We have thought about that and there's no
clear answer for that, sir.
Dr. Kendall. As far as I'm concerned, it was just a few
years ago when Admiral Zumwalt approached us with this question
and concern. And look at us today. It's every day. It's
meetings, it's on the evening news. We need to be ready and no,
we aren't ready. We're getting ready. And those air ventilation
systems are vulnerable and it depends on what substance you're
using, how you're applying it.
So at this point, with all this great nation has done,
putting a man on the moon, all our great technology, this is
one that we need to drop back, evaluate exactly what we need to
get ready and I think with first responders, they're critical
to us, but they need technology and information. And so we've
got to figure out how to make that transfer across lines very
easily. And so it may be under a biological attack, it may be
Texas or it may be California that gets the answer for Kansas
to address it. That's the kind of technology and information
sharing we're going to have to implement.
But I wanted to say, Congressman Neugebauer did invite
people to come to our University. I want to formally say we
support our Congressman greatly. He is a great friend of our
District and our University. And I welcome everybody to come
and see how we would walk through this challenge. And you give
us the challenge. You give us the weapon. You give us the
scenario. We've done it for our leaders in the state. You come
and we will talk to you and perhaps Kansas, working with Texas,
and Oklahoma and so on, we start building regional expertise
and information-sharing.
And I fundamentally believe we can't expect to deal with
this necessarily from Washington, D.C. We're going to have to
be dealing with it right in our regions and our states and in
our communities ultimately.
Mr. Moore. And I'm not saying that. The Federal Government
certainly does not have all the answers, certainly not. And if
Texas has developed a model program, I just want to share in
that information and not just stay down in Texas and I don't
know yet if that's happening and I'm not sure that it's your
responsibility to make sure that information gets out to 49
other states, but I'd sure like to see somewhere in the Federal
Government, the Federal Government identifying model programs
that work well and distribute that information, coordinate that
information with other states. That was my comment.
Mr. Neugebauer. I think that's a great point and certainly
if we're going to put research dollars into it, we talked about
that limited supply, information sharing.
And I'm glad the gentleman moved into the building
environment. I think we've got detection and you've got
containment and mediation. I think this is the next piece of
the puzzle. Building design, I mean, we--I know we have in West
Texas and in Kansas we've got places where people can go for
tornados and we've got designated areas in buildings for people
to go for those events.
Mr. Moore. We have basements.
Mr. Neugebauer. We have those too. I think the next part of
that, our state and our federal officials have to start
thinking about is where is the best place in a building to go.
Instead of smoke detectors now, do we have environmental
detectors and what kind of mediation could we provide people
early in and also in containment? I just would open up for the
panel, your thoughts and things that you see going on and
what--or is there anything going on?
Mr. Mason. Mr. Chairman, we presently on the local level,
usually we have in place already to a certain degree until new
technologies push us in another direction, and that's following
existing shelter in place programs that have been in place for
a number of years developed around communities where
significant hazardous materials risk is involved. If there was
a release at chemical plant X, that community had plans in
place to shelter. Create a safe haven within your home or work
place that kind of shuts yourself off from the outside air, so
on and so forth.
So that's a program that we still profess on a very regular
basis in Johnson County. There can be, again, much more--
utilizing some of the things Dr. Kendall has mentioned, many
more advances made in terms of detection and providing--you
read my mind, is there going to be a chemical detector and bio
detector to sit next to our smoke detector in the house?
Mr. Neugebauer. Exactly.
Mr. Mason. Some day, I guess that's going to be here. I
think a thing that we face again as an emergency response
community is the grant money came out and so did all the snake
oil salesmen. And everybody but Ronco has come forth with the
biodetector kit and we need people like Dr. Kendall and his
institution of higher learning to tell us and establish the
best practices, to run these things through the paces and tell
us that no, this thing here is best used as a paperweight. This
item here is a good piece of detection equipment for first
responders. We need facilities like his to do that work for us.
Mr. Morrissey. Mr. Chairman, I think from a state
perspective, as indicated, we're following now the federal
recommendations that are not new, that are basic about shelter
in place and do other things. I think that's not an area that
we focused on.
I think one of the big concerns about bio detection
systems, generally, is and it's very important again, I think
for the smaller, more rural states is what do you do when the
alarm goes off? And in fact, do we have the resources to
allocate and do we know what resources it takes? We've touched
on the difficulties here with screening. How do you handle the
number of false positives that get generated out of some of
those systems?
