[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
ASSESSING CENTRAL INDIANA'S PREPAREDNESS
FOR A MASS CASUALTY EVENT
=======================================================================
FIELD HEARING
before the
SUBCOMMITTEE ON EMERGENCY
PREPAREDNESS, RESPONSE,
AND COMMUNICATIONS
of the
COMMITTEE ON HOMELAND SECURITY
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
AUGUST 6, 2013
__________
Serial No. 113-31
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Printed for the use of the Committee on Homeland Security
[GRAPHIC] [TIFF OMITTED]
Available via the World Wide Web: http://www.gpo.gov/fdsys/
__________
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COMMITTEE ON HOMELAND SECURITY
Michael T. McCaul, Texas, Chairman
Lamar Smith, Texas Bennie G. Thompson, Mississippi
Peter T. King, New York Loretta Sanchez, California
Mike Rogers, Alabama Sheila Jackson Lee, Texas
Paul C. Broun, Georgia Yvette D. Clarke, New York
Candice S. Miller, Michigan, Vice Brian Higgins, New York
Chair Cedric L. Richmond, Louisiana
Patrick Meehan, Pennsylvania William R. Keating, Massachusetts
Jeff Duncan, South Carolina Ron Barber, Arizona
Tom Marino, Pennsylvania Dondald M. Payne, Jr., New Jersey
Jason Chaffetz, Utah Beto O'Rourke, Texas
Steven M. Palazzo, Mississippi Tulsi Gabbard, Hawaii
Lou Barletta, Pennsylvania Filemon Vela, Texas
Chris Stewart, Utah Steven A. Horsford, Nevada
Richard Hudson, North Carolina Eric Swalwell, California
Steve Daines, Montana
Susan W. Brooks, Indiana
Scott Perry, Pennsylvania
Mark Sanford, South Carolina
Greg Hill, Chief of Staff
Michael Geffroy, Deputy Chief of Staff/Chief Counsel
Michael S. Twinchek, Chief Clerk
I. Lanier Avant, Minority Staff Director
------
SUBCOMMITTEE ON EMERGENCY PREPAREDNESS, RESPONSE, AND COMMUNICATIONS
Susan W. Brooks, Indiana, Chairwoman
Peter T. King, New York Donald M. Payne, Jr., New Jersey
Steven M. Palazzo, Mississippi, Yvette D. Clarke, New York
Vice Chair Brian Higgins, New York
Scott Perry, Pennsylvania Bennie G. Thompson, Mississippi
Mark Sanford, South Carolina (ex officio)
Michael T. McCaul, Texas (ex
officio)
Eric B. Heighberger, Subcommittee Staff Director
Deborah Jordan, Subcommittee Clerk
C O N T E N T S
----------
Page
STATEMENTS
The Honorable Susan W. Brooks, a Representative in Congress From
the State of Indiana, and Chairwoman, Subcommittee on Emergency
Preparedness, Response, and Communications..................... 1
The Honorable Joe Donnelly, a U.S. Senator From the State of
Indiana........................................................ 4
The Honorable Todd Young, a Representative in Congress From the
State of Indiana............................................... 5
The Honorable Jackie Walorski, a Representative in Congress From
the State of Indiana........................................... 6
WITNESSES
Panel I
Mr. Andrew Velasquez, Regional Administrator, FEMA Region V, U.S.
Department of Homeland Security:
Oral Statement................................................. 8
Prepared Statement............................................. 10
Mr. Mark J. Bowen, Sheriff, Hamilton County, Indiana:
Oral Statement................................................. 17
Prepared Statement............................................. 18
Mr. Steven Orusa, Fire Chief, Fishers, Indiana:
Oral Statement................................................. 22
Prepared Statement............................................. 23
Mr. John H. Hill, Executive Director, Indiana Department of
Homeland Security:
Oral Statement................................................. 24
Prepared Statement............................................. 25
Ms. Diane Mack, University Director, Emergency Management and
Continuity, Indiana University:
Oral Statement................................................. 31
Prepared Statement............................................. 33
Panel II
Mr. Chad S. Priest, Chief Executive Officer, MESH Coalition,
Inc.:
Oral Statement................................................. 47
Prepared Statement............................................. 49
Dr. Virginia A. Caine, Director, Public Health Administration,
Marion County Public Health Department:
Oral Statement................................................. 55
Prepared Statement............................................. 56
Dr. Louis M. Profeta, Medical Director of Disaster Preparedness,
St. Vincent Hospital, Indianapolis, Indiana:
Oral Statement................................................. 58
Prepared Statement............................................. 61
Dr. H. Clifton Knight, Chief Medical Officer, Community Health
Network:
Oral Statement................................................. 63
Prepared Statement............................................. 65
Dr. R. Lawrence Reed, II, Director of Trauma Services, Indiana
University Health Methodist Hospital:
Oral Statement................................................. 66
Prepared Statement............................................. 68
Dr. Mercy Obeime, Director, Community and Global Health,
Franciscan St. Francis Health, Indianapolis, Indiana:
Oral Statement................................................. 69
Prepared Statement............................................. 71
ASSESSING CENTRAL INDIANA'S PREPAREDNESS FOR A MASS CASUALTY EVENT
----------
Tuesday, August 6, 2013
U.S. House of Representatives,
Subcommittee on Emergency Preparedness, Response,
and Communications,
Committee on Homeland Security,
Carmel, IN.
The subcommittee met, pursuant to call, at 10:00 a.m., at
Carmel City Hall, One Civic Square, Carmel, IN, Hon. Susan W.
Brooks [Chairman of the subcommittee] presiding.
Present: Representative Brooks.
Also present: Senator Donnelly and Representatives Young
and Walorski.
Mr. Brainard. I want to welcome everybody here to the City
of Carmel and to City Hall. I want to thank the subcommittee
for getting out of Washington. It is a good month to get out of
Washington. Our humidity is a little lower here, I think. But
we certainly welcome you here for today's event. I want to
thank the staff that put so much time into putting this all
together.
We all recognize that no one wants a tragedy, and we like
to think we are immune, but we all recognize that they do
occur, and they occur everywhere, and sometimes in the least
expected places, and that planning and preparation are
important so that we are prepared.
We are proud of our public safety departments here in
Carmel. First, I think some of you know that Carmel was ranked
by CNN's Money magazine as the No. 1 place to live in America
last September, and that is due in part to the safety here in
Carmel. According to the on-line magazine Neighborhood Scout,
an organization that compiles data about neighborhoods and
locations, we are the 33rd-safest city in America.
But we do recognize that no community is immune from crime
or a wide-spread natural disaster. So it is important to
constantly improve our ability to respond in an emergency. Our
public safety officials, key directors, and school
administrators recently had tabletop exercises to review
emergency procedures to better respond to various scenarios. So
we truly appreciate the opportunity today to learn first-hand
from the witnesses gathered here, to share their knowledge of
emergency preparedness.
I don't think Carmel has ever hosted a subcommittee or a
committee meeting of the U.S. Congress before, and once more I
would like to thank Susan Brooks and the other representatives
for being here, and to have arranged it here at City Hall. We
appreciate it and I want to commend you for getting out. This
is good, I think, for committees of Congress to get outside of
the Beltway and be here, and so thank you and welcome.
At this time, I am pleased to turn it over to our
Congresswoman, Susan Brooks.
Mrs. Brooks. Thank you. Thank you, Mayor Brainard.
Mr. Brainard. If I could just ask everyone please to just
make sure all phones and electronic devices are silenced, are
powered off, and ask everyone to please turn the flashes off on
your camera. Thank you very much.
Mrs. Brooks. The Committee on Homeland Security,
Subcommittee on Emergency Preparedness, Response, and
Communications, will come to order. The subcommittee is meeting
today to examine the state of emergency preparedness here in
Central Indiana.
First, I want to thank everybody, including Mayor Brainard.
We really appreciate the effort that your staff, led by Nancy
Heck and others, had in putting this hearing together.
I would like to also thank the witnesses who are here today
to testify. I would like particular thanks also to our Homeland
Security staff who came out from Washington, DC to coordinate
this important hearing: Natalie Nixon, Debbie Jordan, Eric
Heighberger, and Moira Bergin. They came out to help work with
the City of Carmel to arrange this important hearing. So I do
appreciate all the effort that has been taken with respect to
this hearing, including my own staff, that put a lot of time
and energy into making sure that all of you were here to learn
about this important topic today.
This is not a town hall meeting. This is an official
Congressional hearing. So unlike a town hall meeting, we abide
by certain rules of the Committee on Homeland Security and the
House of Representatives. I kindly wish to remind our guests
today that demonstrations from the audience, including applause
and verbal outbursts, as well as any use of signs or placards--
I didn't see any coming in--are a violation of the rules of the
House of Representatives. It is important that we respect the
decorum and rules of this committee.
Also, so that you are aware, this hearing is being webcast
live on the committee's website, which is homeland.house.gov.
I now recognize myself for an opening statement.
As Chairwoman of the Subcommittee on Emergency
Preparedness, Response, and Communications, it is a great honor
to be here in Carmel City Hall to discuss Central Indiana's
preparedness for a mass casualty event. As a former deputy
mayor of Indianapolis and a United States Attorney for the
Southern District of Indiana, I have had the privilege of
working with some of the finest first responders, law
enforcement, and emergency managers in the State. I also had
the opportunity to travel to FEMA's training academy in
Emmetsburg, Maryland long ago and received valuable training on
crisis communications as well. This training further
demonstrated that those involved in preparing for, responding
to, and recovering from a disaster are selfless professionals.
We are fortunate to have so many dedicated individuals here
in Central Indiana as we face our fair share of threats and
hazards. According to Indiana's recent Threat Hazard
Identification and Risk Assessment or, known in the emergency
management community as THIRA, natural disasters, industrial
emergencies, and cyber attacks ranked among our highest
concerns. I also received a briefing just last week from the
Department of Homeland Security regarding threats posed by
weapons of mass destruction and what they would look like.
Chemical, biological, nuclear, and radiological attacks are
still very real threats. A successful attack in the
Indianapolis or Central Indiana area could severely strain our
medical and hospital systems and have grave consequences for
our people and our economy.
After the tragic events of September 11, 2001, the 9/11
Commission, which was co-led by former Indiana Congressman Lee
Hamilton, stated that one of the main failures that led to the
attack was the lack of our own imagination. Although Central
Indiana may be more susceptible to events such as flooding and
tornadoes, for which we have all trained and prepared, we must
not let our own failure of imagination catch us flat-footed,
and we must be prepared for the range of threats to which we
are vulnerable.
For example, there are many unexpected incidents that can
occur in any area. As we saw just recently in West, Texas, a
fertilizer explosion just a few months ago, an industrial
incident, whether intentional or accidental, can cause great
damage, injury, and loss of life.
At this time, I would like to pay my respects to some
Zionsville residents, Jeanette and Tim White, who are here with
us today. Jeanette's brother, Kevin Saunders, was a first
responder in West, Texas. They are Zionsville residents, and we
thank you for your attendance today. We also last week entered
on your behalf a letter that Mr. White prepared to the Homeland
Security Committee ensuring his request to make sure that we
all work together to make sure that our first responders know
what they are running into and what the dangers are that they
are facing. So, thank you for being here.
In addition, we know we must be ready for large events here
in the State of Indiana. We host the incredible Indianapolis
500 every year. We like to host Final Fours as often as we can;
and the Super Bowl, which we hosted and would love to host
again. But these all present unique situations and challenges
for law enforcement responders and emergency managers.
As we approach September, which is National Preparedness
Month, we must ask ourselves: Are we doing everything we can to
be prepared? After the Boston bombings, I asked myself once
again: How would we have handled a similar attack? In Boston,
we saw a coordinated response from first responders, law
enforcement personnel, and medical personnel that no doubt
saved many lives and mitigated damages. Are we as prepared as
Boston was?
Boston's success was, in part, due to their preparations
for this type of an event. They effectively used their Federal
grant dollars to improve their security programs. They held
training and exercises to test their plans, and they promoted
the use of interoperable communications across multiple
jurisdictions and sectors.
In fact, in November of last year, Boston took part in an
exercise called Urban Shield. This scenario was designed to
assess that region's overall response capabilities to a series
of complex incidents, and the exercise tested, among other
things, their coordination of public health and medical service
capabilities.
Additionally, a helicopter-borne imaging unit that the
Massachusetts State Police used to locate and capture Djokar
Tsarnaev was purchased with State Homeland Security Grant
Program funds.
Now, we have held, as well, emergency-related exercises
here in Indiana many, many times. But right now, Indiana is
involved in another mass training exercise. Beginning on July
21, USNORTHCOM began an exercise called Vibrant Response 13-2
at Muscatatuck Urban Training Center. This exercise simulates a
nuclear detonation in an urban environment. It spans 5 weeks
and includes 8,000 personnel from 22 States. Later this month,
the Navy and Department of Energy will conduct an exercise
focusing on the derailment of a train transporting spent
nuclear fuel shipments. This exercise is designed to provide
practical experience to emergency management personnel and
policymakers.
Today, I want to learn what Central Indiana is doing to
prepare for a mass casualty event, and I hope this causes
communities all across the country to be asking the same
question. I would like to hear what planning, training, and
exercises are taking place. I also want to hear of any areas
where we may need to improve in order to be as prepared as we
can be.
Benjamin Franklin once said, ``By failing to prepare, we
are preparing to fail.'' Let's use our imaginations. In doing
so, I believe we will be better prepared for both the known and
the unknown.
We have two very distinguished panels of witnesses here
today, and I look forward to their testimony.
I am also very pleased that my Indiana colleagues who were
able to be here with us today took the time out of their
incredibly busy schedules back here at home in the State of
Indiana and in their own districts to be here, and so I am very
honored to be having with us today the Senator from Granger,
Indiana, Senator Donnelly, for any opening statement he might
have.
Senator Donnelly. Thank you, Madam Chairwoman.
I want to thank Chairwoman Brooks for organizing this field
hearing and for allowing me to participate; and to Mayor
Brainard, the City of Carmel, Hamilton County, and the State of
Indiana for all the hard work you do every day to keep us safe.
I am pleased we have the opportunity to bring this
discussion on the security of Hoosier communities from
Washington, DC to Indiana. To all of our first responders who
are here with us, thank you, and around the State. You put your
lives on the line every single day. Your family never knows
whether you are going to be coming home at night. So to all of
you, thank you for your dedication.
Central Indiana has grown enormously over the last decade
and is an economic hub for our State. We must be prepared with
the resources and the assistance on a local, State, and Federal
level to successfully respond to a mass casualty event. The
timing of this hearing is excellent, as Congresswoman Brooks
was saying. I was at the Urban Training Center in Muscatatuck
yesterday where we observed the largest homeland security
exercise conducted annually in our Nation, the Vibrant Response
Northern Command exercise. We had 27 different State National
Guards here in Indiana. We had over 6,000 people working on
this exercise. Muscatatuck has become, across the entire
country, the central place for training for incidents here in
the entire United States. We are very proud of our own National
Guard and what they have done to make Muscatatuck the center of
choice.
This exercise prepared the military, homeland security
personnel, and first responders for responding to a nuclear
attack in an urban area down at Muscatatuck yesterday. I was
deeply impressed by what I saw, and I look forward to hearing
your expertise today and perspective on preparing for an
emergency event on a local level.
Central Indiana frequently hosts world-class sporting
events, as Congresswoman Brooks was saying: The Super Bowl, our
own Indy 500. We are proud to host these events, and to
continue to be considered for them, we must be fully prepared
to respond to a major disaster. I am especially interested in
learning more about how we communicate and coordinate our
actions between Federal, State, and local agencies to ensure a
seamless response to affected communities.
I thank the witnesses for being here, and I especially want
to thank the Chairwoman for hosting this, and to Congressman
Young and Congresswoman Walorski for being here today as well.
I look forward to hearing the testimony. Thank you.
Mrs. Brooks. Thank you, Senator Donnelly.
I would now like to recognize the gentleman from
Bloomington, Mr. Young, for any opening statement he might
have.
Mr. Young. Well, thank you so much, Madam Chairwoman, and I
thank all of you for being here today, for taking time out of
your busy and important days to testify, for those that are
testifying, and just to be privy to the testimony that is
delivered, for everyone else who is here with us today.
I want to thank the City of Carmel. As a Carmel High School
graduate myself, I am a bit parochial and proud to be back here
in Carmel.
Listen, the topic that we are discussing today, the
preparedness of Central Indiana for a mass casualty event, is
not only an essential one that we air publicly, it is one that
is near and dear to my heart. Each of us is sort-of shaped by
our own personal experiences, and before coming to Congress I
had spent 10 years in the military. In the course of that time,
I was trained in anti-terrorism and force protection. This was
the pre-9/11 era, and today happens to be, dictated by our
Federal Government, a period of heightened preparedness and
alert as a result of circumstances and intelligence we have
collected around the world. So I think this is certainly a
timely hearing.
I would also say after I left the military, I spent my last
day at a think tank in Washington, DC, and it happened to be 9/
11, and that was a formative experience and reminded me that we
as a Nation had a long way to go in terms of coordinating our
efforts between agencies and with the American people
themselves in order to figure out what happens during a day of
mass chaos, and such days will come again as a result of either
terrorist attacks or natural disasters or industrial accidents
or what-have-you.
Within weeks after leaving that job, I worked for a United
States Senator, Senator Lugar. I happened to be in the office
during the time of the largest bioterrorism attack in American
history. Remember the anthrax attacks on Senate and House
office buildings and some other sites.
So all of these things have reinforced my belief that we
need to continue to do everything possible to prepare for these
contingencies. Now, since I have been in Congress, I represent
the Ninth District, which runs from just south of Indianapolis
to the Ohio River. It is also tornado country, at least it has
been in recent years, and we suffered a horrible, deadly
tornado that went through many of our towns. I see a lot of
familiar faces in the audience, people who helped us through
that tragic event and came together.
Together we learned that though much progress has been
made, much remains to be made in terms of coordinating our
efforts between agencies and among personnel in order to help
people when they need it the most.
So my expectation, my hope today is that we can tease out
exactly what is being done to prepare for the next disaster,
what has been done, and how we can help at the Federal level,
help enable all of you to do your jobs in a more effective way,
how to educate our constituents about how to prepare for a mass
casualty event and reduce the number of casualties.
With that, I will yield back to Madam Chairwoman and thank
all of you again for being here today.
Mrs. Brooks. Thank you.
At this time, the Chairwoman now recognizes the gentlewoman
from Jimtown, Mrs. Walorski, for any opening statements you
might make.
Mrs. Walorski. Thank you, Madam Chairwoman. I, too, am
grateful to be here today, and I am grateful for your
leadership in hosting this field hearing today.
I serve on the Armed Services Committee. I am from the
Second District in Indiana, which is in the South Elkhart and
Northern Indiana area. One of my extreme, I would say, passions
is making sure that we keep our Nation safe. My husband and I
were living in Eastern Europe during 9/11, and when we watched
it on TV from thousands of miles away, it changed my
perspective forever on what National security is to this
country. We didn't know if we would ever see our families
again, and we didn't know if we would ever get home again and
what home would look like. They started the evacuation process
in Europe where we were to move all Americans to a safe place.
In the Second District, we had our issues as well with
Mother Nature. But I am grateful to sit here with Senator Joe
Donnelly, Representative Todd Young, and under the leadership
of Congresswoman Brooks so that we can figure out a way that
Indiana can again lead the Nation. Our State is leading the
Nation in virtually every matrix that has any kind of
comparable grid in it, and this is also an area. I can tell
you, to the mayor and to the resources here in Carmel, I toured
some of the trucks outside before we came in here, and what a
system we have, and that we have a chance to learn how to do
better.
So the issue that we are learning about today is certainly
Central Indiana. I can tell you as well, Grissom Air Reserve
Base is doing training exercises this weekend. This is a very
appropriate time to be talking about this, as Congressman Young
just said, when we have 21 embassies around the world that are
continuing to be closed as we lead up to September 11 again.
Whether it is an attack from individuals who seek to do us
harm, or living in the Midwest where we live and the dangers
that we face with Mother Nature, I am here to learn, take
notes, and just ask questions on how we can do things better;
and to, again, I know, stand and be proud of this Hoosier State
because we do all things well.
So to every first responder, I am the daughter of a city
fireman, and I so much appreciate every one of you that fights
the fight every day for us on the front lines. So I look
forward to hearing from our panels today.
Thank you again, Madam Chairwoman, and I yield back the
remainder of my time.
Mrs. Brooks. Thank you to the gentlelady from Jimtown,
Indiana.
We are pleased today to have two panels of very
distinguished witnesses before us today on this important
topic. I am now going to introduce the first panel, and they
will then testify, and then we will switch to the second panel
after they have given their opening statements and testify.
To my left, Mr. Andrew Velasquez is the administrator of
the Federal Emergency Management Agency's Region V. In this
role, he coordinates preparedness response, recovery, and
mitigation activities for the States of Illinois, Indiana,
Michigan, Minnesota, Ohio, and Wisconsin. Mr. Velasquez was
appointed to this position in April 2010 after serving as
director of Illinois' Emergency Management Agency. So, thank
you for coming and joining us.
Next on the panel is Mr. Mark Bowen, who is the sheriff of
Hamilton County, Indiana, a position to which he was elected in
November 2010. Sheriff Bowen has been with the Hamilton County
Sheriff's Department since 1991 and was appointed chief deputy
sheriff in 2003. Prior to being elected sheriff, he served many
roles in the sheriff's office, including field training
officer, firearms instructor, accident reconstructionist,
Special Emergency Response Team member, Tactical Tracking Team
member, and Honor Guard member.
Next is Mr. Steve Orusa. Chief Orusa is the fire chief of
Fishers, Indiana. Chief Orusa is a published author and a
frequently invited speaker on public safety leadership and
development techniques. He has provided analysis on public
safety response for USA Today, Fire Chief magazine, Fire
Engineering magazine, and has also appeared on BBC, MSNBC, Fox
News, and CNN to provide expert analysis on disaster response.
Next to the chief is Mr. John Hill. He is the executive
director of the Indiana Department of Homeland Security, a
position Governor Pence appointed him to in January of this
year. Mr. Hill is responsible for the State's emergency
management and homeland security efforts, which include
planning and assessment, preparedness and training, emergency
response and recovery, fire and building safety, and field
services. Prior to joining IDHS, Mr. Hill served as the
administrator of the Federal Motor Carrier Safety
Administration. He also served as a member of the Indiana State
Police from 1974 to 2003, providing expertise as commander of
the Commercial Vehicle Enforcement Field Enforcement and
Logistics Division.
Finally, I would like to have the opportunity to see if
Senator Donnelly would like to introduce a witness on behalf of
the Democrats.
Senator Donnelly. Thank you very much, Madam Chairwoman.
I would like to introduce Ms. Diane Mack. Ms. Mack is the
IU Director of Emergency Management and Continuity. She is
responsible for ensuring that all IU campuses have viable and
adequately-tested emergency response plans, and that each IU
department has plans in place to ensure critical functions can
be recovered quickly if they are interrupted by emergencies
such as a building fire or tornado damage.
I know that is a location of great fondness to Congressman
Young as well, and if you would like to say a word, go right
ahead, sir.
Mr. Young. Thanks for your service. Thank you for
affiliating yourself with such a fine university, and just if
you ever need anything, please do call. We are all here to
help.
Mrs. Brooks. Thank you.
At this time I would like to inform everybody that the
witnesses all have submitted full written statements and
testimony, and that will appear in the record.
I just also would like for everyone to realize that we are
on a timer system, and there is a timer here up at the podium,
and everyone has 5 minutes to testify. When the light turns to
yellow, that means you have 1 minute remaining. When the light
turns to red, that means that your 5 minutes are up.
We are going to begin now with Mr. Velasquez. Thank you,
and we will now recognize you for your testimony.
STATEMENT OF ANDREW VELASQUEZ, REGIONAL ADMINISTRATOR, FEMA
REGION V, U.S. DEPARTMENT OF HOMELAND SECURITY
Mr. Velasquez. Good morning, Chairman Brooks, Senator
Donnelly, Congresswoman Walorski, and Congressman Young. Thank
you for the opportunity to appear before you to discuss what
FEMA Region V is doing to support the States in our region,
including the great State of Indiana, to prepare for all
hazards and how those efforts could support our response to a
mass casualty event.
As stated before, I am Andrew Velasquez, the Region V
administrator, and in addition to serving the State of Indiana,
Region V is also responsible for serving the States of
Illinois, Michigan, Minnesota, Ohio, and Wisconsin, and 34
Federally-recognized Tribes. Region V enjoys a very close
working relationship with each of our six States, partnering
with our State directors, our homeland security advisers, as
well as our adjutant generals, as we work together to enhance
safety and security for our region and the residents that live
within our region. I hope that you will learn from our
testimony today that we have been continuing that partnership
with Director Hill since his recent appointment.
FEMA operates on the principle that all disasters,
regardless of scale, are inherently local. As such, county and
local first responders play a vital role during the initial
response to any emergency. As we all know, if a local
jurisdiction or a county jurisdiction becomes overwhelmed, then
the Governor can request assistance from the Federal Government
through FEMA. This is the tiered response philosophy that we
employ. It is how the emergency management system and process
operates in this country for most incidents. If the Federal
support becomes necessary, FEMA will help coordinate response
activities, including leveraging support from our volunteer,
faith-based, and private-sector partners.
This does not mean that the Federal Government is passive
in its support to our States. We are in regular contact with
our State partners so that when severe weather threatens or
there are reports of any unusual activity, we can begin
preparations such as prepositioning commodities, activation of
response personnel, and the activation of our Regional Response
Coordination Center.
With that basis, please allow me to explain the various
efforts that are currently undertaken to increase preparedness
throughout the region for any hazard that may present itself,
including those that could result in significant levels of
damage or destruction.
Our frameworks. Consistent with the principles and
directives established by the National Preparedness System,
FEMA is developing a series of National frameworks which
describe the roles and responsibilities of all stakeholders.
These frameworks include the NRF, the National Response
Framework, which has been in place since 2008 and updated this
year. This framework aligns roles and responsibilities across
Government and the private sector in a unified approach.
The National Disaster Recovery Framework, which was
recently rolled out across the country, focuses on how to
restore, redevelop, and revitalize the health, social,
economic, natural, and environmental fabric of the community,
as well as build a more resilient Nation.
The foundation of these frameworks rests on the
understanding of the potential threats and risks that affect
the State. A process known as THIRA, which was recently
mentioned, and risk assessments are used to determine what can
happen, where it can happen, when it can happen, and how bad it
could be.
With regard to funding, FEMA works to increase State and
local preparedness by supporting a variety of grant programs
and working to ensure that they are managed effectively. As a
Nation, we have made significant investments in National
preparedness capabilities throughout our various grant programs
during the past decade. Through our various grant programs
during the past decade, we have seen preparedness in the area
of building capabilities, equipment purchases. We have also--
due to certain reductions in overall preparedness grants,
grantees are currently required to focus their funding on the
maintenance and sustainment of current capabilities and closing
gaps in core capabilities.
Given today's topic of the hearing, I would also like to
note the increased emphasis on mass casualty events represented
in the grant guidance for fiscal year 2013. The Homeland
Security Grant Program guidance specifically prioritizes on
improving immediate emergency victim care at mass casualty
events. Within this priority, there are two key objectives:
Improving emergency care to victims of mass casualty events,
including mass shootings; and improving community first aid
training.
FEMA has provided more than $547 million to the State of
Indiana through 23 different preparedness grant programs since
fiscal year 2002. In 2012, the total amount of grant funding
was just over $24 million. These dollars have come from a wide
variety of programs to support different initiatives in the
State of Indiana. They have supported building capacity and
capability through the State level, through planning grants,
safety of key infrastructure such as ports, chemical
facilities, and transit, promoting preparedness of individuals
through Citizen Corps programs, increased capability of local
first responders through the fire grant, and staffing for
adequate fire and emergency SAFER Grant programs.
In closing, FEMA Region V is continuously working to evolve
our approach to preparing America's citizens and responding to
events that threaten their lives and livelihoods, and to better
fulfill FEMA's mission. To that end, we are actively working
with our Government partners at the State, Tribal, and local
levels, as well as our non-Governmental partners, to prepare
for whatever may impact the region, and we look forward to
continuing that great work.
I appreciate the opportunity to appear before you today,
and I look forward to answering any questions you may have.
Thank you very much.
[The prepared statement of Mr. Velasquez follows:]
Prepared Statement of Andrew Velasquez
August 6, 2013
introduction
Good morning Chairman Brooks, Ranking Member Payne, and Members of
the subcommittee, I am Andrew Velasquez, Region V administrator for the
Federal Emergency Management Agency (FEMA).
Thank you for the opportunity to appear before you to discuss what
FEMA's Region V is doing to support the six States in its Region:
Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin, in
addition to assisting 34 Tribal governments in their efforts to prepare
for all hazards.
FEMA's mission is to support our citizens and first responders to
ensure that as a Nation we work together to build, sustain, and improve
our capability to prepare for, protect against, respond to, recover
from, and mitigate all hazards. We accomplish this through grants,
training, exercises, and other support, and work with our State,
Tribal, territorial, and local partners to lessen the impact of future
disasters through mitigation efforts.
FEMA is committed to getting resources into the hands of State,
local, Tribal, and territorial governments and their first responders,
who are often best-positioned to prepare for and respond to acts of
terrorism, natural disasters, and other threats. Here, in Region V, it
is my job to coordinate preparedness activities among our State and
Tribal partners.
FEMA operates on the principle that all disasters, regardless of
scale, are inherently local. Local fire, police, and emergency
management agencies will always be the first to respond and the first
to begin the process of recovery. As such, local and county first
responders play a vital role during the initial response to any
emergency. If a local jurisdiction becomes overwhelmed, the community
can request the assistance of their county, which can provide immediate
assistance and if necessary request additional assistance from the
State.
