Official Remarks & Reports

Dr. Bernadine Healy President and CEO American Red Cross Hearing on Terrorism and U.S. Government Capabilities Senate Appropriations Committee Subcommittee on Commerce, Justice, State and Judiciary Appropriations

 

MAY 10, 2001

WRITTEN STATEMENT

Last May in a federally directed exercise, more than 2,000 people were exposed to an infective agent released by a terrorist from a fire extinguisher at Denver's Performing Arts Center. After the event, audience members returned to their homes, seemingly unharmed by this odorless, colorless release.

Within a number of days, 1,500 people were dead from pneumonic plague. In addition, 3,000 were hospitalized, and nearly 19,000 awaited medical care at area hospitals with flu-like symptoms. Since this disease is highly contagious, it was impossible to predict how far it had spread.

A quarantine was declared for the 15 counties surrounding the Denver area, and the Governor prepared to request the state legislature declare a statewide quarantine. Pneumonic plague had also spread to other states, including California, Illinois, Florida, Pennsylvania, and Georgia, as well as overseas to England and Japan..

The American Red Cross immediately activated its disaster operations center in Virginia, alerted its network of chapters, established a toll-free hotline to answer questions from the public, and initiated disaster welfare inquiries. Nurses and mental health counselors took calls from those worried about exposure to the agent. Distressed family members at numerous sites across the country demanded more information about the condition of loved ones. People were desperate for information.

The American Red Cross also began implementing federal response plan activities under Emergency Support Function #6 - Mass Care, to ensure that people quarantined had enough food and water. We were bombarded with requests for food and blankets to give to victims and emergency response crews. We ended blood collection in affected areas within and outside of Denver to maintain the integrity of the nation's blood supply, and made an emergency plea for increased blood donations elsewhere in the country. We stood ready to assist with the inevitable hospital overflow. Response to this event required a team of players: local police, fire and rescue departments, hospitals, the American Red Cross, FEMA, the Federal Bureau of Investigation, and other government agencies.

As this emergency intensified and the human impact increased, the federal government's simulated exercise ­ called TOPOFF ­ concluded without a full exploration of the medical and health implications (Emergency Support Function #8, Health and Medical Services) and family linking issues (Emergency Support Function #6). But in fact, the enormous impact of a biological attack was just beginning to be realized, and was greater than anyone had anticipated. There were numerous questions, including:

  1. Would people be displaced from their homes or restricted in their movement within their communities? Who would trace their movements?

  2. By what means of transport would trained disaster volunteers be brought in to set up and staff shelters and initiate family linking networks? What kind of advance security clearances would be needed?

  3. What structures would be useable for civilian shelters and who would source the large inventory of relief materials and communication equipment routinely used by Red Cross relief workers in smaller-scale disasters?

  4. Are adequate provisions made for hospital overflow and triage?

  5. What information will be provided to the public ­ when, by whom and what mechanism would be used to disseminate it? Can we ensure that the public ( both those who are involved and those who are watching ( trusts and has confidence in the communication source?

  6. Is a mass quarantine enforceable when loved ones are separated?

  7. How would the National Pharmaceutical Stockpile maintained by the Department of Health and Human Services (HHS) ­ sure to be tapped in a situation such as this one ­ be broken down and distributed?

  8. How would we bring in the blood and blood products needed within quarantined areas?

  9. Who would care for the dying and dispose of the dead as their numbers continued to grow?

  10. What would be the reporting structure for emergency relief and response organizations from the federal down to the local community level, and by what means would they work in an integrated way?

The human toll ­ physical and psychological ( will dominate a WMD event both in the affected site and across the country. In TOPOFF, we saw the critical nature of teamwork in the context of enormous unpredictability, as the exercise involved simultaneous, simulated attacks in Portsmouth, Washington, DC, as well as Denver.

More than just a test of the U.S. government's Federal Response Plan, TOPOFF tested our collective ability to meet the unique human challenges that we will face during a WMD attack. This is where the Red Cross has the most to contribute ­ inherent in our mission is a focus on the needs of people, to prevent and relieve human suffering. We are experts in caring for people during times of disaster.

