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Director of Office of Emergency Preparedness and National Disaster Medical System

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Introduction by Kenneth L. Adelman


Director of Office of Emergency Preparedness and National Disaster Medical System, United States Department of Health and Human Services
Thank you very much. As your token "walk-on," I will try to be brief and give you an overview of how the federal government is organized to respond to the types of nightmares that Josh raised and that we saw in Japan.

There is a lot of good news in what has happened in this Administration. First, the President, through the appointment of James Lee Witt, has revitalized Federal Emergency Management Agency (FEMA), and FEMA has responsibility for an all-hazards approach to both natural and man-made catastrophic disasters.

As FEMA is a management coordinating agency, there are 12 action agencies beneath it that are responsible for various programs. Our Secretary, Donna Shalala, is responsible for the health, medical, and health-related social services program from an executive agency standpoint. Dr. Philip Lee, our Assistant Secretary for Health, is the senior official that would be responding in this type of a crisis.

The way the Federal Response Plan is developed is that there are 12 departments and agencies that support the Department of Health and Human Services, enabling one to bring to bear all of the federal assets for health and medicine to respond to a local or state catastrophe.

There are three elements that are important to focus on in this brief discussion. First is the concept of prevention. There are two modes. First, the intelligence that can be gathered throughout the world and domestically in dealing with the type of threats the United States may face. They can come in essentially three different formats: A threat with a warning, a threat with no warning (that is really an action), or a threat with no action accompanying it. The case in Japan was an action without a known previous threat.

As one moves in to respond to the third, that category of an action with no threat, these are the things that you need to know: First, the crisis is managed in the Federal plans through the Federal Bureau of Investigations. They are the crisis managers. The consequence manager is the organization, FEMA, through its Federal Response Plan. The lead for any health and medical would be the Department of Health and Human Services.

Immediately upon receipt of this type of information, one would go into the Federal Response Plan, and the focus would be on the detection of whatever agent was involved, diagnosis of the agent, recommended therapy, mitigation, removal of the contaminating material, and public information that would be involved.

I think we saw in the case of the Japanese episode a scene from Dante's Inferno that would deal with the massive type of action that Josh referred to. It is important to note that no amount of planning, no matter how well done, would prevent the deaths and morbidity at a Ground Zero attack area. This is something that is necessary for all of us to know.

On the other hand, the good news is that there is a great deal of work in the practice of medicine that would enable us to respond expeditiously. The key is in the local community. There is excellent planning through the Federal Response Plan for an all-hazards plan that deals with both man-made and natural hazards.

We have been exercised in responding to many things in the last three years: The response to Hurricane Andrew, the Midwest floods, the Southeast floods, the North Ridge earthquake, and the California floods. We all know each other, and we are not exchanging business cards at the time that we are there. The massive terrorist response is really no different, conceptually, than the response to a massive earthquake. Both of those occur without warning and with loss of life. Both of them need a very rapid deployment of individuals, and I am pleased to inform you that this Administration, through its action to revitalize FEMA and the Federal Response Plan, has stitched these types of events.

This is not to say that these are not difficult and that we must focus on rapid detection. As a microbiologist and pathologist, 24 to 48 hours is not the answer. There needs to be good research to focus on that.

On diagnosis and information, I would not want to call for the hands of the people that are hypochondriac within their own, but all of you know the extent to which people respond with imagined threats and the need to get out good information and with the plans in place, I believe that we can respond, because these weapons, unlike the nuclear ones, do have good forms of therapy. Remember, the first eight to ten hours are extraordinarily difficult.

Thank you very much for your attention.

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