If the response is beyond the State's or Tribe's capability, then
the Governor or Tribal official is able to request assistance from the
Federal Government through FEMA to the President. This tiered response
philosophy is how the emergency management system operates to support
an impacted community for most incidents. If the President determines
that Federal support is necessary, FEMA will help coordinate response
activities, including leveraging support from its volunteer, faith-
based, and private-sector partners.
This does not mean that the Federal Government is passive in its
support to States and Tribes. FEMA, through its 10 regional offices and
headquarters, is actively monitoring open-source media and reports from
Federal partners, such as the National Weather Service and the U.S.
Geological Survey. FEMA is also in regular contact with its partners so
that when severe weather threatens, or there are reports of any unusual
activity, the Region can begin preparations, such as the prepositioning
of commodities, activation of response personnel (e.g., Incident
Management Assistance Teams, collocation of FEMA staff with State
Emergency Operations Centers, Urban Search and Rescue teams), and
activation of the Regional Response Coordination Center (RRCC) for any
potential response that may be warranted.
doctrine
The emergency management field has evolved significantly since the
terrorist attacks of September 11, 2001. The attacks that day exposed a
reality that we must now not only consider, but also plan for. One of
the outgrowths of those attacks was Homeland Security Presidential
Directive 8. This Directive was updated to reflect the evolution of our
understanding of these types of events and of lessons learned.
In March 2011, the President signed Presidential Policy Directive 8
(PPD-8), which focused on preparing for the threats that pose the
greatest risk to the security of the Nation, including: Acts of
terrorism, cyber incidents, pandemics, and catastrophic natural
disasters. PPD-8 establishes, among other things:
A National Preparedness Goal, which contains our collective
focus for success and provides a basic definition of the core
capabilities;
A National Preparedness Report, which enables us to report
on our progress toward building capacity;
A series of National Planning Frameworks, which set the
strategy and doctrine for building, sustaining, and delivering
the core capabilities across the five mission areas--
prevention, protection, mitigation, response, and recovery.
FEMA has worked with representatives from across the whole
emergency management community to develop these products. PPD-8
emphasizes creating a robust capability based on cross-jurisdictional
and readily-deployable State and local assets. This would mean that
Federally-funded capabilities, such as equipment and teams, can be
deployed across the Nation in response to a catastrophic event. Second,
planning focuses on those events that severely stress the Nation's
resources and lead to major impacts on our communities. This does not
mean that we will abandon our planning related to reoccurring hazards
and those events that are most likely to happen. However, it does mean
that we need to step outside of our comfort zone and think about those
threats and hazards that could overwhelm us and stress the Nation's
emergency management system.
PPD-8 focuses on a shared responsibility approach to all phases of
emergency management, not just response. In this approach, the whole
community is engaged before, during, and after a disaster.
frameworks
Four of the five frameworks have been published. The National
Disaster Recovery Framework (NDRF) which was released in September 2011
and recently rolled out across the country, focuses on how to restore,
redevelop, and revitalize the health, social, economic, natural, and
environmental fabric of the community and build a more resilient
Nation. The updated National Response Framework (NRF), as well as the
new National Prevention and National Mitigation Frameworks, were rolled
out on May 6, 2013. Each of these frameworks addresses the unique
expectations and challenges for each mission area.
The NRF aligns roles and responsibilities across Government and the
private sector in a unified approach in responding to any threat or
hazard.
Prevention-related activities are covered in the first edition of
the National Prevention Framework. This framework focuses on addressing
the challenges stemming from an imminent terrorist threat.
Fostering a culture of preparedness--centered on risk and
resilience to natural, technological, and human-caused events--is what
the first edition of the National Mitigation Framework is all about.
The document provides context for how the whole community works
together and how mitigation efforts relate to all other parts of
National preparedness.
The Protection Framework is under development. We are working
closely with our partners in DHS and across the emergency management
community to ensure that the development of the Protection Framework is
closely aligned with the implementation of Presidential Policy
Directive 21 and Executive Order (EO) 13636, which address
infrastructure protection and cybersecurity respectively. This
alignment will ensure that the efforts undertaken under PPD-21 and
EO13636 will be linked to the larger protection mission space.
funding
In addition to doctrinal changes, FEMA works to increase State and
local preparedness by supporting a variety of grant programs and
working to ensure that they are managed effectively.
These grants are grouped into three broad categories, including:
Overarching homeland security grant programs in support of
State, local, and Tribal governments;
Targeted infrastructure protection grants which support
specific critical infrastructure protection initiatives within
identified jurisdictions; and
Firefighter grants programs, which provides funding for
staffing and equipment directly to fire service agencies based
on a competitive process.
As a Nation, we have made significant investments in National
preparedness during the past decade. Due to reductions in overall
preparedness grants, grantees are currently required to focus their
funding on the maintenance and sustainment of current capabilities
along with closing gaps in core capabilities as identified in the
THIRAs and State Preparedness Reports.
Given the topic of today's hearing, I would also like to note the
increased emphasis on mass casualty events represented in the grant
guidance for the Fiscal Year 2013 Homeland Security Grant Program. The
guidance specifically prioritizes on improving immediate emergency
victim care at mass casualty events. Within this priority there are two
key objectives: Improving emergency care to victims of mass casualty
events, including mass shootings; and improving community first aid
training.
The DHS/FEMA Regional Catastrophic Preparedness Grant Program
(RCPGP), which started in 2008, identified 10 High-Threat Urban Areas
to receive funding to develop regional catastrophic incident plans. One
of the 10, the Illinois-Indiana-Wisconsin Combined Statistical Area
(Il-In-Wi CSA) encompasses 16 counties and the City of Chicago. Since
the program began, the area has received more than $14 million. The
RCPGP focuses on three primary goals: (1) Fixing shortcomings in
existing plans; (2) building regional planning processes and
relationships; and (3) linking operational and capabilities-based
planning to resource allocation. The four primary core capability areas
are Transportation/Evacuation; Mass Care and Sheltering; Public
Information and Warning; and Logistics and Resource Management. With
this funding, the Regional Catastrophic Planning Team, consisting of
representatives from the 16 counties, has coordinated planning efforts
with county and local representatives to develop and integrate the
county and local emergency management plans, as well as evacuation
plans for the combined statistical area. In addition, they have
developed the Gear Up Get Ready campaign, which focuses on preparing
citizens to become more resilient during emergencies and disasters.
FEMA has provided more than $547 million to the State of Indiana
through 23 different preparedness grant programs since fiscal year
2002. In 2012, the total amount of grant funding was just over $24
million. These dollars have come from a wide variety of programs to
support initiatives in the State of Indiana. They have supported
building capacity at the State level through planning grants, the
safety of key infrastructure sectors like ports, chemical facilities,
and transit, promoted preparedness of individuals through the Citizen
Corps program, and increased capacity of local first responders through
the Fire Grant and Staffing for Adequate Fire & Emergency Response
(SAFER) Grant programs.
We also work to increase resilience by reducing the impact of
future disasters, whether they are floods, tornadoes, severe storms, or
terrorist attacks. The agency's mitigation grant programs are available
to State, Tribal, territorial, and local governments. These programs
support cost-effective projects that will lessen the impact of future
disasters by encouraging the development of local mitigation plans;
acquisition and removal of flood-prone properties; and construction of
storm water detention basins.
FEMA has provided Indiana approximately $46 million in mitigation
funding since fiscal year 2008. This funding has improved resilience
through the removal of flood-prone properties, which is a priority for
the State of Indiana. When all of the existing projects are completed,
nearly 950 flood-prone homes will have been permanently removed from
danger and their owners compensated to move. Indiana has also
undertaken projects to promote the development and adoption of local
hazard mitigation plans, public awareness campaigns, and tornado alert
sirens.
As we look to further strengthen our ability to prepare for events,
the President's fiscal year 2014 budget proposes to reform the grant
programs and establish a National Preparedness Grant Program. Creating
this program would create a robust National network of capabilities,
eliminate redundancies, and make the most of our limited resources,
while strengthening our ability to respond to evolving threats across
America.
risk assessment
As a condition of grant funding, DHS/FEMA requires a Threat and
Hazard Identification and Risk Assessment (THIRA) for States and Urban
Area Security Initiative (UASI) cities and recommends county and
municipal emergency management programs also conduct a THIRA.
The THIRA process helps communities identify capability targets and
resource requirements necessary to address its anticipated and
unanticipated risks.
THIRAs also help the Federal Government understand regional trends
and gaps where Federal resources may be needed to support State and
local governments. FEMA Region V has actively engaged its States to
cooperatively undertake this assignment. Working together to identify
capability requirements, FEMA is able to more quickly ensure that
should Federal support be needed, it will be in the best position to
deliver what States and Tribes need, when they need it.
planning
Region V, in coordination with its Federal, State, and Tribal
partners, collaborates on catastrophic planning initiatives for events
that stretch the capabilities of local and State governments beyond
their typical response efforts. For example, our planning includes
projects, such as All-Hazards Response Planning, Catastrophic
Earthquake Planning, and planning for an Improvised Nuclear Device. Our
plans are built around both the Response Core Capabilities found in the
National Preparedness Goal and on the administrator's intent to include
whole community concepts in planning efforts.
One way that we are ensuring we incorporate the views of our key
operational partners is through quarterly Regional Interagency Steering
Committee meetings, held at our Regional offices in Chicago and around
the region. These meetings give us the opportunity to discuss various
emergency management planning and preparedness issues with our
partners.
Having a wide variety of stakeholders involved in the development
of our plans helps ensure that responders at all levels know what their
respective roles are and how they interrelate, which leads to a more
coordinated response.
Region V All-Hazards Plan
The notion of all-hazards planning has been a driving force in
emergency management for many years. Region V developed its All-Hazards
plan utilizing a combination of planning factors such as, Metropolitan
Statistical Area (MSA) information, potential infrastructure
vulnerabilities, State capabilities, historical disaster information,
modeling, and the unique characteristics of Region V.
While Region V faces a wide range of hazards, we have identified
nine National Planning Scenarios that guide our planning efforts. These
include an Improvised Nuclear Device, Pandemic, Catastrophic Dam or
Levee Failure, Nuclear Release, Major Winter Storm, New Madrid/Wabash
Valley Seismic Zone Earthquake, Chemical/Biological Incident, Major
Summer Storm and Multi-State Flooding.
Using MSA information based on demographic data pulled from the
2010 Census provides us with an immediate snapshot of potential
resource needs that may arise in the event of an overwhelming disaster
in any of our States. We analyze the population of an area, the number
of households, the number of children, as well as percentages of
households that are below the poverty line, in assisted living, have
persons with disabilities or other people with access and functional
needs, have transportation needs, and those with Limited English
Proficiency.
Using the expertise of other Federal agencies and our own resources
within DHS, we are also looking at potential infrastructure
vulnerabilities that could negatively affect survivor outcomes and
response capabilities. Each State also has identified critical
infrastructure that they believe to be vulnerable in the event of a
catastrophic incident.
As I mentioned earlier, information pulled from State Preparedness
Reports and THIRAs is a critical element of our Regional All-hazards
planning. This information allows the Region to survey each State and
determine potential resources the Federal Government may need to
provide in the event of a catastrophic incident.
As you know, Region V, which is centered in the middle of the
United States, has a number of characteristics that make our All-
Hazards planning unique. We are home to 17 percent of the National
population, including Chicago, the third-largest U.S. city; 10 cities
within Region V are designated under the Urban Area Securities
Initiative; we are a major transportation shipping point with 15
percent of all U.S. freight shipments (by weight) originating within
Region V and 25 percent of all U.S. rail traffic traveling through
Chicago to reach other points within the United States. In addition,
Chicago is a major hub for telecommunications, natural gas, and air
travel.
Region V Earthquake Plan
The FEMA Region V earthquake plan provides guidance on how the
Region will coordinate and execute its responsibilities and mission to
effectively respond to and provide immediate Federal resource support
following a catastrophic earthquake, aftershock, or cascading impacts
from such events. Region V has two notable potential earthquake
threats, the Wabash Valley Seismic Zone and the New Madrid Seismic
Zone. Region V States, including Indiana, have established a history of
successful planning efforts in preparation for a catastrophic
earthquake, particularly within the New Madrid Seismic Zone, though the
lessons learned and processes used also have value for a Wabash Valley
incident. The earthquake plan was developed around a 7.7 magnitude New
Madrid Seismic Zone scenario, which was based on seismic modeling
conducted by the Mid-American Earthquake Center.
This planning effort included workshops, exercises, and on-going
planning with Federal, State, and local partners. These workshops, held
in each of the potentially impacted New Madrid States between 2006 and
2010, focused on the Response Core Capabilities outlined in PPD-8, as
well as on resource allocation. These workshops culminated in National-
Level Exercise 2011, which focused on a catastrophic earthquake event
in the zone.
Following this large-scale exercise, we are continuing to work with
our partners to expand our planning efforts, focusing on logistics,
operations, and planning. These workshops placed a heavy emphasis on
commodities, staging, and logistical needs in disaster response. The
next milestone for this plan will be a CAPSTONE exercise, driven by the
Central United States Earthquake Consortium and its member States, to
examine the private-sector resources in a New Madrid event.
Improvised Nuclear Device Planning
The third planning effort that has helped us tremendously to expand
our preparedness for all hazards, and in particular for large-scale
disasters, is our planning for an Improvised Nuclear Device (IND). Our
IND planning effort focuses on identifying effective response tasks
that could save and sustain lives. While such an incident would have
specific impacts, the process that we used to develop the plan is one
that we could use to expand our preparedness for other catastrophic
events.
With this in mind, Region V is developing a contingency plan for a
10-kiloton explosion. The plan is being developed collaboratively with
more than 300 partners at the Federal, State, and local levels, as well
as from private-sector and voluntary agency representatives.
The resulting document is a blueprint for common understanding that
outlines how partners need to respond to an event from hour 1 to hour
96.
new innovations/lessons learned
As we move forward, it is important to note that we are constantly
working to improve our operations. We are learning lessons not just
from past disasters, but also from disasters to which we are currently
responding. We are implementing new force structures to improve the way
we deliver services, new technologies to improve our situational
awareness and coordination, new logistical models to improve the way we
deliver commodities, and new partnerships to expand the notion of whole
community in preparedness and response.
New Force Structures
To ensure that we are consistently delivering a high level of
service to disaster survivors and to our State, local, and Tribal
partners, while at the same time ensuring we continue to complete our
non-disaster response functions, FEMA is moving toward a new force
structure that maximizes our staff and capabilities. To this end, the
agency recently stood up new, full-time Incident Management Assistance
Teams (IMATs), and is hiring disaster response staff that can deploy
for longer periods of time.
FEMA has also established members of the DHS Surge Capacity Force,
made up of employees from other DHS components and Federal agencies.
During Hurricane Sandy, we deployed more than 1,100 of our co-workers
from the various DHS component agencies in support of the response
operations. We have also adopted a new model for serving disaster
survivors by standing up Disaster Survivor Assistance Teams (DSATs) to
replace the former Community Relations function. These new DSATs are
deploying to the field fully trained and equipped not only to share
information about the help available after a disaster, but also to go
into neighborhoods and register survivors, answer case-specific
questions, and facilitate survivor access to our full range of post-
disaster services.
Any incident that would generate mass casualties would involve the
deployment of large numbers of FEMA and DHS staff. These new force
structures and programs ensure a more nimble and robust response and a
higher level of service to disaster survivors. Region V was the first
region to utilize the DSAT model in response to severe flooding in
Illinois, allowing it to be more survivor-centric by bringing services
to survivors, rather than asking them to come to FEMA.
New Technologies
FEMA is implementing new technologies to improve our preparedness
and response capabilities, using satellite imaging and flood modeling
to improve disaster response, engaging with the public through social
media, and adopting new technologies to improve interactions with our
response partners.
We have adopted, and actively use WebEOC, which is an emergency
management information-sharing tool that allows us to work toward a
common operating picture among multiple partners in real time. FEMA
recently joined States in using this technology, allowing for greater
collaboration between these partners. We are also using EMNET, a
satellite-based information-sharing system, to ensure productive
collaboration.
Commodity Warehousing
FEMA Region V is piloting a new model for the storage and delivery
of emergency supplies in the event they are needed for disaster
response. We are working with regional food bank distribution centers
to shave valuable time off FEMA commodity delivery. We will store FEMA
commodities at no cost at six food bank centers located across Region
V, in addition to utilizing commodities stored at FEMA's existing
Distribution Centers that are located in coastal States. With this new
initiative, an initial supply of commodities, such as water and Meals
Ready to Eat (MREs), will reach disaster survivors more quickly and
establish the supply chain from more remote centers.
FEMA worked with Feeding America--the Nation's leading domestic
hunger-relief non-profit organization--to develop the plan. Feeding
America's mission is to provide nutrition support through a Nation-wide
network of member food banks and engage the country in the fight to end
hunger. The Region estimates that we will be able to store 5 to 7
truck-loads at the distribution centers, which is enough to respond to
a mid-size disaster. Commodities in storage include water, shelf-stable
meals, and infant/toddler supplies.
As we all know, all commodities have a shelf life. In the event
that the food we put in storage is not used, our plan outlines a
process that would allow the food banks storing the commodities to
request, through FEMA's established surplus process, donation to that
food bank before they expire.
The new storage plan will deliver a number of other benefits to
regional operations. For example, deliveries coming from distribution
centers on the East Coast or in the South may be delayed by weather
conditions or other disaster disruptions, making speedy delivery a
concern. Region V will have initial supplies pre-staged locally which
will increase the speed of delivery and decrease the potential for
weather- or travel-related delays.
The six food banks in Region V currently under consideration for
this initiative are:
Second Harvest Heartland, St. Paul, MN;
Greater Chicago Food Depository, Chicago, IL;
Northern Illinois Food Bank, Geneva, IL;
Gleaners Food Bank of Indiana, Inc., Indianapolis, IN;
Cleveland Food Bank Inc., Cleveland, OH;
Gleaners Community Food Bank of Southeastern Michigan,
Detroit, MI.
Private-Sector Partnerships
FEMA continues to expand its outreach to and engagement with the
private sector. Region V has a full-time staff member who works to
conduct outreach to a wide range of non-Governmental partners,
including small, medium, and large business, as well as academia, trade
associations, and other organizations. Throughout the year, FEMA's
Private Sector staff works with the private sector to provide
information on tools and resources to support preparedness, and
integrate the private sector into the emergency management effort.
FEMA's National Private Sector team is comprised of headquarters staff,
10 regional liaisons, and a disaster workforce cadre of approximately
40 reservists.
During steady-state, non-disaster operations, this FEMA office
focuses its efforts on ways to engage the private sector in activities
ranging from education campaigns, to opportunities for providing
feedback on National policies, to participation in joint exercises.
FEMA established a special Private Sector Representative (PSR)
position in 2010 to communicate, coordinate, and collaborate between
public and private-sector stakeholders before, during, and after
disasters. Unlike the full-time Federal positions established starting
in 2008, a PSR is a member of the private sector who serves as a
Special Government Employee (SGE) during their 90-day tenure with FEMA,
effectively representing the entire private sector while they are a
PSR.
When the NRCC is activated, these special Government employees
serve as critical liaisons between FEMA and private industry by
leveraging private-sector coordination and collaboration capabilities
and sharing situational awareness information.
The PSR in Region V is currently filled by a representative from
Walgreens. At FEMA Headquarters, representatives from eight companies,
including Target, Big Lots, Brookfield Properties, Systems Planning
Corporation (a small business), Verizon, Citi, Wal-Mart, and Dominion
Power Company serve a similar role.
FEMA has also been instrumental in helping to establish the
National Business Emergency Operation Center (NBEOC). The NBEOC is a
virtual network of National corporations, Federal, State, local,
Tribal, territorial governments, and trade associations that have roles
in disasters. Illinois is the only State in the Region that has a
dedicated Business Emergency Operation Center (BEOC). The BEOC
activates whenever the State Emergency Operations Center activates and
provides situational awareness to the Regional Response Coordination
Center and to the Regional Private Sector Liaison.
In Indiana, we are actively engaged with the Northwest Indiana
Information Sharing Workgroup. This group is comprised of the private
sector, State, and local emergency managers, academia, faith-based
groups, and other Federal agencies. This workgroup is part of the
Homeland Security Information Network--Critical Sectors (HSIN-CS).
HSIN-CS is a secure, unclassified, web-based system that serves as the
primary, Nation-wide DHS information-sharing and collaboration system.
Members of this group meet regularly and were active in planning for
the recent NATO meetings in Chicago.
faith-based, community, and volunteer partnerships
Ultimately, FEMA is only one part of our Nation's emergency
management enterprise. This effort is a shared responsibility and our
partners at all levels help communities prepare for, protect against,
mitigate, respond to, and recover from all hazards.
The agency relies on our voluntary agency partners to help us
support State and local governments by providing services that we may
not be in the best position to provide. Our collective response is
greatly enhanced by the on-going efforts of faith-based, community, and
volunteer organizations. We depend on them as true partners to help on
the front lines as well as behind the scenes, to receive and distribute
commodities, manage and staff shelters and mass feeding facilities,
provide counseling services and much more.
During my emergency management career, beginning as the executive
director of Chicago's Office of Emergency Management and
Communications, then as the director of the Illinois Emergency
Management Agency, and now as a regional administrator for FEMA, I have
been a strong supporter of working closely with faith-based and
community partners, and believe that their engagement is vital to our
Nation's resilience.
Whether it is through providing shelter, food, or clothing to those
in need, removing debris to help communities begin the road to
recovery, or helping families rebuild their homes, faith-based and
community organizations have always played a vital role in meeting the
needs of Americans. In an incident that generates mass casualties, the
effective execution of these support functions will be essential to the
region's preparedness and response.
As regional administrator, I have charged our Region V team to work
collaboratively with local, State, Tribal, and National partners to
support faith-based and community leaders to determine how best to
provide assistance to disaster survivors. With the support of the DHS
Center for Faith-Based and Neighborhood Partnerships, we have been able
to make strong progress over the past 4 years, hosting several events
to strengthen those relationships. It is my belief that as we
strengthen these partnerships today, we will be better-positioned to
deliver essential services during our disaster response.
closing
In Region V, we are continuously working to evolve our approach to
preparing America's citizens to respond to the events that threaten
their lives, homes, and livelihoods, and to better fulfill FEMA's
mission. To that end, we are actively working with our Governmental
partners at the State, Tribal, and local level, as well as with our
non-Governmental partners to prepare for whatever may impact the Region
and look forward to continuing that good work.
I appreciate the opportunity to appear before you today and look
forward to answering any questions you may have.
Mrs. Brooks. Thank you, Mr. Velasquez.
The Chairwoman will now recognize Sheriff Bowen.
STATEMENT OF MARK J. BOWEN, SHERIFF, HAMILTON COUNTY, INDIANA
Sheriff Bowen. Thank you, Chairwoman Brooks. Chairwoman
Brooks, Senator Donnelly, Representative Walorski,
Representative Young, and Members of the subcommittee, it is
truly an honor to appear before you today. My name is Mark
Bowen, and I am the elected sheriff of Hamilton County,
Indiana. I would like to thank you for the opportunity to
appear before you today, along with my esteemed colleagues, to
discuss Central Indiana's preparedness for a mass casualty
event.
Mrs. Brooks. Excuse me, Sheriff. Is your mic turned on?
Thank you.
Sheriff Bowen. While Indiana still remains a wholesome,
midwestern State known primarily for its agriculture and
basketball, Central Indiana has grown into a thriving
metropolitan community, making a name for itself throughout
standing primary, secondary, and higher-educational
institutions, affordable housing, low taxes, low crime rates,
and high-profile events such as the NCAA Final Four, PGA BMW
Championship, Indianapolis 500-mile race and mini-marathon, the
Brickyard 400, and the 2012 NFL Super Bowl.
As Indiana continues to grow, develop, and to host National
events, it is more important than ever that we focus on our
preparedness plans to protect Hoosiers and those who visit our
fine State.
As we have seen through incidents across the country, from
Columbine to 9/11, to Hurricane Katrina, to Sandy Hook, and to
the Boston Marathon bombings, Americans are vulnerable, and
Hoosiers are no exception, as evidenced by the Indiana State
Fair stage collapse, the Henryville tornado, and the Richmond
Hills gas explosion. It is not a question of if a mass casualty
event will occur in Indiana but when will it happen, how will
it happen, to what magnitude it will happen, and will we be
prepared for it when it does happen?
Indiana has come a long way in the past 10 years when it
comes to preparing for mass casualty events. The events of 9/11
and other large-scale disasters have forced public safety to
look at large-scale disasters not only from a local perspective
but from a regional perspective as well. Indianapolis, Indiana
and the surrounding region has been part of the Urban Area
Security Initiative for the past 8 years. As a UASI region, we
have worked diligently to meet the guidelines set out in
Presidential Policy Directive 8. State and local officials in
the Indianapolis urban area have been working in conjunction
with the Indiana Department of Homeland Security to ensure that
threat and hazard identification and risk assessments are being
done and updated annually.
Hazard mitigation plans are being implemented, core
capabilities are being identified, assets are being secured,
memorandums of understanding are being executed, and training
is being conducted. Unfortunately, we cannot do all this work
and then put it on a shelf until an event happens. We must be
ever-vigilant, constantly updating our risks, evaluating our
plans, updating our training, and maintaining our resources and
equipment. Complacency can easily become our Achilles heel.
This is where we need your help, the help of our local
emergency management agencies, and the help of the Department
of Homeland Security. Risk assessment, threat assessment,
planning, training, resource allocation, communications and
interoperability are just a few of the critical components
necessary to our success in mitigating hazards and restoring
order. While local first responders are the primary resources
inserted into a mass casualty event, these resources are
quickly overwhelmed and must rely on mutual aid from other
jurisdictions, including State and Federal agencies.
Through the cooperation of IDHS, Central Indiana has become
a well-structured and well-organized UASI region and, by its
virtue, become more stable and better prepared to deal with
major events, including mass casualties. The State Fair,
Henryville, and Richmond Hills are prime examples of success
stories due in large part to the planning, training,
organization, and teamwork that has been developed through the
efforts of homeland security. It is critical that these
agencies continue to function at a high level, especially in
times of peace and serenity, in order to ensure that our local
jurisdictions are up-to-date on their training, that they are
conducting their threat assessments, updating their policies
and procedures, maintaining their equipment, and following
training in ensuring best practices, fostering and building
relationships, establishing funding sources and conducting
training so that we do not become complacent and be caught off-
guard when the event does happen.
I want to thank you all for taking the time to meet with us
here today and for your interest in Indiana's preparedness for
mass casualties and for all that you do to keep the homeland
safe and secure. Thank you.
[The prepared statement of Sheriff Bowen follows:]
Prepared Statement of Mark J. Bowen
August 6, 2013
Chairwoman Brooks, Ranking Member Payne, Senator Donnelly,
Representatives Walorski and Young, and Members of the subcommittee, it
is truly an honor to appear before you today. My name is Mark Bowen and
I am the elected sheriff of Hamilton County, Indiana. I would like to
thank you for the opportunity to appear before you today along with my
esteemed colleagues to discuss central Indiana's preparedness for a
mass casualty event.
While Indiana still remains a wholesome mid-western State known
primarily for its agriculture and basketball, central Indiana has grown
into a thriving metropolitan community making a name for itself through
outstanding primary, secondary, and higher educational institutions,
affordable housing, low taxes, low crime rates and high-profile events
such as the NCAA Final Four, PGA BMW Championship, Indianapolis 500-
mile race and Mini Marathon, Brickyard 400, and the 2012 NFL Superbowl.
As Indiana continues to grow, develop, and to host National events,
it is more important than ever that we focus on our preparedness plans
to protect Hoosiers and those who visit our fine State. As we have seen
through incidents across the country from Columbine to 9/11 to
Hurricane Katrina to Sandy Hook to the Boston Marathon bombings,
Americans are vulnerable and Hoosiers are no exception as evidenced by
the Indiana State Fair stage collapse, the Henryville tornado, and the
Richmond Hills gas explosion.
It is not a question of if a mass casualty event will occur in
Indiana but when it will happen, how it will happen, to what magnitude
it will happen, and will we be prepared for it when it does happen?
Indiana has come a long way in the past 10 years when it comes to
preparing for mass casualty events. The events of 9/11 and other large-
scale disasters have forced public safety to look at large-scale
disasters not only from a local perspective but from a regional
perspective as well.
Indianapolis, Indiana and the surrounding region has been part of
an Urban Area Security Initiative (UASI) for the past 8 years. As a
UASI region, we have worked diligently to meet the guidelines set out
in Presidential Policy Directive 8. State and local officials in the
Indianapolis Urban Area have been working in conjunction with the
Indiana Department of Homeland Security to ensure that Threat and
Hazard Identification and Risk Assessments (THIRA) are being done and
updated annually, Hazard Mitigation Plans are being implemented, Core
Capabilities are being identified, assets are being secured,
memorandums of understanding are being executed, and training is being
conducted.
Unfortunately, we cannot do all this work and then put it on a
shelf until an event happens. We must be ever-vigilant, constantly
updating our risks, evaluating our plans, updating our training and
maintaining our resources and equipment. Complacency can easily become
our Achilles heel. This is where we need your help, the help of our
local emergency management agencies (EMA) and the help of the
Department of Homeland Security (DHS).
Risk assessment, threat assessment, planning, training, resource
allocation, communication, and interoperability are just a few of the
critical components necessary for our success in mitigating hazards and
restoring order. While local first responders are the primary resources
inserted into a mass casualty event, these resources are quickly
overwhelmed and must rely on mutual aid from other jurisdictions
including State and Federal Agencies.
Through the cooperation of IDHS, central Indiana has become a well-
structured and well-organized UASI region and by its virtue become much
more stable and better prepared to deal with major events including
mass casualties. The State Fair, Henryville, and Richmond hills are
prime examples of success stories due in large part to the planning,
training, organization, and teamwork that has been developed through
the efforts of homeland security.