The American Red Cross is an essential partner with federal response agencies during disasters by charter and by statute. Our primary focus is on the human needs of those affected, and we respond to both the physical and emotional devastation experienced by people during and after a disaster. Our duty yesterday, today and tomorrow is to serve humanity with dignity, valor, and compassion. Our devotion to human welfare is evident throughout our history; our expertise is unmatched.

AMERICAN RED CROSS HISTORY

Beginning with Clara Barton our earliest official mission was to care for victims of war. Our service extended to unexpected disasters that put the public at risk. Almost a century ago, America was entrenched in a battle against tuberculosis, which killed thousands of Americans annually. The nation's number-one health menace, known as the Great White Plague, prompted the first national Red Cross health campaign. Red Cross volunteers traveled door-to-door in a massive effort to educate and inform people about the health risks of tuberculosis and its prevention through proper hygiene.

During the 1918 flu pandemic, the Red Cross mobilized more than 15,000 nurses in less than four months to teach prevention and care for those afflicted by influenza. In the United States between 500,000 and 800,000 people died. (Vaccinations and other health efforts continue today. Last year, we provided vaccinations for nearly 100,000 people. We teach lifesaving first aid and CPR and health classes to over 12 million Americans each year.)

During World War I, the American Red Cross provided all nurses, many medics and other medical volunteers for the US military effort. They worked as auxiliaries with orders and played clearly defined, respected ( if not revered)roles in that war effort.

Throughout World War II, the American Red Cross again provided medical personnel and rose to meet previously unimagined challenges. We recruited and certified more than 100,000 nurses to support our military. Roughly 500 Red Crossers gave their lives in the service of this country.

Blood banking and transfusion medicine was in its infancy in World War II. During that war we collected 13.3 million units of blood from American civilians for shipment overseas to save the lives of soldiers. The American Red Cross is a steward of the blood supply ­ responsible for roughly half of U.S. needs. The demand for blood has grown dramatically and the technology behind it even more. The American Red Cross provides leadership in implementing new testing and processes to improve the safety of the blood supply. Today, we continue to confront new and emerging threats to our blood supply.

Red Cross leader Mabel Boardman wrote in 1915, "the American Red Cross owes a patriotic duty to the country to help fight and overcome any pestilence that endangers the health and happiness of the people. "

We are duty-bound to the American public to do this in a sympathetic and caring way.

We evolve to meet the public's expectations. One hundred years ago, we could not have imagined the devastation of the Oklahoma City bombing, the violence at Columbine High School or countless aviation disasters here and around the world. With each unspeakable tragedy, we adapt to find new ways to serve people at their most vulnerable and desperate moments with expertise and compassion. This includes a major program in mental health and spiritual counseling, as appropriate.

RESPONDING TO DISASTERS OF THE 21st CENTURY

We have a responsibility to be prepared for the disasters of tomorrow. With weapons of mass destruction we would face a disaster beyond anything we have imagined, and one which will tax both government and private resources to the utmost. These important hearings are to assess our collective capabilities to respond to terrorist attacks and to identify critical areas of expertise ( those which already exist, those which need to be expanded, and those which must be developed.

The American Red Cross has unique capabilities and expertise, derived through more than 100 years of experience with disasters and public health challenges. An integral part of our success in meeting the needs of the American people has been our unique ability to quickly mobilize expert volunteers. In 1943, President Franklin Delano Roosevelt referred to the Red Cross "Army of Mercy" and called upon the American people to " rededicate themselves to the splendid aims and activities of the Red Crossto enlist in the army of mercy mobilized under the banner of the Red Cross."

With a presence in almost every community, Red Cross employees and volunteers are among the first on the scene of a disaster, and work closely with local and state first responders. The Red Cross has systems and infrastructure in place, which support our nationwide capability to help prepare for and respond to disasters of every kind, quickly and routinely. We can mobilize a network of trained staff and volunteers in communities throughout the nation, experts in logistics, nursing, mental health, communication, and sheltering.

Most importantly, the public trusts us. The American Red Cross is a trusted, independent organization that can serve as a vital link between all levels of government and the American public during an event of this magnitude.

