[Congressional Record Volume 147, Number 157 (Wednesday, November 14, 2001)]
[Senate]
[Pages S11791-S11794]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DODD (for himself, Mr. DeWine, and Ms. Collins):
  S. 1685. A bill to meet the needs of children when preparing for and 
responding to acts of terrorism; to the Committee on Health, Education, 
Labor, and Pensions.
  Mr. DODD. Mr. President, I am pleased to join with my colleague from 
Ohio, Senator DeWine, and my colleague from Maine, Senator Collins, in 
introducing legislation today to strengthen our Nation's ability to 
protect children during times of terrorism and bioterrorism.
  It's a terrible thing that we have to be here to talk about how to 
protect children from terrorism. But, as all of us know only too well, 
the terrorist incidents of September 11 have changed the world for all 
of us. In order to ensure that the needs of children are not overlooked 
as a national terrorism response package is drafted, we are introducing 
this legislation today specifically geared toward the needs of 
children. Our bill would: strengthen emergency and rescue services for 
children; ensure that all needed medicines in the case of bioterrorist 
attack can be safely used for children; ensure that the mental health 
needs of children directly affected by terrorist and bioterrorist 
attacks are addressed; and, enable the Secretary of HHS to determine 
and respond to other unique needs that children may have related to 
terrorism.
  Shockingly, not all ambulances, hospitals and emergency personnel are 
prepared to handle children's emergencies, let alone emergencies 
related to terrorism. In fact, fewer than half of all hospitals with 
emergency departments have the equipment necessary to stabilize 
seriously injured children.
  Our bill will expand the Emergency Medical Services for Children 
Grant Program administered by the Department of Health and Human 
Services. Those first on the ground need to be prepared to deal with 
the specific needs of children in any type of terrorist or bioterrorist 
attack.
  Children are especially vulnerable to the chemical and biological 
agents that could be deployed in a terrorist attack. Nerve gas agents, 
such as Sarin gas for example, are denser than water and concentrate 
lower to the ground, in the breathing zone of children. And the more 
permeable skin of newborns and children puts them at risk of greater 
exposure to toxins that may be absorbed.
  It is crucial to secure information on dosage, possible side effects 
and the effectiveness of various agents in our children. Just a few 
weeks ago, the Senate unanimously passed the reauthorization of a law I 
authored with Senator DeWine to address the appalling lack of pediatric 
information about the drugs we used for our kids. The law, which has 
been an unparalleled success, provides a market incentive for drug 
companies to test their products for use in kids and to create kid-
friendly drug formulations.
  Our re-authorization of this law will ensure that all approved drugs 
that are identified as important for children will get studied, either 
by the manufacturer or by a third party with pediatric clinical 
expertise. These third party studies will be paid for using private 
dollars from an NIH Foundation or using the $20 million authorized in 
the bill for this purpose.
  Today, we are asking the Secretary to do the same for medicines that 
can be used to protect our kids in a bioterrorist attack. Our proposal 
authorizes funding to ensure that the products that are important for 
children will get studied by manufacturers and by qualified third 
parties to determine how a child's body breaks down and absorbs the 
medicine, potential risks, and effectiveness.
  Without adequate information about how a drug works in kids of 
different ages and sizes, children are more likely to be under- or 
over-dosed or to experience dangerous side effects. By instructing the 
Secretary to contract our

[[Page S11792]]

