Good afternoon. I am Dr. Robert Knouss, Director of the Office of Emergency
Preparedness in the U.S. Department of Health and Human Services (HHS).
I am pleased to have the opportunity to appear before the Senate Appropriations
Subcommittee on Labor, Health and Human Services and Education on the very
important topic of the Nation's Public Health Infrastructure Regarding Epidemics and
The Office of Emergency Preparedness is responsible for coordinating HHS' continuity
of government, continuity of operations, and the provision of public health and medical
services following emergencies and disasters that sufficiently degrade local capacity as to
require national assistance. In this role we also work with other federal agencies and the
private sector to develop capabilities and capacities for responding to the health and
medical needs of affected populations.
HHS is actively participating in the Department of Justice led effort to develop a Five-Year
Inter-Agency Counter-terrorism and Technology Plan. This effort will address
specific strategies and requirements for all agencies involved in the counter-terrorism
I am also the Director of the National Disaster Medical System (NDMS) which is a
partnership between the Department of Defense, the Department of Veterans Affairs, the
Federal Emergency Management Agency, HHS and the private sector. This system can
provide medical response to an affected area, evacuate patients, and provide definitive
care if local and state resources are overtaxed. Under the Federal Response Plan, NDMS
assets are incorporated into Emergency Support Function #8, Health and Medical
Services, and have been deployed to a wide variety of emergencies such as natural
disasters, plane crashes, and terrorist incidents.
The Sarin gas attack on the Tokyo subway system and the Oklahoma City bombing of the
Alfred P. Murrah Federal Building left the world shocked by these senseless and horrific
acts of terrorism. One of our greatest challenges is addressing the complex preparedness
issues posed by a terrorist use of a WMD on civilian populations. The human health
impact of such a release or detonation is the primary consequence of such an attack.
HHS is taking a "systems" approach to building response capability and capacity at the
local, state and federal levels. Our counter-terrorism strategy includes the following key
elements: Enhancing local resources because disaster response in this country begins at
the local level; developing partnerships to improve local and state health and medical
system coordination and capability to respond effectively; and improving federal health
and medical capability to rapidly augment state and local responses. Our resources
include those of the National Disaster Medical System.
As part of this system, we have developed specialized national medical response teams
(located in Washington, D.C., Winston-Salem, Denver and Los Angeles) that can
augment local resources in the event of a WMD threat or event. Instances where these
teams have been used include: (1) in response to the bombing in Centennial Olympic
Park; (2) pre-positioned to respond if needed during the Summit of the Eight last year in
Denver; (3) during the Inauguration in 1997; and (4) in the Capitol during the State of the
Union Address this year. It was also one of these teams, the one in Winston-Salem, that
responded under State auspices, to the event that occurred earlier this year in Charlotte,
In creating these resources, we have not been alone. Some of the key HHS agencies with
which we have been working very closely to address counter-terrorism issues include the
Centers for Disease Control and Prevention, the Agency for Toxic Substances and
Disease Registry; the Food and Drug Administration, and the National Institutes of
Health. External to HHS we have been working with other federal departments and
agencies, the National Academy of Science's Institute of Medicine, and local and state
governments, as well as with nationally recognized individual experts.
We have also supported 27 major metropolitan areas for the development of local
Metropolitan Medical Strike Team Systems. These enhancements to existing local
response systems are designed to provide initial on-site response and provide for safe
patient transportation to hospital emergency rooms for treatment in the event of a WMD
terrorist attack. These MMST Systems are characterized by specially trained responders
for on-site triage and initial medical treatment; specialized pharmaceuticals and
decontamination equipment; enhanced emergency medical transportation; definitive
hospital care; and the provision of assistance from the National Disaster Medical System,
if needed. Our plans are to continue developing local MMST Systems in conjunction
with the Domestic Preparedness Program's 120-city initiative. Further system
development is necessary to assure adequate surveillance, laboratory support and
pharmaceutical distribution systems in the event of a biological weapon release.
The program of enhanced preparedness that the President called for in his Naval
Academy commencement speech on May 22nd, and his recent signing of Presidential
Decision Directive 62, will strengthen our nation's defenses against the growing threat of
unconventional attacks against the people of the United States. This directive designates
HHS as the lead Federal agency, in support of FEMA, to plan and prepare a national
response to medical emergencies arising from the terrorist use of weapons of mass
destruction. We will be supported by other Federal agencies in this effort. Together we
plan to continue to provide enhanced local response through the strengthening of local
systems and the provision of Federal supporting teams, if necessary -- for the
prevention, detection, identification and public health response to the release of a weapon
of mass destruction.
Of significant concern is how best to protect our civilian population from biological
weapons. In response to the President's directive, HHS is exploring a range of
approaches for upgrading our public health systems for detection and warning and for
providing medical care for massive numbers of affected people. We are examining a
broad spectrum of needs that includes research and development, pharmaceutical
stockpiles, public health surveillance, and response capabilities.
Secretary Shalala recently requested that the Assistant Secretary for Planning and
Evaluation convene a working group to develop a HHS strategic plan for strengthening
and expanding our role in the Government-wide bioterrorism effort. Implementation of
the plan and oversight of the resulting activities will be the responsibility of the Assistant
Secretary for Health and Surgeon General.
Thank you for this opportunity to discuss our counter-terrorism initiatives with you. I
would be glad to answer any questions .