I don't think we have answers for that, but I think those
are very real concerns from a national perspective before we
get to making significant commitments to particular systems.
Mr. Schable. Mr. Chairman, it's interesting what we've been
talking about here because historically CDC, health departments
in the state and the counties work on human beings and all of a
sudden now we're being tasked more and more with environmental
microbiology, that is, we at CDC don't do much of that. We are
certainly embarking on a lot more of that in these detection
systems, that is, how can we help the first responders. As he
has said, many of the tools out there, you might as well just
flip a coin whether or not the answer is correct or not. We are
working on--the National Institutes of Health has put
significant research funds out the door to many different
groups who wish to apply for these types of grants to work on
environmental microbiology.
We can detect almost anything in a human being very
quickly, but trying to detect whether or not there might be
anthrax in a dust bunny sitting over there--it may sound
simple, but it's not so simple, sir.
Mr. Moore. Thank you, Mr. Chairman. That kind of was my
uneasy feeling and has been since September 11, actually. The
Federal Government will probably do a pretty decent job of
protecting our nation from the nuclear strike, probably. And
that chemical contamination is going to be fairly readily
discernible and we can probably deal with that, but where we're
really behind the eight ball and behind the curve is on
bioterrorism and really trying to recognize when it's happened
and it may take sometimes hours or days before we really know,
and then preventing it. And we've talked about a couple of
areas already.
I want to ask Dr. Kendall a question, if I can, please. In
your written testimony, Dr. Kendall, there were indications
that the University of Kansas and Kansas State are participants
in the national consortia for countermeasures to biological and
chemical threats and that the University of Kansas is a
collaborator with the Zumwalt Program which you mention in your
testimony, Dr. Kendall.
What are the Kansas universities' roles in these programs?
Are there other ways that you think institutions in Kansas or
around the country could be working together?
Dr. Kendall. I appreciate you mentioning that point. As I
earlier testified, the national consortium was developed
originally with the University of Texas at Austin, University
of South Florida and our program, called the National
Consortium for Countermeasures to Biological and Chemical
Threats. And we received our first funding from Congress in the
year 2000 after discussions in 1999. That entity has been
operational since the first funding was received in 2000.
In just this past year, the expansion and to other
universities, and in fact, 17 universities are a part of the
consortium now. We had last May, our meeting in Texas, I hosted
it at Texas Tech and Kansas representatives were there.
Unfortunately, we didn't have an expansion in research funding
at that time. However, there are discussions as to
collaborative projects and other places in which we could share
resources. And in fact, in just two weeks, we will be meeting
in Florida. They're hosting this event this year and we--and so
we will have consortium members from most of the universities
including our program. And we intend to with the new
presidential directive and the great expansion of interest in
bioterrorism, to forge out some new proposals and ideas to
leverage this knowledge into operational platforms that can
help people save lives and protect property.
So they are in the dialogue and they are welcome and we
intend to reach out and embrace them for collaborative research
and also education.
Mr. Moore. Thank you. Mr. Chairman?
Mr. Neugebauer. What I was going to say and I know that I
have a few more questions and the gentleman does also. I don't
know what your time schedules are for airplanes and stuff. So
if a Panel Member feels that they need to go take care of a
little thing like airplane reservation or has one, feel free to
excuse yourself, but in fact, we have you all together here and
I think this is an excellent opportunity for dialogue and we'll
continue a little longer here, but I do want to be sensitive to
anybody that has any.
One of the things that is--I've heard the comment made in
communications and in planning at the regional and local level
and statewide level and the--obviously the states are
disseminating a lot of the money from homeland security for
many of these initiatives, but do you feel like everybody is
being included and everybody is at the table that we need at a
planning level or are there some people being left out? What's
your sense of that, Mr. Turner?
Mr. Turner. I think regionally since 9/11 the people that
need to be at the table are at the table. If you ask me does
every one of a particular discipline, do they feel they're at
the table? Probably not, but I think that discipline has been
represented at the table.
We still have this--there's still a certain amount of
independence with all of our entities and a concern of mine is
that while we're at the table and realize what we need to do,
we know we need better information systems and everybody has
their idea about which information system is the best for their
hospital or organization, I think it's important that the
government not get into mandating what information system is
out there, but that whatever systems are out there, they need
to be able to speak to each other.