needed studies, we can ensure that we get vital information on the 
medicines needed most for our kids.
  Since September 11 our children have been faced with images and 
emotions that are difficult for them to understand and deal with. They 
have seen airplanes crashing into places where people work, they have 
seen people fleeing from collapsing buildings, they have family members 
searching and grieving for missing loved ones, they have heard about 
people being poisoned and dying from the mail. All of this is beyond 
belief. These are very complicated and stressful times for all of us, 
but especially for children.
  Children sense the anxiety and tension in adults around them. And, 
like adults, children experience the same feelings of helplessness and 
lack of control that disaster-related stress can bring about. Unlike 
adults, however, children have little experience to help them place 
their current situation into perspective.
  Our proposal authorizes the Secretary of Health and Human Services to 
provide immediate emergency mental health and substance abuse 
prevention and treatment services to those children residing in 
communities directly affected by terrorism. This new authority will 
double the amount of emergency funding for mental health services and 
ensure that children's mental health needs are specifically addressed. 
This new initiative will provide approximately $17.5 million in 
emergency funds for children's mental health services.
  To deal with other unique needs of children, we provide the Secretary 
of Health and Human Services with broad authority to allocate emergency 
crisis response grants. Such grants could be made at the Secretary's 
discretion to schools, child care centers, Head Start centers, or other 
entities dealing with children to assist in developing evacuation 
plans, in training personnel to understand children's needs related to 
terrorism, and how to communicate effectively with children and parents 
about terrorism. Millions of children spend more than half their waking 
hours with teachers and other caregivers. These professionals must be 
able to understand what children are going through and be prepared to 
help them get through it. As we've seen over the last few weeks, in 
practice, this is not always as easy to do as it sounds.
  The President has asked that all Americans get back to normal. It is 
our responsibility to provide our children affected by these tragic 
events with the best tools and resources to get back to normal.
  I ask unanimous consent that a summary of our legislation and the 
text of the bill be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 1685

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Kids and Terrorism 
     Preparedness Act''.

     SEC. 2. EMERGENCY MEDICAL AND RESCUE SERVICES FOR CHILDREN.

       (a) In General.--Section 1910(a) of the Public Health 
     Service Act (42 U.S.C. 300w-9(a)) is amended--
       (1) by striking ``may make grants to States or accredited 
     schools of medicine in States to support a program of 
     demonstration projects for the expansion and improvement of 
     emergency medical services for children'' and inserting ``may 
     make grants to, or enter into contracts with, States, local 
     government entities, Indian tribes, accredited schools of 
     medicine, and nonprofit children's hospitals to improve 
     emergency medical services for children who need treatment 
     for trauma or critical care'';
       (2) by inserting before the first period the following: ``, 
     including injury prevention activities and data collection'';
       (3) by striking ``3-year'' and inserting ``4-year''; and
       (4) by striking ``4th'' and inserting ``5th''.
       (b) Authorization of Appropriations.--There is authorized 
     to be appropriated $45,000,000 to carry out section 1910 of 
     the Public Health Service Act (42 U.S.C. 300w-9).

     SEC. 3. APPROPRIATE MEDICINES FOR CHILDREN IN THE FACE OF 
                   BIOTERRORISM.

       (a) Meetings.--The Secretary of Health and Human Services, 
     in consultation with Commissioner of the Food and Drug 
     Administration, the Director of the National Institutes of 
     Health, and the heads of other appropriate Federal entities, 
     shall convene meetings with drug manufacturers, biotechnology 
     manufacturers, and medical device manufacturers to formulate 
     a plan for the development of new, and enhancement of 
     existing, countermeasures (including diagnostics, drugs, 
     vaccines, biologics, and medical devices) that may be 
     appropriate to prevent and treat children who are exposed to 
     biological agents and chemical, radiological, or nuclear 
     toxins.
       (b) Notice of Products and Referrals.--The Secretary of 
     Health and Human Services shall give public notice of the 
     products (including diagnostics, drugs, vaccines, biologics, 
     and medical devices) that should be studied with respect to 
     children, in response to bioterrorist threats.
       (c) Contracts, Grants, and Cooperative Agreements.--The 
     Secretary of Health and Human Services shall award contracts, 
     grants, or cooperative agreements to manufacturers described 
     in subsection (a), and other entities with the appropriate 
     capacity and expertise, to conduct needed studies relating to 
     children.
       (d) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section for fiscal year 2002.

     SEC. 4. CHILDREN'S MENTAL HEALTH.

