Local Needs and Preparedness for WMD Incidents: The Current and Sobering US Picture

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Local Needs and Preparedness for WMD Incidents
The Current and Sobering - US Picture

• Glenn Paulson, Ph.D., Veronica Novoa, B.S.
• School of Public Health,
• University of Medicine and Dentistry of New
  Jersey
• New Brunswick, New Jersey, USA

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Introduction
Local Needs and Preparedness for WMD Incidents
A Case Study from Kentucky (Paulson, 2002)

• Hazmat Training in Kentucky
• Antiterrorism Act of 2002
• Local/County Needs Levels of Preparedness
  Unknown
• Survey Process
• Types of Persons Surveyed
• Individuals Provided Confidential Responses
• Distributed in Four Regions of KY
• Four Critical Issues communication, incident
  command, on-scene capabilities, and off-site needs

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Local Needs and Preparedness for WMD Incidents
A Case Study from Kentucky (Paulson,
2002) Detailed Results
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Conclusion and Hypothesis

• Conclusion Needs ranged from High to Very High
  while level of preparedness was Low
• Hypothesis Only limited progress has been made
  since 2002 at the local level across the United
  States
• Methodology Analysis of various reports, studies
  and media articles as they become available

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Methods

• Routinely searched the internet for materials
• Numerous reports, studies, and media articles
  collected and evaluated to assess the current
  status

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RAND Issue PaperMeasuring Evaluating Local
Preparedness for a Chemical or Biological
Terrorist Attack
(Fricker, 2002)
Percentage with a WMD Plan That Addresses
Response to a Biological or Chemical Incident
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Examples of Reports Collected
January 2002 Q1 Do you consider your county
public health department prepared to respond to a
bioterrorism crisis in your community?
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Examples of Reports Collected
Q3 If you answered no to either question, would
insufficient funding be an obstacle that would
prevent appropriate and timely response?
Q2 Do you consider your county public health
department prepared to respond to a chemical
warfare crisis in your community?
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Examples of Other Reports Collected

• Surveyed county administrators and clerks
  nationwide with 715 responses.
• Among the major findings are the following
• Nearly 72 of counties are facing budget
  shortfalls
• 56 of counties are facing reductions in state
  funding for state-mandated programs
• While counties are struggling to deal with the
  revenue reductions, the demand for
  county-provided services continues to rise

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United States General Accounting
OfficePreparedness Varied Across State and
Local Jurisdictions (April 2003)

• state and local officials reported deficiencies
  in capacity, communication and coordination
  elements essential to preparedness and response,
  such as workforce shortages and a lack of
  regional coordination and compatible
  communication systems

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Examples of Other Reports Collected
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Examples of Other Reports Collected
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Examples of Other Reports Collected
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The Council on Foreign RelationsEmergency
Responders Drastically Underfunded, Dangerously
Unprepared (July 2003)

• most cities do not have the necessary equipment
  to determine what kind of hazardous materials
  emergency responders may be facing

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Comparative Study
America at Risk A Homeland Security Report
Card by the Progressive Policy Institute in July
2003 Results of Survey Conducted Included
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Trust For Americas Health StudyReady or Not?
Protecting the Publics Health in the Age of
Bioterrorism (December 2003)

• Worked with an advisory committee of state and
  local officials
• Examine 10 key indicators to assess areas of
  improvement and areas of ongoing vulnerability in
  our nations effort to prepare against
  bioterrorism and other large-scale health
  emergencies
• Each state received a score based on a scale of
  the 10 key indicators, with each state receiving
  one point for achieving an indicator

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Trust For Americas Health Study Ready or Not?
Protecting the Publics Health in the Age of
Bioterrorism 2004 (December 2004)

• Several of the indicators differ from 2003
• Preparedness in 2004 should be greater than in
  2003, given additional time and funding
• Overall scores demonstrate incremental progress,
  but preparedness is still lagging behind goals
  and expectations
• No states achieved top possible score
• Still major areas of vulnerability that leave
  Americans at risk

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Trust for Americas Health State by State 2004
Scores Compared to 2003 Scores
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Trust for Americas Health State by State 2004
Scores Compared to 2003 Scores

• Summary
• 34 states obtained higher scores
• 9 states remained the same
• 7 states declined

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Trust for Americas HealthNew Report Finds
Progress, But Basic Federal and State
Bioterrorism Capabilities Lacking Three Years
After 9/11 (12/14/2004)

• This report found that more than three years
  after 9/11 and the anthrax tragedies, weve only
  made baby steps toward better bioterrorism
  preparedness, rather than the giant leaps
  required to adequately protect the American
  people. The conclusions of this study demand an
  answer to the big question here what will it
  take to make bioterrorism and public health
  preparedness a real national priority?
• Lowell Weicker Jr., Trust For Americas Health
  Board President and Former U.S. Senator and
  Governor of Connecticut
• Response to Ready or Not? Protecting the Publics
  Health in the Age of Bioterrorism 2004