It is critical that these agencies continue to function at a high
level especially in times of peace and serenity in order to ensure that
our local jurisdictions are up-to-date on their training; that they are
conducting their threat assessments; updating their policies and
procedures; maintaining their equipment; following trends and ensuring
best practices; fostering and building relationships;, establishing
funding sources and conducting training so that we do not become
complacent and be caught off guard when the event does happen!
Thank you all for taking the time to meet with us here today, for
your interest in Indiana's preparedness for mass casualty and for all
you do to keep the Homeland safe and secure.
Appendix
Question 1. What are the main threats facing Indiana?
Answer. Indiana like any other State across our great Nation is
vulnerable to a multitude of threats both natural and man-made. In 2012
a Threat and Hazard Identification and Risk Assessment (THIRA) was
conducted by the Indianapolis Urban Area in accordance with
Presidential Policy Directive 8. The following Threats and Hazards were
identified.
Natural
Acts of Nature
Flood
High Wind
Snow
Tornado
Hail
Ice
Heat Emergencies
Disease Outbreak
Drought
Epidemic
Technological
Accidents or Failures of Systems
HAZMAT
Accidental Explosion
Dam/Levee Failure
Power Failure
Airplane Crash
Radiological Release
Train Derailment
Human--caused
Intentional Acts
IED/VBIED
Arson/Incendiary Attack
Cyber Attack
Chemical Agent
Conventional Attack
Hostage Taking
Biological Attack (contagious)
Biological (non-contagious)
Aircraft as a Weapon
RDD
Food and Water Attack
Nuclear Attack
Agro-Terrorism
Civil Disturbance
Cyber Incidents
Sabotage
School Violence
Terrorist Acts
Active Shooter
One of the primary natural threats/hazards facing Indiana is a
tornado. Indiana is prone to tornados and has experienced many
significant events in its history. The most recent event, an EF 4
tornado that touched down in Henryville, Indiana in March 2012, is a
prime example of the profound impact that a significant storm can have
on a densely-populated community during peak hours.
One of the primary technological threats/hazards facing Indiana is
that of a hazardous materials explosion which could involve mass
casualties, mass evacuation, and profound public health concerns.
One of the primary human-caused threats/hazards would be an act of
terrorism committed at a large-scale public event such as the Indy 500,
the Brickyard 400, a Colts game, or any number of other large-scale
publicly-attended venues.
Question 2. What are we doing to prepare for these events?
Answer. Indiana has come a long way in the past 10 years when it
comes to preparing for mass casualty events. The events of 9/11 and
other large-scale disasters have forced public safety to look at large-
scale disasters not only from a local perspective but from a regional
perspective as well.
Indianapolis, Indiana and the surrounding region has been part of
an Urban Area Security Initiative (UASI) for the past 8 years. As a
UASI region, we have worked diligently to meet the guidelines set out
in Presidential Policy Directive 8. State and local officials in the
Indianapolis Urban Area have been working in conjunction with the
Indiana Department of Homeland Security to ensure that Threat and
Hazard Identification and Risk Assessments are being done and updated
annually, Hazard Mitigation Plans are being implemented, Core
Capabilities are being identified, assets are being secured,
memorandums of understanding are being executed and training is being
conducted.
Question 3. How well are we prepared for the range of threats
facing our State?
Answer. Overall, Indiana is positioned very well to deal with the
range of threats facing our State. While we cannot possibly train for
every possible scenario that may play out, we can and have identified
what we believe to be the most likely threats and hazards facing our
community. Public Safety Agencies and personnel have been briefed on
these potential hazards and are enhancing their policies and procedures
and their training as well. As a result of lessons learned from
incidents that have taken place across the country, situational
awareness has been elevated not only in the public safety arena but
also in the private sector and by the general public. More attention
has been given to pre-planning of events and to incident action plans.
The National Incident Management System (NIMS) has become standard
operating procedure and critical delays in responding to incidents,
establishing command, assessing needs, and executing operating
procedures has been greatly reduced.
In 2012, central Indiana was tested on a number of occasions. One
primary example would be the EF 4 tornado that hit Henryville, Indiana,
in March. The tornado swept through a densely-populated community in
the middle of the day causing catastrophic damage, killing several
people, and injuring numerous others.
Another noteworthy event was the Richmond Hill subdivision
explosion in November 2012 which was determined to be a man-made event
that resulted in the death of two people and the catastrophic damage to
a 3-block radius in a residential community.
These events were mitigated successfully using an all hazards
approach and the NIMS model.
Question 4. How does IDHS work with FEMA to plan for the various
threats facing Indiana?
Answer. This question is not applicable and left for IDHS response.
Question 5. What assistance does the State receive from FEMA and
the Federal Government?
Answer. This question is not applicable and is left to IDHS.
Question 6. What training do our first responders receive?
Answer. Law enforcement first responders receive training in threat
identification and assessment, first aid, hazardous materials
identification and assessment, National Incident Management Systems
(NIMS) procedures, perimeter security and containment, evidence
preservation and collection, active-shooter training, and personal
protective equipment (PPE) training.
The training has not only been conducted within individual
departments but in conjunction with other agencies across the region.
Partnerships have been developed with schools, businesses, and crime
watch organizations to include them in active-shooter and other
scenario-based training.
Question 7. What plans are in place at the various levels of
government for the threats?
Answer. Many areas of local government have taken a proactive
approach to the threats and are assessing their policies and
procedures, identifying critical infrastructure needs, establishing
Continuity of Operation Plans and Continuity of Government (COOP & COG)
plans, implementing training and executing memorandums of understanding
with one another, and constantly updating these plans.
Question 8. What exercises have been held in the past year?
Answer. In the past year, table-top exercises have been conducted
on scenarios that involved a mass casualty event at the Indy 500, an
active-shooter/terrorist situation at the Fort Benjamin Harrison
Finance Center, an airport mass casualty, a fair train mass casualty,
and an active-shooter public/private partnership scenario with Rolls
Royce.
Hamilton County is currently working on a weather-related all-
hazards live training drill involving police, fire, and EMS that is
scheduled to take place in October.
Question 9. How have different jurisdictions worked together to
plan for such events?
Answer. Discussions and training have taken place through
organizations such as the International Association of Chiefs of Police
(IACP) and the Indiana Sheriff's Association (ISA). Through the
Commission on Accreditation for Law Enforcement Agencies (CALEA),
accredited agencies are required to implement and update all-hazard and
unusual occurrence policies. Table-top exercises have taken place and
full-scale exercises have taken place and/or are being discussed.
Dialogue has increased throughout the region, assets and resources have
been identified, memorandums of understanding have been executed, data
sharing and interoperable communications have been discussed.
Question 10. Are intra-state agreements in place to facilitate
cooperation between jurisdictions?
Answer. Many local jurisdictions have been in discussions with
their neighbors to facilitate cooperation and many have executed inter-
local agreements to provide support in cases of emergency.
Thankfully, the Mid-west mentality and desire to work together to
get the job done remains strong!
Question 11. Are the communications systems of the first responders
able to talk to each other before, during, and after an incident?
Answer. Central Indiana first responders work off of a number of
different communications systems. Not all are interoperable before an
incident takes place. In most cases, local jurisdictions are able to
communicate with one another but when first responders have to travel
outside of their primary areas of responsibility, communications can
become an issue.
Patches can be established through most systems or radios can be
switched to the State Mutual Aid frequencies but this takes time and
often results in poor connectivity.
The State is working on enhancing the State-wide radio network and
bridging the gap by bringing the system up to P-25 standards. Hamilton
County has also implemented plans to enhance their radio infrastructure
and bring it up to P-25 standards.
Unfortunately, the burden is on local units of government to build
and maintain these complicated systems and many simply can't afford it.
Mrs. Brooks. Thank you, Sheriff Bowen.
The Chairwoman now recognizes Chief Orusa to testify.
STATEMENT OF STEVEN ORUSA, FIRE CHIEF, FISHERS, INDIANA
Chief Orusa. Chairwoman Brooks, Senator Donnelly,
Representatives Walorski and Young, good morning. On behalf of
the town of Fishers town council president John Weingardt and
town manager Scott Faultless, thank you for the opportunity to
discuss Central Indiana's preparedness for a mass casualty
event.
From the 2011 State Fair collapse to the 2012 Richmond
Hills explosion to the Colonial Hills Baptist Church bus crash
just last month, our firefighters, paramedics, and EMTs are at
the tip of the spear during these tragic events, but they
weren't the only first responders. Bystanders, neighbors, and
people given the chance to go about their business decided to
stay and help our personnel serve professionally and
heroically. Mass casualty events are an amazing example of
humanity, service, and teamwork.
Both the work leading up to these events as well as quick
action following the events highlight the significant progress
that we as a region have made over the past years responding to
mass casualty incidents. But there is still more work to do,
and we are continuing to learn from these events to strengthen
our preparedness and training and exercise programs as they
relate to mass casualty and hostile situations.
Marion and Hamilton counties have worked with FEMA to
assess gaps and prioritize grants and investments. In 2012, we
completed a Threat and Hazard Identification and Risk
Assessment, the THIRA, a process for assessing regional
capability gaps required by each State and urban area designed
to prioritize investments and key deployable capabilities. Many
of the capabilities demonstrated in the aforementioned events
and aftermath were built or enhanced and have been sustained
through the preparedness suite of homeland security grant
programs, including UASI Urban Area Security Initiative Grant
Program, and the State Homeland Security Program.
As a former paramedic, UASI task force member and chief, I
can attest to the importance of preparing our public safety men
and women for whatever may come. Grant funds provided
commodities and training that were essential in response
incidents. In part because of the investment made in the
system, and in no small part because of the outstanding work of
our first responders, patients were triaged, treated, and
transported in an orderly manner to the appropriate hospitals
based on their needs.
Mass casualty incidents are high-risk, low-frequency
events. This means we cannot rely on our call volume alone to
be safe and effective. In order to assess capabilities,
identify gaps, and create improvement plans, we must conduct
tabletop, functional, and full-scale exercises to improve and
sustain our capacity and safely and effectively rise to the
occasion of a mass casualty incident.
Individual agencies can practice blocking and tackling, but
until we scrimmage together and rehearse under game-like
conditions, we cannot identify and analyze the gaps critical to
improve capability. These operational readiness exercises
provide us an environment where mistakes can be made and
lessons learned when they are affordable, in a controlled
training environment. The alternative is too costly.
Quite simply, our preparedness system works like it should,
but we need your help. The challenge is providing the backfill
and overtime required to engage our people in realistic, high-
quality, scenario-based exercises and at the same time keep our
communities protected. Historically, we have depended on UASI
funding and State Homeland Security Program funding. Central
Indiana did not qualify for UASI funding in 2013, and it is
unknown for 2014. As a consequence, State Homeland Security
funding may be reduced.
In closing, our public safety men and women pride
themselves on doing whatever it takes, no matter what the
conditions, to serve those in need, but I believe we owe them
more than that. We owe them a system which plans, organizes,
exercises, and evaluates the capabilities. We owe them a system
that prepares them to be successful. Our covenant with them is
to do everything in our power to keep them safe and effective.
When we commit them to harm's way, we commit their families to
harm's way. We have no greater responsibility. We need your
help to support UASI funding in Central Indiana.
On behalf of the first responders we all serve, it is an
honor and a privilege to be here today. Thank you for this
opportunity, and I look forward to answering your questions.
[The prepared statement of Chief Orusa follows:]
Prepared Statement of Steven Orusa
August 6, 2013
Chairman Brooks, Ranking Member Payne, Senator Donnelly,
Representatives Walorski and Young, and Members of the subcommittee:
Good morning, I am Steven Orusa, fire chief for the Town of Fishers
Department of Fire and Emergency Services. On behalf of town council
president John Weingardt and town manager Scott Fadness, thank you for
the opportunity to discuss central Indiana's preparedness for a mass
casualty event.
From the 2011 State Fair Stage Collapse to the 2012 Richmond Hills
Explosion to the Colonial Hills Baptist Church bus crash last month,
our firefighters, paramedics, and EMTs are the tip of the spear during
these tragic events, but they weren't the only first responders.
Bystanders, neighbors, and people given the chance to go about their
business decided to stay and help our personnel serve professionally
and heroically. Mass casualty events are an amazing example of
humanity, service, and teamwork.
Both the work leading up to these events, as well as quick action
following the events, highlight the significant progress that we, as a
region, have made over the past years responding to Mass Casualty
Incidents. But there is still more work to do, and we are continuing to
learn from these events and others to strengthen our preparedness and
training and exercise programs as they relate to mass casualty and
hostile situations.
Marion and Hamilton Counties have worked with FEMA to assess gaps
and prioritize grant investments. In 2012, we completed a Threat and
Hazard Identification and Risk Assessment (THIRA), a process for
assessing regional capability gaps required by each State and urban
area designed to prioritize investments in key deployable capabilities.
Many of the capabilities demonstrated in the aforementioned events
and aftermath were built or enhanced and have been sustained through
the preparedness suite of Homeland Security Grant Programs (HSGP),
including the Urban Area Security Initiative (UASI) Grant Program and
the State Homeland Security Program (SHSP).
As a former paramedic, US&R Task Force member, and chief, I can
attest to the importance of preparing our public safety men and women
for whatever may come. Grant funds provided commodities and training
that were essential in response to incidents. In part, because of the
investment made in the system, and in no small part of the outstanding
work of our first responders, patients were triaged, treated, and
transported in an orderly manner to the appropriate hospitals based on
needs.
Mass casualty incidents are high-risk/low-frequency events. This
means we cannot rely on our call volume alone to be safe and effective.
In order to assess capabilities, identify gaps, and create improvement
plans, we must use table-top, functional, and full-scale exercises to
improve and sustain our capacity to safely and effectively rise to the
occasion of a mass casualty incident.
Individual agencies can practice ``blocking and tackling,'' but
until we scrimmage together and rehearse under ``game-like'' conditions
we cannot identify and analyze the gaps critical to improve capability.
These operational readiness exercises provide an environment where
mistakes can be made and lessons learned when they are affordable: In a
controlled training environment. The alternative is too costly.
Quite simply, our preparedness system works like it should, but we
need your help. The challenge is providing the backfill and overtime
required to engage our people in realistic, high-quality, scenario-
based exercises and at the same time keep our communities protected.
Historically we have depended on UASI funding and SHSP funding. Central
Indiana did not qualify for UASI funding in 2013 and it is unknown for
2014. As a consequence SHSP funding may be reduced.
In closing, our public safety men and women pride themselves on
doing whatever it takes, no matter what the conditions, to serve those
in need, but I believe we owe them more than that. We owe them a system
which plans, organizes, exercises, and evaluates their capabilities; we
owe them a system that prepares them to be successful. Our covenant
with them is to do everything in our power to keep them safe and
effective. When we commit them to harm's way we commit their families
to harm's way. We have no greater responsibility. We need your support
to return UASI funding to central Indiana.
Mrs. Brooks. Thank you, Chief Orusa.
I now recognize Mr. Hill to testify.
STATEMENT OF JOHN H. HILL, EXECUTIVE DIRECTOR, INDIANA
DEPARTMENT OF HOMELAND SECURITY
Mr. Hill. Good morning, Madam Chairwoman, Senator Donnelly,
and Representatives Walorski and Young. Thank you for having us
here today. I really represent the whole Department of Homeland
Security, but also thousands of first responders, as Chief
Orusa just indicated. So I certainly don't stand here 6 months
into the job with all the rewards and success that we have had
so far.
I would also like to thank the panel members. It is a
pleasure to work with them and to experience first-hand
meetings with them and to do planning and work together.
The Department of Homeland Security is committed to
providing State-wide leadership, responsiveness to our public
safety professionals, and subject-matter expertise to
continually develop the State's public safety capabilities
while working for the well-being of our citizens, property, and
communities.
Indiana Governor Michael Pence is committed to a
coordinated public safety system in Indiana. To better provide
for the needs of the States, it is essential for us to
constantly evaluate our plans, preparedness, processes, and
procedures. Therefore, Governor Pence, on his first day in
office, invited me and his whole public safety team to his
office to really address the need for public safety and
preparedness in our State. One of the things that he directed
me to do was to have an objective external view of our agency
and conduct an assessment of the Department of Homeland
Security to allow it to improve and take it really from good to
great.
One of the things that we have done is we have engaged a
firm known by many people in the private-sector world of
emergency preparedness and crisis communication, James Lee Witt
and O'Brien, Witt O'Brien Associates. They are doing an
assessment of our agency, and the report has just been
delivered to me, and we will be engaging in some updates of
that in the next 6 months.
The assessment included experts from not only public
safety, but they talked to people all throughout the State, and
I look forward to working with our first responders to improve
our response in the next few months.
I have submitted a very lengthy report to the panel, and I
am going to defer further discussions so we can get into
questions, and I look forward to taking your questions later.
[The prepared statement of Mr. Hill follows:]
Prepared Statement of John H. Hill
August 6, 2013
Chairman Brooks, Ranking Member Payne, Senator Donnelly,
Representatives Walorski and Young, and Members of the subcommittee, it
is an honor to appear before you today. My name is John Hill, and I am
the executive director of the Indiana Department of Homeland Security
(IDHS). Thank you for inviting me to testify on Central Indiana's
preparedness for a mass casualty event, and for your interest in this
critically important issue. I would also like to thank Federal
Emergency Management Agency (FEMA) Region V administrator, Mr.
Velasquez, Sheriff Bowen, Chief Orusa, Mr. Chad Priest, and other panel
members for their on-going partnership with IDHS' preparedness and
response activities. The Indiana Department of Homeland Security is
committed to providing State-wide leadership, responsiveness to our
public safety professionals, and subject-matter expertise to
continually develop the State's public safety capabilities while
working for the well-being of our citizens, property, and economy. The
agency was founded in April 2005, with the merger of the State
Emergency Management Agency, State Fire Marshal's Office, Office of the
State Building Commissioner, Public Safety Training Institute, and the
Counter Terrorism and Security Council.
Indiana's Governor, Michael R. Pence, is committed to a coordinated
public safety system in Indiana. The goal of this system is to exhibit
the maximum efficiency of primary public safety agencies in the State,
while removing unnecessary redundancies where they exist and employing
Federal, State, and local resources in a harmonized fashion.
To better provide for the needs of the State, it is essential for
us to constantly evaluate our plans, preparedness, processes, and
procedures. Governor Pence on his first day in office directed me to
undertake a thorough review of Indiana's emergency preparedness and
response capabilities and report the findings to him. Realizing that an
objective and external observation and assessment of IDHS would provide
important feedback, the agency engaged Witt O'Brien to identify
weaknesses and opportunities for improvement. Witt O'Brien is an
internationally recognized authority in crisis and disaster management.
The assessment included review by public safety experts to evaluate
IDHS and other State and local organizations, which served as the basis
for findings and recommendations to improve Indiana's readiness. Witt
O'Brien recently submitted a draft of its report concerning the Indiana
Department of Homeland Security. The report is being reviewed.
Implementation will commence in the next month to improve Indiana's
emergency management practices.
federal, state, local partnership
The State of Indiana has spent considerable time, effort, and
resources in preparing for, responding to, and recovering from
emergency situations. Our State is organized into ten distinct
districts, each a partner of the other nine, and all uniquely prepared
for emergencies. Each county has its own emergency management agency or
emergency manager, with significant training, preparedness, and
mitigation opportunities for emergencies and disasters. Routinely,
counties join together to train for and respond to emergencies in their
respective district. This multi-layered approach--Federal, State,
district, county, and city--creates multiple levels of partnership and
preparedness.
We have excellent coordination with our State and local partners--
organizations like the Indiana State Department of Health, Indiana
National Guard, Indiana State Police, and county emergency management
agencies, local police and fire departments, among others. In
conjunction with Federal partners, such as the Federal Emergency
Management Agency (FEMA), U.S. Department of Homeland Security (DHS),
Federal Bureau of Investigation (FBI), Nuclear Regulatory Commission
(NRC), Department of Energy (DOE), and Department of Defense (DOD), we
work to create a safer, better-prepared State for Hoosiers.
emergency response
Just as public safety requires the coordination of many multi-
faceted and fluid elements to be successful, there are several
functional aspects to the diverse IDHS organization. One high-profile
area, especially during times of emergency or disaster, is led by the
emergency response and recovery division, which monitors situations
around the State and provides coordination of Indiana's considerable
resources to assist whenever and wherever needed.
To coordinate Indiana's significant resources, we have a State
Emergency Operations Center (EOC) that is staffed 24 hours a day each
day of the year. The EOC serves not only as a communications hub for
on-going public safety coordination throughout the State, but also as a
command-and-control center during large-scale disasters where all
necessary parties are represented with their respective emergency
support function (ESF) linkage. ESF functions include both Governmental
and private representatives.
The EOC facility has been recently toured by responders from other
States and countries, including representatives from the Australian
Consulate in Chicago, and public safety professionals from Great
Britain, Israel, and South Korea.
disaster recovery
Long after the immediate response by emergency workers, the work of
recovery for a community can be daunting. Homes and businesses may be
affected; and, completing damage assessments is an incredibly important
process. Once again, this necessitates careful coordination among
Federal, State, and local authorities. These assessments are crucial to
determining eligibility for individual and public assistance from FEMA.
We have learned that local emergency managers need assistance from
the State to properly understand and administer the assessment for
damaged property. Chairman Brooks, you saw, first-hand as you toured
flood-ravaged areas in April of this year, how many of your
constituents suffered property loss, both individually and as part of
their community infrastructure. As devastating as it was, the millions
of dollars of loss did not qualify for Federal assistance. In recent
years, the threshold to qualify for Federal disaster aid has steadily
increased. Indiana must increasingly shoulder more of the financial
burden for our residents. Fortunately, the Indiana General Assembly
anticipated this and established a State Disaster Relief Fund (SDRF)
which provides for limited financial assistance to individuals and
communities under certain conditions. As a result of the April 2013
flooding, Governor Pence declared an emergency for affected counties
and the residents and communities were eligible to apply for SDRF
compensation. Disbursements for the 2013 central Indiana flooding will
be the largest ever awarded for disaster relief using the SDRF.
An integral aspect of response and recovery is mitigation, which
seeks to reduce or eliminate threats and risks of known hazards.
Recovery and mitigation efforts go hand-in-hand with one another.
Recovery operations evaluate damage that resulted from a disaster, and
determine next steps to assist individuals. From that and other
assessments, our mitigation efforts are born. By understanding the
potential damage in a given disaster, we can better prepare for them
and work to find ways to reduce or even eliminate risks associated with
them. The Indiana Standard Hazard Mitigation Plan and Hazard Mitigation
Grant Program provide a base and framework for mitigation efforts.
training and exercise
Training and participation in simulated exercises is another key
component to the IDHS' ability to coordinate the State's disaster
preparedness. Exercises can range from seminars and drills, to full-
scale exercises involving hundreds of individuals from many areas of
the State. In fact, IDHS has organized exercises that have included
multiple States, and even observers from foreign countries. In the last
3 years, IDHS has organized the training of more than 37,000 responders
in classes that have connections to mass casualty, weapons of mass
destruction, and CBRNE (chemical, biological, radiological, nuclear,
explosive).
The Muscatatuck Urban Training Center is a highly-regarded training
complex that provides unique learning situations, and is in our own
backyard. Having the ability to configure buildings or collapsed
structures into real-life scenarios with role players not only improves
the training environment, but also provides emergency responders with
vital experience that exceeds a traditional classroom training
environment.
During one recent full-scale exercise, we had an international
visitor in emergency management indicate he had never seen a facility
like Muscatatuck in his considerable experience. The facility is used
by emergency responders from around the world and includes military and
civilian role players. Indiana is remarkably poised to not only better
equip our responders but to also encourage regional and National
training activities that are essential when faced with large-scale
disasters such as an earthquake or WMD event. Even as we are now having
this hearing, nearly 7,000 members of the U.S. military from NORTHCOM
are engaged with local responders at the Muscatatuck venue in an
exercise called Vibrant Response. Next week, Ohio authorities will
deploy 150 responders and officials to coordinate a simulated WMD
attack. Members of IDHS will be observing the exercise to learn how to
adapt and apply our plans to different emergencies that may arise, and
to better coordinate regional response that would be required should
central Indiana experience a mass casualty event. I have directed our
staff to fully participate in the Vibrant Response exercise in 2014 and
2015.
During my experience in working on Hurricane Katrina relief in 2005
and coordinating numerous activities with the U.S. military active
duty, reserve, and National Guard forces, I saw how critical it is to
understand not only the resources and capability that active-duty
forces bring to large-scale disasters, but also how coordination must
be carefully integrated with civilian authorities for maximum
effectiveness.
A variety of training sessions are used to supplement exercises.
These sessions can range from search-and-rescue and emergency medical
services training, to hazardous materials (HAZMAT), radiological
emergency, and terrorism and weapons of mass destruction (WMD)
training. Our first responders have a wide array of learning tools
available. Regular interaction and coordination within the public
safety community, along with extensive training utilizing the National
Incident Management System (NIMS), contributes to our State's response
to emergency situations. For example, just in the past month, I
authorized more than a dozen of our local responders to travel to wild
fires in Alaska and California to better provide them with training to
understand their importance in coordinating disaster response and
organizing resources for appropriate deployment, all the while working
within the NIMS framework. It is worthwhile to reiterate that the
availability of Federal training grant dollars, State coordination, and
local participation makes such shadowing/learning opportunities
possible. Indiana is committed to an integrated approach in support to
our local community emergency managers and responders.
strategies and tactical plans
Planning is another important aspect to IDHS. The planning division
is charged with establishing the strategies and tactical plans used
throughout the State for emergency management, but it also includes
multiple disciplines, including the State-level agencies of the Indiana
State Department of Health, Indiana State Police, Indiana National
Guard, Indiana Department of Transportation, Indiana Department of
Correction, and Indiana Department of Environmental Management; local
agencies including fire, law enforcement, emergency management,
emergency medical service, and more; and Federal agencies, such as U.S.
Department of Homeland Security, Federal Emergency Management Agency,
U.S. Department of Energy, and the Federal Bureau of Investigation.
IDHS has actively participated in the preparation, review, and
publication of more than 50 plans or annexes to prepare for a variety
of emergencies. Such plans require regular updates and validation. Our
planning division is required to not only develop comprehensive
emergency plans but must engage in the training and exercise of plans
to ensure what is intended is being achieved.
grants support local and state agencies
Another important function within the IDHS Planning Division is
grant management. Grant management works to effectively administer
funding to local communities as provided either from the State or the
Federal Government. These funds provided to IDHS are distributed
throughout the State for training, exercise, equipment, and personnel.
In 2012, more than $11 million in grant funding was awarded. More than
$7.3 million of that total, or about 64.3%, went to locals, which
includes support to county emergency management agencies, by paying
half of the cost of directors and, in the counties where there are
additional staff, 50% of the cost of assistant directors and support
staff is reimbursed. More than $4 million, 35.7%, went elsewhere in the
State. Even money that goes to the State is used to benefit and provide
for locals. Currently 43 IDHS employees are grant-funded, for a total
of more than $2.7 million annually. The majority of these positions
directly support training, exercise, planning, and emergency response
and recovery. Their work is ultimately for the benefit of local
emergency response efforts.
IDHS receives funding from four main Federal grants: The Homeland
Security Grant Program (broken into the State Homeland Security Program
and the Urban Areas Security Initiative), Emergency Management
Performance Grant, Nonprofit Security Grant Program, and Hazardous
Materials Emergency Preparedness Grant Program.
The Homeland Security Grant Program (HSGP) plays an important role
in the implementation of the National Preparedness System (NPS) by
supporting the building, sustainment, and delivery of core capabilities
essential to achieving the National Preparedness Goal (NPG) of a secure
and resilient Nation. Delivering core capabilities requires the
combined effort of the whole community, rather than the exclusive
effort of any single organization or level of Government. This grant
provides planning, equipment, training, exercise, and management and
administrative funding to emergency prevention and preparedness to the
State of Indiana. This funding has been used to support our district
task forces. We are in the process of evaluating the 2014 HSGP grant
funding proposals and will align any approved requests with the agency
strategic plan and Governor Pence's Roadmap for Indiana.
The purpose of the Emergency Management Performance Grant (EMPG)
Program is to assist State, local, territorial, and Tribal governments
in preparing for all hazards. Title VI of the Stafford Act authorizes
FEMA to make grants for the purpose of providing a system of emergency
preparedness for the protection of life and property in the United
States from hazards and to vest responsibility for emergency
preparedness jointly in the Federal Government, States, and their
political subdivisions. The Federal Government, through the EMPG
Program, provides necessary direction, coordination, and guidance, and
provides necessary assistance, as authorized in this title, so that a
comprehensive emergency preparedness system exists at all levels for
all hazards. We use the EMPG primarily to support county emergency
managers.
The Nonprofit Security Grant Program (NSGP) provides funding
support for target-hardening activities to nonprofit organizations that
are at high risk of a terrorist attack and are located within one of
the specific UASI (Urban Areas Security Initiative)-eligible urban
areas.
The Hazardous Materials Emergency Preparedness (HMEP) grant program
is intended to provide financial and technical assistance as well as
direction and guidance to enhance State and local hazardous materials
emergency planning and training. The HMEP Grant Program distributes
fees collected from shippers and carriers of hazardous materials to
emergency responders for HAZMAT training and to Local Emergency
Planning Committees (LEPCs) for HAZMAT planning. IDHS uses this grant
to advance our CBRNE training and risk prevention efforts.
A breakdown of these grants since 2010 is as follows.
