[Senate Hearing 107-292] [From the U.S. Government Publishing Office] S. Hrg. 107-292 EMERGENCY PREPAREDNESS FOR THE ELDERLY AND DISABLED ======================================================================= FIELD HEARING before the SPECIAL COMMITTEE ON AGING UNITED STATES SENATE ONE HUNDRED SEVENTH CONGRESS SECOND SESSION __________ NEW YORK, NY __________ FEBRUARY 11, 2002 __________ Serial No. 107-18 Printed for the use of the Special Committee on Aging U.S. GOVERNMENT PRINTING OFFICE 77-851 WASHINGTON : 2002 ____________________________________________________________________________ For Sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512-1800 Fax: (202) 512-2250 Mail: Stop SSOP, Washington, DC 20402-0001 SPECIAL COMMITTEE ON AGING JOHN B. BREAUX, Louisiana, Chairman HARRY REID, Nevada LARRY CRAIG, Idaho, Ranking Member HERB KOHL, Wisconsin CONRAD BURNS, Montana JAMES M. JEFFORDS, Vermont RICHARD SHELBY, Alabama RUSSELL D. FEINGOLD, Wisconsin RICK SANTORUM, Pennsylvania RON WYDEN, Oregon SUSAN COLLINS, Maine BLANCHE L. LINCOLN, Arkansas MIKE ENZI, Wyoming EVAN BAYH, Indiana TIM HUTCHINSON, Arkansas THOMAS R. CARPER, Delaware PETER G. FITZGERALD, Illinois DEBBIE STABENOW, Michigan JOHN ENSIGN, Nevada JEAN CARNAHAN, Missouri CHUCK HAGEL, Nebraska Michelle Easton, Staff Director Lupe Wissel, Ranking Member Staff Director (ii) C O N T E N T S ---------- Page Opening Statement of Senator Larry E. Craig...................... 1 Panel I Hon. Benjamin A. Gilman, A Representative in Congress from the State of New York.............................................. 3 Josefina G. Carbonell, Assistant Secretary for Aging, U.S. Department of Health and Human Services........................ 6 R. David Paulison, U.S. Fire Administrator, Federal Emergency Management Agency.............................................. 20 Stephen Ostroff, M.D., Associate Director for Epidemiologic Science, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Department of Health and Human Services....................................................... 22 Alexander Parzych, Assistant Chief of Fire Prevention............ 35 Richard Sheirer, Director New York City Office of Emergency Management..................................................... 36 Wayne Osten, Director, Office of Health Systems Management....... 38 Igal Jellinek, Executive Director, Council on Senior Centers and Services of New York........................................... 41 Michael Benfante, Employee of Network Plus....................... 44 Andrea Dale, Visiting Nurse Service of New York.................. 49 APPENDIX Information on Emergency Evacuation Devices...................... 83 (iii) EMERGENCY PREPAREDNESS FOR THE ELDERLY AND DISABLED ---------- MONDAY, FEBRUARY 11, 2002 U.S. Senate, Special Committee on Aging, New York, NY. The committee met, pursuant to notice, at 2 p.m., at 5 Penn Plaza, Room 302, New York, NY, Senator Larry Craig, presiding. OPENING STATEMENT OF SENATOR LARRY E. CRAIG Senator Craig. Ladies and gentlemen, if I could have your attention. We will start this hearing on the Special Committee on Aging of the U.S. Senate. First and foremost, let me thank all of you so very much for being with us today. We view this as a very special hearing to hear from New York City, and to have you share with us some of the things that you have learned in the last several months. Five months ago today attacks on America began right here in this city: First at the World Trade Center as, of course, you all know. Many of you who are New Yorkers may well have experienced it visually and in reality firsthand. Then, of course, down in a city where I spend a fair amount of my time, Washington DC., and the Pentagon. These attacks on America I think changed all of our lives in some way and many lives and many institutions in major ways. I suspect none of us will ever forget that tragic day. I came here shortly after the attacks with my friends and colleagues from the U.S. Senate. We stood in shock and in awe at Ground Zero and what we saw with the devastation that was clearly evident there. I chose to come back here today so that we could look at some of the expertise and some of the finest emergency response that clearly went on during that time that the world is now well aware of. I think New Yorkers learned much about the tragedy of September 11, and I want to hear what you have learned as it relates to the seniors, the elderly, and the some of the infirm of America and what we might learn better so that the Special Committee on Aging can turn to people like Governor Ridge, who is now heading up homeland security, and we might offer suggestions and even propose regulation changes or law changes to some of our agencies as it relates to all of that. Well, there are all heroes, but there are some heroes here today, Michael Benfante--there are many more just like him, people who help strangers in a time of need, and I could go on and on as it relates to some of the wonderful things that occurred in this city. Abe Zelmanowitz, we want to recognize him, the work he did on behalf of a friend, a paraplegic in a wheelchair, and all that is now part of the history of September 11. These were heroes: The firemen who arrived at the scene, many who gave their lives; we all know about that now, and we will never forget it, and we will continue to honor it. They were and are brave men and women who responded in the line of duty. According to a poll