Beyond The Blue Canaries

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It's not only air currents that will spread the poison, though: It's the victims as well. Every person flccing the scene can carry the chemical on clothes and skin, where it continues to endanger not only the victim, but everyone the victim touches or even approaches. In Tokyo, where authorities were slow to set up a perimeter, so many contaminated victims rushed to hospitals or doctors' offices that several medical facilities became contaminated in turn and had to close down. Tending to poison-soaked patients in cramped ambulances or ill-ventilated wards, some paramedics and nurses became sick themselves. And most hospitals, in Japan and America alike, can decontaminate only a handful of patients at a time.

That means decontamination must take place before victims reach the hospital. People who are exposed to the chemicals or simply standing near the danger zonc—all of them frightened, many of them sick, blinded, or choking-must be directed, even dragged, to "decontamination corridors" where they can be cleaned. But a crowded rush-hour subway can produce hundreds of victims, a packed sports arena, perhaps tens of thousands. Pretty soon, decontamination is a logistical nightmare. Most federal and local experts agree that the best first step to take when decontaminating large crowds of people is to strip off their outer clothing-which will be permeated with poison—and shower them off. "We can do a tremendous amount of good by just taking the clothes off you," Eversole said. But to persuade a panicky and mixed-gender crowd to strip off their clothes and leave behind their valuables-"What chaos," he sighed.

Many cities have bought special decontamination trucks or trailers with showers inside, but these are
expensive and take time to set up. Other cities plan to roll in ordinary fire trucks and set the hoses for a
gentle spray. "We can move literally hundreds of people through that fairly quickly," said Seattle's
Deputy Chief Vickery. But that exposcs patients not just to public view, but to the weather as
well-which in winter may merely convert the victims' problem from poisoning to hypothermia.
Vickery plans to improvisc protective tarpaulins; other departments, such as Los Angeles County's,
actually have inflatable, heated tents. And some officials speak bluntly of their intention to commandeer
the nearest large building that has showers. "As soon as an incident goes down, one of the first things!
will do... is look to see where the closest junior high school, high school, or college is," one official
said. "I'll shut that place down."

Mass Casualty

When a chemical victim is clean enough to be treated safely, the medical problem has just begun. Especially in this efficiency-minded age of managed care, no city has much slack in its medical system. On even a normal night, many cities must institute "bypasses" when an overloaded emergency room refuses to accept more patients. In a true mass-casualty disaster, doctors, drugs, and even space will run out fast.

In most hospitals, "they're running at max most of the time," said Battalion Chief Michael Arras of the St. Louis Fire Department. "It's going to be riass havoc if you have a thousand people [injured]." As one health expert put it: "If push comes to shove, you put people on the floor. Nobody says that, but that's what happens." Many cities plan to set up field hospitals in parking lots or public buildings.

Harder to address is the shortage of supplies. Nerve gas antidote, for example, includes the heart drug atropine, which most ambulances already carry but in doses less than a tenth of what a nerve gas victim needs. Other agents do their damage and are gone, with no need for an antidote. But to keep the victims breathing while their ravaged lungs repair themselves may require rare and expensive ventilators. Even basics such as blankets and intravenous bags will run short.

Beyond The Blue Canaries

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Some cities have used federal grants and their own resources to stockpile such supplies. Chicago, for
cxample, has "triage vans"—literally truckloads of blankets, stretchers, and medical supplies. Still, in the
long run, drugs expire, and gear breaks down, and the cost of stockpiling expensive, specialized supplics
in mass-casualty quantities is more than any single city can bear. So the federal Health and Human
Services Department has a two-tiered system of stockpiles. Enough supplies for 5,000 victims can be
ready to fly within hours to the site of a terrorist incident-in theory. More medicine will be en route the
next day.