We're going to go with Cerner. Someone else is going to go
with McKessen. We need to make sure that on top of everything,
they're able to speak, but I do believe that regionally the
players are at the table.
Mr. Moore. I think you make a good point there and I think
it's working with CDC, making sure multiple platforms, making
sure when the information gets to the CDC, it's in a readable
form. It's kind of like exporting a spreadsheet. You may have a
different spreadsheet program that you may need to make sure
that whatever spreadsheet you send, the person on the other end
is able to open that spreadsheet. And so I think as we
disseminate that information, do you feel like in the private
sector, in the companies that are helping provide that
technology are they at the table right now with us and are they
in the loop? Are they listening to the needs and some of the
challenges?
Mr. Turner. Some other folks might be able to speak to this
more factually than me. I don't see a lot of emphasis when we
get with the private sector on bioterrorism. I do see it
getting a lot of information that helps us with taking care of
our patients, disseminating that information, but I don't see a
lot of talk about doing it for the purpose of addressing
bioterrorism, but others might know better than me.
Mr. Morrissey. Mr. Chairman, I think that may be because
the focus has perhaps been at the state and federal level and
with universities and research in terms of the development
process and certainly there's been significant private sector
involvement in developing the products that facilitate
planning, communications, a whole range of areas.
I touched on in my testimony, the Governor's concern about
the initial question that you raised and she literally upon
taking office started asking questions about how homeland
security efforts were being coordinated and was everyone at the
table and how is that done. And as a result of that discussion,
formed a new body whose focus was to give an overarching view
to the various elements of both the bioterrorism program and
for us at the state level, integrating that homeland security
effort into the ongoing emergency response, and existing
emergency response capability that was there.
The Kansas Division of Emergency Management has primary
responsibility for emergency response under state law. We've
always had a close relationship with them related to disaster
response. It got significantly greater with the advent of the
bioterrorism funding and development of those programs and so I
think yes, we have those folks at the table, but as you said,
is there someone out there who feels differently, I'm sure
there are.
One of the problems has been just getting to it all and we
talked about food security, a number of issues that we agree
are a high priority. We don't have as much work done on them
yet at this point.
Mr. Neugebauer. And I think that brings up a point that I
want to make and the way I feel and I want to encourage all of
us to, as we move forward in this, in Congress and the
Administration and the people out in the field and in the
research and in the private sector is we don't have a lot of
time to work on just one thing at a time. We really have got to
be working on this issue in a multi-disciplined way. We need to
bring the private sector in. We need to start talking about
designing buildings and ventilation systems for future
buildings.
We know the retrofit cost would be phenomenal, but the
problem is if we wait two, three, four or five more years
before we really determine what's the best way to do that,
we've got three, four, five years of buildings that don't have
the capability. The problem with not addressing feed lot
contamination or animal contamination, if we wait, two, three,
four or five years, we've got that many more years of
opportunity there, so I think what we have to begin to do is
identify where, who's doing what and begin to develop some
niches and some specialties and have different groups working
on that rather than all of us trying to work on one particular
issue at a time. I think in order to commercialize that, which
is the ultimate goal here is that with research and any of
those kind of things that we're learning is quickly getting
them commercialized and in a format that everybody understands
so that we can share that information and make sure that our
information systems are talking to each other. So I think as we
move forward and we want to talk to people, certainly encourage
the Administration that we've got to really do this on a broad
basis.
Mr. Moore. Can I just add something?
Mr. Neugebauer. Sure.
Mr. Moore. I think the Chairman has made an excellent
point. We need to multi-task here and you know, we live in a
free society and an open society and we think this is the
greatest country in the whole world and it is. We value and
love the freedom and openness of our society. But it's those
very things that make us vulnerable, make our nation
vulnerable.
And we need to find ways, I guess, to work together and
this should not be--it's not partisan at all. It's not about
Republicans and Democrats, it's about Americans and working
together to protect our nation and our people. And we've talked
about the food supply. We've talked about biological agents
that can get into the food supply or air. We've talked about--
we haven't talked about huge containers that come into the
ports around our country that could have a dirty bomb. And we
make an effort to inspect some of those containers, but boy,
I'll guarantee you, there's just thousands of them that really
don't get inspected is my understanding.