commissioned by the National Organization On Disability last November, 58 percent of people with disabilities say they do not know who to contact about emergency plans for a community in event of a terrorist attack or other crises. In other words, we are just beginning to learn that there is a whole community of people out there who find themselves or feel increasingly vulnerable as a result of September 11. Sixty-one percent say that they have not made plans to safely or quickly evacuate their own homes, and it goes on and on. Well, those are some of the issues that we will talk about today with the panels that we have assembled, and I want to thank you all so very, very much for coming. The first person who is with us today, I am very proud that he had the time to join us because he is a gentleman I got to know a long while ago. I served in the House for 10 years, and during that period of time I got to know and appreciate Congressman Ben Gilman from here in your area. Ben has been one of those great public servants who constantly gives of his time and his talent to all of his great State and now to the Nation, and I was extremely pleased that Ben would join us today and to become a part of a panel not only to give testimony, but to sit here at the dais with me and, Ben, I will tell you that you can question and participate just like this was a joint House and Senate hearing because that is what we are going to make it with Ben's presence here. Let me also thank my chairman, John Breaux of Louisiana, for allowing me to bring the committee up here today for what I think is an extremely valuable hearing. Then what we are going to do because of the character of the way we set this room up so that you are all a part of it in a somewhat roundtable discussion, I am going to work my way around the room and introduce you and receive your testimony and then, as I ask questions this afternoon, while some of them might be specific to you as an individual in your expertise, please feel free to add to or join in as questions are asked and you feel you have additional information to offer. I would also tell you that all of your written testimony is a part of the record and will be reviewed by the committee and can be reviewed by all Senators because it is a part of our committee record. So, we again thank you all so very much for being with us this afternoon. We will keep our hearings on schedule and on time; we will make every effort to do that. Now let me turn to a good friend over the years and I know one of your very best in Washington and here in New York, Congressman Ben Gilman. Ben, thanks so much for being with us. [The prepared statement of Senator Larry Craig follows:] Prepared Statement of Senator Larry Craig Good afternoon. Thank you for attending today's hearing of the Senate Special Committee on Aging. I would like to thank the witnesses for agreeing to testify on the critical issue of emergency preparedness for the elderly and disabled. I know that some of you have stories of personal experiences that may be difficult to tell, and I especially thank you for being here. Five months ago today attacks on America began right here in New York City--first at the World Trade Center and then at the Pentagon. These attacks on America changed our lives forever. No one will ever forget that terrible day. I came here shortly after the attacks with my friends and colleagues from the U.S. Senate. We stood in shocked awe at the scope of the devastation at the site of the World Trade Center. I chose to come back here today so that we can call upon the expertise of the finest emergency responders in the nation. New Yorkers learned much from the tragedy of September 11 and I look forward to hearing your testimony, ideas and suggestions about how we can address the needs of seniors and disabled people in future times of crisis. We will also hear from at least one hero today, Michael Benfante--and there are many more just like him--people who helped strangers in a time of need. There are other heroes we will never hear from--people who laid down their lives for others. One of those heroes we will not hear from--but one we should recognize--is Abe Zelmanowitz. He stayed by the side of his friend, Ed Beyea, a quadriplegic who used a wheelchair. When it came time to evacuate the World Trade Center, Abe stayed with Ed and waited with him to be rescued. Abe lost his life waiting with his friend Ed--Abe Zelmanowitz was a hero. There were other heroes too--the firemen who arrived on the scene, many of whom also gave their lives for others. These brave men and women have always put their lives on the line. It is critical to their safety, as well as for the safety of the rest of us, that our nation's firefighters have access to the equipment, training, and personnel they need--and I am working hard in Washington, DC, to make that happen. According to a poll commissioned by the National Organization on Disability last November, 58 percent of people with disabilities say they do not know who to contact about emergency plans for their community in the event of a terrorist attack or other crisis. Sixty-one percent say that they have not made plans to quickly and safely evacuate their home. Clearly we must highlight the need for greater preparation in meeting these needs. I'd like to thank each of the witnesses for being here today and for sharing their insights into his complex problem. I look forward to hearing your