----------------------------------------------------------------------------------------------------------------
2010 2011 2012 2013
----------------------------------------------------------------------------------------------------------------
HSGP--SHSP...................................... $11,326,441 $5,663,221 $2,801,316 $3,459,364
HSGP--UASI...................................... 7,104,700 0 1,250,000 0
EMPG............................................ 6,562,747 6,529,870 6,749,053 6,592,684
NSGP............................................ 0 0 28,161 0
HMEP............................................ 512,532 512,532 537,270 536,745
---------------------------------------------------------------
TOTAL..................................... 25,506,420 12,705,623 11,365,800 10,588,793
$ CHANGE (prev. year)........................... .............. -12,800,797 -1,339,823 -777,077
% CHANGE (prev. year)........................... .............. -50.18% -10.54% -6.83%
----------------------------------------------------------------------------------------------------------------
fire and building safety
Also under IDHS's organizational umbrella is the State Fire
Marshal, who leads IDHS's fire and building safety. This includes
commercial building construction plan review, general building
inspection, and specific responsibility for the compliance of elevators
and boiler and pressure vessels. Inspections also occur for annual
festivals, fairs, and other entertainment venues, including amusement
rides. Arson investigators are also placed throughout the State to
assist with local fire investigations when help is requested.
IDHS' certification branch administers the licenses for
firefighters, emergency medical services personnel, and conducts
ambulance inspections.
mass casualty response
The agency provides assistance with State-wide HAZMAT and CBRNE
response and expertise. Many local communities have highly-qualified
HAZMAT responders and central Indiana is fortunate to have considerable
expertise when needed. Having capabilities such as CBRNE will be
crucial during a mass casualty incident as a result of either an
accident or terrorist attack.
With volunteers from a variety of groups in the medical, mental
health, and funeral director communities, the Indiana Disaster Portable
Mortuary Unit (DPMU) is maintained by IDHS and is designed to relieve
overwhelmed morgues where a disaster has occurred. It has all of the
necessary tools which are required during such a mass casualty.
Another organization crucial to the State's planning and response
is the Office of Faith-Based and Community Initiatives (OFBCI). OFBCI
works to link organizations to those in need by using grants and
services. It advocates for volunteerism, including faith-based
initiatives which make a difference in the community both before and
after a crisis has endangered a community. The OFBCI offers support for
Emergency Support Function 14, Long-Term Community Recovery. It also
works with the Indiana Voluntary Organizations Active in Disaster
(VOAD) team to provide support and relief in the aftermath of disaster
situations. The combination of these two organizations assisted in
harnessing the power of volunteers just last year when devastating
tornadoes ripped numerous Indiana communities. Their efforts resulted
in substantially lower costs, saving millions of dollars for those
affected by the Southern Indiana tornado event recovery in 2012. Debris
removal was an excellent example with not only volunteers, but
strategic use of other State resources.
Several of these aspects come into play when working to increase
our preparedness for a mass casualty incident. Over the past 5 years,
nearly $1.2 million in grant funding has been allocated toward
preparedness, specifically for CBRNE or WMD events. From that, more
than $850,000 has assisted central Indiana. This support provides
equipment to our first responders, vehicles to aid in response and
recovery, and training classes and conferences for added education.
Chairman Brooks has properly identified the importance of focusing
also on events that could result from terrorist activity or a
consequence of man-made events. The recent tragic bombing during the
Boston Marathon illustrates the need for integration and coordination
among intelligence gatherers, fusion center analysts, law enforcement
agencies, and local responders. Following the Boston bombing, Indiana
adapted planning efforts for the events in central Indiana such as the
Indianapolis 500 Festival Parade and 500 Mile Race. Traffic was
diverted from critical infrastructure, screening techniques were
employed that clearly elevated detection protocols and heightened
intelligence activities all combined to improve threat identification
and risk management at one of the country's largest sporting events.
Our on-going preparedness is on three levels: Federal, State, and
local. At the Federal level, we work with military and non-military
entities to enhance safety efforts, train, exercise, and plan.
Groups like FEMA and the FBI offer resources to aid in our
preparation. FEMA Region V has been responsive to the needs of the
State, especially during times of emergency. The FBI is a teammate of
ours in CBRNE response and radiation training. The FBI also holds an
annual conference on WMDs, which IDHS promotes and attends. IDHS
recently held a comprehensive planning exercise involving policy
leaders from IDHS, ISDH, Indiana Board of Animal Health, Indiana
Department of Transportation, Indiana State Police, Indiana State
Department of Agriculture, State Chemist, Department of Natural
Resources, Utility Regulatory Commission and Indiana National Guard's
53rd Civil Support Team to simulate an ingestion pathway from nuclear
reactor radiation release and how it could affect Indiana residents and
businesses. We also have established close relationships with the
Nuclear Regulatory Commission and the Department of Energy to better
prepare for and understand these lead Federal agencies' role in a
nuclear disaster.
State partners, including the Indiana State Department of Health,
Indiana Department of Transportation, and Indiana National Guard
regularly complement and enhance IDHS' work. We not only prepare for
events in the future, but also strive to secure the everyday safety of
our citizens.
local agencies: key to indiana's efforts
Local partners are really the backbone of Indiana's efforts. When
an emergency or disaster occurs, local agencies and responders are the
first to experience the event and they are best equipped and trained to
handle the situation. Just over a week ago, Indianapolis witnessed a
horrific mass casualty event with an overturned bus returning from a
week of church camp. Tragically, four individuals lost their lives but
a rapid and professional response by numerous fire and emergency
medical personnel treated or transported over 30 injured passengers,
several hospital staffs coordinated the treatment of the injured and
law enforcement continues to conduct an in-depth analysis of the
crash's cause. The response by professional local responders was an
example of how well they have prepared for tragedy when our communities
are affected.
The Indiana State Department of Health (ISDH) and Red Cross also
perform active roles in aiding our initiatives and furthering the
overall emergency preparedness of our State. The IDHS and ISDH began
the development of the Indiana Disaster Medical System, intended to
provide a structure and protocols for the State to support local mass
casualty response. In support of the Indiana Disaster Medical System,
the ISDH is in the process of procuring a 50-bed mobile hospital to
provide a medical facility for communities suffering from disasters and
an operating location for medical and non-medical volunteers. The ISDH
has also developed the Advance Medical Supply Unit, which contains the
most common types of supplies that medical personnel on the ground may
need during mass casualty response. The ISDH has also nearly completed
development of the new volunteer management system, SERV-IN, which will
be utilized to better manage both medical and non-medical volunteers.
The Red Cross has several internal training courses for their
volunteers, which closely reflect the training provided by IDHS. These
courses provide information on the effects of weapons of mass
destruction and terrorism, CBRNE events, and mental health
considerations during a WMD or terrorist event. This training makes Red
Cross an important partner during times of emergency. Volunteers are
necessary in a variety of roles during mass casualties and perhaps even
more importantly, in providing long-term care and support for those
visibly injured and others who are mentally traumatized.
IDHS, along with its partner organizations, casts a wide net over
the State of Indiana. By coordinating activities and initiatives with
Federal, State, and local partners, IDHS is working diligently every
day for Indiana.
conclusion
In closing, I would like to thank Chairman Brooks, Ranking Member
Payne, Members of the Indiana Congressional delegation in attendance,
and the Members of the subcommittee for calling this hearing today. The
issues discussed here are vital to the lives not just of Hoosiers, but
to all Americans. I am proud to work every day to provide for the needs
of the State, and the safety of our citizens. I am committed to working
with the committee and our public safety partners to promote a safer,
more secure State for all.
Mrs. Brooks. Thank you, Mr. Hill.
The Chairwoman now recognizes Ms. Mack to testify.
STATEMENT OF DIANE MACK, UNIVERSITY DIRECTOR, EMERGENCY
MANAGEMENT AND CONTINUITY, INDIANA UNIVERSITY
Ms. Mack. Good morning, Chairwoman Brooks. I appreciate
this opportunity to work with you again. Senator, Congressman,
and Congresswoman, thank you also for the opportunity to share
with you a university perspective.
I represent the Office of Emergency Management and
Continuity with Indiana University. IU has eight campuses
within Indiana across a distance of 300 miles and with
approximately 150,000 students, faculty, and staff. We also
have centers in Wisconsin, Montana, and Kenya, and 6,000 world-
wide travelers each year. We abide by National voluntary
emergency management standards and comply with Federal
regulations, most notably the Higher Education Opportunity Act
and the Clery Act.
The Clery Act, while noble in its intent, is focused on
after-the-fact data accounting. While IU abides by such
regulations, our priority is on prevention, mitigation, and
preparedness to reduce the need for response and recovery.
In my office, the emergency management directors have
somewhat different roles than local emergency managers. We are
not just coordinators but rather we are expected to be in
command of our largest incidents. We expand our own knowledge
base through integration with other teams such as the FEMA
Search and Rescue Indiana Task Force 1 and the State Incident
Management Assistance Team.
We have responded in command and general staff positions to
the Henryville, Indiana EF-4 tornado, which covered 71 square
miles, and to Hurricane Sandy on Long Beach Island, New York.
We brought those lessons learned back to IU and applied them.
The university environment offers unique challenges in
addition to the age-old question of how to get teenagers to pay
attention to anything. We conduct camps for access and
functional needs children and support camps for children of all
ages during the summers. We face increasing active-shooter
threats, have thousands of laboratories, including 900 in
Indianapolis alone, have experienced devastation due to
flooding, and most campuses of all universities in Indiana host
major events.
For IU, in addition to our 60,000-person football venue, we
host international swimming, diving, and track events,
concerts, the Nation's largest half-marathon at IUPY in
Indianapolis, and the Little 500 at IU in Bloomington. This
year, the Komen Race for the Cure and Little 500 happened on
the same day, and both occurred less than a week after the
Boston Marathon bombings.
With so many events of significant size, preparations for
mass fatality and mass casualty incidents is forefront. Two
weeks ago I presented on mass fatality and mass casualty
incidents at the National Sports Safety and Security
Conference. My focus in these efforts is to expand the
traditional mindset of game-day operations and to the ``what-
if'' scenarios. We need to instill a sense of advanced planning
and complete synchronization of public safety and event
management in advance of a major incident. We need to have a
standardized common operating picture for all responders and
events management and ensure adequate plans, training, and
exercises in advance. We have integrated this approach into IU
football and are expanding to other events and campuses as
well.
In early June of this year, IU provided the Incident
Management Team and served in unified command with the
Bloomington Fire Department for a three-site search and rescue
exercise that was spearheaded by the Indiana National Guard and
Israeli Defense Forces. The lessons learned from this exercise
cannot be replicated in a classroom or with any amount of
equipment.
For prevention of a mass casualty incident, equipment
becomes key. But for the response to a mass casualty incident,
the true ability to manage the situation lies not with the
equipment but with the ability of the responders to mentally
grasp the situation, adapt and be flexible, and work within a
larger organizational structure than most have ever faced. The
incident management perspective of command of the whole
incident, which consists primarily of coordination of all
resources and the setting of joint priorities rather than
maintaining control of individual department resources, is
paramount. These organizational and individual capabilities are
honed through rigorous training and exercises that build on
all-hazards plans.
In advance of disasters, IU coordinates extensively with
local, State, and National organizations. IU has excellent
cooperation with law enforcement for active-shooter exercises,
and we depend on local fire departments for day-to-day
responses. We continue to work with these departments
surrounding all IU campuses on the integration with IU's team,
response teams, and command capabilities. IU has built incident
management teams on each campus and a system-wide IM team. As a
wholly-encompassed institution rather than individually-managed
departments, IU has uniquely sustainable team capabilities, and
we focus existing knowledge areas into incident command system
roles. For example, purchasing becomes logistics. All faculty,
staff, and students have a role in a disaster.
In terms of funding for preparedness, IU is confronted with
the funding quandary that exists for homeland security grants.
IU is a quasi-State entity, which means that we are eligible
for the State portion of homeland security funding. However,
very little State funding is available, and local funding is
not available directly for universities.
We have been fortunate in our achievement of two emergency
management for higher education grants over 5 years, but that
funding stream is no longer available. Such funding, with
refocused guidelines, would be helpful for universities,
especially in regard to preparedness for other major incidents.
In summary, universities are progressing in their planning
for mass casualty and mass fatality incidents, and increased
local coordination of Federal funding would assist progress.
The incident command system works well for all jurisdictions--
Federal, State, local, Tribal, and universities--not just for
incidents but also for major events; and all-hazards advance
planning, including the ``what-if'' visionary components, will
increase the efficiency and effectiveness of any response.
I appreciate the opportunity to present this testimony and
will answer any questions at the appropriate time. Thank you.
[The prepared statement of Ms. Mack follows:]
Prepared Statement of Diane Mack
August 6, 2013
Good morning Congresswoman Brooks, I appreciate this opportunity to
work with you again. Senator, Congressman, and Congresswoman, thank you
also for the opportunity to share with you a university perspective.
I represent the Office of Emergency Management and Continuity with
Indiana University. IU has eight campuses within Indiana, across a
distance of 300 miles, and with approximately 150,000 students,
faculty, and staff. We also have centers in Wisconsin and Montana, and
6,000 world-wide travelers each year. We abide by National voluntary
emergency management standards, and comply with Federal regulations,
most notably the Higher Education Opportunity Act and the Clery Act.
The Clery Act, while noble in its intent, is focused on after-the-fact
data accounting, and while IU abides by such regulations, our priority
is on prevention, mitigation, and preparedness, to reduce the need for
responses and recovery.
In my office, our Emergency Management Directors have somewhat
different roles than local emergency managers. We are not just
coordinators, but rather, we are expected to be in command of our
largest incidents. We expand our own knowledge base through integration
with other teams such as the FEMA Search and Rescue Indiana Task Force
One, and the State Incident Management Assistance Team. We have
responded in command and general staff positions to the Henryville,
Indiana EF-4 tornado, which covered 71 square miles, and to Hurricane
Sandy on Long Beach Island, New York. We brought those lessons learned
back to IU and applied them.
The university environment offers unique challenges in addition to
the age-old question of how to get teenagers to pay attention to
ANYTHING. We conduct camps for access and functional needs children and
sport camps for children of all ages during the summers. We face
increasing active-shooter threats, have thousands of laboratories,
including 900 in Indianapolis alone, have experienced devastation due
to flooding, and most campuses of all Indiana universities host major
events. For IU, in addition to our 60,000-person football venue, we
host international swimming, diving, and track events, concerts, the
Nation's largest half-marathon at IUPUI in Indianapolis, and the Little
500 at IU in Bloomington. This year, the Komen Race for the Cure and
Little 500 happened on the same day, and both occurred less than a week
after the Boston Marathon bombings.
With so many events of significant size, preparations for mass
fatality and mass casualty incidents is forefront. Two weeks ago, I
presented on Mass Fatality/Mass Casualty incidents at the National
Sport Safety and Security Conference. My focus in these efforts is to
expand the traditional mindset of game-day operations into the ``what-
if'' scenarios. We need to instill a sense of advance planning and
complete synchronization of public safety and event management in
advance of a major incident. We need to have a standardized common
operating picture for ALL responders and event management, and ensure
adequate plans, training, and exercises in advance. We have integrated
this approach into IU football and are expanding to other events and
campuses as well.
In early June of this year, IU provided the Incident Management
Team and served in unified command with the Bloomington Fire Department
for a three-site search-and-rescue exercise that was spearheaded by the
Indiana National Guard and the Israeli Defense Forces.
The lessons learned from this exercise cannot be replicated in a
classroom or with any amount of equipment. For prevention of a mass
casualty incident, equipment becomes key. But for the response to a
mass casualty incident, the true ability to manage the situation lies
not with the equipment, but with the ability of the responders to
mentally grasp the situation, adapt and be flexible, and work within a
larger organizational structure than most have ever faced. The incident
management perspective of command of the whole incident, which consists
primarily of COORDINATION of all resources and the setting of JOINT
priorities rather than maintaining control of individual department
resources is paramount. These organizational and individual
capabilities are honed through rigorous training and exercises that
build on all-hazards plans.
In advance of disasters, IU coordinates extensively with local,
State, and National organizations. IU has excellent cooperation with
law enforcement for active-shooter exercises, and we depend on local
fire departments for day-to-day responses. We continue to work with
these departments surrounding all IU campuses on the integration with
IU's response team and command capabilities.
IU has built incident management teams on each campus, and a
system-wide IMT. As a wholly-encompassed institution, rather than
individually-managed departments, IU has uniquely sustainable team
capabilities, and we focus existing knowledge areas into incident
command system roles. For example, Purchasing becomes Logistics. All
faculty, staff, and students have a role in a disaster.
In terms of funding for preparedness, IU is confronted with a
funding quandary that exists for homeland security grants. IU is a
quasi-State entity, which means that we are eligible for the State
portion of homeland security funding. However, very little State
funding is available, and local funding is not available directly for
universities. We have been fortunate in our achievement of two
Emergency Management for Higher Education (EMHE) grants over 5 years,
but that funding stream is no longer available. Such funding, with
refocused guidelines, would be helpful for universities, especially in
regard to preparedness for CBRNE and other major incidents.
In summary, universities are progressing in their planning for mass
casualty/mass fatality incidents, and increased local coordination and
Federal funding would assist progress. The Incident Command System
works well for all jurisdictions--Federal, State, local, Tribal, AND
universities--not just for incidents but also for major events, and
all-hazards advance planning--including the ``what-if'', visionary
components--will increase the efficiency and effectiveness of any
response.
I appreciate the opportunity to present this testimony, and will
answer any questions at the appropriate time. Thank you.
Mrs. Brooks. Thank you, Ms. Mack.
While typically the Chairwoman would recognize themselves
for 5 minutes of questioning, it has come to my attention that
Congressman Young, which is not uncommon in Congressional
hearings as well, has to be other places. So I will defer my
questioning to Congressman Young from Indiana.
Mr. Young. Thank you so much, Madam Chairwoman. I really
appreciate it. Sorry I can't be with everyone longer today.
I want to start with a question. Try to limit your response
to 1 minute each. Just very quickly, Chief Orusa, Sheriff
Bowen, and Director Mack, you each indicated the importance of
being properly resourced to fulfill your training mission and
for other purposes, to make sure you are fully prepared for a
mass casualty event.
I want to know how do you measure the effectiveness of
dollars spent? Of course, one metric might be the number of
hours trained. Another might be conceivably the skill sets of
individuals within your purview. Each of you take a turn at
this so that we can assess as policymakers whether or not these
monies are being spent and how they need to be spent.
Sheriff Bowen. Well, obviously, that is a difficult
question to answer and one that we hope we never have to
answer. Certainly, it is important that we have the resources
in play and that we have the training and those components in
play to be able to deal with a hazard. But until we are
actually tested, as Chief Orusa stated, we can block and tackle
all day long, but until we are truly tested in an event, we
really don't know what our true capabilities will be and
whether our infrastructure will match up to what the needs of
that specific event are.
So while I would like to say that we have tested that
equipment and that training in a real-life scenario, I am proud
to say that we have not had to do that and hopefully will not
have to.
Mr. Young. Right.
Chief Orusa. The Homeland Security Exercise and Evaluation
Program is an excellent program, and it focuses on gap
analysis, core capabilities, and improvement plans. So that
tactical task-level section is addressed.
Also, our training budgets through the State Homeland
Security Program have very rigid budget requirements that we
have to submit. So not only is there oversight financially,
there is oversight from a core capability and improvement
standpoint.
Mr. Young. Thank you.
Ms. Mack.
Ms. Mack. I would also agree with the Homeland Security
Exercise Evaluation Program. Coming up with objective criteria
for measurement of such things is going to be very difficult.
But we did demonstrate at this past year if the State had not
provided the funding, if the homeland security funding had not
come through and been applied to the Muscatatuck exercises,
which allowed us to expand our capabilities and be able to
manage that in an exercise environment, we would have had a
much more difficult time for the Henryville tornado and also in
Long Beach, New York. It was very clear that the people who
worked at those exercises, those large State-level and
National-level exercises, were much more prepared.
Mr. Young. It can be very difficult. I know it is an
imprecise science, trying to measure a low-risk, high-impact
sort of event, and that is what we are dealing with here. It is
hard to assess probabilities. But nonetheless, we do have the
gap analysis, and an independent study has been commissioned,
Director Hill, you indicated, to assess emergency preparedness
and assess overall capabilities of our entire State operation.
You indicate you are still reviewing that report, but within
the next month or so we can expect to see implementation of
some of the findings.
Could you share with us some of the initial gaps identified
within that report, sir?
Mr. Hill. Sure.
Mr. Young. Thank you.
Mr. Hill. I appreciate the question, and I can understand
that there is a lot of sensitivity to this because it is not
intended really to replace what we have been doing. There has
been a lot of tremendous work done in the last few years
regarding the State of Indiana.
I would say to you that one of the biggest gaps is making
sure that we have integrated at the local level planning
capability, not just at the State level. By that I mean do
people at the Emergency Management Agency level in each county
have resources that help them do planning, based upon what
Chief Orusa said, in terms of threats, hazards, identification,
risk analysis, the THIRA.
One of our goals this year is to really get out into those
local communities as a part of that and identify those risks at
the local level, not just what Indianapolis thinks but what do
the local communities identify as their risk? That is going to
be critically important in doing that.
In regard to the cost savings, Representative Young, I
would just say to you that one of the things that we do to
measure cost-effectiveness, in the Henryville tornadoes, FEMA
actually assessed the damage, and they estimated debris removal
at $40 million. Due to the resources, the tremendous work that
was done with local agencies, Department of Corrections, not-
for-profit groups, we actually ended up with a bill of about
$11 million. So that is one big cost analysis that we were able
to do on the mitigation side after preparedness.
Mr. Young. Thank you for your encouraging responses, and I
yield back.
Mrs. Brooks. I thank you, the gentleman from Bloomington. I
really appreciate your participation in this panel today. I
welcome you back to your hometown of Carmel and just really
appreciate the interest that you have shown in ensuring that
our first responders and our medical professionals have the
resources that they need, and I just want to thank you for
being here today.
At this time, I would ask the gentleman from Granger,
Indiana for any questions he might have.
Senator Donnelly. Thank you, Madam Chairwoman. To all of
you, thank you for your service, and to all the first
responders.
Sheriff Bowen, you had mentioned that Central Indiana first
responders work off of different communications systems, and I
was wondering if there is any effort now to try and be on the
same system, and what issues this causes when an event occurs?
Sheriff Bowen. Well, there are issues when an event occurs.
Obviously, being on different communications systems causes
breakdowns. Hamilton County is looking at moving forward with
their communications technology to a P-25 platform, which is
the state-of-the-art National recommended communications
network. So we are moving in that direction. That will allow
interoperability with the City of Indianapolis and other
regions.
So it is critical that communications are functioning at a
high level. Any time that you are involved in a mass casualty
incident, bringing folks together from other regions that have
different types of communications systems, it is challenging.
So there are things that can be done to network those systems
together, but obviously it takes time and expertise.
Senator Donnelly. Right. Are there any efforts or
discussions going on to get everybody together as they go
forward with communications purchases, for instance, with other
sheriffs' offices or other counties or other cities, to see if
we can all get on the same platform?
Sheriff Bowen. There is certainly a move towards that. The
State is working towards the P-25 system. Obviously, funding is
a critical component to any communications network. It is very
technical and very expensive, and the funding component is
really the roadblock as we move forward.
Senator Donnelly. Okay.
Chief Orusa, thank you for your service. You come from a
very fast-growing place. All you have to do is drive in in the
morning to find that out.
[Laughter.]
Senator Donnelly. As you look at the challenges you have,
how do you keep up with the businesses coming in, knowing what
is in place in those businesses, in the subdivisions that are
going in, in the various plants that are in Fishers? How do you
make sure that you know what is going on there, and what
requirements you have, and how do you cope with the growth that
you are dealing with?
Chief Orusa. Any challenges for us--and growth is well-
stated as one of them--the foundation of the organization and
the operational philosophy and leadership philosophy is really
that any challenge, whether it is growth, whether it is
disaster, whether it is laying off fire fighters, whether it is
no pay raises, has to do with our values and our mission.
Through collaboration with all the people in our organization,
we did a values audit and we re-wrote our values and our
mission statement, and we adopted a certain leadership
philosophy which means there is no more leadership out of self-
promotion, pride, or self-protection, fear. It is service-
driven, out of a dedication to a cause or relationship.
So it starts with that, and then the next step is putting
the best and brightest in our organization together to
collaborate, to have a vision that anticipates the growth and
identifies and defines what the challenges are, and then
getting support from our policymakers financially to try to get
ahead of that growth.
Senator Donnelly. How do you get word, for instance, if a
company is coming in to handle these particular chemicals or
these particular things? How do you find that out?
Chief Orusa. We have a fire prevention bureau, and we have
an EMA director that works closely with our department head in
economic development and business development. So right away,
we are in the decision-making process. When that happens, we
can identify that as a target hazard before it is built,
identify and define any risks, and then try to prevent and
mitigate those risks before they become----
Senator Donnelly. Okay.
Mr. Hill, we are a proud agricultural State that does an
extraordinary job, and obviously a lot of fertilizer and
related products are handled in our State as well. I was just
wondering what the procedures are for those facilities that
store fertilizer, that make fertilizer, what inspections are
planned and what rules you have regarding that.
Mr. Hill. Well, Senator, there is something called the
Community Right to Know, and basically what it amounts to is
any facility that has those kind of chemicals are required to
report those various storage capacity and quantities on-hand to
the State Department of Environmental Management.
Senator Donnelly. Do you have an inspection plan that you
work together with these locations to make sure--or, in effect,
I think it is helpful to them to know, hey, here is how we
would like you to handle these products?
Mr. Hill. Yes. We are required to go out and inspect those
sites, and just this year after the West, Texas event, I was
very concerned about it and asked the fire marshal to come in
and have a discussion with me, and we used a GIS application to
identify any facility that stored fertilizers within 500 meters
of any school, hospital, community gathering-place, and then we
went out and personally inspected those facilities immediately
to make sure we knew what was in the building, to confirm what
they had reported was accurate; and then second, to make sure
that they were, in fact, following fire building code safety.
So those kind of processes are in place. There are a lot of
facilities. We have an annual inspection where we go around and
inspect them. We work with the State chemist, who is based out
of Purdue University, and we also work with him very closely.
Senator Donnelly. Very good. Thank you.
I think I am out of time.
Mrs. Brooks. Thank you.
I must say, I attended the hearing on West, Texas and saw
the diagram of that fertilizer plant explosion, and it was in
very close proximity to a school and an apartment complex, and
so there was incredible damage.
At this time, I would ask the gentlelady from Jimtown for
any questions she might have.
Mrs. Walorski. Thank you, Madam Chairwoman.
I think I have to address my remarks to Mr. Velasquez since
we are talking also about Northern Indiana, and to Mr. Hill.
Again, thanks for all of you being here.
But I want to go back to the question that Senator Donnelly
asked because I think it is applicable, especially in places
like Northern Indiana, where it is a very diverse area where we
have significant athletic--the University of Notre Dame--
activity just about every weekend in the fall, but also
surrounded by rural areas. In many cases, there are fire
territories and fire districts.
I am just wondering, I guess, Mr. Velasquez, from the
position of our proximity even to Chicago, closer to Chicago
than we are to Indianapolis, does that present a different set
of circumstances? If so, how is the communication handled
between local, State, and Federal in the event of, say, an
attack on Chicago? When the communication systems go down, what
do you do in rural areas?
Mr. Velasquez. That is a great question. I appreciate that.
I will say that, obviously, as Director Hill mentioned, what is
critically important as it relates to planning for whatever
hazards may befall us is that integrated approach to emergency
planning. That is one of the things that we have taken on at
FEMA Region V as a priority, making sure that as we plan for
whatever events may affect us, whether they are natural or
whether they are on the terrorism side, to ensure that everyone
is coming to the table from an integrated perspective to plan
for those events. That is the only way that you can better
understand capabilities and what people can bring to the table.
I will mention one of the areas that we focused our
attention on in the region and really embraced planning for is
improvised nuclear devices and an improvised nuclear device
detonation in a large metropolitan area. We have basically
spearheaded one of the most comprehensive planning initiatives
to confront this type of threat, and I can tell you that
Indiana has been at the table with us with regard to that
planning effort.
We have partnered with the counties, the northern counties.
In Indiana, folks have attended a number of our meetings to
discuss the impacts of an event of this magnitude, the primary,
secondary, tertiary effects of this type of an event, what
evacuation would look like, what are those types of needs, what
are the capabilities, how we can provide funding support
through FEMA's public assistance program in terms of how we
would provide funding for host States in an evacuation-type of
a circumstance, how we would communicate, what would that mean,
the wind speed, direction, plume, time, shielding. All of those
factors play a role in our decision-making process, how we
would communicate that.
So I can assure you that we have taken on, as Director Hill
has mentioned, a very integrated approach to planning, making
sure that as we plan for whatever events may befall us, we are
bringing everybody to the table to ensure that we have an
effective and a coordinated response to an event.
Mrs. Walorski. I appreciate it.
Mr. Hill, what do we do in rural areas with volunteer fire
departments in districts and territories?
Mr. Hill. Volunteer fire departments are very important, as
you know. Seventy percent geographically of our State is served
by volunteer fire departments. One of the things that Governor
Pence has asked me to do through our staff is to look at the
feasibility of a State-wide Fire Academy. So he has dedicated
funding in his budget. As you know, this was a pretty tight
year. So we are going to be looking at, how do we improve fire
service in the rural areas?
I have been in contact with members of Noble County just
recently and I learned that they have plenty of equipment, but
they are having trouble staffing some of that equipment during
the daytime because people are working. That is a very real
issue that we have to address.
To answer your question, we work regularly with them
through our Fire Marshal's Office, but I also want you to know
that I went around and visited every one of the 10 districts
after assuming office, and I will be going around to those 10
districts again after we get done with this assessment, talking
through this.
But there is tremendous capacity that has been built up
both equipment-wise and organizationally in our 10 homeland
security districts that make local response viable, as opposed
to somebody coming in from Indianapolis and helping them.
Mrs. Walorski. I appreciate it.
Mr. Velasquez, just one quick question. So are we victims
in Region V? Has sequestration taken resources that we need in
Region V?
Mr. Velasquez. We have done a good job of leveraging our
resources, our capabilities. We have taken a very regional
approach to leveraging resources. So I think we are doing a
pretty decent job and making sure that we are leveraging all of
those capabilities that exist in the region, and that regional
approach is critical.
Mrs. Walorski. I appreciate it.
Madam Chairwoman, I yield back the remainder of my time.