And we haven't even mentioned here, and this wasn't the
point of this, but as a nation, it's part of the threat of
terrorism against our country. We used to get up every morning
before September 11 and turn on the television and drink a cup
of coffee and watch TV and read about or see on television a
report of some horrible suicide bombing in the Middle East or
some terrorist incident in Europe and we thought well, that
never happens here at least, but we found out on September 11,
we're part of the real world and we do have to be prepared for
that because the Chairman and I were talking before we started
here and we can take all the steps that we can imagine which
would cost millions and billions of dollars and yet still not
be able to protect everybody because somebody tried to
assassinate and shot President Reagan several years ago with
the best security protection in the country. If somebody is
willing to give up their life, there's a good chance that
they're going to be able to hurt some people and I'm just
amazed that we haven't seen the suicide bombings that we see in
the Middle East happen here because there are demented people
there and there are some demented people in this country as
well. And it would just be tragically easy for something like
that to happen.
And I'm not trying to spread any ideas to anybody, but as
we said before if we've thought about it, I guarantee you
people around this world have thought about it as well and I'm
really glad, Mr. Chairman, that you were willing to come here
today because we need--I guess the one other area I want to
identify and ask a question about and just throw this out.
We've talked about coordination of information and ways to
protect our country. And I still have this uneasy feeling,
again, it's not critical of anybody because it's such a huge
task. It's just going to take time for us to develop the ways
to do this, but coordination of information and spreading
information like this VIPER program. I'm sure there are other
great programs in other states and I just question or wonder if
this information is getting around to the other states so they
can look at implementing similar programs in their states.
What I don't want to happen is just one or two states
develop great programs and the rest of the country not hear
about it and I think that would be a good responsibility of the
Department of Homeland Security, for example, to disseminate
that information around and make sure everybody has access to
it, so if they want to develop a similar program, they have
that opportunity.
Mr. Neugebauer. And I think that as I read the President's
press release, I think that is part of the initiative here is
to make sure that there is coordination because as Mr. Moore
and I have observed first hand sometimes we're appropriating
money in different areas and sometimes for the same cause
without--not a lot of coordination going on. And we're at a
time in our country, one, that's not the right public policy,
but secondly, we're at a time in our country where we're
watching what we're spending and we need to spend it wisely and
so we do need that coordination to go on.
Mr. Moore, I always like to ask the panel--because they're
the experts and you and I are here to listen--when are they
going to ask this question and we never asked that question and
we leave here not really hearing some information that we
needed to hear and certainly we have your testimony and opening
statement.
But was there in this dialogue, did it spur a question that
we should have asked that you would like to bring up or a point
that----
Mr. Morrissey. Mr. Chairman, it's not a point. It's one
that's been raised a couple of times, but I think it's worth
noting. In the issue of information exchange and technology
transfer, an appropriate federal role and that is one that I
think CDC has taken a lead in and that is standard setting.
It's been raised, noted a couple of times. The issue is not
you should pick up the system we're using or translate it, but
that we can all develop systems that can communicate based upon
federal standards that are defined and achievable in the public
health information network that Mr. Schable mentioned is down
the road in attempting to organize public health information
systems, to be able to do that. I know there are other
standards around and it seems to me from a federal perspective
in the area we're talking about, that has to be a critical
basic function. How do we assure that all of these systems are
going to be able to link up?
Mr. Neugebauer. I think it's a good point. Any----
Ms. Kent. I would have to say I concur with that because at
the local level we're looking at spending money. We want to be
sure that we spend it on something that's going to be
compatible with neighboring counties and neighboring states and
I think the Federal Government does have a role in being sure
to help with those standards so that the money we're spending
is very well spent and that we can all be talking to each other
and understanding what is going on. And I think that's true in
terms of communication technology also in terms of radios and
all of that type of thing.
Mr. Neugebauer. Mr. Schable, could you enlighten us, maybe
what's going on at the federal level to address that?