testimony. STATEMENT OF HON. BENJAMIN A. GILMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK Rep. Gilman. Thank you, Senator Craig, for your kind invitation to join the Senate Special Committee on Aging. It has done so much good for so many of us and keeps us all apprised of the needs of our aging in both the Senate and the House. I want to thank our participating panelists who are here from the Federal Government, and the State Government and the City Government, as well as visiting nurses and some of the other important dignitaries who we look forward to hearing from today. I represent a little, small part of New York State a little bit north of New York City in Westchester, Rockland, Orange, and Sullivan Counties. Regrettably we had over 90 families that lost their next of kin in the World Trade Center tragedy. And that is why this hearing is so important as we try to learn from the lessons of what occurred at that time. As New York continues to recover from the tragic events of 9/11, our Nation continues to go through the process of discerning what best we can learn from all of that experience. It is important we discuss the issue of emergency responses for our elderly and our disabled. I commend this Special Committee on Aging, for moving forward so that we can put together some better thoughts for the future. Hopefully we won't have to need those preparations, but better to be prepared than not prepared. Mr. Chairman, obviously emergency evacuation procedures need to be reconsidered. While no one before September 11 could have envisioned the massive brutal destruction or the speed in which it occurred, we have to recognize the special and unique challenges which exist for our elderly and our disabled. The World Trade Center Tower Number One and Number Two burned for 102 minutes and 56 minutes, respectively, before the top floors of each tower collapsed onto the lower floors. Even more incredible is the fact that 8 seconds later, the entire second tower collapsed, and in 10 seconds Tower One followed suit. That means that more than 50,000 individuals employed or visiting the towers had about an hour to walk down 104 smoke and debris-filled floors and hallways--no small task for any young person, relatively healthy individual, let alone someone either elderly or disabled. All of us from the New York metropolitan area and across the nation are grateful for the heroism displayed by our firefighters, our police, our rescue people and emergency personnel. Those services were taxed to the maximum, the maximum extent possible, more than anyone could have ever imagined prior to 9/11. And while we need to proceed forward and determine our best to reconfigure current emergency preparedness plans, we should make certain that we pay careful attention to addressing this specific and different needs which exist for the elderly and disabled, and that is why I am so pleased to join Senator Craig today as we address this problem. However, it is also important that we realize that 9/11, while unique in its once unthinkable occurrence, may not be the last of such events as our nation engages in our war on terrorism; and, as the President reminds us, this may not be the last event. Accordingly, at today's hearing we need to hear from the top City, State, and Federal officials on what we have learned from September 11 and what is being done to correct any lapses or inconsistencies which it may be found to exist with regard to emergency preparedness and evacuation. In an emergency situation advanced planning, of course, is the key to safety and to piece of mind. This also rings true for those elderly and our disabled. Without the assistance of coworkers those individuals most often could be left behind. Decisions and now what must be done during such an event must be thoroughly reviewed to determine how best to meet those kind of emergencies prior to any event happening. This includes the obvious concerns that have come about in my own region recently, when it comes to nearby nuclear power plants. I am specifically referring to Indian Point, which is just up the river within a 30-mile range from here, Senator Craig. Let me read you two brief quotes with regard to that problem. State and local governments are the first line of defense in the event of a serious nuclear power plant accident, and their ability to respond depends to some extent on the adequacy of guidance and training provided by FEMA--and I am pleased FEMA is here today--and other Federal agencies. Further, more can be done to help state and local governments to respond effectively to a radiological emergency. Now, those quotes were taken from a 1984 U.S. Controller General GAO report entitled Further Actions Needed to Improve Emergency Preparedness Around Nuclear Power Plants. Proper improvements to the emergency preparedness plan for any event can be made when those responsible for public safety at all levels of government effectively communicate with each other. And that is why it is so good, Senator Craig, to have all of these agencies represented here today. Hopefully this process will enhance our preparedness to these kind of emergencies. So, in closing, permit me to again stress my sincere appreciation for all of the incredible heroism, the dedication displayed by all of those that were involved in this tragic event: Our firefighters, our police, our agency personnel, emergency personnel, rescue personnel, and our good Samaritans. And