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Related Headlines
Unprepared for Terror First Responders as
Vulnerable to Terror as Those They Protect
06/21/03 (ABCNEWS.com)
Homeland Security Money Doesnt Match Terror
Threat 10/29/03 (USA Today)
Unprepared for Terror Report U.S. Dangerously
Unprepared for Attack 10/25/03 (ABCNEWS.com)
Emergency Responders Are Unprepared and
Underfinanced to Handle Another Attack 06/30/03
(ABCNEWS.com)
A 20/20 investigation finds that many local fire
and police departments dont have the funding to
buy equipment needed to respond to biological,
chemical or radiological terror attacks. (June
2003)
Think Tank Gives U.S. Homeland Security D
Grade 07/23/03 (reuters.com)
U.S. Unprepared for Terror Attack First
responders need more money House boosts homeland
RD 07/07/03 (Chemical Engineering News)
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Other Related Headlines
2 Years Later, Gaps in Security Remain From
Travel to Food, Plugging the Holes is Herculean
Task 09/11/03 (MSNBC.com)
Nation Unprepared for Terrorist Attacks
Sept. 2003 (The Nations Health)
Bioterrorism Preparedness Criticized 12/11/03
(Associated Press)
2B Hasnt Stopped Gaps in Bioterror Readiness
12/12/03 (USA Today)
States Tracked on Bioterror Plans Report Warns
that Local Budget Cuts are Limiting Action
12/11/03 (Associated Press)
States Unprepared for Public Health Emergencies,
Bioterror Feb. 2004 (The Nations
Health)
Domestic Security Gets a Mixed Appraisal
3/25/04 (NY Times)
DHS Budget Criticized for Shortchanging First
Responders 02/09/04 (MSNBC.com)
Homeland Security Takes Steps to Fix Financial
Problems 3/15/04 (GovExec.com)
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Other Related Headlines
Emergency Readiness Gains Cited 09/05/04
(Washington Post.com)
Study Finds Chemical Plants are Still Vulnerable
to Terrorism 10/28/04 (Pittsburgh
Tribune-Review)
Poll Finds Most Americans Have Not Prepared for
a Terror Attack 10/28/04 (NYTimes.com)
How Safe Are We Really? Better Protection for
Elected Officials Gaps Remain 02/03/04 (NBC
News)
States Slow to Prepare for Bioterror 12/14/04
(CNN)
Local Officials Bemoan Process for First
Responder Aid 08/13/04 (GovExec.com)
Domestic Terrorism New Trouble at Home
11/15/04 (USA Today)
Bioterrorism Risk Perceptions and Educational
Needs of Public Health Professionals Before and
After September 11, 2001 A National Needs
Assessment Survey July-August 2004 (Journal
of Public Health Management Practice)
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Other Related Headlines
Toward a Framework for Understanding Lay
Publics Comprehension of Disaster and
Bioterrorism Information 5/31/2005 (Journal of
Biomedical Informatics)
Scrutiny Continues Over Airline Screening
Sept. 2005 (The Associated
Press)
U.S Lacks Unified Emergency Radio System

9/13/2005 (Associated Press)
Homeland Security Department Review Warned that
Nation was Woefully Unprepared
9/27/2005 (Associated Press)
Homeland Conferees Back More Aid for High-Risk
States 9/29/05
(GovExec.com)
Local Emergency Teams Resist Plain-Language
Radio Rules 8/26/2005 (GovExec.com)
When Bioterrorism Strikes Communication Issues
for the Local Health Department October 2005
(Health Promotion Practice)
Educating Health Professionals to Respond to
Bioterrorism
July-August 2005 (Public Health
Reports)
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Other Related Headlines
Public Health and Terrorism Preparedness
Cross-Border Issues July-August
2005 (Health and Wellness Resource Center)
Ability of Physicians to Diagnose and Manage
Illness Due to Category A Bioterrorism Agents
9/26/2005 (Archives of Internal Medicine)
Developing National Performance Standards for
Local Public Health Systems
September-October
2005 (Journal of Public Health Management
Practice)
Weapons of Mass Destruction- Threats and
Responses August 2005 (British Medical
Journal)
New Report Offers Ways to Speed Airport
Security 6/6/2005 (WashingtonPost.com)
Bioterrorism Preparedness Expenditures May
Compromise Public Health
October 2005 (American
Journal of Public Health)
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Another Comparative Study
The Department of Homeland Securitys First
Year A Report Card by the Century Foundation
in 2004 Results of Studies Included
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United States General Accounting OfficeResponse
Capacity Improving, but Much Remains to Be
Accomplished (February 2004)

• Although states have further developed many
  important aspects of public health preparedness,
  since April 2003, no state is fully prepared to
  respond to a major public health threat. States
  have improved their disease surveillance systems,
  laboratory capacity, communication capacity, and
  workforce needed to respond to public health
  threats, but gaps in each remain. Moreover,
  regional planning between states is lacking, and
  many states lack surge capacitythe capacity to
  evaluate, diagnose, and treat the large numbers
  of patients that would present during a public
  health emergency.