MANDATED RESPONSIBILITIES OF AMERICAN RED CROSS

We derive our authority from our Congressional Charter of 1905. This covenant directs us to carry out humanitarian service to victims of war, and a "system of national and international relief and apply that system in mitigating the suffering caused by pestilence, famine, fire, floods, and other great national calamities, and to devise and carry out measures for preventing those calamities." We are also entrusted to serve "in accordance with military authorities as a medium of communication between the people of the United States and the armed forces" Today, through our Armed Forces Emergency Services, we have over 300 American Red Cross staff deployed worldwide, assisting our men and women in uniform.

The charter defines the role of the American Red Cross as an auxiliary to the U.S. government in the fulfillment of the Geneva Conventions to protect victims of conflict. In the event of an act of war, we are obligated under the Geneva Conventions to inform the public about international humanitarian law. In carrying out these responsibilities, our focus will be on the moral and legal obligation to exercise humanitarian restraint within our own communities during a moment of great trauma.

The Red Cross has obligations under the Federal Response Plan, codified by the "Robert T. Stafford Disaster Relief and Emergency Assistance Act" (Public Law 93-288, as amended). We have lead responsibility for Emergency Support Function #6 (ESF #6), Mass Care. We meet the needs of disaster victims by providing food, shelter, clothing, and by operating a family linking system to report on the status of those affected and to reunite them with their families. We also support the Department of Health and Human Services, the lead agency for "Health and Medical Services" (ESF #8), and support FEMA as the lead agency for "Information and Planning" (ESF #5).

Congress has made funding available to the Pine Bluff Arsenal in Arkansas to establish the "Clara Barton Center for Domestic Preparedness." The center will be a training facility focused on community WMD response. We thank Senator Tim Hutchinson for his support of the Arsenal's program and the American Red Cross.

ROLES AND RESPONSIBILITIES OF AMERICAN RED CROSS IN A WMD EVENT

Terrorism on U.S. soil has become an appalling fact of life. The last time that such devastation occurred in this country was during the Civil War, and out of the chaos of that war came the American Red Cross. Determining how we will respond to threats of biological, chemical and nuclear warfare is a strategic priority.

In any disaster, the primary role of the Red Cross is to respond to the needs of affected people. Immediately following a disaster, before a presidential declaration is made triggering federal response and resources, the Red Cross is on site sheltering and feeding victims, their families, those fleeing the affected area, and first responders.

Our response to Hurricane Floyd in 1999 demonstrates the scope of our capabilities. The Red Cross provided food, comfort, mental health counseling, and safe havens for more than 200,000 people for several weeks, and we are continuing to assist communities affected by the hurricane, even today. Many blood drives in the southeastern United States were cancelled, resulting in the loss of approximately 10,000 units. Through our national blood system, the Red Cross provided hospitals in the area with an uninterrupted supply of blood throughout the storm and its aftermath by shipping in approximately 8,000 units.

During a WMD event the number of people needing our services could easily be many times more than we have ever cared for. Therefore, we must be prepared to do more than we have ever done.

Trusted Provider of Information to the Public - Before, During and After

During times of great crisis, Americans will seek information, services and comfort from a trusted civilian source. We will be prepared to educate and inform the public about how to prepare for and respond to a WMD event, providing educational and disaster materials in advance, as we currently do in other disasters.

As the incident unfolds, a frightened public will naturally turn to neighbors and community leaders for information and assurance. By virtue of the fact that the Red Cross is tightly woven into the fabric of our communities, we can serve as a calm voice of reassurance in close coordination with authorities on the scene. We will inform the public about sheltering options and give them basic health and safety information. We will provide reliable information quickly ( as we did during the Oklahoma City bombing.

Under the Geneva Conventions, our role in providing clear, factual, widely available information will take on added importance, especially if a particular ethnic or religious group within our country becomes isolated or targeted because of a perceived association with the attacker. Our principles of neutrality and impartiality give us a platform to address these issues and protect civilians. Just as we have done elsewhere in the world for many generations, we will care for victims of war in our own communities, again consistent with the Geneva Conventions.