Mr. Schable. Well, as I mentioned, what's called PHIN,
Public Health Information Network, is a large program trying to
bring some order to all of these surveillance systems, if you
will. I mean CDC, historically, asks the state and local health
departments for data to come in. I mean many, I don't know, I'm
not exactly sure how many data streams the State of Kansas has
and the State of Texas has to CDC, but I'm sure it's a lot. It
would be nice if all of those data streams all from a computer
networking capability were all able to talk to each other and
if the State of Kansas wanted to share a piece of information
with the State of Texas, someone could just hit a submit button
instead of when sometimes the data shows up at the other state,
it's completely garbled because somebody didn't use the same
DL7 code or--I'm not a computer expert, but I mean that's one
of the things we're trying to do is make some kind of sense and
order out of these hundreds and hundreds of data streams that
are coming in and it almost sounds easy, but that's another
major task is to try to get these things so that all of the
extant data streams which might not work which are very
important and have to be changed over so that they do work.
We don't want to tell the State of Texas or the State of
Kansas in half of your data systems you're going to have to go
out and hire 10 more people just to reprogram everything you've
got, then that would be disaster.
What we need to do at the federal level is to come up with
something that can take a data stream that's not perfect and
mold it over into a thin compliant system so that we have
something that people can look at data quickly, can share data
very quickly.
Mr. Turner. I agree with everything that's been said about
the information. I also would like for us not to forget the
basics and that is that we provide funding for CDC or whomever
to make sure that we're able to quickly produce the
antibiotics, the vaccinations that we need locally to take care
of at least a 72-hour period of need.
Mr. Moore. May I ask a question, Mr. Chairman? My question,
and I don't know who to ask this to, I suspect it may be here
and Dr. Kendall or Mr. Morrissey, but are all the players at
the table, all the interested stakeholders, the parties, for
example, pharmaceutical companies and you just mentioned
vaccines, if they can be manufactured, developed quickly
enough. Is there a stockpile large enough to handle those? When
people are sick and go into a drugstore, is there a way to
monitor what's happening there in terms of what kind of
medications they may be getting to treat certain symptoms and
which may--they may not even go to a--I suppose they're going
to go to a doctor, but maybe they don't even know what they
have.
What are we doing to, what are we doing to determine if
people are, go to a doctor and then they're prescribed a
medication, they end up at the drug store and they buy a
prescription and maybe they've been correctly diagnosed, maybe
not, but is there a way that we can look at patterns there?
I've heard about some software and I think Cerner's, I've been
out to Cerner once or twice and they've talked about a software
program they have to try to monitor that.
Mr. Turner or Mr. Schable or anybody, Mr. Morrissey, can
you comment on that and what we're doing there?
Mr. Schable. Several of the departments, Health and Human
Services, Homeland Security, there are what are called
requirements committees in which what we do, along with the
NIH, they're there, we look at what is, what do we think is
required in the future for the level of do you need this
vaccine or that vaccine or this antibiotic or that antibiotic?
What does the Nation need in the strategic national stockpile
that CDC runs?
And so there are groups of high experts that try to sit
down and think what is important, what needs to be done? Do we
have enough of this drug or that drug? A pharmaceutical company
isn't going to make a drug that no one is ever going to use, so
we have to tell them this is something that's important. We
think it needs to be in the stockpile. And that information
then is given to the pharmaceutical companies. So we are
working at that level.
But what you just mentioned, sir, is that the issue of
would it be nice to know, because a lot of people when they get
sick don't even go to the doctor. Unfortunately, there are a
lot of marginalized individuals who cannot afford health care,
barely can afford to go buy some aspirin at a discount super
store. And so is there a way to monitor the amounts of the
drugs sold? And CDC is embarking on a biosurveillance
initiative, we call our bio intelligence center in which we are
trying to put that data together, not only pharmaceutical data,
laboratory data, data on emergency room admissions. This is
just the start. We're just getting ready to do this because,
obviously, in the same issue would be of data monitoring. All
of these people are using different types of data sets, plus
when, can you imagine the amount of drugs that are sold on a
daily basis in the United States, when that came to the CDC,
you would have a huge database. Someone has to write computer
software that says when something happens, a red flag goes off
so someone--no one person could monitor all of that. It would
have to be the computers. But the computer program has to say
you better look in Kansas City, because all of a sudden
everybody is starting to buy some type of antibacterial drug or
some type of something to monitor upper respiratory infections.
That could be a key. And so we are just now embarking on doing
that and we're moving down that path.
Mr. Neugebauer. Dr. Kendall.
Dr. Kendall. I think at it though with the drug companies,
they are probably going to need to be encouraged because it
takes so much money to develop a new product and bring it to
the market these days. And I think this is going to be an area
that's going to be very important to us and perhaps that may be
something the Science Committee could consider, how to
encourage new drug research, that may not be immediately
needed, but would set the platform to be able to deal with
these kind of ultimately potentially terrorist threats.