       Section 501(m) of the Public Health Service Act (42 U.S.C. 
     290aa(m)) is amended--
       (1) in paragraph (1)--
       (A) by striking ``2.5 percent'' and inserting ``5 
     percent''; and
       (B) by striking ``paragraph (2)'' and inserting 
     ``paragraphs (2) and (3)'';
       (2) by redesignating paragraphs (2) and (3) as paragraphs 
     (3) and (4), respectively; and
       (3) by inserting after paragraph (1), the following:
       ``(2) Condition.--A condition of paragraph (1) is that 2.5 
     percent of the funds subject to paragraph (1) may only be 
     available for the provision of emergency mental health and 
     substance abuse treatment and prevention services to children 
     who are directly affected by terrorist acts.''.

     SEC. 5. CRISIS RESPONSE GRANTS TO ADDRESS CHILDREN'S NEEDS.

       Title III of the Public Health Service Act is amended by 
     inserting after section 319G (42 U.S.C. 247d-7) the 
     following:

     ``SEC. 319H. CRISIS RESPONSE GRANTS TO ADDRESS CHILDREN'S 
                   NEEDS.

       ``(a) In General.--The Secretary may award grants to 
     eligible entities described in subsection (b) to enable such 
     entities to increase the coordination and development of 
     bioterrorism preparedness efforts relating to the needs of 
     children.
       ``(b) Eligibility.--To be an eligible entity under this 
     subsection, an entity shall--
       ``(1) be a State, political subdivision of a State, a 
     consortium of 2 or more States or political subdivisions of 
     States, a public or private non-profit agency or 
     organization, or other organization that serves children as 
     determined appropriate by the Secretary; and
       ``(2) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.
       ``(c) Use of Funds.--An entity shall use amounts received 
     under a grant under this section to carry out activities for 
     the coordination and development of bioterrorism preparedness 
     efforts relating to the physical- and health-related needs of 
     children.
       ``(d) Funding.--The Secretary may use amounts appropriated 
     under the 2001 Emergency Supplemental Appropriations Act for 
     Recovery from and Response to Terrorist Attacks on the United 
     States (Public Law 107-38) to carry out this section.''.
                                  ____


          Kids and Terrorism Preparedness Act of 2001--Summary

       As America prepares to gird itself against terrorist 
     threats, our children's parents, teachers, caretakers, and 
     emergency response personnel must be given new tools and 
     instruments to protect them. For example, they must be 
     trained in emergency response and evacuation plans developed 
     by local authorities to protect children during times of 
     terrorist threats or incidents. Children must have 
     appropriate medicines in the appropriate dosages to help 
     protect them from chemical and biological agents that might 
     be deployed in a terrorist attack. They must also have access 
     to mental health services to address the emotional trauma 
     that can accompany acts of terrorism.


           emergency medical and rescue services for children

       Increases federal support for EMS training to ensure that 
     first responders (i.e., firefighters, police, paramedics, 
     etc.) are trained and equipped to address the specific 
     medical needs of children.
       More than doubles the resources available through the 
     Department of Health and Human Services Emergency Medical 
     Services for Children program from $18.9 million per year to 
     $45 million.


     appropriate medicines for children in the face of bioterrorism

       Authorizes funds to enable the Secretary of HHS, in 
     consultation with the FDA, NIH, and the pharmaceutical, 
     biotech, and device industries, to ensure that every medicine 
     identified for potential use for kids in responding to 
     bioterrorism can be studied to determine proper pediatric 
     dosing and effectiveness. This is critical because children 
     are simply not smaller versions of adults--their bodies react 
     to drugs differently. Without adequate information about how 
     a drug

[[Page S11793]]

     works in kids of different ages and sizes, they are more 
     likely to be under- or over-dosed or to experience dangerous 
     side effects.


                        children's mental health

       Establishes grants for Emergency Mental Health Services for 
     Children that would ensure that children directly affected by 
     terrorist acts would be able to receive a comprehensive array 
     of community-based mental health services. With these grants, 
     communities could develop integrated systems of care that 
     coordinate services among multiple child-serving agencies in 
     incorporating parental involvement at every stage of service 
     delivery. These grants would be administered by the Center 
     for Mental Health Services (CMHS), housed within the 
     Substance Abuse and Mental Health Services Administration 
     (SAMHSA). The Emergency Mental Health Services for Children 
     grants would be funded at about $17.5 million per year--up to 
     2.5 percent of total SAMHSA appropriations.


           crisis response grants addressing children's needs

       The Secretary may provide grants to eligible entities to 
     increase the coordination and the development of bioterrorism 
     preparedness efforts relating to the needs of children. Such 
     grants would be provided at the discretion of the Secretary 
     using information the Secretary identifies as being critical 
     to meeting the physical and health-related needs of children. 
     The Secretary may use funds from emergency appropriations 
     made available earlier this year.