That leaves the hardest shortage, the human one: With hundreds or thousands of patients, where do the doctors and nurses come from? East Baton Rouge Parish, which contains the city of Baton Rouge, is actually developing a database of nurses and doctors who have retired, moved to administrative work, or changed careers, so it can call them up in an emergency. The nation's largest medical system, the Veterans' Affairs Department, is finishing a similar list of its personnel who can help out in disasters. Health and Human Services actually has the largest such reserve. It can call up from across the nation more than 70 disaster medical assistance teams, each comprising up to 100 medical personnel who have volunteered to deploy to disasters that range from earthquakes to terrorist attacks.

While doctors are rushing in, the National Disaster Medical System will bring overflow patients out, transferring them, by military airlift if necessary, to VA facilitics or 2,000 participating private hospitals nationwide.

But all of this would still take time. In the first awful hours after an incident, as on a battlefield, the only option is triage. "Every life is important, and there is no acceptable number of deaths," said Clark Staten, director of the Emergency Response & Research Institute in Chicago. "But reality may set in as you are faced with larger and larger numbers of casualtics, and you're going to have to make realistic choices at that point about who can be saved and who can't."

Triage is not a solution anyone is happy with. But the fact is that the medical community is where fire departments were a few years ago—just beginning to prepare for cncounters with weapons of mass destruction. The emerging model is HHS' Metropolitan Medical Response System. Originally intended as yet another rapid-response team, the program evolved into a far broader effort, one that links government-run emergency services with private hospitals, thereby creating a coherent community disaster plan. Although the program is providing 97 cities with an average of $600,000 apiece, HHS and outside experts agree that that is only seed money. The cities must spend their own funds to continue the programs. The grant's greatest valuc is as an incentive to get all partics to come together and plan. Said Oklahoma City Fire Chief Gary Marrs, "Just the fact that we've got the MMRS designation and got that group working [means] we've got them at least coming to the table and talking."

The Future

Now that federal, state, and local officials are talking, the challenge is to maintain the momentum. The Domestic Preparedness Program's original list of 120 cities will be trained by 2002, but federal officials are just now brainstorming about how to maintain and freshen the capabilities the program created. Indeed, since the program's October transition from the Defense Department to Justice, East Baton Rouge Parish's JoAnne Moreau noted that her city had received no funding or follow-up from either department. "We're in the black hole now," she said.

Even HHS' Metropolitan Medical Response System provides only an initial infusion of funds; it doesn't offer continuing support to train and exercise people, or to maintain equipment. The Justice Department envisions that its requirement that each state conduct a self-assessment will become the foundation for a

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comprehensive national plan, but the interagency coordination is still lacking to carry out such a strategy.
Also lacking is a national library of best practices, which would provide such information as how best to
do mass decontamination, or the most important lessons learned from past exercises. The nonprofit
Emergency Response and Research Institute says, based on its own efforts to create such a database, that
one could be had for less than $250,000. After Oklahoma City and Tokyo, the United States, in its
eagerness to get on top of the terrorist threat, leaped over such simple but important stops. That initial
sprint to safety accomplished a great deal. But now the marathon lies ahead.

Mr. SHAYS. It starts out,

When you walk into clouds of poisonous gas for a living, it helps to have a sense of humor, even a morbid one. That's why fire department hazardous materials specialists often call their police colleagues "blue canaries." It is a reference to the songbirds that old-time miners took with them underground as living or dying indicators of bad air in the shafts. The joke goes like this, "There's a policeman down there. He doesn't look like he's doing too well. I guess that's not a safe area," explained John Eversole, chief of special functions for the Chicago Fire Department.

In their oxygen masks and all-enclosing plastic suits, "hazmat" specialists such as Eversole can approach industrial spills with confidence and they do, dozens of times a day, all across the country. Fortunately, so far, they have not had to don those suits in response to some terrorist group that has doused an American city, subway, or airport with lethal chemical weapons.

What we did in our District is we invited a response team to come to the District and act out a scenario where an Amtrak train had encountered a derailment, and the police went in, and they were the first responders, and they didn't come out alive because of the chemicals.

We had about 40 agencies-some Federal, but we had the local police, we had the State police, we had the National Guard, who were the response team, and it was a fascinating experience to see how everybody would coordinate their activity.