Provide Food, Shelter and Basic Health Support

Although we use the shorthand of WMD to refer to potential terrorist attacks, our response and preparation will depend upon the agent used. Nuclear, chemical, radiological and high yield explosive agents each carry unique response requirements. Biological weapons provide the greatest challenge in terms of shelter and containment since the attacks may not be successfully detected and identified until days after its release. Infection of thousands of civilians could require weeks to months of quarantines and martial law.

Never before has the need to integrate our capabilities been more apparent. Never before has coordination between the Red Cross and federal government agencies been more essential. Never before has our role as the link between the American public and federal response officials been more vital.

Large numbers of people will flee or be evacuated from areas impacted by an attack. Hospital facilities will be overwhelmed. It might be expected that the Red Cross will not only be asked to provide food, shelter and basic first aid to those displaced by the disaster, but to augment existing health care facilities which will devote resources to treat the most gravely injured. Hospital patients with less serious conditions and those in non-acute care settings will be moved to shelters to make room for the more seriously ill and injured. We will need trained medical professionals to observe for symptoms, administer medications and vaccines, and provide basic health care.

In 75 communities our Red Cross chapters are working with the Metropolitan Medical Response System (MMRS) to develop plans to handle patient needs. As the MMRS grows, our chapter capacity will grow along with it.

The Red Cross learned from the Oklahoma City bombing and through our response to aviation disasters by our specially trained Aviation Incident Response (AIR) team, that families need to have one place to go where they can receive information and compassionate support. The Red Cross will establish Family Support Centers, or Compassion Centers ­ such as those established in Oklahoma City ( during WMD incidents to provide crisis counseling from licensed mental health and pastoral counselors. Basic health support will be needed in service centers and shelters, and if appropriate, vaccination programs might be carried out there. Family linking services will be provided to reunite families separated from loved ones in the chaos and confusion following a WMD event. Representatives of the local Coroner's Office and the Office for Victims of Crime will also be on hand to answer questions and provide information.

AMERICAN RED CROSS RESPONSE TO HUMAN NEEDS FOLLOWING A WMD EVENT

Our current thinking, which clearly will evolve as we work with our partners in preparing for and responding to WMD events, is outlined below. These functions build upon our past and current capabilities.

Mobilize Expert Volunteers to Respond to People's Needs

Over the past century, the Red Cross has demonstrated its ability to mobilize expert volunteers during times of crisis. With an event of the magnitude that we are discussing today, the nation's response system will be challenged. Red Cross must recruit and train volunteers with a wide range of expertise to be ready to meet extraordinary demands.

  • Red Cross Medical Reserve Corps - "Mercy Battalion": We will need to establish a corps of medical reservists (general practitioners, pediatricians, internists, respiratory therapists, physician assistants, pharmacists, and nurses) to be deployed from around the country. As envisioned, this corps will supplement the work of those medical professionals, primarily Emergency Medicine physicians, supporting the Department of Health and Human Services' National Disaster Medical System (NDMS). The Corps will enable the Red Cross to expand the basic health care provided in our shelters. As we create and mobilize the Red Cross Medical Reserve Corps we will need to remove obstacles related to state licensure requirements and ensure liability protection for these medical professionals. There must be pre-existing agreements that guarantee total integration of this Reserve Corps and the resources to support it into the response effort, such as means of transportation, prior security and other clearances for involved personnel.

  • Vaccination Capability: Biological terrorism could easily overwhelm the nation's public health infrastructure. The Red Cross can work with public health officials to assist with vaccinations by offering the people, facilities and assistance for rapid and large-scale emergency vaccinations. As stated previously, during last year alone we assisted with immunizations for nearly 100,000 people.

  • National Pharmaceutical Stockpile: As requested by the Centers for Disease Control (CDC), the Red Cross is prepared to mobilize volunteers to break down and assist in dispensing the National Pharmaceutical Stockpile (NPS) strategically located throughout the country, so that these medications are ready when needed.

  • Mental Health Issues: As the American Red Cross has seen in traumatic situations from Kosovo to the crash of Egypt Air 990, mental health counseling is an important part of recovery. Even today, five years later, we are still counseling people in Oklahoma City. Following the Tokyo Subway sarin gas attack in 1995, where 12 people died and over 5,000 sought help, the vast majority of those who needed help were from beyond the affected area. The Red Cross can mobilize more than 4,000 licensed, trained, practicing mental health professionals in an emergency.