  Mr. DeWINE. Mr. President, I rise today to join my friends and 
colleagues, Senator Dodd and Senator Collins, to introduce the ``Kids 
and Terrorism Preparedness Act.'' I want to thank Senators Dodd and 
Collins, for their commitment and dedication to protecting America's 
children. They are two of this Nation's strongest advocates on behalf 
of kids, and I have enjoyed working together with them on a variety of 
children's health and safety issues.
  Most recently, just a few short weeks ago, Senator Dodd and I were 
able to pass our Best Pharmaceuticals for Children Act, which is going 
to help make sure that children get the right kinds of medicines when 
they are sick and in the proper dosages.
  As the father of eight and grandfather of six, I can tell you from 
first-hand experience that we can not treat children the same way we 
treat adults. This is true for prescribing medicines to protect 
children when they are sick. And, it is also true in implementing 
measures to protect our nation against terrorism, especially chemical 
and biological terrorism.
  This is why it is so important that as we begin to re-assess how we 
respond to terrorist attacks, we think long and hard about the 
differences between adults and children. The bill we are introducing 
today goes a long way toward ensuring that the needs of kids are taken 
into consideration. It goes a long way toward making sure that those 
who respond to terrorist attacks are prepared to treat and deal with 
children and their unique needs.
  We have to realize that children simply are not small adults. For 
example, children breathe faster than adults, which means they will 
inhale poisons and chemicals more quickly than adults.
  Children lose body heat faster than adults and so if a child needed a 
decontamination shower as a result of a chemical attack, firefighters 
and emergency crews will need to take special precautions for children, 
like setting up heat lamps to keep them warm so they do not go into 
shock. It also means providing those kids with a safe, comfortable 
environment to ease their fears.
  Children often can not swallow pills. We need to make sure that we 
have antibiotics or other medicines that are in forms, like liquids, 
that children can take.
  And obviously, children are physically smaller than adults, they are 
lower to the ground, which can put them in the direct path of some 
agents, like chlorine or sarin gas, both of which are heavier than air 
and settle lower to the ground where children would be breathing.
  I have talked to firefighters and pediatricians in Ohio, who have 
told me that they simply are under-prepared right now to treat 
children's needs. The reality is that today fewer than half of our 
Nation's hospitals with emergency departments have the necessary 
equipment to treat sick and injured kids. We need to change that, and 
soon.
  The bill we are introducing today will help change things. First, our 
bill would increase the funding of the Emergency Medical Services for 
Children block grant from $17 million to $45 million. By doing so, we 
are helping the first responders, those at the local level, get the 
training they need to meet the special needs of children.
  Furthermore, our bill gives the Secretary of the Department of Health 
and Human Services, HHS, the flexibility to provide $17.5 million in 
grants to eligible entities to address children's mental health needs 
and provide substance abuse prevention and treatment options for 
children in the event of a terrorist emergency.
  The bill also allows the Secretary of HHS to provide grants to 
eligible entities to enable such entities to increase the coordination 
and the development of bio-terrorism preparedness efforts relating to 
the needs of special populations, including children. Such grants are 
provided at the discretion of the secretary using information the 
secretary identifies as being critical to meeting the physical and 
health-related needs of children.
  In conclusion, children represent a huge portion, 30 percent, almost 
one-third, of our Nation's population. We have an obligation to protect 
them. And, our bill today, is a step toward doing just that. I urge my 
colleagues to join us in support of this legislative effort. It is a 
good bill and one that can make very real, very positive differences in 
the lives of America's children.
  Ms. COLLINS. Mr. President, I am pleased to join with my colleagues, 
Senator Dodd and Senator DeWine in introducing the Kids and Terrorism 
Preparedness Act to strengthen our ability to protect our children as 
our Nation prepares for and responds to acts of terrorism.
  Every generation has a defining event. Our parents will never forget 
the attack on Pearl Harbor, and the baby boomers will never forget the 
day President Kennedy was shot. This generation will always remember 
September 11 and the horrific images of the two airliners slamming into 
the twin towers of the World Trade Center.
  These terrorist attacks have evolved into an ongoing crisis that has 
created some particularly difficult challenges for our Nation's 
children. Thousands of children lost a family member or loved one on 
September 11. Tens of thousands more are close to another child who 
suffered an immediate loss. Millions of other children across the 
country watched the repeated broadcasts of the fiery crashes, workers 
falling to their deaths, the terrible building collapses and the panic 
that followed. These images have enacted an emotional and psychological 
toll on all Americans, but children are particularly vulnerable. 
Moreover, the current anthrax scare has only added to the anxiety of 
children who now fear that their own houses may not be a sanctuary 
against a bioterrorist attack delivered through the mail.
  As our Nation takes steps to plan and prepare for future attacks, it 
is critical that we consider the unique needs of children who are more 
susceptible to biological and chemical attacks. Since they are smaller 
than adults, they may get sick from smaller amounts of harmful 
substances. They have a higher respiratory rate than adults, which 
means that they would get relatively larger doses of an inhaled 
substance in the same period of time. Moreover, some dense chemical 
agents, like chlorine and sarin, accumulate close to the ground, right 
in the breathing zone of children.
  The problem is compounded because our current tools to combat 
terrorism are now always sensitive to children's needs. For example, 
Cipro, which is being widely prescribed for people who have been 
exposed to anthrax, is generally not recommended for use by children 
because of concerns that it can impair bone and joint growth. It is 
clear that immediate steps must be taken to develop drugs and vaccines 
appropriate for children that can be used to respond to a bioterrorist 
threat or attack.
  Children also need different sized medical equipment from adults. I 
am therefore extremely troubled that, at present, many ambulances and 
emergency departments do not have child-sized equipment and supplies, 
such as oxygen masks, IV-tubes and neck braces. We must therefore do 
more to support our Emergency Medical Services workers and ensure that 
they are trained and equipped to meet the specific medical needs of 
children.

