September 11, 2001 : Attack on America
Testimony of Dr. Lew Stringer - A Review of Federal Bioterrorism Preparedness Programs from a Public Health Perspective. Subcommittee on Oversight and Investigations; October 10, 2001

A Review of federal Bioterrorism Preparedness Programs from a Public Health Perspective.
Subcommittee on Oversight and Investigations
October 10, 2001
10:00 AM
2322 Rayburn House Office Building


Dr. Lew Stringer
North Carolina Division of Emergency Management


Mr. Chairman and Members of the Committee, thank you for inviting me here today to discuss the issue of Weapons of Mass Destruction Preparedness. I am Dr. Lew Stringer, Medical Director of the North Carolina Division of Emergency Management. I have a long history of emergency management experience that ranges from services as a local EMS Medical Director for 27 years, Director of the Special Operations Response Team a disaster organization in North Carolina and involvement with the National Disaster Medical System through the Office of Emergency Preparedness, USPHS since 1990.

In 1995, because of concerns regarding Weapons of Mass Destruction (WMD) in the US, I was one on sixteen people asked by the Office of Emergency Preparedness, USPHS, to advise and develop strategies to deal with the consequence management of a WMD event. PDD 39 and the Nunn-Lugar-Demenici initiative were enacted during this time. Our group concluded that from the consequence management side, a WMD event was primarily a local issue. Local agencies needed to be trained, organized in a uniform manner and equipped to deal with the initial response in order to save lives. Mutual aid agreements needed to be in place with surrounding communities and state agencies should be immediately involved. The state agencies should respond to assist the” locals” in dealing with this complex and unusual emergency event that would rapidly overwhelm most local communities. Our group concluded that law enforcement, fire, HAZMAT, EMS, hospitals, Public Health, and local emergency management had to be brought together to assess additional training, organizational and equipment needs. These agencies needed to develop a plan. And, they needed assistance from the federal government.

Our committee named this new local entity the Metropolitan Medical Response Team, MMRT. In 1997, the first MMRT was formed in Washington, D.C. From that team concept, came the resource material to be used by OEP/USPHS for the other cities in the system. 120 of the largest cities in the US were selected to receive the Nunn-Lugar-Demenici training grants administer by DoD and then to receive the grants administered by the OEP/USPHS to organize and equip these MMST’s. They are now known as Metropolitan Medical Response Systems, MMRS. It was our recommendation that several regional specialized medical response teams be formed and equipped by the National Disaster Medical System, OEP/USPHS to respond rapidly to assist communities affected by the WMD event. These teams were founded as Nation Medical Response Team, NMRT/WMD. I developed the first SOP for the NMRT’s early in 1996. There are four teams. I am the commander of the NMRT/WMD East, in Winston-Salem, N. C.

As of December 21, 2000, of the 120 designated MMRS cities/metropolitan areas, DoD had completed the training for 68 cities and had begun the training of 37 additional cities before the program was turned over to the Office of Justice Program (OJP) to administer. After a city completed the NLD Domestic Preparedness Program “Train the Trainer”, OEP/USPHS contracts with the city’s metropolitan area, providing a $ 600,000 grant for the development of plans, additional training, and equipment purchases to give the metropolitan area a unified multi-discipline team capable of responding to a terrorist event. According to OEP/USPHS, as of September 2001, 97 cities have received or in the process of receiving funding from OEP. OEP states that 49 cities are fully or partially functional. Only 26 cities have purchased the pharmaceuticals necessary to treat the victims. It is my opinion, looking at information I have received from several federal agencies, that it will be 5-6 years before all 120 cities are fully functional.

In 1999, OJP initiated a nationwide assessment of vulnerability, threat, risk, capabilities, and needs. Each state with their local jurisdictions was to complete this assessment and develop a long-range plan that was to include federal funding for the purchase of needed equipment. I have been told, that by September 2001, only four (4) states (give names) have turned in their completed assessment making them eligible for the 2000-2001 monies. Funding is not released until the completed assessment along with a three-year strategic plan is returned to OJP.

It has taken my state of North Carolina 1 ½ years to complete the assessment and the 3-year plan. I have found the assessment to be complex and difficult to complete. NC does not have the resources to collect the data in a timely fashion. Local jurisdictions needed help in amassing the information. There is much diversity within the state, large cities and small rural counties made completing complicated.

The plan for North Carolina includes:

  • 1. Equipping our 6 regional HAZMAT response teams, our highway patrol, and our state disaster team

  • 2. Assisting financially our largest cities or highest risk cities (metropolitan area affecting 20 counties). Of our 100 counties, 80 counties will receive no financial assistance. Charlotte, NC, the second largest banking center in the US, will not receive funding through our plan, because they received separate financing from Congress.

  • In an explosive, chemical or nuclear event, victims are concentrated in that area. First responders will rescue, decontaminate, treat, and transport victims to health care facilities. With a biological event, victims will not likely be concentrated in any one area. Victims will receive most of their treatment at health care facilities. In this biological scenario, health care workers will be the first responders.

    Until the horrendous events at the World Trade Center and the Pentagon and in the past history of disasters, victims have self-triaged to health care facilities bypassing the EMS system. In our present structure, ONLY law enforcement, fire, HAZMAT and EMS are considered First Responders by the federal government and eligible for funding in WMD Preparedness. This shortfall was pointed out to Congress in the 2000 Gilmore Report. The Noble Training Center, OEP/USPHS at Fort McCullen in Alabama is the only federally funded WMD training support for health care workers that I know in existence today.

    CDC has an excellent program, well received by the states, to assist states and local communities with a WMD event:

    The National Pharmaceutical Stockpile, NPS, delivered on site in 6-12 hours.

    State grants to improve and upgrade laboratories and improve reporting of disease patterns. These grants assist state and local public health services to upgrade labs for agent identification, develop Bio-terrorist planning, implementation of the electronic surveillance programs of the Health Alert Network, and collect epidemiological information.

    The health care community has been a difficult player to bring to the WMD planning table. Sadly, the health care systems operate in a “crisis mode” of staffing and financial problems on a daily basis. Several health care facility managers in my state of North Carolina have told me, “I have no time or finances for a hope not activity”. This attitude must change. (We) in emergency management must help the health care system with planning, training and equipment to enable these dedicated individuals, be prepared to safely receive and effectively treat WMD victims.

    I look at the support provided by the OEP’s National Disaster Medical System for the four National Medical Response Teams for WMD. The 4 teams, staffed by volunteers who have to train without pay, receive limited funds for additional equip purchases and maintence. This funding is not enough to maintain the NMRT’s proper readiness state to respond to assist state or local communities. It would be proper, in my opinion, to increase the funding for the NMRT program.

    I believe that the health care system must be funded and supported to become an active player in order to resolve the consequences of a WMD event. I am concerned that many cities will not be able to effectively manage the consequences of a WMD event for the next 4-5 years. I have pointed out to you that in my state of North Carolina, like many other states, little or no training or equipment is in place to respond to a WMD event if it occurred today.

    As a state and a local emergency management official, I understand that it will be the state and local governments that will respond and manage the consequences of such an event for many hours and even after the federal assets arrive.

    I have read about all of the money appropriated by Congress to the many federal agencies for WMD Preparedness. Frankly, I wonder and do not understand where all that money has gone?

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