But Mr. Chairman, I was just thinking here, if I could have
one more minute just to speak. I was just thinking about your
comment about many years ago and the nuclear threat to the
country. And I can think about when I was a child the Cuban
Missile Crisis and how that challenged this country and its
backbone. And I look at what we did as a nation and then in my
lifetime we have seen the Cold War diminish to a great degree.
We've seen the Berlin Wall fall. We've seen an enormous
increase and our presence relative to challenging and being
able to take on the nuclear threat.
At this point we have a new challenge, biological
terrorism. It's more difficult to target it. It's more
difficult to follow it and it's more difficult to even tell
where it is at any given time. So I think both of you are to be
complimented for holding this meeting and hopefully many other
meetings in the future because we as a nation are getting ready
and we're not ready. We're beginning to get ready. And
technologies are emerging and we have a wonderful opportunity
to transfer information and to work together, but this reminds
me of back in the '60s and beginning to think about the nuclear
threat.
Indeed, gentlemen, this country will respond, I'm
convinced. And it's going to take leadership from leaders like
you to bring us together, challenge us as did Admiral Zumwalt
did me years ago. And then I think the technology, the
capabilities, the universities, the health responders will work
together and we will make this nation stronger and safer.
Mr. Neugebauer. I want to thank this panel. I think we've
had a great discussion here today, good questions. I encourage
you if you have any follow-up information that you want to
provide to the Committee to do so and we will put that in as
part of the record.
You can't have a hearing like that without the help of a
lot of folks and certainly, Mr. Turner, we want to thank you
and your staff for providing this facility for us. I want to
thank Jimmy Hague and Elizabeth Grossman, and Sarah Matz from
my office and I know Marsha Shasteen and then Jana Denning.
Jana, thank you for your help and then Jill deVries. Jill,
thank you for your help in making this possible.
In closing, I would just like to say that this is a very
important issue in our country and it's going to be more and
more important every day as we fight this front and this is a
front that we're not just fighting in Iraq and Afghanistan and
other parts around the world. This is unfortunately--the
battleground is, has been brought and could be brought to our
homeland. So we want to continue to work with you. We're
relying on you to challenge us and to keep us moving in a
direction that protects our citizens. As I've said, I was very
fortunate the first 54 years of my life. I didn't have to live
a fearful life in my own country. And I don't intend for my
children or your children or grandchildren and my grandchildren
have to live a fearful life in their own country.
It's going to be a challenge, but you know that's the great
thing about America is when we're challenged, that seems to be
when we do our very best work. And so I'm going to thank all of
you for being here and thank you for your attendance and your
participation today.
Mr. Moore. May I make a quick closing statement as well? I
really appreciate the statement that the Chairman just made
here because he's talking about what a challenge we have in the
future, but that we as a nation do rise to the challenge and I
appreciate the comments by Dr. Kendall and all of you for being
here today because I think we've had a good discussion about
some of the challenges.
I had to smile because he said, Dr. Kendall said, when he
was a boy we would have these air raid drills or nuclear drills
or something where you would put your head down on your desk
and put your hand over the back of your neck as if that's going
to protect from a bomb, you know? And now we're sort of talking
about little masks and duct tape and that's probably not going
to protect us from some of the things we need protected against
as well.
We are at the front of the challenge here, but I'm
absolutely confident as the Chairman indicated, as Dr. Kendall
and you all have indicated, that we can meet this challenge as
a nation and protect our people in the future and we just have
a lot to learn here. And I think we, in the last two and a half
years, have begun to scratch the surface about how much we have
to learn, but I'm absolutely confident that we can do it. So
thank all of you, and Mr. Chairman, thank you especially for
convening this hearing.
Mr. Neugebauer. Thank you. We're adjourned.
[Whereupon, at 11:30 a.m., the hearing was concluded.]