  • Special Emergency Response Team (SERT): The Red Cross will develop a highly trained, multi-functional specialty "strike" team to immediately respond to a WMD incident anywhere in the United States and its territories. In coordination with designated federal agencies, this team will activate and draw upon all Red Cross resources and capabilities.

Strategic Blood Reserve

The American Red Cross is a steward of the nation's blood supply. Our capacity to recruit volunteer donors and collect, process, test, store and distribute that blood is unmatched. During a terrorist attack involving mass casualties, or a radiological incident, blood will be needed. In order to provide lifesaving blood and blood products for patients in need during all disasters, the American Red Cross has a national system and is creating a strategic blood reserve.

Red blood cells outdate in 42 days and platelets outdate in 5 days. The supply of these lifesaving products must be constantly replenished. The Red Cross is committed to mobilizing its volunteer donors and to expanding and stabilizing collections to ensure an adequate national supply of blood products for patients whenever and wherever needed.

Support through the International Red Cross Movement

Just as the strength of the American Red Cross lies in our community presence, our global strength lies in our relationships with more than 177 sister societies throughout the world. When we experience a disaster in the United States our partners around the world often volunteer to help. Most recently in the Seattle earthquake we received immediate offers from other societies most experienced in responding to earthquakes ( the Colombian Red Cross, the Turkish Red Crescent and the Japanese Red Cross.

Some of these societies are experienced with WMD and have capabilities from which we can learn. In the past decade, Japan has experienced three nuclear accidents and a chemical attack. Their Red Cross has valuable experience, especially as it relates to the provision of medical services following an incident. In Ukraine, we are learning how to address the long-term impact of nuclear accidents, including the psychological effects of a slowly unfolding disaster and the difficulty in educating people about unseen risks. In Israel, our counterpart the Magen David Adom has vast experience running the country's emergency medical system and has undertaken extensive preparations for WMD attacks. This includes expertise related to triage based on specific symptoms, hospital overflow and field hospital set-up, and the provision of health and safety messages for the public.

REQUIREMENTS

The American Red Cross is an important private sector partner with Congress and the Executive Branch agencies in the development of a national strategy to prepare the nation to meet the human needs of those affected by WMD. We are an independent humanitarian organization with a history of trust and caring with the American public, as well as recognized effectiveness in national disasters. We have demonstrated success in working well in public-private alliances. Our more than 100 years of experience in helping people recover from disasters and coordinating relief will contribute to your leadership efforts to address this major national security issue.

Congress can rely on the American Red Cross to take a leadership role in addressing the human needs following catastrophic events. To coordinate and carry out this role, we need the following support:

  • Clear Direction: The American Red Cross must be a partner in planning with federal, state and local designated response agencies if we are to be responders. There must be clear direction as to where all the players fit in the preparedness and response structure.

  • Investment in Human Assets: The Red Cross will need to make major investments in people. The precise number of personnel to be trained, their defined responsibilities and expertise, and the range of skill levels appropriate for certification will be a key outcome of a cohesive, national planning effort. Training will include the establishment of a network of specially designed training centers. As a private organization, we would need relief from legal and regulatory obstacles that would prevent or delay our ability to serve. This will include the appropriate pre-approved security clearances, and provisions allowing recognition of medical licensure and liability protections wherever the event occurs.

  • Mobilization: As we mobilize personnel and materials, the Red Cross will need pre-approved access to various means of transportation to support rapid deployment and access. The issues associated with prepositioning of physical assets and inventory, and the parties responsible for purchase, storage and transport of these resources will need to be determined.

  • Financial Resources to Invest in Response Efforts: Although the American Red Cross gets virtually all of its resources from private sources, such sources are not likely to be adequate until tragedy strikes. Consequently we would require public investment in the range of $20 million annually over the next five years, for training as well as preparations for mobilization. This estimate does not include the costs associated with developing the strategic blood reserve. Obviously, these figures are rough estimates, as they will be dictated by the ultimate plan developed by Congress and the Administration.

For the past century, Congress and the American Red Cross have been partners in meeting the needs of the American people. Together, we can save lives.