Mrs. Brooks. Thank you. I believe I mentioned in my
statement the last week before heading back to Indiana I had an
in-depth discussion with Doctor Tara O'Toole, who is the Under
Secretary for the Department of Homeland Security's Science and
Technology Directorate, because I wanted to ask her, because I
didn't have a lot of knowledge about the consequences and
threats in a mass casualty attack when a biological weapon or a
nuclear weapon might be used. One of the issues we discussed
was whether or not to evacuate an area when you don't have this
kind of advanced warning, as Mr. Velasquez just talked about,
of what is called an IND, or an improvised nuclear device
detonation.
What I am curious about, we have obviously, throughout the
country and in Indiana as well, issues involving flooding or
maybe have issues involving hurricanes on the East Coast. I am
curious what kind of training and what kind of discussions take
place in communities and in our communities here with respect
to whether or not evacuation is necessary, and I think I will
start with you, Mr. Hill.
Mr. Hill. Well, it is a very probing--it is a very
insightful question, but I will say a couple of things.
Mrs. Brooks. Well, and if I could, because what Mr.
Velasquez reminded us, and if you think about a nuclear device,
you have to think about issues or an attack involving wind
speed and the plume and the direction and all those things, and
these are things that we don't think about very often here in
Indiana. So, I am sorry.
Mr. Hill. That is all right. Just last month, the policy
team at State of Indiana met to deal with this issue of a
nuclear mishap or intentional act, and we spent 5 hours in the
policy room talking through scenarios. FEMA was there. They
were doing an evaluation of us. This wasn't just something to
make us feel good. We were being evaluated on our effectiveness
in being able to do that.
I can tell you that the key thing in this kind of decision
is having the right people in the room that have expertise. For
example, you mentioned in Northern Indiana the farms. You have
to have people in the room who understand agriculture, who
understand how this radiation can be transported, how it can
move through food. I don't have that knowledge. We have to
bring in the proper people to make those decisions.
Second, I would say to you one of the things that amazed me
at the Boston bombing was the way, when they asked for the
people to stay in their homes, the way they did it. That is
incredible for the City of Boston.
So I think what we have to realize is that communication of
expectations is going to be very important, through the media,
social media, all kinds of venues, that we clearly communicate,
after policy decisions are made, what we expect the public to
do for their safety. It is going to be hard to keep people
indoors when they want to get home to their families and so
forth, but I think sometimes sheltering in place, from what I
have been reading and studying, is a very key element in this
decision making.
Mrs. Brooks. Thank you so much.
Sheriff Bowen, anything you would like to comment on with
respect to evacuations?
Sheriff Bowen. Well, obviously, this is critically
dependent upon the size and scope of the incident and the
accuracy of the intelligence, and the time frame for conducting
an evacuation. It is important that we do get it right because
we could run into the ``boy who cried wolf'' mentality if we
continue to ask people to do things and it becomes unnecessary.
Then we are going to lose the faith of the community. As Mr.
Hill stated, in the Boston situation, it worked, and it worked
very well. But we run the risk of crying wolf oftentimes, as we
had seen in Hurricane Katrina when people were asked to leave.
People had been through those types of incidents before and
didn't respect the request to evacuate and chose to ride the
storm out.
Obviously, we are dealing with a much more catastrophic
event than ever seen or ever prepared for, and that only leads
to the situation for the mass incident and what we have to do
in preparation and cleaning up afterwards and helping those
folks.
So if warnings are not heeded within the critical time
frame, all we can do is shelter in place and hope for the best.
It is very much a case-by-case situation, and as Director Hill
said, we must rely on the experts in the field, the weather
forecasters, the health experts, and those that are in the know
to help make the best decision possible.
Mrs. Brooks. Thank you. Thanks.
Ms. Mack, I can't even imagine, having been in higher
education at Ivy Tech as General Counsel. We didn't have
residents, though, at Ivy Tech, and all of those students that
you are responsible for. What kind of discussions do you have
at IU?
Ms. Mack. We are having those very similar evacuation
versus shelter-in-place discussions. With our increasing
population of international students, evacuation is incredibly
difficult for them. So we have to take that into consideration
as well. This is why we stress the all-hazards planning. In
having those tools in your toolbox, depending on the scenario,
depending on the situation on the ground, you can pick which
tools you need for the appropriate situation and apply it.
Mrs. Brooks. Thank you very much. My time is up.
We are now going to start a second round of questioning,
and I will yield to the gentleman from Granger.
Senator Donnelly. I think this is the lightning round.
[Laughter.]
Senator Donnelly. Sheriff, at the end of the day when you
sit there in your office and you think about the things that
you are challenged with and you look at the scenarios that are
possible, what is the one thing you say, look, this is the area
we really need to get better at?
Sheriff Bowen. Well, I would say that with regard to the
challenges that we face, it is in making sure that we are
training, preparing, identifying threats and hazards, working
as a community to help protect our citizens not only from
public safety but from the private sector as well. It is a
group effort. It is an organized effort on all of our parts to
help keep our communities safe.
Senator Donnelly. Okay. Mr. Hill, this year at the Indy
500, it was shortly after Boston, and one of the challenges we
faced--and I know they were working very hard. But one of the
challenges we faced was all the coolers coming in and all the
traditions that we have had at the 500. How do you keep our
traditions in place while at the same time keeping people safe
and making sure that they can enjoy the race in safety? Are you
working directly with the folks at the Indy 500 at the present
time?
Mr. Hill. Senator, following the Boston event, I attended
the planning session for the Indianapolis 500, and we are
integrally involved in the planning process leading up to that.
One of the things that had to be discussed was the reality of
what they just saw in Boston and how pervasive it was in terms
of the public's endangerment. So we made a decision, not me
personally but the Public Safety Committee, the chief of the
Speedway Police and so forth. They made an intentional effort
to bring up this cooler issue, and it wasn't very pleasant at
the time but most people understood why it was important, that
we protect our people coming to that event.
There was also another key part of that planning process
that was adjusted that they hadn't done previously. They
blocked off Georgetown Road, which then protected the whole
backside of the infrastructure from having any kind of
opportunity for an IED or any kind of mass explosion there. So
there were some very specific things that were integrated into
this year's planning process as a result of that Boston
process. In fact, I attended a de-brief from the Fusion Center
in Boston with the FBI, and we talked about that. As a result
of that, we led to some of these discussions.
Senator Donnelly. Is that a process that for next year you
have already begun working together with the 500 folks?
Mr. Hill. Well, the people meet monthly leading up to that,
so they are already meeting for next year's event. So this is
an on-going process. It began really before last year, but it
is something that is institutionalized, and it is a very
effective tool in working through planning for these major
events.
Senator Donnelly. Thank you.
Ms. Mack, when you take a look at the challenges you face,
do you have a list of scenarios you go through on a constant
basis, or develop additional ones as you go through? How does
that take place, that you look and go here are the 10 biggest
challenges we face, here are the newest challenges we face? How
does that process work?
Ms. Mack. We do have, in addition to our all-hazards plan,
a comprehensive emergency management plan, and we have hazard-
specific annexes. Inasmuch as we try to avoid management by
shiny object, we do realize that we need to capitalize on
certain situations. As much as that is not a situation we ever
want to be in, we do need to make sure that we are harnessing
the energy, as it were, for example, with Boston. It was a
tragic situation, but we did need to make changes for that. As
Mr. Hill was saying with the 500, the public will understand
your changes when you implement changes after a big situation.
Senator Donnelly. I found they are always willing to step
up and do whatever is necessary. I am just wondering, do you
have somebody who is like the designated person who brings up
the difficult scenarios and the difficult problems that may
arise in events when you get together?
Ms. Mack. Absolutely. When we do our planning, I have three
certified emergency managers certified by different sources who
work with us and who are very good at poking holes in our plans
and making sure that they are the best that they can be.
Senator Donnelly. Thank you.
Thank you, Madam Chairwoman.
Mrs. Brooks. Thank you.
I now turn to the gentlelady from Jimtown.
Mrs. Walorski. Thank you, Madam Chairwoman.
My question is, you know, I am proud to be a Hoosier, and I
think we do all things well. So my question is: When it comes
to best practices and kind-of back to what Congressman Young
was asking prior on best usage of dollars spent, how it is
measured? You all have been involved in training. Sheriff, I
know you have, and the fire fighters have as well. Then I
guess, Mr. Hill, you are new to the game. But as you look
across the country and you go to all of these different
exercises and you have colleagues around the country, my
question is: What best practices have you been able to pick up
and implement in the State of Indiana so that you can really
say, you know what, I saw that, I learned it, and it is
something we should do here? What would that be for all of you?
What do we do well?
Mr. Bowen.
Sheriff Bowen. Well, I think as Hoosiers, we are all
willing to step up and do, as Senator Donnelly said, what is
necessary to make sure that we are protecting our community. I
think through social media and other avenues, the communication
between the folks in our communities has grown. The gathering
of intelligence and the sharing of that information in an
effort to make our area much safer has increased.
So I think we need to continue to expand upon that again.
It is not just public safety. It is not just police and fire
and homeland security here to protect the citizens in our
communities. It is our communities as a whole. I think that, as
you say, Hoosiers are willing to step up and do their part to
make sure that we are keeping our area safe.
Mrs. Walorski. Mr. Orusa.
Chief Orusa. Well, I agree with Sheriff Bowen. It is about
the people that participate in the interoperability and the
relationships that you build ahead of a disaster. But most
notably, the lessons learned were in the Super Bowl last
February, where we created the use of a playbook. An incident
action plan is a management tool. But the planning section
chief, I believe he is in the room, Tom Seevack, created a
playbook, and it had supplemental information such as responder
life safety information, weather, contingency plans, key
personal contact information mapping, and now that has been
recognized as a best practice and it is being used at other
venues that hold the Super Bowl.
So we are grateful for that. It is about the people, and we
have really talented people in Indiana.
Mrs. Walorski. Great. Thanks.
Mr. Hill.
Mr. Hill. Just briefly, I would say two things. First of
all, there has been referenced on the panel about Muscatatuck
Urban Training Center. I think we can't overstate that enough,
how important that is for our people to have real-life
experiences. So I would just mention that.
But second, I think Indiana has done a very good job, again
credit to my predecessors, in integrating the National Incident
Management System, NIMS, and incident command structures that
allows us to have a common architecture for communication, not
necessarily the technology but the manner in which we
communicate with one another. We are all talking from the same
script. I think the formation of these teams throughout the
State that allow us to communicate and respond locally to
emergencies, I know that my work in the State police 30 years
ago, there just was not the local capacity to respond to some
of these major emergencies that we have today. Frequently, I am
hearing about emergencies that are being handled totally by the
local people without any involvement from outside sources. I
think that is a tribute and a testimony to some of the progress
that has been made.
Mrs. Walorski. I appreciate it.
Ms. Mack, any comments on the university level?
Ms. Mack. I would agree with what all the panelists have
said, and it has allowed us, based on the teams that have been
built up largely with this funding and the integration of the
incident command system, we have been able to move beyond that
and integrate other facets of disaster response such as
volunteers and donations management, those kinds of things
which are really advanced emergency management.
From a college perspective, we know that if anything
happens on any of our campuses, we are going to have thousands
of people, right then and there, who are ready to respond, and
we need to have our process and procedures and structures in
place to be able to handle that and have them help us with the
response, instead of being part of another thing we need to
take care of.
Mrs. Walorski. I appreciate it. Thank you.
I yield back my time. Thanks.
Mrs. Brooks. Thank you. I appreciate all the testimony that
everyone has given today, and you each brought a very unique
perspective to this topic, and you have given us a lot to think
about.
But in a bit of a lightning round as well, as you
suggested, you have an opportunity which is a little bit
unusual to have Members of both chambers, the House of
Representatives and the United States Senate, here. Coming
here, we want to hear from you what is it Congress could be
doing or should be doing to help you in your efforts, to help
you.
I think I will just start with you, Ms. Mack, and work
backwards, this way on the panel. What can you state briefly?
What can Congress be doing to assist you to make sure that you
all are sleeping even better at night?
Ms. Mack. Well, I would request a couple of things. First
of all, a funding line for universities I believe needs to be
reinstated Nation-wide. There were limited numbers of emergency
management for higher education grants that were distributed.
There were only two rounds of grants, and that has disappeared.
So I would request that.
I would also request the continuation and even expansion of
preparedness training and exercise funding for that. That is
what will move us forward in the development of our skill sets
and our ability to respond from all levels of government,
including the university.
I would also ask you to look at the Clery Act and
potentially even refocus it. Instead of it being an accounting
of the crimes that have occurred, look forward, look forward to
the prevention and mitigation part of it, really gear it
towards what is this doing to really achieve the objective of
it. The intent is to reduce crime, especially on university
campuses, and then also compare the campus crime rates, which
it really focuses on, to the surrounding areas. I think you
will find that universities have a much lower crime rate even
than the surrounding areas, but that is not factored into the
equation.
So those are the things that I would request from a
university perspective.
Mrs. Brooks. Thank you.
Mr. Hill.
Mr. Hill. I would just say a couple of things. First of
all, the UASI Urban Area Security Initiative funding is really
a critical component. I think the way in which that is done is
a little bit uncertain to us out here in the real world. We got
a document, and I understand there is a document, but there is
a lot that goes into evaluating those security areas, and this
last appropriations cycle I think they limited it to 25, and
Indiana did not factor in.
One of the things that concerns me is that Indianapolis has
done big events for so long that we are sometimes viewed as
being acceptable in that area and not as big a risk, and I
don't think the State should be penalized because they have
done a good job in the past. There is still a lot of backfill,
a lot of work that needs to be done to bring off these events.
So that is one of the things.
Then second, I think continued oversight at the Federal
level for FEMA is important. The THIRA process to me is
critical, but we need guidance, and we need it out sooner. This
is certainly not any discredit to my colleague on the panel
today because I know that he doesn't have anything to do with
this, but at the headquarters level we need to have that
guidance out. It is very important.
Mrs. Brooks. Thank you very much.
Chief Orusa.
Chief Orusa. Operational readiness exercises are key to
keep our people safe and effective in harm's way. We can write
all the policies and procedures, we can have all the tabletop
exercises, but until we have scenario-based training, which is
funded through UASI, and training and exercise grants, we can't
have crisis rehearsal and stress inoculation so they can
function in that gray environment during a disaster, where they
are forced to problem-solve and decision-make in a combat
environment. It is very, very expensive to do that training,
and we depend on the Federal Government to provide us the
funding to do so, and it is critical that we give our people
those skill sets.
Mrs. Brooks. Thank you, Chief.
Sheriff Bowen.
Sheriff Bowen. I would concur with Mr. Hill and Mr. Orusa.
I haven't seen the benefits of being in a UASI region. It is
important that we continue to fund those programs. EMA, IDHS,
Homeland Security as a whole has been an integral part in
making sure that Indiana has come together regionally, not just
locally but regionally to prepare, to train, and plan for
unknown hazards and all hazards, and it is important that we
continue to provide that training and that regional approach to
the training.
As local agencies, we can train on our own. But as we all
know, our resources will be immediately overwhelmed in a
critical incident, and it is going to require those efforts
from those other agencies and that cooperation to manage a mass
incident.
So we would ask your assistance in considering to fund
those projects and to help us as we move forward.
Mrs. Brooks. Thank you.
Mr. Velasquez.
Mr. Velasquez. Thank you, Chairman Brooks. We appreciate
certainly the offer, and we also appreciate the committee's
support of our department and our programs. In addition to
supporting the President's budgetary requests and other
programmatic requests, I think Members of Congress can
certainly help us in the area of encouraging individual
preparedness.
You mentioned September as National Preparedness Month, and
individuals play a crucial role in helping to prepare this
Nation for crisis. If we can get more and more individuals
prepared to develop a preparedness mindset in this country, we
would be in a better place and reduce the amount of casualties
that we have in this country as a result of disasters and other
crisis situations. So, thank you.
Mrs. Brooks. Thank you.
I would like to thank the witnesses for their valuable
testimony. This panel is going to be dismissed.
I do want to allow the members of this panel to realize
that Members of the subcommittee may be submitting questions to
you in writing, and the hearing record will be open for 10 days
for you to respond in writing if you should receive any further
questions.
So at this time, the clerk will prepare the witness table
for the second panel.
Again, I thank you all so very much for your testimony
today.
We will be having those on the second panel please proceed
to the witness table. Thank you.
Our first witness is Mr. Chad Priest, the chief executive
officer with the MESH Coalition, Inc. Prior to joining MESH,
Mr. Priest was an attorney at the law firm of Baker and
Daniels, practicing public health and health care law in
Indianapolis, and in the Washington, DC offices. He served on
active duty in the United States Air Force as a family practice
primary care optimization nurse, and while in the military he
specialized in emergency preparedness-related issues.
Next on our panel is Dr. Virginia Caine. She is the
director of the Marion County Public Health Department. Dr.
Caine is a past president for the American Public Health
Association, the Nation's oldest and largest public health
organization, and was the recipient of the National Medical
Association's 2010 Practitioner of the Year Award. Throughout
her career, Dr. Caine has worked to promote and advance public
health locally, Nationally, and internationally through
innovative programs and unprecedented collaborations.
Next on the panel is Dr. Louis Profeta. He is the medical
director of disaster preparedness at St. Vincent Hospital. Dr.
Profeta served as the clinical instructor of emergency medicine
at Indiana University and is the founder of Emergency Room
Advice Safety and Education. Dr. Profeta also authored the
popular book, ``The Patient in Room 9 Says He's God.'' Sounds
like an interesting read.
Next on our panel is Dr. Cliff Knight. He is the chief
medical officer of the Community Health Network, a position he
has held since October 2009. Dr. Knight had previously served
as vice president of medical affairs for Community Hospital
North and Community Hospital East. Before assuming that role in
2007, he was director of Community Family Medicine's residency
program, and his peers honored him as the Family Medicine
Teacher of the Year.
Next on the panel is Dr. R. Lawrence Reed. He is the
director of trauma services at Indiana University Health
Medical Hospital. Dr. Reed's past professional responsibilities
have included associate chief of the Trauma Service and
Surgical Intensive Care Unit at Herman Hospital in Houston,
Texas; and director of the Surgical Intensive Care Unit and
director of the Trauma Center at the Duke University Medical
Center, just to name a few. Dr. Reed has authored more than 60
periodical articles and 27 book chapters, most on the topic of
critical care.
At this time, I would now like to turn to Senator Donnelly
for any introductions he might have.
Senator Donnelly. Madam Chairwoman, I want to thank the
witnesses for being with us, for sharing their views on this
extraordinarily important topic. With that, I would be happy to
turn it over to you.
Mrs. Brooks. Okay.
Senator Donnelly. Oh, and I would like to introduce also
Dr. Obeime. Dr. Obeime has worked for the Sisters of St.
Francis since July 1996. She helped start and served as medical
director of the St. Francis Neighborhood Health Center from
1998 to 2010, when she became the director of Community and
Global Health at Franciscan St. Francis Health. I want to
mention that the Sisters of St. Francis provide medical care
across our State, do an extraordinary job from Lake Michigan to
the Ohio River, and please let the Sisters know we are in their
debt for all of their hard work.
Dr. Obeime graduated from the University of Benin in
Nigeria in 1998 and completed a clinical genetics fellowship in
Family Medicine residency at IU in 1996. Dr. Obeime is board-
certified in family medicine, bariatric medicine, and hospice
and palliative medicine.
Thank you so much for being here with us today.
Mrs. Brooks. I would just now like to thank all of the
witnesses who have also submitted full written statements, and
those will appear in the record.
At this time, the Chairwoman will now recognize Mr. Priest
to testify for 5 minutes.
STATEMENT OF CHAD S. PRIEST, CHIEF EXECUTIVE OFFICER, MESH
COALITION, INC.
Mr. Priest. Good morning, Chairwoman Brooks, Senator
Donnelly, Congresswoman Walorski, and the staff of the
subcommittee. On behalf of the MESH Coalition, we appreciate
the opportunity to be before you today, and we applaud your
commitment and dedication to the important issues that we have
been discussing.
I would like to share three points with the committee
today. First, I want to briefly describe what the MESH
Coalition is and how through our coalition partners, many of
whom are seated here today, we are building resilience in the
health care community and Central Indiana.
Second, I would like to discuss that our public-private
coalition model that we have developed here we believe is one
of the most sophisticated and progressive models in the United
States. We believe it is replicable throughout the United
States, and we think that is an imperative to promote health
care resilience.
Finally, I would like to discuss how we might partner to
build sustainable and resilient funding for health care
emergency management that isn't solely reliant on grants but
that takes health care entities in their usual financial
reimbursement models and considers those so that we can be
assured of continued funding for this important work.
At the outset, I am pleased to report that through the work
of the partners here next to me and coalition partners all over
Central Indiana, we believe we are uniquely well-prepared to
respond to events here in Central Indiana. While it would be
hubris to guarantee a successful response to any incident,
especially those that would overwhelm any region's ability to
respond, such as a widespread biological attack or a nuclear
attack, we believe that the systems and processes that we have
built here are some of the most robust and sophisticated in the
Nation.
The MESH Coalition is a Nationally-recognized nonprofit,
public-private partnership that enables health care providers
to respond effectively to emergency events and remain viable
through recovery. Our programs increase capacity in health care
providers to respond to these events such as mass casualties.
It protects our critical health care safety net and promotes
integration and coordination between the Government and the
private sector.
Our subscribing partners include the Marion County Public
Health Department, the Richard Roudebush VA Medical Center,
Community Hospitals of Indiana, Franciscan St. Francis Health,
Wishard Health Services, Indiana University Health, St. Vincent
Hospital, the Indiana University School of Medicine, and the
Indiana University School of Nursing. We routinely work with a
wide array of partners, including our State partners like the
State Department of Health and the Department of Homeland
Security.
All of these partners recognize an essential truth, and
that is that we are, in fact, better together. None of our
health care facilities and organizations can go it alone in a
crisis, and even in a competitive health care environment, what
you see here today is a recognition that we all must come
together when the going gets tough.
MESH does a few core things. We provide health care
intelligence services to the health care community to allow
them to prepare and respond to events. We utilize social media
not only to push information out but to monitor and predict and
analyze threats. We issue a daily intelligence brief to health
care providers across the city. We conduct community-based
planning which brings people together from disparate
professions and backgrounds. An example would be the building
of the Super Care Clinic at the Super Bowl, a primary care
model that actually helped manage surge throughout the event.
We conduct sophisticated legal, regulatory, and financial
policy analysis, recognizing that the delivery of health care
is essentially a complex business enterprise, as well as a
clinical one. Health care viability depends in large measure on
sustaining revenue cycles to continue operations, and we pay
very close attention to that.
Finally, we recognize that effective response, the
difference that makes a difference between hospitals that do
well in crisis and those that don't, are good clinicians that
can make good decisions under tough conditions. To that end, we
provide advanced clinical training to technicians, doctors, and
nurses to make them better prepared to respond when the going
gets tough.
We had a unique funding approach at MESH that pairs
traditional emergency management funding with private support.
Our hospitals have not just made a brief or casual commitment
to emergency management; they have made that commitment with
their dollars, and that has built the MESH Coalition. It is a
model that is unique. We are extremely proud of the vision that
these health care leaders have had in building our coalition,
and we are also helping to promote this through partners such
as the Northwest Healthcare Response Network in Seattle, and
the Northern Virginia Hospital Alliance, which operates in the
National capital region, leveraging our communities.
We know that grant funding in and of itself is not a
sustainable model for health care emergency management. As
stewards of public resources, we have to find creative ways to
incentivize health care response. However, there is, in fact, a
Federal role here, and as you all know, that Federal role is
most helpful when it is sustainable and it continues on.
Hospitals do deserve a predictable way to manage emergency
issues.
I want to thank you for your leadership in this area. Thank
you for including us on this distinguished panel. We are
pleased to be here. I look forward to discussing this with you
further.
[The prepared statement of Mr. Priest follows:]
Prepared Statement of Chad S. Priest
August 6, 2013
Good morning Chairman Brooks, Senator Donnelly, Congresswoman
Walorski, Congressman Young, and staff of the subcommittee. On behalf
of the MESH Coalition, we appreciate the opportunity to discuss health
care emergency management in Central Indiana with you today and applaud
your commitment and dedication to this important issue.
I am pleased to report at the outset of my testimony that as a
result of the cooperative efforts of Central Indiana health care,
public health, emergency management, and public safety partners through
the MESH Coalition, the health care infrastructure in Central Indiana
is well-positioned to respond and recover from a wide range of crises
and emergencies. While it would be hubris to guarantee a successful
response to any incident, especially those that would almost certainly
overwhelm any region's ability to respond, such as a direct nuclear or
widespread biological attack, Central Indiana is a National leader in
health care infrastructure resilience and we believe our systems and
processes are some of the most robust and sophisticated in the Nation.
I would like to address how we have developed this resilience, in
part, through closely-coordinated cooperation among the public and
private sectors through the MESH Coalition. The MESH Coalition is a
Nationally-recognized, nonprofit, public-private partnership that
enables health care providers and organizations to respond effectively
to emergency events and remain viable through recovery. We provide
health care intelligence, community-based planning, policy analysis,
and clinical training to our health care, public safety, public health,
and emergency management colleagues. Our programs increase capacity in
health care providers to respond to emergency events, including mass
casualties, protect our critical health care safety net, and promote
integration and coordination between the Government and private sector.
Today, I would like to share three points with the committee:
1. The public-private partnership coalition model that our partners
have developed here in Central Indiana is one of the most
progressive and sophisticated models of health care emergency
management in the United States, and we believe that this model
can, and should, be replicated throughout the United States.
2. Through a comprehensive portfolio of programs, the MESH
Coalition is continuously improving Central Indiana's ability
to mitigate, prepare, respond, and recover from both small and
large-scale emergency events.
3. We believe that in order to promote the spread and adoption of
health care coalitions, we must work together to find creative
and cost-effective means of providing sustainable, on-going
support to these efforts, while maintaining appropriate
stewardship of public resources.
the mesh coalition model
The MESH Coalition enables health care providers to respond
effectively to emergency events and remain viable through recovery.
Through the MESH Coalition, health care providers, public health
practitioners, emergency medical service providers, emergency managers,
law enforcement agencies, fire departments, and private businesses are
working together to plan, train, share information, and shape policies
that protect the health care system and facilitate an effective
emergency response. Our public-private partnerships increase capacity
in the health care system to respond to emergency events, protect our
critical health care safety net, and promote integration and
coordination between the Government and private sectors.
This unique partnership was founded as a grant project of the
Indiana University School of Medicine and Wishard Health Services with
a $5 million award from the United States Department of Health and
Human Services Emergency Care Partnership Grant Program. MESH was one
of five organizations funded through this Program to develop innovative
models for health care emergency management, and was the only non-
profit successfully formed because of the award.
Our Board of Directors is comprised of hospital chief executives
and clinical leadership, as well as community partners. These entities
include: The Indiana University Schools of Medicine and Nursing, The
Marion County Public Health Department, Richard Roudebush Veterans
Affairs Medical Center, Community Hospitals of Indiana, Inc.,
Franciscan St. Francis Health, Wishard Health Services, Indiana
University Health, and St. Vincent Hospital & Health Care Center, Inc.
One of the unique aspects of MESH that helps us be successful is
our funding model, which pairs public grant funding with private fee-
for-service and subscription funds--meaning that our coalition partners
have all put ``skin in the game,'' creating powerful incentives for
executive and system engagement in critical emergency management
activities. While historically we have received Federal grant funding
from the Emergency Care Partnership Program, the Urban Areas Security
Initiative (UASI) program, and the Metropolitan Medical Response System
(MMRS), subscription fees from partnering health care organizations are
nearly 45% of our total revenues. In addition, our fee-for-service
programs continue to minimize the gap between private and public
funding streams. This is of particular importance given that there have
been significant reductions in Federal grant programs, and we
anticipate further cuts in the future.
central indiana preparedness
Central Indiana communities are as prepared as any other across the
country to respond to an emergency event. However, we believe that an
effective response is a necessary, but not sufficient, condition to
safeguard the health care infrastructure during crisis events. It is
critical that we improve the overall resilience of our health care
system to respond to a range of threats, then quickly return to
baseline operations in order to provide effective care to our
community. The MESH Coalition helps build resilience through four core
services: (1) Health care intelligence services; (2) community-based
planning; (3) policy analysis; and (4) clinical education and training.
I would like to take a moment to describe how each of these services
better prepares Central Indiana to respond to a mass casualty event.
Health Care Intelligence Services
In order for health care providers to effectively manage
significant increases in patient volume during major mass casualty
incidents, they must operate from a Common Operating Picture. To build
this Common Operating Picture every day, the MESH Coalition conducts
real-time monitoring of disparate data streams for potential threats to
the health care sector. These data streams include open-source sites
such as news media and weather, restricted sources such as homeland
security and other access-controlled portals, and radio communication
sites such as those streaming aircraft and public safety radio traffic.
In addition, we monitor and utilize social media platforms such as
Twitter and Facebook, an area in which you, Chairman Brooks, have been
an extraordinary proponent.
The threats we detect are distributed to our partners via email,
social and news media, public safety information channels, and the MESH
Daily Situational Awareness Brief. The Brief is an email we send daily
to health care providers, emergency managers, and public health
professionals throughout Central Indiana, and it provides specific,
actionable information on threats to the health care sector, from
severe storms to emerging infectious diseases and everything in
between. What makes the Brief unique is the inclusion of specific
action steps that allow recipients to immediately improve their
preparedness for potential emergency events. The Brief is frequently
used in hospital team meetings and bed huddles as an intelligence
source and discussion initiator.