many of these true national heroes reside in my congressional district. I have a number of our police and firemen residing in my area, and many lost their lives regrettably on that faithful day. So I look forward along with Senator Craig to hear your testimony today and your good thoughts of what we can do to prepare for any future event. God willing, we will not have any such occurrence again. Thank you, Senator Craig. [The prepared statement of Rep. Gilman follows:] Prepared Statement of Rep. Benjamin A. Gilman I want to thank Senator Craig for the invitation to participate at today's hearing. As New York continues to recover from the tragic events of September 11, and our Nation continues to go through the process of discerning what can be learned from the experience, it is important that we discuss the issue of emergency responses for the elderly and disabled. I commend the Special Committee on Aging for proceeding forward today. Mr. Chairman and Ranking Member, clearly emergency evacuation procedures need to be reconsidered. While, no one before September 11, could have envisioned such destruction or the speed in which it occurred; we must recognize the special and unique challenges which exist for those elderly and/or disabled. World Trade Center tower number one and two burned for 102 minutes and 56 minutes respectively, before the top floors of each tower collapsed onto lower floors. Even more incredible, is the fact that eight seconds later the entire second tower collapsed and in ten seconds tower one followed suit. This means that more than 50,000 individuals employed or visiting the towers had approximately an hour to walk down 104 smoke and debris filled floors and hallways. No small task for a young, relatively healthy individual, let alone someone either elderly or disabled. All of us from New York and across the Nation are grateful for the heroism displayed by our firefighters, police, rescue and emergency personnel. These services were taxed to the maximum extent possible--more than anyone could have ever imagined prior to September 11. While we need to proceed forward and determine how best to reconfigure current emergency preparedness plans, we must be sure to pay careful attention to addressing the specific and differing needs which exist for the elderly and disabled. However, it is also important that we realize that September 11, while unique in its once unthinkable occurrence, may not be the last such event, as our Nation engages in the war on terror. Accordingly, at today's hearing we need to hear from top City and State officials on what has been learned since September 11 and what is being done to correct any lapses or inconsistencies, which may be found to exist with regard to emergency preparedness and evacuation. In an emergency situation, advance planning is the key to safety and peace of mind. This statement also rings true for those elderly and/or disabled. Without the assistance of co- workers these individuals most often would be left behind. Decisions on how and what must be done during such an event must be planned and determine now prior to its happening. In closing, I want to again stress my sincere appreciation for all of the incredible heroism displayed by our firefighters, police, emergency and rescue personnel. Many of these true national heroes reside in my congressional district and many lost there lives on that fateful day. Thank you. Senator Craig. Ben, thank you very much. Ms. Gilman, thank you for joining us today. As far away as Idaho is, you would think that we were relatively untouched by it. It is simply not the case. Certainly we were touched emotionally, and Idahoans have responded in a variety of ways. But uniquely enough, we have a company that is homed in Idaho that was started in Idaho a long while ago who had a division that was housed in the World Trade Center and lost 13 employees, four of them native Idahoans. That is something that oftentimes we don't realize, but I think when we examine the magnitude of the loss of the Trade Center that occurred here, that it truly was a national situation, an incident, and I think the Congressman, as you know, and certainly with your efforts has tried to respond in that context. Now, let us move around the table and hear from all of you. As you know, the Special Committee On Aging in the Senate is not an authorizing committee. In other words, we don't write legislation. We hold hearings and oversight on those issues that are of concern to the seniors and the elderly of our country, and then we make recommendations to other committees. Oftentimes Chairman Breaux or myself or members of our committee will actually testify before other committees about our findings. There are several committees in the Senate and the House that are unique in this way. We are largely an investigative oversight body. That is an uniqueness of the Special Committee. So, with that, let me introduce our first person to testify with us today, Josefina Carbonell, the Assistant Secretary of Aging at HHS. Again, thank you so very much for being with us. We would like to ask all of you to stay within the 5 minute rule if you could, please. STATEMENT OF JOSEFINA G. CARBONELL, ASSISTANT SECRETARY FOR AGING, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Ms. Carbonell. Thank you, Mr. Chairman, and members of the committee. It is indeed a pleasure and an honor to discuss the Administration on Aging's perspective on