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National Journal ArticleSecond-Class Security
(Gorman, May 2004)
Grades
A B C D F
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National Journal ArticleSecond-Class Security
(Gorman, May 2004)
Grades
A B C D F
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National Journal ArticleSecond-Class Security
(Gorman, May 2004)
Grades
A B C D F
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Baseline Magazine.comHomeland Security Report
Card(Gage, Dignan, August 2005)
Grades
A B C D F
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Centers for Disease Control and
Prevention/American Medical Association First
National Congress on Public Health Readiness
(July 2004)

• Our public health system has in many ways become
  the victim of its own successuntil recently,
  public health funding was grossly underfunded in
  much of our country. Now it is merely
  underfunded.
• John C. Nelson, MD, MPH,
• President of the AMA

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Redefining Readiness Terrorism Planning
Through the Eyes of the Public (Roz D. Lasker,
September 2004) Center for the Advancement of
Collaborative Studies in Health, with the New
York Academy of Medicine

• Disjointed relationship between emergency
  planning and risk perception/communication
• The danger of assumptions people may NOT follow
  instructions/directions
• Noticeable decrease in public trust in government
• Plans are basedon planners assumptions about
  what the public cares about and how people will
  behavebut there are numerous examples in the
  literature of people not responding as planners
  expected.
• If plans fail to address the issues that are
  important to the American public and if the
  public does not follow protective instruction, a
  large number of people will be unnecessarily
  harmed.

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Breathing Easier?Report of the Century
Foundation Working Group on Bioterrorism
Preparedness (2004)

• much more needs to be done to strengthen the
  nations ability to respond to a public health
  crisis involving bioterrorism.

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Examples of Other Reports Collected

• August 3, 2005
• Q1 To fight terrorism, in your opinion, should
  the government put more emphasis on

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Examples of Other Reports Collected

• Q2 Do you worry that terrorists may obtain
  biological, chemical or nuclear weapons to attack
  the U.S?

• Q3 Do you worry that there may be another major
  terrorist attack against the U.S. in the near
  future?

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Homeland Security How Far Have We
Come?(Nicholas Hoover and Eric Chabrow,
9/5/2005)Information Week

• Many of the critical intelligence failures
  of Sept. 11 happened because the right people
  didnt have the right information at the right
  time. Since then, data sharing has been a top
  priority at all levels of government as well as
  between government and business, but theres
  still a long way to go before nimble, effective,
  and secure data-sharing systems are established.
  If we started on the 20-yard line, were maybe
  on the 30, says Ed Hammersla, chief operating
  officer of Trusted Computer Solutions, a data
  security products and service provider. Weve
  made some progress, but not a whole lot.

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Report on the Status of 9/11 Commission
RecommendationsPart I Homeland Security,
Emergency Preparedness and Response(September
14, 2005)EMERGENCY PREPAREDNESS RESPONSE
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Report on the Status of 9/11 Commission
RecommendationsPart I Homeland Security,
Emergency Preparedness and Response(September
14, 2005)TRANSPORTATION SECURITY
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Report on the Status of 9/11 Commission
RecommendationsPart I Homeland Security,
Emergency Preparedness and Response(September
14, 2005)BORDER SECURITY
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Examples of Other Reports Collected

• More crises like September 11 and Katrina are
  inevitable, from a major California earthquake to
  a nasty flu virus, from a terrorist attack to
  mega-storms.
• If we dont learn the real lessons this time,
  the worst is yet to come.

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Knowledge about the Initial Presentation of
Smallpox among Emergency Physicians in
Washington, DCAcademic Emergency Medicine (2005)

• Written true/false test prepared based on
  smallpox information found on the Centers for
  Disease Control Prevention (CDC) webpage
• RESULTS Average test score was an F (59)
• CONCLUSION Some current CDC website facts on
  smallpox are known by the large majority of
  emergency physicians in Washington, DC, but
  questions based on other facts were incorrectly
  answered by the majority of the physicians that
  were tested

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Closing Question

• Is the glass half full yet?

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For Further Information

• PI Glenn Paulson, Coordinator Emily Perry,
• Phone [phone], Phone [phone],
• E-mail paulsogl_at_umdnj.edu E-mail
  perryem_at_umdnj.edu
• New Jersey Center for Public Health Preparedness
  at UMDNJ
• School of Public Health, Suite 3700
• PO Box 2688, 335 George Street
• New Brunswick, NJ 08903-2688
• Phone [phone]
• Fax [phone]
• Website http//www.njcphp.org