I mention that because we focus primarily on the national response, but we have three levels of government, and they could put up charts, not maybe as complex as this but somewhat as complex.

So I envision your recommendation is that this homeland office would-and I don't ever see it as a fortress America, but this homeland office would also work, what, to coordinate this and the response? Maybe you could explain, Senator.

Senator RUDMAN. Yes, it would. One of its primary functions is to work with localities, municipalities, counties, States, so if something went wrong then there would be a plan, people would know who did what and when and where in terms of what if the local hospital becomes disabled. What if the local police department is disabled? What if the local fire department is disabled? What if the communications network goes down? What do you do? And that's what we ought to be talking about.

Mr. SHAYS. Would it also get involved-I'm looking at one of the charts that you can't see because it is closest to me, but it says, "Department of Agriculture." I'm just thinking, "Now, what would the Department of Agriculture do," and then you have a real, live example of the civil liberties of farmers in Great Britain who are seeing their personal property destroyed against their wishes, in some cases, because of foot-in-mouth disease.

Now, a terrorism could simply do what, General Boyd, as it relates to that?

General BOYD. The proliferation of disease, with biological warfare in animals as well as human beings. I mean, there is almost every aspect of Government has some piece of this where potentially it has involvement. But, again, the point that you made and the point that certainly we've made in our report is the coordination of all of that in an effective, coherent way just doesn't get accomplished.

Mr. SHAYS. We're going to shortly get on to the next panel, but let me ask this question. We obviously have a deterrent. We want to prevent and we want to protect the public from a terrorism at

tack. That is obviously our first interest. But obviously we then have a response to an attack. It can be basically disarming a nuclear weapon. Obviously, that is something that we are prepared to do very quickly. But take any of the three areas of mass destruction, you have communications problems, you have health problems, you have the property, the fire, the police, and so on. You have the hospitals. But you also want to solve the crime, because we want to hold people accountable for what they may have done. It relates to this issue here. My biggest interest, obviously, is to prevent, and yours, as well, and to protect.

In the process of your doing your research, only the intelligence allows us to sift through hosts of vulnerabilities to distinguished the real threats. What was the Commission's view of the currency and reliability of U.S. threat assessment? And how could it be better?

Senator RUDMAN. Well, I'll be happy to answer that, as I answered, I believe, before to Chairman Gilman. I think that there has been a vast improvement in the human intelligence aspects of the work of the CIA overseas and the FBI here within this country in terms of identifying threats, not only against cities and citizens but against individuals, such as the President. Having said that, it is the most difficult, because unless you are 100 percent you lose. So I would add to your comment, Mr. Chairman, that the response be planned meticulously so every place in this country knows how it would respond, and a good place to look-and your staff can get it for you very easily-is get all of the Japanese Government's reports and all the publicly available information on the attacks of deadly gas in the Tokyo subway system by a terrorist group several years ago. We've looked at all that and the U.S. intelligence community has all that. It's all available.

Here was a city with a fire department pretty well organized dealing with a mass of people in such a small area, and look at the confusion that resulted and the problems that existed. And we're talking about a fairly minor attack in terms of the number of people affected and the number of stations that were affected. We've got to look at that. It will help to answer your question about re

sponse.

Mr. SHAYS. Thank you. But your bottom-line point is that you have a good amount of confidence in our capabilities?

Senator RUDMAN. I do. Unfortunately, I want to stress you can't have 100 percent confidence. You would be a fool to. And, unfortunately, in this business just one slips through-and my greatest concern, incidentally-personal opinion, not in the report, but based on a lot of work that I have done I am more concerned about chemical and biological right now than I am about nuclear. Mr. SHAYS. OK.

Senator RUDMAN. I think it is a serious threat, easily deployed, and hard to deal with.

Mr. SHAYS. Let me conclude this just asking if either of you would like to ask yourself a question that you were prepared to an

swer.

Senator RUDMAN. I think you've asked them all.

General BOYD. You've asked the best ones.