At the direction of the Marion County Public Health Director, and
in cooperation with the Indianapolis Division of Homeland Security, we
also serve as the Marion County Medical Multi-Agency Coordination
Center (MedMACC). The MedMACC is staffed and operational 24 hours a
day, 7 days a week, 365 days a year to provide a critical link between
Marion County health care facilities, the Marion County Public Health
Department, the City of Indianapolis, and the Indianapolis Division of
Homeland Security. The MedMACC is activated to support everything from
mass casualty incidents like the recent bus accident on the northeast
side of Indianapolis, to supporting emergency responders during large-
scale events like the Indianapolis 500, to coordinating health care
response during disasters like the stage rigging collapse at the
Indiana State Fair in August 2011. In 2012 alone, the MedMACC was
activated 17 times.
During an activation, the MedMACC manages hospital surge by
assisting with the distribution of patients during mass casualty
incidents. For example, during a mass casualty incident, the MedMACC is
dispatched and completes just-in-time hospital emergency department
polling. We relay this information to field command units via public
safety radio systems to facilitate better patient transport decision-
making and avoid overwhelming any one facility. During large-scale
emergency events, the MedMACC provides direction through an executive-
level Policy Group consisting of individuals from various health care
entities throughout Marion County, many of whom serve on our Board of
Directors. The MedMACC also has the capability to identify and secure
resources for health care providers and organizations during emergency
events, to assist public health authorities in providing care to
vulnerable populations during crisis events, and to provide just-in-
time subject matter expertise on Chemical, Biological, Radiological,
Nuclear, and high-yield Explosives (CBRNE) threats, as well as
emergency medical, legal, and policy issues. In the event of an area-
wide or regional mass casualty incident, we can also deploy critical
resources such as core medical supplies, and up to four Multi-Agency
Support Tactical Facilities, which are equipped to function as
emergency mobile field hospitals. An example of one of these facilities
is deployed outside today in coordination with the Hamilton County
Emergency Management Agency.
Community-Based Planning
Health care in Central Indiana is, to say the least, a highly-
competitive enterprise. In many communities, intense health care
competition has made it challenging--or impossible--to bring providers
together to prepare for disaster and crisis events. We are fortunate in
Central Indiana, as our health care organizations fully understand that
coming together to plan for emergency events saves lives and is in the
best interest of everyone. In fact, our health care partners have made
a commitment to not compete on safety or emergency management issues
and the MESH Coalition is the result of that commitment.
Traditionally, health care emergency planning has focused on
preparing hospitals to be ``floating islands'' capable of withstanding
emergency events and remaining open to provide patient care. This
approach has resulted in redundant spending on equipment and supplies
in hospitals across the country. Working in silos is not an effective
approach to emergency preparedness. Through MESH, Central Indiana
hospitals team up to share resources and engage in joint emergency
planning. Each month, Hospital Preparedness Officers throughout
Indianapolis work together in MESH working groups to collaborate on
policy, training, and exercises. Using this community-based approach,
we include stakeholders such as hospitals, first responders, and other
local officials to coordinate and prepare for potential threats, as
well as large-scale anticipated events such as the Indy 500 and the
NCAA Final Four. This enables staff to develop effective plans and
programs while generating new knowledge about health care emergency
management.
One example of this innovative approach to health care emergency
planning is highlighted by our community's preparation for Super Bowl
XLVI, where we created the Super Care Clinic. As part of the Super
Bowl Village, and in partnership with the Super Bowl Host Committee,
the Super Care Clinic represents an innovation in how volunteers and
attendees are treated at large-scale events. Located inside
Indianapolis' Union Station, this fan-facing forward medical station
served as a clinic for fans, but was intentionally designed as a surge
management strategy in the event of a mass casualty incident. In an
extraordinary gesture, caregivers from Community Health Network,
Franciscan Alliance, Indiana University Medical Group, St. Vincent
Medical Group, Wishard Health Services, and Indiana University Health
volunteered their time to work at the clinic during the entire week of
Super Bowl activities. This was the first clinic of its kind to be
created in the United States and serves as a model for providing health
care services during other mass gathering events.
MESH has also established a host of professional working groups to
address emergency preparedness issues for vulnerable populations. The
Sexual Assault and Domestic Violence Working Group, for example, works
to ensure that health care organizations are able to detect and respond
to domestic violence during emergency events, and that residential and
non-residential Sexual Assault and Domestic Violence providers are able
to continue perform essential functions during an emergency event.
Similarly, the Maternal/Child Health Working Group works to ensure the
needs of new and expectant mothers and their children are considered in
the disaster planning process. This group, in coordination with
providers at Riley Hospital for Children at Indiana University Health
and Peyton Manning Children's hospital at St. Vincent, is currently
developing a registry of Central Indiana home ventilator-dependent
children, with the ultimate goal being to provide early warning during
emergency events. This registry is the first of its kind in Indiana and
is designed to engage patients and families in strategies that increase
community resiliency by protecting access to electricity during natural
weather events. Weather-related power outages are common in Indiana and
loss of electricity can be catastrophic to these patients and their
families.
Beyond facilitating regular working groups, we also recognize that
the health care response in Central Indiana is critical to both
Regional and State-wide response. By working together with the Marion
County Public Health Department and the Indiana State Department of
Health to plan for seasonal flu outbreaks and emerging threats such as
the Middle East Respiratory Syndrome Coronavirus (MERS CoV) and the
Avian Influenza A virus, we have helped the Central Indiana health care
community maintain necessary readiness to respond to all types of
biological hazards, whether they are naturally occurring or an act of
terrorism.
We have also taken a leadership role in wider community-planning
efforts. For example, in 2011 we designed, coordinated, and executed
the first full-scale exercise between the City of Indianapolis and the
Central Indiana health care community, which focused on testing
portions of the downtown Indianapolis Evacuation Plan, and have also
worked with local, State, and Federal partners to plan for terrorist
incidents by participating in the Joint Counterterrorism Awareness
Workshop Series.
Policy Analysis
Health care systems are in the business of taking care of patients
and saving lives, not necessarily responding to disasters. Moreover,
they generally do not have the resources to address the policy, legal,
and regulatory issues associated with emergency events. The MESH
Coalition is a resource for our partners because we can provide
objective analyses of the most pressing disaster-related policy issues
facing Coalition partners. This analytical work supports our mission to
enable health care providers to respond effectively to emergency events
and, importantly, remain viable through recovery. In other words, we
help our coalition partners to think not only about responding to
disasters, but also to plan for long-term sustainability following an
emergency event.
Revenue cycle protection is a considerable factor in ensuring the
availability of health care during and after an emergency event. In a
large-scale emergency, care may be administered at Alternate Care
Sites--substitute locations that serve to expand the capacity of a
hospital or community to accommodate or care for patients. Given the
limited scope of FEMA public assistance grants, reimbursement through
Federal Health Care Programs such as Medicare and Medicaid is critical
to a hospital's financial viability when care is provided in an
alternate location. However, depending on State licensure rules, these
Alternate Care Sites may operate outside of the scope of the hospital's
existing license, creating compliance issues, which may jeopardize
reimbursement.
Several States have developed solutions that allow hospitals to
establish an Alternate Care Site without jeopardizing reimbursement.
For example, the Arizona Department of Health Services permits
hospitals to provide off-site services without a separate license
during a public health emergency declared by the Governor. In North
Carolina, at the request of the State Emergency Management Agency the
Division of Health Service Regulation can waive rules for hospitals
providing temporary services during a declared emergency. In Texas, the
law exempts temporary emergency clinics in disaster areas from
licensure requirements.
In addition to these statutory solutions, many State departments of
health are granted broad waiver authority during emergencies. For
example, the New Jersey Department of Health has the authority to waive
hospital-licensing rules upon determining that compliance would create
a hardship for the hospital and that the exception would not adversely
affect patients. We in Indiana, on the other hand, have no mechanism
for waiving hospital licensure requirements. As such, MESH is actively
working with the Indiana State Department of Health to ensure that safe
and effective health care can be provided in an Alternate Care Site,
while at the same time enabling hospitals to receive reimbursement for
their services and thereby protecting the long-term viability of our
health care infrastructure following a large-scale emergency event.
It is also important that clinicians and policymakers understand
the nuances of what the Institute of Medicine has come to refer to as
``crisis standards of care,'' or the optimal level of care that can be
delivered during a disaster. Clearly, this complex issue has far-
reaching implications in terms of one's ethical responsibility and
legal liability. Even during an emergency event, victims are entitled
to expect reasonable care under the circumstances. The ISDH has taken a
leadership role on this issue by providing guidance for providers on
how to develop consistent procedures for allocation of scarce resources
in the event of an officially-declared public health emergency, in
addition to recommending an ethical framework and clinical algorithms.
MESH Coalition staff have also sought to protect individuals' rights to
reasonable care, and support effective health care response, by
effectively explaining this issue to health care providers both locally
and Nationally.
Clinical Education and Training
Locally, one of MESH's most important contributions to Central
Indiana is the clinical education and training we provide to a wide
array of stakeholders. While traditional health care emergency
management education and training programs have focused on emergency
management core-knowledge such as the Incident Command System (ICS),
evidence from mass casualty and disaster events demonstrates that
effective health care response requires--first and foremost--well-
trained clinical providers who are able to make good decisions under
tough conditions. As a result, we have developed and implemented
courses in emergency response and clinical decision making that are
hands-on, practical, and utilize high-fidelity simulation to prepare
providers to respond to all-hazards scenarios. To date we have trained
thousands of responders, including physicians, nurses, EMTs,
Paramedics, police officers, firemen, and members of the public.
The benefit of courses being developed and conducted by the MESH
Coalition is that we are capable of reaching a wider range of
participants than any single organization, and we are able to provide
centralized resources, thereby lowering per-unit costs. Group offerings
such as Simple Triage and Rapid Treatment (START) training, mass
casualty exercises, limited-resource emergency care courses, and
operational hazardous materials training also give participants from
different health care organizations the experience of learning
together. This method creates consistency between and among providers,
which in turn leads to a uniformity of response during an emergency
event. In addition, we offer regular Continuity of Operations planning
workshops, Emergency Operations Planning workshops, and crisis
communications workshops to partner organizations in order to further
build our community's response capacity.
To facilitate learning opportunities from around the world, we also
coordinate an annual Grand Rounds series that brings National and
international experts in health care emergency response to Indianapolis
to present cutting-edge ideas and programs. These events are free, open
to the public and, through our partners at the Indiana University
School of Medicine, eligible for Continuing Medical Education and
Continuing Education Units at no cost to attendees. The 2012-2013 Grand
Rounds series included presentations on Continuity of Operations
Planning by Dr. Paul Kim, M.D., who is the director of incident
management integration for the National security staff in the White
House, and on Denver's mass casualty emergency response to the Aurora
Colorado theater shootings by Christopher Colwell, M.D., who is the
chief of emergency medicine at Denver Health.
In addition to our group trainings and Grand Rounds, we have a
strong commitment to clinical education, as evidenced by our multi-
disciplinary internships and fellowships. Each year we provide
opportunities for physicians, nursing students, public health graduate
students, law students, and librarians to learn from a team of
dedicated professionals and gain valuable experience in health care
emergency management. In 2012, MESH collaborated with the Indiana
University School of Medicine to create a Disaster Medicine Fellowship.
The fellowship just welcomed its first fellow, who will spend time this
year travelling with our executive staff to Monrovia, Liberia, where
they will help that community's largest hospital redesign its emergency
department and help build the hospital's emergency management plan.
Concurrently, we will have an opportunity to learn from hospital and
community leaders about how they have maintained health care resilience
through significant social crises. This experience will no doubt
provide valuable strategies that can be implemented in our own
community and further enable us to better respond in situations where
resources are limited.
the path forward
As previously noted, we are extremely proud of the vision our
Central Indiana partners have had in the development the MESH
Coalition. We are also convinced that the future of health care
emergency preparedness is directly tied to the development of public-
private health care coalitions such as ours. The U.S. Department of
Health and Human Services has also acknowledged this future by
requiring Hospital Preparedness Program and Public Health Emergency
Preparedness grant program grantees to form strong and resilient
coalitions.
We are helping to promote ``coalition building'' through our
partnership with the Northwest Healthcare Response Network in Seattle
and the Northern Virginia Hospital Alliance in the Capital Region and
Virginia. This partnership, the National Healthcare Coalition Resource
Center (NHCRC), is sponsoring an annual National Healthcare Coalition
Preparedness Conference, and is available to provide technical
assistance and training opportunities to assist communities in meeting
their grant deliverables to develop functional health care coalitions.
However, there are challenges associated with the current funding
mechanism and, as stewards of public resources, we must be creative
about incentivizing the development of health care coalitions, funded
in part by the private health care sector. This does not mean, however,
that there is no role for Federal support. While grant funding is not,
in and of itself, a sustainable solution to protecting and preserving
public health and safety, private-sector health care should not be
solely responsible for preparing and responding to issues of National
significance. For example, in preparing to respond to CBRNE mass-
casualty events, many of which would constitute acts of war against the
United States, the Federal Government must remain a strong funding
partner. Hospitals cannot, and should not, be expected to shoulder this
burden alone. Hospitals deserve a predictable way to manage the expense
of providing care during an emergency event. Indeed, the coalition
model must continue to be a strong public-private partnership, and not
become a private-private partnership.
Chairman Brooks, Senator Donnelly, Congresswoman Walorski,
Congressman Young, and staff of the subcommittee, on behalf of the MESH
Coalition, I thank you for the opportunity to provide testimony on our
efforts to prepare Central Indiana to respond to a mass casualty event.
We are thrilled to be included today, and hope that you will continue
to advocate for proven, cost-effective best practices in health care
emergency response. We also hope that our experiences will provide
insight for coalitions across the country. Finally, we look forward to
working with you to creatively incentivize private-sector participation
in health care preparedness.
Thank you again for your leadership on this important topic; I am
happy to respond to any questions my might have.
Mrs. Brooks. Thank you, Mr. Priest.
The Chairwoman now recognizes Dr. Caine to testify for 5
minutes.
STATEMENT OF VIRGINIA A. CAINE, DIRECTOR, PUBLIC HEALTH
ADMINISTRATION, MARION COUNTY PUBLIC HEALTH DEPARTMENT
Dr. Caine. Thank you. Good morning, Chairman Brooks,
Senator Donnelly, and Congresswoman Walorski; and our hosts,
Mayor Brainard and County Commissioner Christine Altman. I
would like to thank you for the opportunity to come here today
to discuss our efforts to prepare for a mass casualty event in
Marion County. I hope this is the first of many opportunities
to work with the subcommittee.
The Marion County Public Health Department is responsible
for the Emergency Support Function 8, which functions in a
National response framework, which means that the health
department is not only responsible for the public health but
the medical care needs of the entire population of Marion
County during an emergency event. This can include anything
from medical treatment to providing clean drinking water and
sanitation. In addition, the health department is also
responsible for coordinating Emergency Support Function 11
activities, which identifies food, water, our ice needs, and
temporary shelters for animals in the aftermath of an
emergency.
One of our most important responsibilities, though, is
protection against chemical, biological, nuclear, radiological,
and high-yield explosive threats. To monitor and respond to
these threats, the health department operates an environmental
emergency response team which collaborates with our local and
State partners, which includes the Indianapolis Fire
Department, the Hazardous Materials Team, the Indiana
Department of Homeland Security, and the Indiana State
Department of Health. Because of this team, Central Indiana
maintains an excellent state of readiness.
We are also responsible for coordinating the U.S.
Department of Homeland Security's Bio-Watch Program. In
partnership with the Indiana Departments of Environmental
Management and Health, the Indianapolis Metropolitan Police
Department, the Indiana Department of Homeland Security,
Hamilton County Health Department, the U.S. Army Civil Support
Team, and the FBI, we do daily monitoring for the potential of
airborne bioterrorism threats which occur.
So, one of the things that we responded to was a suspicious
powder, including a recent incident at Riley Children's
Hospital at Indiana University Health. We are the only health
department's environmental emergency response team, the only
team in Indiana, that keeps a ready supply of appropriate test
kits to detect ricin, as well as anthrax, botulism toxin, and
poxvirus. While these kits are very costly to maintain, we have
made our capabilities a priority, and we believe that the
financial investments are necessary to be able to respond to
any events that occur.
This proved to be a valuable investment because last year,
when letters containing ricin were being mailed across the
country, we were the only public health department in the State
of Indiana with the ability to test for ricin.
Another important function for Marion County is that during
a biological threat event, we run the point-of-dispensing
system. We are responsible for delivering critical medications
and vaccinations from either the strategic National stockpile
or the State strategic stockpile to the citizens of Marion
County.
We routinely work with our collaborating counties that are
part of the District V hospital and public health department's
programs collaboratively, doing training exercises, and our
best demonstration was the Super Bowl, where we worked with the
FBI, the Environmental Protection Agency, and other Federal
agencies in supporting this event.
We maintain a volunteer medical reserve corps.
Last, I just want to say that Marion County has a
population of nearly 1 million people, approximately one-sixth
the State of Indiana. One of our essential stints is our
public-private partnership with our health care providers. And
not only the hospitals; we work with community health centers,
urgent care facilities, dialysis centers, social workers,
psychologists, to build up a great health care sector in
Central Indiana.
One of our key partners is Wishard Health Services. It is a
safety-net hospital in Central Indiana. It is one of only two
Level I trauma centers in the city and routinely provides
support to mass casualty events. They have a special obligation
to vulnerable populations during and following disaster mass
casualty events, and they take that responsibility seriously.
Shortly, they are going to move to a new facility, and they
are going to have the opportunity to test its ability to
evacuate an entire hospital and relocate patients, and they are
going to do it by the incident command system.
So we are looking forward to it, and I want to thank the
staff for giving us an opportunity to testify on our efforts to
prepare Central Indiana for a mass casualty events. Thank you
for your leadership and your emphasis on this important area of
emergency preparedness. Thank you.
[The prepared statement of Dr. Caine follows:]
Prepared Statement of Virginia A. Caine
Good morning Chairwoman Brooks, Senator Donnelly, Congressman
Young, Congresswoman Walorski, and staff of the subcommittee. On behalf
of the Marion County Public Health Department, I would like to thank
you for the opportunity to come here today to discuss our efforts to
prepare to respond to a mass casualty event in Marion County. I hope
this is the first of many opportunities to work with this subcommittee.
Today I would like to share some of our response capabilities here
in Marion County and emphasize the importance of building partnerships
between the public and private sectors. Here in Central Indiana, we
have built a truly unique health care coalition that allows the Health
Department, Emergency Medical Services, and other public agencies to
effectively collaborate and to work together with our private sector
health care partners. We are prepared to respond to all hazards,
whether natural disasters, disease outbreaks, terrorist threats, or
weapons of mass destruction, because we have built a coalition that
enables all partners to work together to respond.
the health department's role
The Marion County Public Health Department is responsible for
Emergency Support Function (ESF) 8 functions under the National
Response Framework, which means the health department is responsible
for the public health and medical care needs of the entire population
in Marion County during an emergency event. This can include everything
from medical treatment to providing clean drinking water and
sanitation. In addition, the health department is responsible for
coordinating Emergency Support Function (ESF) 11 activities which
entails identifying food, water, and ice needs and temporary shelter
for animals in the aftermath of an emergency.
One of the most important responsibilities of the Health Department
is protection against chemical, biological, radiological, nuclear, and
high-yield Explosive (CBRNE) threats. To monitor and respond to these
threats, the Health Department operates an Environmental Emergency
Response team that collaborates with local and State partners including
the Indianapolis Fire Department Hazardous Materials (HazMat) team, the
Indiana Department of Homeland Security, and the Indiana State
Department of Health. This team plays a very important role, especially
concerning our response to chemical and biological threats. Because of
this team, Central Indiana maintains an excellent state of preparedness
for chemical and biological threats.
Marion County Public Health Department is also responsible for the
coordinating activities under the U.S. Department of Homeland
Security's BioWatch program. In partnership with Indiana Departments of
Environmental Management and Health, Indianapolis Metropolitan Police
Department, Hamilton County Health Department, the U.S. Army Civil
Support team and the FBI, daily monitoring for the potential of
airborne bioterrorism threats occurs.
Our Environmental Emergency Response team responds in conjunction
with the Indianapolis Fire Department HazMat team to secure, sample,
and process hazardous or suspicious materials, especially when
biological hazards are suspected. They respond to all incidents
involving suspicious powders, including a recent incident at Riley
Children's Hospital at Indiana University Health. Marion County Public
Health Department's Environmental Emergency Response Team is the only
team in Indiana that keeps a ready supply of appropriate test kits to
detect ricin, as well as Anthrax, Botulinum toxin, and poxvirus. While
these kits are very costly to maintain, we have made our CBRNE
capabilities a priority and have made the financial investments
necessary to be able to respond when these events occur. This proved to
be a very valuable investment last year when letters containing ricin
were being mailed around the country and we were the only Public Health
Department in Indiana with the ability to test for ricin.
Another important function that the Marion County Public Health
Department performs to protect our community during a biological threat
event is to run the Point of Distribution (POD) system that would be
responsible for delivering critical medications or vaccinations from
either the strategic National stockpile or the State strategic
stockpile to the citizens of Marion County. In addition to running
these points of distribution, we would also maintain communications
with the public to keep them informed of the biological threat and the
best practices they can take to respond to that threat. We continuously
plan and regularly conduct trainings and drills to ensure that we could
effectively distribute vaccines and medication to protect the
population of Central Indiana in the event of either a natural or a
terrorist biological threat.
Because we have invested in a great team, which allows us to
maintain a high level of preparation to respond to environmental
emergencies, we are also called on to lend assistance and to be a
resource beyond the borders of Marion County. We routinely work with
the surrounding counties to provide mutual aid support, engage in
collaborative planning, and participate in mutual training exercises
with local, State, and Federal agencies so that we can be prepared
across the entire Central Indiana Region. One of the best
demonstrations of this collaborative spirit was evidenced in during the
Super Bowl last year, where we maintained a 24-hour support team that
worked with the FBI, the EPA, and other Federal agencies involved in
supporting the event.
Marion County also collaborates to ensure that we have a resilient
community by maintaining a volunteer Medical Reserve Corps. We keep an
on-going registry of licensed medical providers who have the ability to
serve in the event of a disaster or attack by a weapon of mass
destruction, and we call upon these volunteer providers for assistance
during emergency events. These providers include physicians and nurses
to provide immediate medical attention, but we also go beyond the
immediate medical needs to maintain a registry of volunteers who can
treat the deeper health needs of the community, including social
workers and psychologists. We recently had an opportunity to deploy
some of these volunteers to assist the Central Indiana community when
we responded to the home explosion in Richmond Hills. Our social
workers and community psychologist partners worked together with us to
help that community heal after dozens of people were evacuated from
their homes in response to the explosion.
the importance of public-private partnerships
Marion County has a population of nearly 1 million people, or
approximately one-sixth of the population of the entire State of
Indiana. When you include the population of the surrounding counties of
Central Indiana whose residents are not technically a part of our
service area, but who frequently utilize hospitals and other care
providers within Marion County, health care facilities in Marion County
could be asked to service the medical needs of up to 1.7 million
people. The majority of all health care emergency response needs would
have to be met by private-sector providers. One of the things we
realized early on was the critical importance of working together with
the private sector to plan for major disasters or weapons of mass
destruction.
In order for the Health Department to effectively perform its ESF-8
functions, we also determined that it was essential to form strong
partnerships between and amongst the private hospitals, as well as with
local public safety partners who would be able to facilitate
appropriate responses to emergency events. In order to bring about this
capability, we collaborated to form a non-profit health care coalition,
the MESH Coalition. MESH is an organization that helps health care
providers, who are competitors in regular business, work together with
the Health Department, public safety agencies, and other private-sector
organizations to prepare and respond to treats in Central Indiana. No
other city has the kind of partnership between public agencies and the
private health care sector that we have formed here in Marion County.
Our spirit of partnership with private-sector health care providers
is not limited to hospitals, but also extends to the other health care
facilities within the county. We partner with dozens of other provider
organizations, including community health centers, urgent care
facilities, dialysis centers, social workers, and psychologists to
built preparation throughout the health care sector in Central Indiana.
One of our key partners is Wishard Health Services. It is the safety
net hospital in Central Indiana. Wishard is one of only two Level 1
Trauma Centers in the city, and routinely provides support to mass
casualty events. They have a dedicated vice president-level executive
who is responsible for emergency management issues. Wishard has a
special obligation to vulnerable populations during and following
disaster/mass-casualty events and takes that responsibility seriously--
leading to innovation in outreach and disaster management for these
patients. They will shortly be moving to a new facility, in which it
will have the opportunity to test its ability to evacuate an entire
hospital and relocate patients. Wishard will use emergency management
principles, including the Incident Command System (ICS) to organize the
move. Wishard houses/hosts MESH, and was an early founding member of
the coalition. Our philosophy is that to develop a prepared community,
a community which can be resilient in responding to and recovering from
a public health crisis, you must first build a healthy community. A
healthy community foundation is required in order to respond to a
natural disaster or terrorist situation, which means that people in
that community must have access good quality health care, a strong
social support fabric, and the public resources they need to address a
crisis situation.
Chairwoman Brooks, Senator Donnelly, Congressman Young,
Congresswoman Walorski, and staff of the subcommittee, I would like to
thank you for the opportunity to testify today on our efforts to
prepare Central Indiana for a mass casualty event. I would also hope
that our the accomplishments we have made in building a public-private
health care coalition are something that other cities can benefit from
to improve their health care systems' ability to respond emergencies.
Again, thank you for your leadership and your emphasis on the
importance of emergency preparedness.
Mrs. Brooks. Thank you so much, Dr. Caine.
I now call on Dr. Profeta to testify for 5 minutes.
STATEMENT OF LOUIS M. PROFETA, M.D., F.A.C.E.P., MEDICAL
DIRECTOR OF DISASTER PREPAREDNESS, ST. VINCENT HOSPITAL,
INDIANAPOLIS, INDIANA
Dr. Profeta. Chairwoman Brooks, Senator Donnelly,
Representative Walorski, thank you for allowing me the
opportunity to come speak here and for taking an interest in
this very important topic.
The development of pre-hospital and emergency management of
victims of mass casualty disasters arose in the mid-19th
Century in the United States to address the needs of wounded
soldiers in battle. This concept continued to grow with the
birth of municipal and hospital-based ambulance services,
followed by the development of emergency medicine services in
the mid-1950s.
In the infancy of development of EMS and emergency medicine
and emergency systems, Indianapolis experienced one of the
worst disasters in the 20th Century. On October 31, 1963, at
the Indiana State Fairgrounds Coliseum during the opening night
of the Holiday On Ice show, a gas leak explosion under the
grandstands killed 74 people and resulted in 400 casualties.
Fifty-four people were dead at the scene, 20 died in subsequent
days, 165 people were admitted, and 209 were treated and
discharged home.
Many sustained injuries as bad as, if not worse than, those
that we saw in the Boston Marathon explosion because many of
these people were killed in crush injuries and a subsequent
fire that erupted within the Coliseum.
In 1963, there was no social media. There was no
comprehensive mass casualty plan, no 24-hour news, no
sophisticated trauma centers. Indianapolis EMS had just started
to use two-way radio communication to coordinate ambulance
dispatch, but there was no practical means to triage and
distribute mass casualty patients throughout the city.
In this case, in this instance, the dying were evacuated
from the burning Coliseum. They were pulled into a nearby
cattle barn, and a major attempt was made to transport and
triage this huge number of casualties. St. Vincent's Hospital
alone saw well over 100 patients from this disaster, with more
than 50 needing to be admitted, and most requiring surgical
intervention. Nearly all of the 400 casualties arrived at local
emergency departments in less than 2 hours, and most within 30
minutes. In fact, the first patient showed up at St. Vincent's
Hospital, and that is how St. Vincent's found out about the
explosion, because he showed up with bad injuries and said,
hey, the Coliseum just exploded.
What is remarkable is that the injury patterns that we saw
in the Coliseum explosion were very similar to those that we
would expect in a suicide bomb attack in Israel, and also what
we saw in Boston. St. Vincent's Hospital's prevailing disaster
plan was developed from our knowledge and our reflection on
these past tragedies. At St. Vincent's Hospital, we have
modeled our mass casualty strategy, including emergency
department mobilization staging, on the tactics and the
procedures followed by several Israeli hospitals and military.
Israeli expertise is considered second-to-none in organizing
hospitals' methods of response to a mass casualty incident.
Specifically, we studied the strategies utilized by the
Western Galilee Hospital in Northern Israel, as well as Magen
David Adom, which is the Israeli version of the American Red
Cross, to respond to acts of terror. Their emergency processes
are predicated on speed, simplicity, reproducibility, and
security.
At St. Vincent's Hospital, in the event of a multi-casualty
incident, we begin by evacuating our entire emergency
department and mobilizing all of our patient cots to the
turnaround entrance to the emergency department to facilitate
and allow easy off-loading of EMS patients.
Next, a seasoned emergency physician triages curbside so
that we can send those valuable ambulances and paramedics back
out onto the street with little to no delay. In fact, we can do
this within 2 to 3 minutes, have those people back out on the
streets and taking care of more casualty victims. We believe
our system would function very well in a Boston-type event, but
we also believe it would operate expertly in a Coliseum-
magnitude explosion.
Certainly, the disaster response in the Boston Marathon was
well-organized, it was well-coordinated, it was well-planned,
but it occurred in the middle of a situation where you were
near seven of the finest medical centers in the world and where
you already had 200 EMS providers, medical tents, and support
personnel staged at the location near or around the event.
Some years ago, following September 11, St. Vincent's
Hospital reviewed the injury pattern data from prior Israeli
suicide studies and structured our emergency department's
disaster response based on those studies. For example, if there
are 100 victims in a suicide bombing, we can expect that 18 to
20 percent are going to die at the scene, 6 percent are going
to need emergency intubation in our department, 5 percent are
going to need chest tubes, 12 to 18 percent will require
immediate surgery, and 8 percent are going to require
laparotomies. In addition, 35 to 40 percent of those patients
are going to require admission to the hospital, and the rest
will be considered walking wounded.