Appendix:
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Additional Material for the Record
Prepared Statement of Scott C. Voss
An Overview of Current Local Public Health Initiatives in Johnson
County Kansas and the Kansas City Metropolitan Area
3 May 2004
Scott C. Voss, MPH
Public Health Emergency Coordinator, Johnson County Health Department
Co-Chairman of the Public Health Emergency Subcommittee
of the Regional Homeland Security Coordinating Committee,
and Chairman of the Epidemiology Section of the Kansas Public Health
Association
Introduction
Thank you, Chairman Neugebauer and Representative Moore, for
providing me the opportunity to testify on Bioterrorism Preparedness
efforts in the Kansas City Metropolitan Area. My name is Scott Voss and
I serve as the Public Health Emergency Coordinator for the Johnson
County, Kansas Health Department. Johnson County, Kansas is situated on
the border between Kansas and Missouri. With an estimated 2004
population of 495,788, Johnson County represents more than 25 percent
of the total population of the Kansas City Metropolitan Statistical
Area.
Additionally, I serve as the Co-Chair of the Public Health
Emergency Subcommittee of the Kansas City Regional Homeland Security
Coordinating Committee. This objective of the Public Health Emergency
Subcommittee is to regionalize all public health emergency activities,
within the Kansas City Metropolitan Area. I also serve as the Chairman
of the Epidemiology Section of the Kansas Public Health Association.
You have had a chance to hear from my colleague from the Lawrence-
Douglas County Health Department, Ms. Kay Kent, regarding the
interaction of local public health with State and federal agencies
during a response to a public health crisis. Her testimony was
appropriate and true. However, Douglas County is not part of the Kansas
City Metropolitan Statistical Area. Therefore, Ms. Kent could not
provide you with a perspective on the efforts that local public health
has undertaken within the Kansas City Metropolitan Area and
specifically within Johnson County Kansas. My testimony will provide
you with that information.
Issues Confronting a Bi-State Multi-Jurisdictional Region
Local public health agencies in the Kansas City metropolitan area
are faced with a relatively unique challenge. As with many other local
public health agencies, we must coordinate our plans and responses with
other local public health agencies from neighboring jurisdictions. This
can be a relatively easy task, when both agencies are receiving
guidance from the same state health department. However, here we are
confronted with a situation where we must work with health departments
that receive their guidance from a different state health department.
While the overall goal of the local health departments is the same, the
specific guidance and timelines we have been given differ.
To address this issue, the local public health agencies have formed
the Public Health Emergency Subcommittee. This committee, which was
formed under the Kansas City Metropolitan's Regional Homeland Security
Coordinating Committee, was created to provide a forum from which local
public health agencies could meet and work through these bi-state
challenges. The subcommittee has developed working groups to address
the following; Quarantine and Isolation, Epidemiology and Surveillance,
the Strategic National Stockpile, Training and Exercises, and Planning.
Together, this subcommittee has fostered a spirit of cooperation
between all of the participating agencies and has resulted in many
regionalized public health decisions.
Early Detection Systems
Here is Johnson County we are currently implementing three
syndromic surveillance systems for the early detection of bioterrorism
or public health emergencies. These systems respectively look at school
absenteeism, emergency department data, and 9-1-1 emergency call data.
The first system was designed to monitor the rate of absenteeism in
our public schools. Over the past several years, our department has
worked closely with the school nurses responsible for the 153 public
schools in Johnson County. Together, we have implemented a system,
which collected information on the number of children absent each day
and the type of illness they were experiencing. Through careful
analysis of this system and review of scientific literature on school
based absenteeism surveillance, it was determined that this system was
of little benefit. As of this year, we have altered this system to only
collect information from the schools when total school absenteeism
reaches 15 percent. We have included a notification when the
absenteeism increases by five percent of the total student population
in one day. We are currently testing this system to determine its
functionality.
The second system relies on information collected at emergency
departments. We have identified two hospitals, within Johnson County,
to be sentinel syndromic surveillance sites. Working with the infection
control nurses at each of these hospitals, we identified the specific
indicators of a possible bioterrorism event, as they would be recorded
in the hospitals. Each day we receive a report from the infection
control nurses with the data from the previous day. Currently there is
no mechanism for the collection and dissemination of this data on the
weekends, so the data from the weekend is transmitted to us on Monday
morning. This is a very simple form of hospital based syndromic
surveillance. We are currently investigating other methods of real time
hospital data surveillance.