[[Page S11794]]

  The legislation we are introducing today will help us to meet these 
special needs of children as our nation prepares to defend itself 
against terrorist threats. For example, it more than doubles the 
resources available through the Department of Health and Human Services 
Emergency Medical Services for Children program to ensure that first 
responders, our firefighters, our police, and our paramedics, are 
trained and equipped to handle the special medical needs of children.
  It also authorizes grants to enable the Secretary of Health and Human 
Services, in consultation with the Food and Drug Administration, the 
National Institutes of Health, and the pharmaceutical, biotech, and 
device industries, to formulate a plan for the development of new, and 
enhancement of existing, drugs, vaccines, diagnostics, and medical 
devices that may be appropriate to prevent and treat children who are 
exposed to a bioterrorist attack. This is critical because children are 
not simply smaller versions of adults, their bodies react to drugs 
differently.
  To help meet the mental health needs of children in crisis, the 
legislation authorizes grants to be administered by the Center for 
Mental Health Services within the Substance Abuse and Mental Health 
Services Administration for emergency mental health prevention and 
treatment services for children who are directly affected by terrorist 
acts. To deal with other unique needs of children, our bill provides 
the Secretary of Health and Human Services with broad authority to 
allocate emergency crisis response grants. Such grants could be made at 
the Secretary's discretion to State and local governments or public or 
private non-profit organizations serving children to increase the 
coordination and the development of bioterrorism preparedness efforts 
relating to the needs of children.
  These are difficult and dangerous times, but all is not bleak. We can 
take great comfort from the extraordinary resources with which America 
is blessed. Besides our spiritual muscle, we have a proof of economic, 
scientific, and material strength which we have only just begun to tap. 
The legislation we are introducing today will help to strengthen our 
response to the terrorist threat by ensuring that the special needs of 
children are not overlooked, and I urge all of my colleagues to join us 
as cosponsors.
                                 ______