Therefore, in the face of a large casualty, St. Vincent's
emergency department can be confident in saying we can take 100
patients because we already know what we are getting. There is
no need for an extensive, multilayered, mobile command center
running interference. In fact, Boston was lucky when compared
to other suicide bombing instances such as the Park Hotel
bombing in 2002 in Israel. They actually had less fatalities
and less serious injuries than what we really should have
expected in an event like that.
On a yearly or biannual basis, St. Vincent's experiences
events that cause patient surgeons in our emergency department.
They largely go unnoticed because they don't involve a bomb and
they don't involve a novel organism. Certainly, there have been
significant pan-flu epidemics with H1N1 at a time when these
have overwhelmed our emergency department in terms of volume
but not in terms of acuity. In other words, we have a lot of
patients, but they are really not that sick.
Because of the lack of high acuity in surgeries such as
these, the ED can easily accommodate these extra patients
without a huge strain on the system. However, the last couple
of years we have seen weather events, ice storms in particular,
that have resulted in surges where the average patient volumes
in some of our emergency departments were 100 patients greater
than what we might typically see in a 24-hour period of time,
and most of those people came within a 12-hour window. Many of
them had serious fractures, head injuries. Some of those people
even died, especially our elderly who were on concomitant blood
thinners.
Statistics actually show that in a city the size of
Indianapolis, we are going to see 1,000 injuries that require
emergency department visits on every single day of significant
ice accumulation, and we handle those completely fine, all the
hospitals do, without a whole lot of attention from the media.
In closing, as a community and as a State, we have
certainly come a long way in regards to preparedness since the
1963 Coliseum events, and an increase in terrorist-type attacks
have drawn disaster preparedness into the spotlight. New
organizational structures such as the Indiana Emergency
Management Agency Field Services Division, MESH, have sprung up
to help coordinate when disasters strike. The reality, however,
is that we have made very little improvement to disaster
coordination and communication when these events actually
occur, and we have made very little advancement in
communication and coordination since 1963.
This can be illustrated in the recent bus mass casualty
event that occurred on July 27. The first responder efforts
were amazing. The EMS efforts were amazing. But there certainly
was a breakdown in communication, both externally and
internally, that led to an emergency department only 4 miles
away from this mass casualty event completely mobilized,
completely evacuated, only to get two patients from this event.
So certainly those are issues that we need to address, again
both internally and externally.
We have to place a greater emphasis and expect more Federal
support for advanced communications in time of disaster. As
hospital systems, we have to adopt the attitude that united we
stand and divided we fall. I want to thank you for the
opportunity to speak here today.
[The prepared statement of Dr. Profeta follows:]
Prepared Statement of Louis M. Profeta
Aug. 6, 2013
The development of pre-hospital and emergency management of victims
of mass casualty disasters arose in the mid-19th Century in the United
States to address the needs of wounded soldiers in battle.\1\ This
concept continued to grow with the birth of municipal and hospital-
based ambulance services, followed by the development of emergency
medical services in the mid-1950s.\1\
---------------------------------------------------------------------------
\1\ Blackwell, Tom, MD, FACEP. ``Prehospital Care of the Adult
Trauma Patient.'' Up to Date. Up to Date, 29 May 2013. Web. 31 July
2013.
---------------------------------------------------------------------------
In the infancy of the development of EMS and emergency medicine,
Indianapolis experienced one of its worst disasters in the 20th
Century. On October 31 in 1963 at the Indiana State Fairgrounds
Coliseum during the opening night of the Holiday on Ice show, a gas
leak explosion under the grand stands killed 74 people and resulted in
nearly 400 casualties.\2\ \3\ Fifty-four people were dead at the scene
and 20 died in subsequent days; 165 people were admitted and 209 were
treated and discharged home.\2\ \3\ Many sustained injuries as bad if
not worse than those in the recent Boston Marathon bombing because the
explosion was also accompanied by fire. Most of the victims who died
immediately were either crushed or severely burned.\3\
---------------------------------------------------------------------------
\2\ ``RetroIndy: The 1963 Coliseum Explosion.'' Indianapolis Star.
N.p., 17 Apr. 2013. Web. 31 July 2013.
\3\ ``Coliseum Explosion.'' Coliseum Explosion. Indianapolis Star,
10 July 2001. Web. 31 July 2013.
---------------------------------------------------------------------------
In 1963 there was no social media, no comprehensive mass casualty
plan, no 24-hour news, no sophisticated trauma centers. Indianapolis
EMS had just begun to use two-way radio communication to coordinate
ambulance dispatch, but there was no practical means to distribute and
triage mass casualty patients throughout the city.\4\ In this case, the
dying were evacuated from the burning Coliseum, pulled into a nearby
cattle barn and an attempt was made to prioritize for transport to
local hospitals.\2\ \5\ The vast majority of victims self-
transported.\5\
---------------------------------------------------------------------------
\4\ ``Indianapolis EMS to Mark 125 Years of Service Indianapolis
EMS.'' Indianapolis EMS to Mark 125 Years of Service Indianapolis EMS.
Indianapolis Department of Public Safety, 17 May 2013. Web. 31 July
2013.
\5\ Drabek, Thomas. ``DISASTER IN AISLE 13 REVISITED.'' DISASTER IN
AISLE 13 REVISITED. N.p., 18 May 1995. Web. 31 July 2013.
---------------------------------------------------------------------------
St. Vincent Hospital alone saw well over 100 patients from this
disaster, with more than 50 needing admission and most requiring
surgical intervention. Nearly all of the 400 casualties arrived at
local emergency departments in less than 2 hours and most within 30
minutes.\5\ Surprisingly, the injury patterns, morbidity, and mortality
of the casualties sustained that day are remarkably similar to those
sustained by both suicide bombing victims in the Middle East, as well
those injured in the Boston Marathon bombing. St. Vincent Hospital's
prevailing disaster plan has developed from our knowledge of and
reflection on these past tragedies.
At St. Vincent Hospital, we have modeled our mass casualty
strategies, including emergency department (ED) mobilization and
staging, on the tactics and procedures followed by several Israeli
hospitals and military. Israeli expertise is considered second-to-none
in organizing hospitals' methods of response to a multiple casualty
incident (MCI).\6\ Specifically, we have studied strategies utilized by
the Western Galilee Hospital in Northern Israel, as well as the Magen
David Adom (the Israeli version of the Red Cross), to respond to acts
of terror. Their emergency processes are predicated on speed,
simplicity, reproducibility, and security.\7\
---------------------------------------------------------------------------
\6\ Leichman, Abigail Klein. ``The Israeli Sharing His Mass
Casualty Expertise in Boston.'' ISRAEL21c. N.p., 24 Apr. 2013. Web. 31
July 2013.
\7\ ``Preparing for Emergencies: A SPECIAL MEETING OF THE RED CROSS
WITH MDA ISRAEL.'' MDA ISRAEL. N.p., 25 July 2013. Web. 31 July 2013.
---------------------------------------------------------------------------
At St. Vincent Hospital, in the event of a multi-casualty incident,
we begin by evacuating our entire emergency department (ED) and
mobilizing all of our patient cots to the driveway at the entrance to
the ED to allow easy offload of EMS patients. Next, a seasoned
emergency physician triages curbside, so that we can send ambulances
back out with little to no delay in the transfer of other injured. This
procedure allows EMS vehicles and personnel to be back out on the
streets and in service within 2-3 minutes of arrival to the ED.
We believe our system would function very well in a Boston-type
event, but we also believe it would operate expertly in a Coliseum-type
explosion as well. Certainly, the disaster response to the Boston
Marathon bombing was well-organized, well-coordinated, and well-
planned.\8\ Fortuitously, this multi-casualty incident occurred in a
location near seven of the finest hospitals and medical centers in the
world. In addition there were already more than 200 EMS providers on-
scene with medical tents and equipment on-hand.\8\
---------------------------------------------------------------------------
\8\ Krisberg, Kim. ``Preparedness Paid Off in Boston Marathon
Bombing Response.'' JEMS.com. Journal of Emergency Medical Services, 1
July 2013. Web. 31 July 2013.
---------------------------------------------------------------------------
Some years following the September 11 attacks, St. Vincent Hospital
reviewed the injury pattern data from prior Israeli suicide bombing
studies and structured our emergency department's disaster response
based on those studies. For example, if there are 100 victims in a
suicide bombing, we can expect 18-20% to die at the scene, 6% to need
emergency intubation in the ED, 5% to need chest tubes, 12-18% to
require immediate surgery, and an additional 8% to require
laparotomies. In addition, 35-40% of the victims will need to be
admitted; the remainder of the patients will be walking wounded.
Therefore, in the face of a large casualty incident, St. Vincent ED
can be confident in saying, ``we can take 100 patients'' because we
already know what we are getting. There is no need for an extensive,
multi-layered mobile command center running interference. In fact,
Boston was lucky when compared to similar events such as the Park Hotel
bombing in 2002 in Netanya, Israel; statistics show that many more
people could have been killed at the scene in Boston.\9\
---------------------------------------------------------------------------
\9\ ``Passover Suicide Bombing at Park Hotel in Netanya-27-Mar-
2002.'' GxMSDev. Israeli Ministry of Foreign Affairs, 27 Mar. 2002.
Web. 31 July 2013.
---------------------------------------------------------------------------
On a yearly or biennial basis, St. Vincent experiences events that
cause patient surge issues in our ED. These events may largely go
unnoticed because they do not involve an explosion or a novel organism.
Certainly there have been significant panflu epidemics with H1N1 and
these at times have overwhelmed the ED in terms of volume but not in
acuity. In other words, the ED may see a lot of patients who are not
really that sick. Because of the lack of high acuity in surges such as
these, the ED accommodates the extra patients without a huge strain on
the system.
However in the last couple years, a few weather events (ice storms)
have resulted in surges where average patient volumes in some of our
EDs were 100 patients more than average over a 24-hour period with most
of that surge showing up in a 12-hour window. In addition, in one of
those events, a large percentage of patients had serious fractures and
head trauma, which required significant resources and often admission.
In fact, statistics show you can expect 1,000 emergency injury visits
per day in a city the size of Indianapolis for each and every day of
significant ice accumulation.\10\
---------------------------------------------------------------------------
\10\ ``Work-Related Injuries Associated with Falls During Ice
Storms.'' Centers for Disease Control and Prevention. Centers for
Disease Control and Prevention, 15 Dec. 1995. Web. 31 July 2013.
---------------------------------------------------------------------------
In closing, as a community and as a State, we have certainly come a
long way in regards to preparedness since the 1963 Coliseum explosion.
An increase in terrorist-type attacks has drawn disaster preparedness
into the spotlight. New organizational structure such as the Indiana
Emergency Management Agency and Field Services Divisions along with new
organizations such as MESH have sprung-up to help coordinate events
when disasters strike. The reality however, is that we have made very
little improvements to disaster coordination and communication when
these events actually occur and have made very little advancement in
communication and coordination since 1963. This was perfectly
illustrated in the recent bus crash mass casualty event that occurred
on Saturday, July 27. St. Vincent Hospital and Trauma Center, the
second-busiest trauma center in the State of Indiana only received two
patients from a mass casualty event not more than 4 miles away. We were
not only the closest hospital, we were the closest trauma center, and
more than likely mobilized had the most organized disaster plan in the
city, yet only received two patients from this tragedy. We must place a
greater emphasis and expect more Federal support to advance
communications in the time of a disaster. There is no place for
territorial imperatives and imperialistic attitudes from individual
hospitals and EMS agencies during a disaster response. As hospital
systems, we must adopt the attitude that united we stand and divided we
fail.
Mrs. Brooks. Thank you, Dr. Profeta.
The Chairwoman now recognizes Dr. Knight for 5 minutes.
Thank you.
STATEMENT OF H. CLIFTON KNIGHT, CHIEF MEDICAL OFFICER,
COMMUNITY HEALTH NETWORK
Dr. Knight. Good morning, Chairwoman Brooks, Senator
Donnelly, Representative Walorski, and the staff of the
subcommittee. On behalf of Community Health Network, we
sincerely appreciate this opportunity to discuss Indiana's
preparedness for a mass casualty event with you today. Your
commitment and dedication to this important issue shows a
proactive interest that we do sincerely appreciate.
My name is Cliff Knight. I am a family physician, and I am
the chief medical and chief academic officer for Community
Health Network. Today I want to provide you with some basic
background information about our organization, our engagement
with emergency preparedness efforts, and our concerns regarding
being optimally prepared for the potential of catastrophic
events in Central Indiana.
We are based in Indianapolis, and Community Health Network
is a private, not-for-profit system consisting of six general
acute hospitals, a cardiovascular-focused acute care hospital,
a freestanding rehabilitation hospital, as well as hundreds of
ambulatory sites of care, encompassing a full spectrum of both
primary care services and subspecialty services. In addition,
we provide extensive homecare-based services. We have
approximately 13,000 employees and host 2 million patient
encounters each year across all of our facilities.
Each of our acute care hospitals provides emergency
services. Internally, we provide extensive educational
programming for in-the-field emergency medical providers, and
we meet or exceed all the standards of the Joint Commission
related to emergency preparedness. To accomplish this, we train
staff, we track supplies, and regularly communicate with our
teams regarding issues and trends of importance.
Throughout our facilities, we also perform drills using a
variety of scenarios multiple times per year. Community has an
emergency operations plan, as well as a surge plan. Utilizing
resources throughout our district support structure, we are
able to help support patient influx as necessary. As a
district, we drill for severe patient influx on an annual basis
at least.
In Indiana, we believe our greatest and most likely risks
are related to natural disasters such as tornadoes and
earthquakes. However, we take very seriously the plausibility
of a terrorist-initiated disaster resulting in a surge in acute
care needs. We aim to be prepared in ways that accommodate the
needs that would arise from a variety of causes.
Community Health Network actively participates in
activities with the MESH Coalition, as well as the Indianapolis
Coalition for Patient Safety. We found that both organizations
uniquely are suited to support our efforts to coordinate and
standardize approaches to issues common to all the hospitals in
Indianapolis.
For example, our involvement in the Indianapolis Coalition
for Patient Safety has resulted in our participation in city-
wide efforts to standardize approaches to addressing influenza
outbreaks, both H1N1 and seasonal, and the resulting surges in
patient care.
Though we are confident in our preparedness for adequately
responding to mass casualty situations, we strongly believe
that there is more that can and should be done to optimally
prepare. Our greatest fears are around our ability to quickly
mobilize enough health care providers and staff in response to
an emergent need. We, of course, have designated on-call
personnel, but would need to mobilize additional resources
quickly. We believe this can be accomplished through
communication avenues utilizing standard methodologies--cell
phones, text messages, social media, and public
communications--but this is a theoretical given that
communications may be interrupted in a large-scale event with
widespread damage.
To address this, we urge continued focus on supporting
redundancies and refinements in public communication
infrastructure as a safeguard.
Another area of concern is related to the reality of
funding for training and education of our personnel. As
economic forces require us to function more efficiently, it
becomes problematic to regularly remove providers and staff
from their primary functions in order to free them up to focus
on training and education.
In addition, our observation is that we need to be more
fully involving hospitals and EMS providers in training and
education. There seems to be a lack of funding to support this
involvement for private hospitals and private EMS services.
In order to accomplish broader coordination and improved
participation in preparation, Federal funding to support these
efforts would be helpful.
Thank you all for this opportunity to provide a status
report regarding our emergency preparedness in Central Indiana
and for your commitment to improving our capabilities, and I
look forward to providing any other additional information for
clarification or questions you may have.
[The prepared statement of Dr. Knight follows:]
Prepared Statement of H. Clifton Knight
August 6, 2013
Good morning Chairman Brooks, Senator Donnelly, Congresswoman
Walorski, Congressman Young, and staff of the subcommittee. On behalf
of Community Health Network, we appreciate this opportunity to discuss
Central Indiana's preparedness for a mass casualty event with you
today. Your commitment and dedication to this important issue shows
proactive interest that we sincerely appreciate.
Today, I plan to provide you with some basic background information
about our organization, our engagement in emergency preparedness
efforts, and our concerns regarding being optimally prepared for the
potential of catastrophic events in Central Indiana.
community health network
Based in Indianapolis, Community Health Network is a private, not-
for-profit system consisting of 6 general acute care hospitals, a
cardiovascular-focused acute care hospital, and a free-standing
rehabilitation hospital as well as hundreds of ambulatory sites of care
encompassing a full spectrum of primary care and sub-specialty
services. In addition, we provide extensive home-based services. We
have 13,000 employees and experience 2,000,000 patient encounters each
year.
emergency preparedness engagement
Each of our acute care hospitals provides emergency services.
Internally, we provide extensive educational programming for in-the-
field emergency medical providers. We meet or exceed all standards of
The Joint Commission related to emergency preparedness. To accomplish
this, we train staff, track supplies, and regularly communicate with
our teams regarding issues and trends of importance. Throughout our
facilities, we also perform drills using a variety of scenarios
multiple times per year. Community has an Emergency Operations Plan as
well as a surge plan. Utilizing resources through our district support
structure, we are able to help support patient influx as necessary. As
a district, we drill for severe patient influx at least annually.
In Indiana, we believe our greatest and most likely risks are
related to natural disasters such as tornadoes and earthquakes.
However, we take very seriously the plausibility of a terrorist-
initiated disaster resulting in a surge in acute care needs. We aim to
be prepared in ways that accommodate the needs that would arise from a
variety of causes.
Community Health Network actively participates in activities with
the Managed Emergency Surge in Healthcare (MESH) Coalition as well as
the Indianapolis Coalition for Patient Safety (ICPS). We have found
both organizations uniquely suited to support our efforts to coordinate
and standardize approaches to issues common to all hospitals in
Indianapolis. For example, our involvement in the ICPS has resulted in
our participation in city-wide efforts to standardize approaches to
addressing influenza outbreaks (both H1N1 and seasonal) and the
resulting patient surges.
needs assessment
Though we are confident in our preparedness for adequately
responding to mass casualty situations, we strongly believe there is
more that can and should be done to optimally prepare.
Our greatest fears are around our ability to quickly mobilize
enough health care providers and staff in response to an emergent need.
We of course have designated on-call personnel, but would need to
mobilize additional resources quickly. We believe this can be
accomplished through communication avenues utilizing standard
methodologies (cell phones, text messages, social media, and public
communications) but this is theoretical given that communications may
be interrupted in a large-scale event with wide-spread damage. To
address this, we urge continued focus on supporting redundancies and
refinements in public communication infrastructure as a safeguard.
Another area of concern is related to the realities of funding for
training and education of our personnel. As economic forces require us
to function more efficiently, it becomes problematic to regularly
remove providers and staff from their primary functions in order to
focus on training and education. In addition, our observation is that
we need to more fully involve all hospitals and EMS providers in
training and education. There seems to be a lack of funding to support
this involvement for private hospitals and private EMS services. In
order to accomplish broader coordination and improved preparation,
Federal funding to support these efforts would be helpful.
Thank you all for this opportunity to provide a status report
regarding emergency preparedness in Central Indiana and for your
commitment to improving our capabilities. I look forward to providing
any additional information or clarifications that may be helpful.
Mrs. Brooks. Thank you, Dr. Knight.
The Chairwoman now recognizes Dr. Reed to testify.
STATEMENT OF R. LAWRENCE REED, II, M.D., F.A.C.S., F.C.C.,
DIRECTOR OF TRAUMA SERVICES, INDIANA UNIVERSITY HEALTH
METHODIST HOSPITAL
Dr. Reed. Thank you, Chairwoman Brooks, Senator Donnelly,
and Congresswoman Walorski. Thank you for the opportunity to
discuss this very critical task. Put very simply, preparedness
saves lives. IU Health has a proven history in treating the
unexpected, the complex, and the unique, and does so with the
highest standard of patient quality care and outcomes.
Our work is, by its very nature, frenetic, yet requires
precision. No two cases are the same. Yet, we remain fully
prepared and ready for events that no one wants to acknowledge
could happen, let alone see. It is like having an army primed
and ready for a battle you hope you will never have to fight.
IU Health is home to two of only three Level I trauma
centers in Indiana. IU Health Methodist is a verified Level I
trauma facility. Wishard-Eskenazi is the other Level I trauma
facility in Indiana, and Riley Hospital for Children at IU
Health is the State's only pediatric Level I trauma center.
This verification comes with immense responsibility and
unparalleled dedication. We strive continually to refine, hone,
and improve our efforts. Being a Level I trauma center means we
have highly-skilled medical talent immediately available on-
site 24/7, two trauma surgeons in-house, around the clock, a
full emergency medical team, including emergency physicians and
nurses, neurosurgeons, orthopedic surgeons, anesthesiologists,
critical care specialists and hospitals, all on-site, day or
night, ready to provide immediate specialized care before
patients--tens, hundreds, or thousands--even hit our doors.
We have the resources at Methodist. We have 35 operating
rooms, a fully-stocked blood bank and critical supplies. The IU
Health system includes our lifeline fleet of critical care
transport comprised of six helicopters and five bases
throughout Indiana. Senior administrators throughout the State
are on call 24/7 with the infrastructure and ability to
immediately call in or send out support to and from sister
facilities.
In the more than 100 years of Methodist history, we have
never gone on diversion for trauma or emergency service, which
is unusual for a private hospital.
Although surge management starts at the scene of an
accident, we have elaborate plans in place at the hospital and
emergency department should patients show up at our doors
unannounced. A
24/7 on-duty team is constantly assessing patient flow and
care, and by virtue of being a large hospital with coverage by
multiple specialties and resources that many hospitals don't
have, we have experience with the cases that others can't
treat.
Indianapolis is home to major activities, teams, and
events, and IU Health plays a major role in supporting most of
these. IU Health is the exclusive provider to the Indianapolis
Motor Speedway and Lucas Oil Stadium, among others, where we
care for thousands of fans each season. Indianapolis hosts
sizable events, including the State Fair, the Super Bowl, the
NCAA Final Four basketball tournaments, big-name concerts, and
numerous conventions. Emergency preparedness is integral to the
planning and success of them all. We have a seat at the table
in the advanced planning for these major public events and
embrace our leadership responsibilities.
But, IU Health cannot do this alone. We are proud to be
part of a larger community with established emergency
preparedness systems and dedication to the charge. This is
where you see the community at its best, as public and private-
sector resources unite to address and plan emergency
preparedness. Planning and innovation has come more to the
forefront for the city and State, as well as local agencies, to
work with them, hospitals, and Government to prepare for the
event of a mass casualty, be it a natural disaster, weapons of
mass destruction, or other. We share a goal and collaborate
rather than compete.
MESH has been a valuable partner in leading preparedness
efforts and sharing intelligence and extending their expertise,
and we are fortunate to have a National leader and partner
based here in Central Indiana. IU Health is fully committed to
supporting the private-sector requirements of this partnership
in hopes that the funding needed for the public effort remains
in place. IU Health regularly hosts hazard vulnerability
assessments, preparedness drills, and shares best practices
with others in the community.
After any major U.S. incident, local or National, we are
privy to an after-action report and gap analysis which we can
use to further refine our plans. IU Health is in constant
communication with MESH, other hospitals, and partners in
immediate District V and throughout the State, all with the
united goal of being prepared to offer the best unexpected
medical care to patients.
Just last week, or actually 2 weeks ago, we treated an
influx of patients we received from an overturned bus accident
that involved three fatalities. We reattached a severed hand,
which can be the difference between a fairly normal life and
one of inconvenience and extreme handicap.
Following the 2011 State Fair stage collapse, before we
could even call in additional resources to prepare for the
arrival of many injured patients simultaneously, our staff
members were already reporting for new and unexpected work on a
Saturday night without even being called. We did not have to
activate our disaster plan. Our team knew they would be needed
and responded immediately. It was an impressive showing of
dedication and commitment and of typical Hoosier values as we
handled a serious community emergency seamlessly. Other
hospitals in Indianapolis--Wishard-Eskenazi, Riley at IU
Health, St. Vincent's--also helped manage several of these
victims. Because of our proximity and our resources, the worst
injuries came to IU Health Methodist.
IU Health uses its size and scope to help further
continuing education and build better relationships. IU Health
recently held a training exercise at the IMS to educate first
responders, increase standards of care, and build better
relationships. We were able to present unique and complex cases
of our Level I trauma team and better understood first
responders' needs of being in the field.
IU Health is a key part of the Indianapolis and Indiana
emergency network. We do things no other systems in the State
can handle. We appreciate your interest and welcome your
continuing support of our efforts to maintain readiness and
serve fellow Hoosiers in time of crisis. Thank you.
[The prepared statement of Dr. Reed follows:]
Prepared Statement of R. Lawrence Reed, II
August 6, 2013
Thank you for the opportunity to discuss this very critical topic--
put very simply, preparedness saves lives. IU Health has a proven
history in treating the unexpected, the complex, and the unique and
does so with the highest standard of patient quality, care, and
outcome.
Our work by its very nature is frenetic yet requires precision. No
two cases are ever the same, yet we remain fully prepared and ready for
events that no one wants to acknowledge could happen, let alone see.
It's like having an army primed and ready for a battle you hope you
never have to fight.
IU Health is home to two (of only three) Level 1 Trauma centers in
Indiana: IU Health Methodist is a verified Level 1 Trauma facility
(Wishard-Eskenazi is the other) and Riley Hospital for Children at IU
Health is the State's only pediatric Level 1 Trauma center. This
verification comes with immense responsibility and unparalleled
dedication. We strive continually to refine, hone, and improve our
efforts.
Being a Level 1 Trauma center means we have highly-skilled medical
talent immediately available on-site 24/7: Two trauma surgeons, a full
emergency medical team including emergency physicians and nurses,
neurosurgeons, orthopedic surgeons, anesthesiologists, critical care
specialists, and hospitalists--all on-site, day or night, ready to
provide immediate specialized care before patients (tens, hundreds, or
thousands) even hit our doors.
We have the resources: 35 operating rooms; a fully-stocked blood
bank and critical supplies; our LifeLine fleet of critical care
transport, comprised of six helicopters and five bases throughout
Indiana; senior administrators throughout the State on-call 24/7 with
the infrastructure and ability to immediately call in, or send out,
support from sister facilities. In the more than 100 years of Methodist
history, we have never gone on diversion for trauma or emergency
services, which is very unusual for a private hospital.
Although surge management starts at the scene of an accident, we
have elaborate plans in place at the hospital and emergency department
should patients show up at our doors unannounced. A 24/7 on-duty team
is constantly assessing patient flow and care. And by virtue of being a
large hospital with coverage by multiple specialties and resources that
many hospitals don't have, we have experience with the cases that
others can't treat.
Indianapolis is home to major activities, teams, and events and IU
Health plays a major role in supporting most of these. IU Health is the
exclusive health care provider to the Indianapolis Motor Speedway and
Lucas Oil Stadium, among others, where we care for thousands of fans
each season. Indianapolis hosts sizeable events, including the State
Fair, the Super Bowl, NCAA Final Four Basketball Tournaments, big-name
concerts, and numerous conventions, and emergency preparedness is
integral to the planning and success of them all. We have a seat at the
table in the advanced planning for these major public events and
embrace our leadership responsibilities.
But IU Health cannot do this alone. We are proud to be a part of a
larger community with an established emergency preparedness system and
dedication to the charge. This is where you see the community at its
best, as public and private-sector resources unite to address and plan
emergency preparedness. Planning and innovation has come more to the
forefront for the city and State as we work with local agencies,
hospitals, and Government to prepare for the event of a mass casualty--
be it a natural disaster, WMD, or other. We share a goal and
collaborate rather than compete.
MESH has been a valuable partner in leading preparedness efforts,
in sharing intelligence and in extending their expertise, and we are
fortunate to have a National leader and partner based here in Central
Indiana. IU Health is fully committed to supporting the private-sector
requirements of this partnership and hopes that the funding needed for
the public efforts remains in place. IU Health regularly hosts hazard
vulnerability assessments, preparedness drills, and shares best
practices with others in the community. After any major U.S. incident,
local or National, we are privy to an after-action report and gap
analysis which we can use to further refine our plans. IU Health is in
constant communication with MESH, other hospitals, and partners in our
immediate District V and throughout the State--all with a united goal
of being prepared to offer the best unexpected medical care to
patients.
key learnings & what is working well
Just last week we treated an influx of patients received from an
overturned bus accident that involved several fatalities; we reattached
a severed hand which can be the difference between a fairly normal life
or one of inconvenient and extreme handicap. Following the 2011 State
Fair stage collapse, before we could even call in additional resources
to prepare for the arrival of many injured patients simultaneously, our
staff members were already reporting for work on a Saturday night. We
did not have to activate our disaster plan. Our team knew they would be
needed and they responded immediately. It was an impressive showing of
dedication and commitment . . . and of typical Hoosier values . . . as
we handled a serious community emergency seamlessly. Other hospitals in
Indianapolis--Wishard-Eskenazi, Riley at IU Health, St. Vincent's--also
helped manage several of these victims. Because of proximity and our
resources, the worst injuries came to Methodist.
IU Health uses its size and scope to help further continuing
education and build better relationships. IU Health recently held a
training exercise at the IMS to educate first responders, increase
standards of care, and build better relationships. We were able to
present unique and complex cases of our Level 1 Trauma team and better
understand first responders' needs of being in the field.
IU Health is a key part of the Indianapolis and Indiana emergency
network. We do things no other systems in the State can handle. We
appreciate your interest and welcome your continuing support of our
efforts to maintain readiness and serve fellow Hoosiers in times of
crisis.
Mrs. Brooks. Thank you, Dr. Reed.
The Chairwoman now recognizes Dr. Obeime to testify.
STATEMENT OF MERCY OBEIME, DIRECTOR, COMMUNITY AND GLOBAL
HEALTH, FRANCISCAN ST. FRANCIS HEALTH, INDIANAPOLIS, INDIANA
Dr. Obeime. Good afternoon, Congresswoman Brooks, Senator
Donnelly, and Congresswoman Walorski. I have lived in District
V and worked in District VII since 1996. I am here today
representing Franciscan St. Francis Health to discuss the
ability----
Mrs. Brooks. Excuse me. Could you pull the mic a bit closer
to you? Thank you.