This system utilizes a product called FirstWatch, developed by
Stout Solutions, to monitor 9-1-1 emergency medical service calls. We
worked with Med-Act (the Johnson County EMS), Johnson County Emergency
Communications, the Health Departments in Kansas City, Missouri and
Sedgewick County, Kansas and Stout Solutions determine the specific
call types to monitor. Once this was established the system began the
silent monitoring of call activity within our county. When it detects a
significant increase in call volume, an alert is sent to the e-mail and
pagers of a select group of responders. We are currently working to
launch regional component of this system that would allow for a
regional view of this data.
The FirstWatch system is a relatively new component to our disease
surveillance arsenal. We are continually working with the company to
identify areas for enhancement of our system and to tune our current
system capabilities. Although this system has not yet provided early
warning for a disease event in our county, it has done so in other
jurisdictions. In 2003, this same system installed in Tulsa, Oklahoma
and Richmond, Virginia provided an early warning to public health of
the arrival of influenza in their communities. With proper calibration
of this system and vigilance, this system has much promise in providing
similar results here.
Mass Prophylaxis Management systems
During a bioterrorism event, it is likely that the public will
require medications in order to prevent contracting the disease. The
Strategic National Stockpile provides the medications for the mass
prophylaxis of the public. To perform the mass prophylaxis on the local
level, we will establish clinics throughout our county, often in sites
not normally used for health care services. These clinics must be
operational in a just a few hours and provide treatment for,
potentially, thousands of victims over a few days.
The primary staff at the clinics will be volunteers, although key
members of the public health departments and government agencies will
provide direction and oversight. A number of initiatives are under way
in the Kansas City area to improve the availability of trained health
care professionals. In fact, the Mid-America Medical Reserve Corps has
identified the SNS deployment as one of the primary volunteer needs in
our area and will begin active recruitment later this month. However,
many health care professionals that volunteer may be required to
provide for the normal care and treatment of patients in hospitals,
physician offices and other health care settings. The competition for
health care professionals will likely reduce the availability of
qualified personnel at the clinics.
The operating efficiency of a clinic will be largely determined by
the availability of key health care professionals to perform critical
knowledge-based decisions, including health assessments and medication
dispensing. If there are not sufficient personnel to make the
decisions, the clinic efficiency and effectiveness will be reduced.
This problem has been recognized at exercises held here in the Kansas
City area and at other locations throughout the Nation. Even with a
corps of trained volunteers, a large magnitude event will likely
overwhelm the available trained resources. The key to increasing the
efficiency of the clinic lies within the ability to utilize less
skilled personnel to complete the paperwork and to remove, to the
greatest extent possible, the decision making process from these less
skilled people.
The Johnson County Health Department is currently investigating a
product from NexGenisys, a Kansas City based company, called
Metropolitan Emergency Dispensing System (MEDS). The product provides
critical support for mass prophylaxis clinics by providing patient
tracking, labeling, inventory reporting and clinical decision support.
This program is designed to improve the efficiency of the prophylaxis
clinics by using an evidence-based clinical decision support system
that will assess risk factors and determine appropriate treatment for
the victims. This will allow for the better utilization of health care
professionals, at a time when this resource will likely be scarce. It
is our hope that utilizing a system, such as MEDS, will allow us to
provide this vitally important medication to our population in a much
more timely manner.
Everyday Benefits of Bioterrorism Preparedness
The tragedy of September 11, 2001 and the ensuing bioterrorism
events of that fall were a terrible moment in U.S. history. While it
was impossible to imagine at the time, good has come from those
horrible events. We have become stronger as a nation, focused clearly
on what are weaknesses are, and worked to strengthen those weaknesses.
Public health is one discipline that has benefited from this focus and
work.
An act of bioterrorism is similar to a naturally occurring disease
outbreak, only on a different scale. Therefore, all of our preparedness
activities that we are undertaking are providing an increased
capability to detect and respond to any disease outbreak.
Additionally, the addition of the risk communicator and information
specialist positions and the development of a risk communication plan
have added an extra level of expertise and capability to our department
public information officer. These new resources have been utilized many
times to develop and refine messages our department sends to the media.
Finally, our efforts in bioterrorism preparedness have made us more
recognizable to outside organizations. In the past, it has been
difficult for the Health Department to make contact with certain groups
or organizations. Now, the Public Health Emergency Preparedness and
Response Program regularly meets with representatives from these
organizations. Many of these groups and organizations actively seek out
our program for assistance or guidance. These new relationships have
provided the opening to work on non-bioterrorism related projects.