Dr. Obeime. Sorry. I am here today representing Franciscan
St. Francis Health to discuss the ability of the Central
Indiana community to respond to a mass casualty event. I am
also here accompanied by Diana Leonard, our full-time disaster
management coordinator. She is responsible for our three
Central Indiana hospitals and serves as a liaison to community
response partners, as well as ensures organizational
preparedness through planning and training.
Franciscan St. Francis Health is one of the largest health
care providers in Indiana, with campuses in Carmel,
Indianapolis, and Morrisville. We are a division of Franciscan
Alliance, one of the region's largest Catholic health care
providers. Our mission is continuing Christ's ministry in our
Franciscan tradition, and we strive to adhere to every word of
the mission statement.
In order to be continuing our hospital, we must be able to
continue to operate through disasters and other emergency
events. We continuously strive to develop comprehensive and
innovative strategies for emergency preparedness, response,
recovery, and mitigation.
Since our founding, our values have been rooted in
Franciscan tradition and the spirit of St. Francis of Assisi.
The health care professionals at Franciscan St. Francis exhibit
compassionate concern for the patients we serve and strive for
Christian stewardship, a just and fair allocation of human,
financial, and spiritual resources.
It is our job to help meet the basic medical needs of
vulnerable populations here in Indiana. Effective health care
emergency preparedness requires carefully considering the needs
of vulnerable populations. Vulnerable populations can be at
greater risk during disaster and crisis events. The social
determinants of health, socioeconomic status, age, gender,
ethnicity, education, disability, and immigration status all
contribute to a lack of equity and access to opportunities and
increased vulnerability to hazards.
Serving culturally-diverse populations is challenging. Our
health system has a large presence on the south side of
Indianapolis, which is home to a large Burmese and Hispanic
population. Emergency events call for the engagement of the
entire community, and we strive to break through language and
other cultural barriers to meet our health care objectives.
You may recall in June 2012, dozens of Indiana children
were sickened and injured when a dangerous chemical combination
in a neighborhood pool created a toxic gas. Then in November,
we were called to assist the victims of the Richmond Hill's
explosion. Because of our hazardous materials and emergency
preparedness training, as well as our partnerships with
community responders, we were able to successfully manage this
patient surge, care for our patients, and achieve positive
health outcomes for all involved.
Franciscan St. Francis Health was an early founding member
of the MESH Coalition, and we have remained a strong member. We
have also leveraged social media as a source of health care
intelligence and utilized platforms such as Facebook and
Twitter to distribute information to our community. By
collaborating with other hospitals, we can prevent redundancies
in emergency planning and create an efficient response
framework among area hospitals.
Chairwoman Brooks, Senator Donnelly, Congresswoman
Walorski, thank you again for this opportunity to speak before
your subcommittee. Emergency preparedness is vital to health
care not only in Central Indiana; it is vital across the globe.
We at Franciscan St. Francis Health appreciate your dedication
to this important area. We stand ready to assist the community
in times of need. Thank you very much.
[The prepared statement of Dr. Obeime follows:]
Prepared Statement of Mercy Obeime
July 6, 2013
Good morning Chairman Brooks, Senator Donnelly, Congresswoman
Walorski, Congressman Young, and all others with us today. I'm here
representing the staff of Franciscan St. Francis Health to talk to you
about our mission, specifically preparing the Central Indiana community
to prepare for emergencies and disasters.
Franciscan St. Francis Health is one of the largest health care
providers in Indiana with campuses in Carmel, Indianapolis, and
Mooresville. We are a division of the Franciscan Alliance, one of the
region's largest Catholic health care providers. Our Indianapolis
hospital offers cutting-edge technology and facilities, including the
south side's only comprehensive cardiac and vascular care program. We
have been ranked by multiple outlets as a Top 100 Hospital and have
received recognition for clinical excellence and outstanding patient
experience.
Since our founding, our values have been rooted in the Franciscan
tradition. In the spirit of Francis of Assisi, the health care
professionals at Franciscan St. Francis exhibit compassionate concern
for the patients we serve and strive for Christian stewardship--a just
and fair allocation of human, financial, and spiritual resources.
Since 1996, I have been fortunate to serve as the director of the
Franciscan St. Francis Neighborhood Health Center at Garfield Park,
where we provide primary medical care as well as health education for
Hoosier families who lack access to affordable health care. Serving
Indiana's underprivileged communities for the past 17 years has been a
challenging but extremely rewarding experience.
It is our job to help meet the basic medical needs of vulnerable
populations here in Indiana. Effective health care emergency
preparedness requires carefully considering the needs of vulnerable
populations. Social factors often cause populations to be at greater
risk during disaster and crisis events. Not unlike the social
determinants of health, socio-economic status, along with age, gender,
ethnicity, class, disability, and immigration status, all these factors
determine lack of equity in access to opportunities and increased
exposure to hazards. During Hurricane Katrina in 2005, for example, and
most recently following Hurricane Sandy, this social vulnerability to
disasters was widely evident as children, women, minorities, and the
poor were disproportionately affected. Serving culturally-diverse
populations also presents challenges. Our health system has a large
presence on the south side of Indianapolis, home to a large Burmese
population. Emergency events call for the engagement of the entire
community, and we strive to break through language and other culture
barriers to meet our health care objectives.
Like most hospitals, we have not been strangers to emergencies.
Last summer, dozens of Indiana children were sickened and injured when
a dangerous chemical combination in a neighborhood pool created a toxic
gas. Our acute care hospital in Indianapolis received 25 patients, all
of whom required decontamination due to chemical exposure. Because of
our hazardous materials and emergency preparedness training, as well as
the partnerships with community responders, staff was able to
successfully manage the surge in patients, while achieving positive
health outcomes for those affected by the incident.
Additionally, Franciscan St. Francis Health--Indianapolis was
called to assist the victims of last fall's Richmond Hills home
explosion. Among the items lost in the event were the medications of
numerous neighborhood residents. Our hospital offered its services to
provide a mobile clinic, working with a local pharmacy to meet the need
for maintenance medications for the residents of Richmond Hills. While
the mobile clinic was never deployed, Franciscan St. Francis stood
ready to assist the community in its time of need.
The mission of Franciscan St. Francis is continuing Christ's
ministry in our Franciscan tradition, and we strive to adhere to every
word of the mission statement. In order for our work to be
``continuing,'' our hospitals must be able to continue to operate
through disasters and other emergency events. Franciscan St. Francis
Health--through individual and collaborative efforts--continuously
strives to develop comprehensive and innovative strategies for
emergency preparedness, response, recovery, and mitigation. We maintain
a full-time disaster management coordinator for our three Central
Indiana hospitals who serves as a liaison to community response
partners, as well as enhance organizational preparedness through
planning and training. Having this resource has allowed us to conduct
full-scale emergency drills and streamline our emergency response plans
into operational checklists. We conduct an annual Hazard Vulnerability
Analysis, a method used to identify the most likely potential dangers
to specific health care providers and to provide action plans for
mitigating and responding to those vulnerabilities. We have upgraded
our equipment, including a robust communications system that operates
across our three campuses. All campuses are also in the process of
becoming certified as ``storm-ready'' by the National Oceanic and
Atmospheric Administration.
While Franciscan St. Francis Health takes the initiative in
creating comprehensive disaster management policies for our hospitals,
we realize that true emergency preparedness cannot exist in a vacuum.
We engage with other health care providers and public safety officials
in order to create an efficient, collaborative emergency management
system. Franciscan St. Francis Health--Indianapolis was an early,
founding member of the MESH Coalition, and we have remained a strong
partner since. MESH is a health care non-profit organization focused on
giving hospitals the accurate information and resources to respond to
emergency events and remain viable through recovery, promotes
collaboration between Marion County hospitals in the area of emergency
management, and provides invaluable resources we could not afford
individually. Our membership with MESH has proven to be very beneficial
over the years, allowing St. Francis to participate in many community
initiatives, including the Super Care Clinic during the 2011 Super Bowl
in Indianapolis, as well as hosting Nationally-recognized emergency
management professionals in the MESH Grand Rounds Series.
Another significant area in which MESH provides assistance is
health care intelligence. During mass casualty incidents, MESH helps us
better manage patient surge by notifying our emergency department how
many patients are being transported to our hospital. MESH serves as the
Medical Multi-Agency Coordinating Center (MedMACC) for Marion County,
providing hospitals with real-time intelligence, including news and
weather, public safety radio traffic, information from restricted
homeland security portals, and social media. Franciscan St. Francis has
also leveraged social media as a source of health care intelligence,
and utilizes platforms such as Facebook and Twitter to distribute
information to our community.
MESH also assists Franciscan St. Francis with emergency planning by
serving as a liaison with non-traditional emergency responders as well
as researching real-world emergencies in order to identify strategies
and tactics that were successful. We also participate in MESH's
Hospital Preparedness Officers Working Group, where emergency
management professionals meet to collaborate on Best Practices for
training, education, emergency planning, and exercises. By
collaborating with other hospitals we can prevent redundancies in
emergency planning and create an efficient response framework among
area hospitals.
Chairman Brooks, Senator Donnelly, Congresswoman Walorski, and
Congressman Young, thank you again for the opportunity to speak before
this subcommittee today. Emergency preparedness is vital to health care
here in Central Indiana and across the country. We at Franciscan St.
Francis Health appreciate your dedication to this important area. I am
happy to respond to any questions this subcommittee might have.
Mrs. Brooks. Thank you, Dr. Obeime.
At this time, I will recognize myself to begin the line of
questioning.
As we have learned in the aftermath of the Boston bombing,
the Boston EMS utilized the Metro Boston Central Medical
Emergency Direction System to alert area hospitals of the mass
casualty event and route patients, and this coordinated
response between EMS medical personnel along that marathon
course and area hospitals undoubtedly saved many lives.
In Central Indiana, what I would like to hear is: How are
we coordinating? Are we holding exercises for a large-scale
event, either individually in your own hospitals or
collectively? I think I would like to hear from each of you
very briefly in how are we working together on a day-to-day
basis before any mass incident.
We will go ahead and start with you, Mr. Priest.
Mr. Priest. In Central Indiana, in partnership with Marion
County and some regional areas as well, the Indianapolis Fire
Department, the Indianapolis EMS, and MESH, we operate the
Marion County Medical Multi-agency Coordinating Center. It is a
mouthful. We call it the MedMACC. The MedMACC's job is to
facilitate communication from scenes, such as the bus accident
that was discussed today, and local hospitals. As I think Dr.
Reed mentioned, surge management does start in the field, and
that means that we need to be able to tell our responders which
hospitals have availability, leaving the decisions to transport
in the hands of those professionals.
Mrs. Brooks. Thank you.
Dr. Caine, coordination among, or training?
Dr. Caine. We originally did a training with the 1,000 U.S.
postal workers in Indianapolis with the fire department and a
number of our hospital partners just recently. We also, about 2
years ago, did a partnership looking at the chemical and
biological threats in our community, as well as we have had
exercises with the hospitals looking at radiological threats,
and we have been fortunate enough to have some of our Federal
agencies come down, the U.S. Army, helping to support some of
our exercises.
So we have numerous training and exercises that we try to
do with the various Governmental agencies, as well as our
hospitals and community partners.
Mrs. Brooks. Thank you.
Dr. Profeta.
Dr. Profeta. In regards to coordinating with a lot of the
hospitals directly, we really don't do that much coordination.
To be honest, we make sure that we are prepared no matter what.
Methodist I don't think calls us to ask us what our capacity
is. I don't recall ever calling Methodist or IU, and vice
versa. We certainly should be doing it more if we need to, but
I have no doubt that I can pick up the phone and talk to any
emergency department, the personnel at any of those
institutions, and they would gladly be able to communicate, and
vice versa with us.
We do a lot of internal training. We run our own drills. We
do a lot of tabletop exercises, active-shooter scenarios, fire
exercises, how do we evacuate the hospital, how do we evacuate
the emergency department and mobilize pharmacy. We take part in
the District V drills, HAZMAT training. We work with Lighthouse
Readiness Group to further train our faculty, and overall we
try to be real active in doing at least two drills a year with
patients, and tabletop drills continuously, and drills at the
safety huddles at the beginning of each day.
Mrs. Brooks. Thank you.
Dr. Knight.
Dr. Knight. Thank you. Some different drills that we
participate in, I got to witness a drill that was done at MESH
recently. They have a command center where they do keep track
of surge capacity in each of the emergency departments around
the city. So if there were an event, MESH can act as a
centralized coordinator to identify the capacity in each of the
different emergency departments. So the emergency departments
don't need to call each other and find out how much space there
is in each of those.
Mrs. Brooks. To clarify, are you all involved in MESH? Are
all of the hospitals here at this table partners in MESH?
[Chorus of ayes.]
Mrs. Brooks. Okay.
Dr. Knight. Within our facilities, we have facility-
specific training drills on at least an annual basis. For
example, in our emergency departments, we have decontamination
showers. We want to make sure that folks really know how to use
those when the time comes, so they will actually go through the
motions of using those, as well as tabletop exercises for
leadership to make sure we know how to deploy personnel
appropriately throughout the facilities. Then we do participate
within our district along with other emergency preparedness
exercises that are done.
Mrs. Brooks. Excellent. Thank you.
Dr. Reed.
Dr. Reed. Yes. Sometimes it seems like we are in a drill
every day. Our emergency department sees somewhere on the order
of 300 patients daily. During the summer surge, we sort of
prepare, as trauma is seasonal, and disease. So from May
through October, we are at full heat handling things. But we do
have internal drills, coordinated drills with outside
facilities, EMS, MESH, other facilities throughout the State.
The thing that we also have at IU Health that is a little
unique is this bridgeline process, that when there is some
event within the health care system, the downtown facilities
and IU Health, there is an immediate linkage between
administrators and directors and executives about the situation
and what is going to be done to solve those issues, anything
from steam factories blasting to electrical problems to
internet situations. So there are a lot of resources, and
usually they are in practice sometime during the week, if not
daily.
Mrs. Brooks. Okay, thank you.
Dr. Obeime.
Dr. Obeime. At St. Francis, we collaborate with our
community partners. Since I started working at St. Francis,
part of my FTE was assigned for me to be able to work with Dr.
Caine and the Marion County Health Department. We have also
worked with MESH. We know that the people who may be most hurt
will be the vulnerable who need the most help. We also do a lot
of internal training for HAZMAT, mass casualty, active-shooter.
We also have WMD exercises. We do all of these on both a local
and regional basis.
Mrs. Brooks. Thank you very much.
I now yield 5 minutes to the gentleman from Granger.
Senator Donnelly. Thank you, Madam Chairwoman.
Mr. Priest, the Super Care Clinic was pretty much the first
of its kind for a mass gathering like that. What is your
biggest challenge to re-creating that at other events here in
Central Indiana or throughout our entire State?
Mr. Priest. Thank you for acknowledging that. It was the
first of its kind. I don't know that we have a biggest
challenge to re-creating it. I think the biggest challenge is
to get another big event so we can do it. Producing that sort
of fan-facing health and wellness program, which really for
fans looked like a clinic but for us was an emergency
management strategy, is something we are prepared to do.
Senator Donnelly. Well, let me ask you this. Eighty-five
thousand people go to a football game in one part of the State,
65,000 in another part of the State, 58,000 in another part of
the State on any given weekend. Do the lessons of MESH
translate to those events?
Mr. Priest. They do. In fact, I have been fortunate enough
to work with my colleague, Dr. Dan O'Donnell, with Indiana
University to actually look at their football program and how
to adopt if not exactly a Super Care Clinic model, something
that is similar, again looking at fan-facing health care.
Senator Donnelly. This is not Indiana-specific, but
obviously there will be another Super Bowl next year. I think
it is in New York. Have you had any conversations with those
people about the things you have learned so that our fellow
citizens of this country have the same benefit of the talents
that all of you brought to our Super Bowl?
Mr. Priest. Senator, New Jersey personnel came to the Super
Bowl here to observe our operations, and we certainly will make
ourselves and have indicated we will make ourselves available
to help them re-create this. We would certainly like to be
helpful.
Senator Donnelly. Thank you.
Dr. Reed, your network goes across the State, from one end
to the other, and in many cases when you look, Methodist is the
final trauma center. That is where some of the very, very most
difficult cases occur. Do you work together with your fellow--
not only IU locations, but other hospital unit locations in
places like Terre Haute and Richmond, Fort Wayne, to try to
provide best practices and to coordinate with them?
Dr. Reed. Yes, we do. We communicate with them when they
have patients to transfer to us on a fairly consistent basis.
Terre Haute is one of our big providers for that kind of
service, as well as Reed Hospital in Richmond. I am also on the
Governor's trauma care committee, where all the trauma
directors in the State, as well as their administrative staff
and people within the State, the Departments of Health and
Homeland Security, interact to help develop an actual trauma
system within the State of Indiana. We are actually one of only
three States that doesn't have a formal trauma system. We are
about halfway through putting things together.
But it is a significant need that is increasingly
recognized, because by getting trauma care not just something
that can be delivered at Methodist's doorstep but something
that can be out there in the community where the patient can
get care faster, or even faster, is very beneficial. We are
actually starting to build our own IU Health trauma system
within the State. We have had consultations and site visits
from the American College of Surgeons for IU Health in
Lafayette and IU Health----
Senator Donnelly. That was the other question I was going
to ask you. Are the lessons that you have learned here being
transported to not only the IU network but to all health care
providers throughout the State?
Dr. Reed. Yes. A number of other hospitals are looking at
becoming trauma centers, Level III or Level II trauma centers,
not that they necessarily need to ramp up their resources. They
already are seeing these trauma patients coming into their
facilities. But by being a verified center, that ensures that
not only do you have the resources but they work well, because
it is a process of managing the patients. It is actually
reviewed in the act of obtaining verification. So that gets
that quality level of care closer to the patient.
Senator Donnelly. Dr. Knight, what is the thing we need to
do better the most right now as you look at the scenarios that
we have to deal with on a regular basis? For want of a better
way to put it, what keeps you up at night?
Dr. Knight. Well, I think that the more we can cooperate
and work together in preparedness, the better off we all are,
because if we can share those expenses of the training and
education and share that preparation, then as a community we do
a better job when those times come. So things like the MESH
Coalition, the Indianapolis Coalition for Patient Safety, and
our district preparedness are all very important so that we are
working more in a coordinated fashion than as individual health
care systems. So I think the more we can do to emphasize that,
the better off our patients are and the communities are that we
serve.
Senator Donnelly. Thank you.
Thank you, Madam Chairwoman.
Mrs. Brooks. Thank you.
Now, if the gentlelady from Jimtown has any questions.
Mrs. Walorski. Thank you, Madam Chairwoman.
I am interested in, obviously, the concept of this MESH at
events, but I am also very aware of the fact--and you are all
saying the same thing. The difference between a planned event
versus an element of surprise, like the bus turnover just a few
weeks ago, where all eyes are on the Super Bowl, the 500, and
the plan is there, and it all comes together.
But, for example, with the bus rollover, which was
unexpected. Nobody knew, thought, or ever conceived that that
was going to happen 5 minutes away from the designation, back
to the church. So when that happens, who takes over then? Dr.
Profeta, when you talked about there was a place right here,
who takes over and says----
Dr. Profeta. At the scene?
Mrs. Walorski. At the scene. Who takes over?
Dr. Profeta. The first responder, whoever is the first
responder at the scene.
Mrs. Walorski. Right. Then do all the hospitals immediately
engage with the first responders?
Dr. Profeta. Not necessarily. I mean, if they call, we
engage. But we go ahead and just engage on our own. We activate
the plan. We get things moving.
When the State Fair collapse took place, the same thing
happened to us. People and doctors started coming in. We didn't
have to call and respond to them. But we have three systems set
up in our emergency department in case each one of them fails
to notify mass numbers of people. Obviously, we monitor social
media, just like anybody else.
But in terms of who initiates the communications at the
scene, it can be variable depending on who shows up. There can
be breakdown. The more levels of interference you have between
a mass casualty event and the hospital that is nearest to that
event, the greater likelihood you have of people being routed
to the wrong facility, deferred to preferential facilities, or
not reaching the location they need to be.
Also, think about it, a vast majority of people, especially
in a mass casualty event, they are not going to come by
ambulance. History shows that they are going to self-transport,
and there is no way of controlling that flow of people. They
know where the emergency departments are. They don't know where
the MESH tent is. They don't know where the secondary command
center is. They know where their local emergency departments
are, and they are going to throw their kids in the car and they
are going to go driving there. That is what we are prepared
for.
Mrs. Walorski. My second question is this: I just want to
kind of throw out to the panel. In my previous tenure as a
State representative, we were briefed at one point--this is a
couple of years ago--on global pandemic of bird flu and what
the State of Indiana was going to do, and it was the first
chance I had to actually look at a State-wide comprehensive
plan of exactly how county facilities, county fairgrounds were
going to be used to operate.
Is there, for this issue of a bioterror attack, a mass
casualty attack on the State of Indiana, does that State matrix
exist where in the event that our entire State, outside even of
the population of Marion County, does that plan exist where we
know exactly who is doing what?
Dr. Caine. Yes. I am also actually a practicing physician.
I am in the Division of Infectious Diseases at Indiana
University School of Medicine. Yes, there is a State plan that
exists. It was actually established by the Indiana State
Department of Health. It was broken down into 10 districts that
we had to prepare for avian flu, and I want to say that for our
H1N1 event that happened, we were able to vaccinate over
200,000 children in the City of Indianapolis and hundreds of
thousands of adults only through the collaboration of all of
our hospital partners and a lot of our contracting agencies
that we use in order to do this.
We have a number of pre-prepared, established sites that
are already designated. We have to inspect them every year with
our security police, even the FBI, in terms of having the
preparation for all of our governmental efficiencies, who is
going to do those vaccinations and at what point.
Mrs. Walorski. So my final question is this: In the event
of an unanticipated mass casualty event like that, and even
aside from just pandemic types of flus and those kinds of
things, the rule of thumb is our country and our State has
about a weekend's worth of groceries for people to buy and
gasoline for people to consume.
What is the rule of thumb in the hospital networks State-
wide? How long can you go before there would absolutely have to
be Federal intervention at a level higher than what you all can
do?
Dr. Profeta. Can I----
Mrs. Walorski. Yes.
Dr. Profeta. I always get amazed every year when we start
talking about influenza. If we look at last year's influenza
outbreak, the vaccine conferred maybe a 50 percent immunity to
the people that were exposed to it. Fortunately, the flu was
not that virulent.
But if you want to say what keeps me up at night, it is not
nuclear weapons or an anthrax exposure. It is influenza. If we
have an outbreak with a serious strain of influenza, a one-
protein change, and the vaccine does not confer immunity to the
vast majority of people and it is highly infective, we are
going to have 50-plus percent of our health care providers
sick, and that includes in nursing homes. I mean, do you think
our support teams or people like our porters and housekeeping
and food services and all those people that end up being sick
are going to show up to work, especially if you have something
with a high mortality ratio?
So I think the entire infrastructure collapses under that
situation. Again, when you have a virulent strain of flu with a
vaccine that does not confer high immunity and a high fatality
ratio, a lot of people are going to refuse to come to work. No
matter how well you think you are going to prepare for an event
like that, it is not going to happen. The system is going to
break down.
Mrs. Walorski. Thank you, sir.
Dr. Profeta. So make sure you have enough food to feed
people out in the community.
Mrs. Walorski. I appreciate it.
Thank you, Madam Chairwoman.
Mrs. Brooks. Okay, thank you.
As we gave the last panel, we would love the opportunity to
hear from you in a little bit of a lightning round, a bit. As
you have Members of Congress here from both the Senate and the
House, what is it that Congress can do to ensure that we can be
as ready as we possibly can for a mass casualty event?
I think we will start this way and work our way back this
time, to wrap up, and if we could just be very brief. We really
appreciate all of you incredibly busy professionals running
major hospital systems and important systems like MESH, we
appreciate that we have kept you longer than we thought that we
might, but this is so very important.
What can Congress do? What can we do to help?
Dr. Obeime. I will make two comments. The first one is we
cannot forget those who cannot take care of themselves. The
system is set up, if you listen to what everybody has said--the
people who do not understand the language, who cannot read, who
cannot write, they will not be able to do anything for
themselves. We need to make sure everybody in their local
community knows who their neighbors are, knows who is going to
take care of them.
The second point is I work for a private institution, I
have for almost 18 years, and I think we have done a wonderful
job of taking care of a lot of people. Every day we hear about
cuts in reimbursement. We hear about cuts in a whole lot of
things. We can work by faith, but we also know that we need
money to take care of people. We need money to pay for things.
If we continue to have cuts, that makes it impossible for
organizations like ours to do the work that we do. Many people
will suffer because we can no longer provide the services that
we provide for them now. I know that the Affordable Care Act is
active and everybody is talking about it, and I know it does
not include everybody. We need to make sure we are looking out
for everyone. It takes only one apple to spoil everything, and
we cannot leave anyone behind.
Mrs. Brooks. Thank you, Dr. Obeime.
Dr. Reed, thank you.
Dr. Reed. Yes. Refraining from further reimbursements and
health care cuts would be the No. 1 priority. As you know, in
order for us to maintain an infrastructure, we have to have
revenue in excess of what it costs us to take care of the
patients because there is no mechanism to provide for
infrastructure like preparedness, and if we are not prepared,
we really don't have a system.
So our system right now is totally based upon how much
extra revenue we were able to generate from the payments we
received over the cost it took us to take care of the patient.
So further reductions in those reimbursements for the care are
going to lead to cuts in places we can cut. We can't really cut
while taking care of a patient, but a lot of those excesses may
disappear, and that leads to infrastructure reductions.
So refraining from further cuts in health care
reimbursement is critical.
Mrs. Brooks. Thank you.
Dr. Knight.
Dr. Knight. I have two things. One is, again, sort of on my
theme I guess of coalition and working together. The MESH
Coalition, the Indianapolis Coalition for Patient Safety, and
the work we do with the district in preparedness, especially
the two coalitions, MESH and the Indianapolis Coalition for
Patient Safety, those are subscription memberships. We pay to
be part of those coalitions as hospital systems, and I think it
really helps us as a community. So any grant funding that could
go to support MESH and the Indianapolis Coalition for Patient
Safety, I think that makes us better prepared as a community
for those sorts of things.
The second thing is echoing what you have heard, and that
is when we train and educate our staff, that is a fixed cost.
That is an expense that there isn't any reimbursement attached
to. As we continue to be pushed to be more and more efficient
in health care, our fixed costs are what we are having to cut
out. So if we don't have some scholarships or something like
that that we can use for education and training for our staff,
those are the sort of things that are going to be cut out.
Mrs. Brooks. Thank you, Dr. Knight.
Dr. Profeta.
Dr. Profeta. The grants, the money is like $20,000 per year
per hospital. The Carmel Marching Band I think can make that in
a bake sale in a week.
You know, the infrastructure, when we talk about
accommodating these huge surges in patients, any of our
hospitals, if we have to accommodate 500 or 1,000 patients that
require beds, not the walking wounded, our infrastructure is
going to break down. If you go to Rambam Hospital, for example,
in Haifa, it is a hospital the size of St. Vincent's Hospital,
they have the ability to move 2,000 extra patients into their
parking garage, which becomes a state-of-the-art hospital
complete with operating suites, infrastructure built for oxygen
suction, electronic monitoring.
We are going to be putting people in the hallways. We
constantly are looking for waiting rooms where we can stack
patients. We don't have a comprehensive--none of the hospitals
really do--a comprehensive, well-thought-out location that is
completely wired from a computer standpoint, from a life
services standpoint. If there was any place where money could
go, it is building out that infrastructure at all the
individual hospitals, especially the major hospitals like St.
Vincent's, Methodist, IU Health, St. Francis, and Community.
Start there, increase the capacity to expand to 500 or 1,000
patients that require in-patient management, and then we can
work out into the periphery.
Mrs. Brooks. Thank you.
Dr. Caine.
Dr. Caine. I just want to also encourage that we continue
to have our Federal funds that go to the Department of Homeland
Security, primarily UASI, but also the MMRS. That is the
Medical Metropolitan Response funding that goes to local health
departments, as well as State health departments. It is so
critical for our training, and I don't want us to also forget
Wishard Hospital and Eskenazi Hospital that primarily focuses
on the vulnerable populations.
Mrs. Brooks. Thank you, Dr. Caine.
Mr. Priest.
Mr. Priest. I think you have heard from the panel that a
lot of the problems we are facing are related to the grant
funding. As you know, the grant funding is not sustainable. It
has not been responsive to communities such as ours, where it
has gone up and down, and now in many cases eliminated. I think
as stewards of public resources, we have to get a little
creative, and I think there are some opportunities in health
care to do that, particularly when we are being asked to
respond to issues of National significance.
I think one of the things to think about is using models
such as pay-for-performance models, incentive payment systems
that exist in our current medical reimbursement system, to fund
this important work that is not merely accruing to the benefit
of hospitals but that truly is part of our community's
preparedness structure.
Mrs. Brooks. Well, thank you all so very much. This has
been valuable testimony, again not just for Central Indiana.
But because it has been webcast, hopefully many other
communities around our country will think about the medical
preparedness of their own communities.
I might remind you that the Members of the subcommittee may
have additional questions. I know that I had several, and we
will ask you to respond to those in writing, and the hearing
record will be open for 10 days.
I just want to thank you all so very much. I want to thank
the City of Carmel. I want to thank Commissioner Altman, who is
here; Chief Green, who is here from Carmel Police Department,
all of your assistance in helping us put this incredible
hearing on.
I want to thank everybody who came and listened and
learned, from the first responders that you heard from on the
first panel, from the medical professionals.
I certainly believe, as I started out this hearing, that
failing to prepare is preparing to fail, and these are all
professionals that work day in and day out trying to ensure
that we do not fail in the critical issue of keeping our
communities safe. So I just want to thank you all so very much.
This subcommittee stands adjourned.
I thank my colleagues for joining me today. Thank you.
[Whereupon, at 12:36 p.m., the subcommittee was adjourned.]