emergency preparedness for the elderly and those within disabilities. We appreciate your leadership in convening this very important hearing. Working in partnership with our national aging network, all the service providers that form part of this aging network, AOA is charged with providing essential home community-based care services to those elderly in most need, some of whom are frail and disabled. The Administration on Aging was at the forefront to serve this population on September 11 in New York City. We were joined by the Centers for Medicare and Medicaid Services and the New York Aging provider network to deliver critical services during this crisis. The emergency help line put into place by CMS and the Administration on Aging received thousands of calls from all over the country, many of which were from older persons and their caregivers. I have submitted written testimony for the record, but I will confine my oral presentation again to the lessons we learned from September 11. Mr. Chairman, I am committed to ensuring that the aging network and all of our providers through state, units on aging and the local area agencies on aging and aging providers are ready and better prepared for any future disaster. There are five needs to be addressed that I would like to address in this brief presentation. First, one of my priorities is to ensure that our states, our area agencies and tribal organizations have emergency and backup plans in place for natural or manmade disasters; that they have timetables for updating and revising these plans and that there also would be ongoing training programs to ensure the timeliness of the training and the implementation stages. The administration is currently updating our disaster assistance materials and plans to conduct training for all levels of the network at the state and local levels. Second, there is the need for alternative and backup communications systems and that is paramount at all levels of government. Battery powered radios and other such devices need to be made available in the even of land line and cell phone failure, which was the case right here in New York. Third, up- to-date emergency contact information needs to be available on key aging officials with emergency protocols to follow. Fourth, we must collect and maintain a special needs roster. This information should be shared with all partners in the different locations across the country and with our local emergency preparedness network. Fifth, the aging network resources need to be coordinated and integrated with larger Federal, state, and local emergency management operations not only to avoid duplication, but most importantly, to ensure that the special needs of elders are incorporated into the overall community preparedness response action plans. Every one who is involved in an emergency has to be sensitive to the fact that some older persons, especially those with disabilities, may become disoriented, may take longer to evacuate, may need special equipment or may depend on others to help them. I want to also call to your attention the need for mental health counseling. These services provide individuals impacted by disasters with an opportunity to react to and talk about what they have experienced. For older persons their day-to-day existence is often fragile, meaning that even the most modest changes may trigger a series of events that threaten or even destroy their ability to continue independently. For example, this happened right here in Chinatown at the City Hall Senior Center. We have learned much from the September 11 event, especially that we cannot predict the future. We can, however, be better prepared. The commitment of Secretary Thompson to help our seniors and their families was put to the test of September 11. HHS is one department that exemplifies the capacity of all agencies to provide critical assistance during crisis. I applaud the dedication of so many of our Federal partners, such as the CDC, FEMA, CMS and others who have answered the call that day and in the weeks and months that followed. We are particularly humbled by the heroic work of the New York Aging Service Provider Network including Igal Jellinek, who you will hear from later. I want to thank you for calling today's hearing. As responsible public officials we must do everything in our power to help our communities be better prepared. Most areas around the country have emergency plans in place, and it is critical that these plans cover the needs of the elderly. Mr. Chairman, I salute your commitment to our nation's older Americans and their characters and I would be happy to respond to any questions. [The prepared statement of Ms. Carbonell follows:] [GRAPHIC] [TIFF OMITTED] T7851.001 [GRAPHIC] [TIFF OMITTED] T7851.002 [GRAPHIC] [TIFF OMITTED] T7851.003 [GRAPHIC] [TIFF OMITTED] T7851.004 [GRAPHIC] [TIFF OMITTED] T7851.005 [GRAPHIC] [TIFF OMITTED] T7851.006 [GRAPHIC] [TIFF OMITTED] T7851.007 [GRAPHIC] [TIFF OMITTED] T7851.008 [GRAPHIC] [TIFF OMITTED] T7851.009 [GRAPHIC] [TIFF OMITTED] T7851.010 [GRAPHIC] [TIFF OMITTED] T7851.011 Senator Craig. Thank you very much, Josefina. In a little while you are going to be hearing from Marion Anello. Ms. Carbonell. Yes. Senator Craig. Marion is one of those seniors who found herself evacuated into an area that was somewhat ill prepared to respond to her needs. So, following her testimony I want to come back to you and get not only your reaction, but some of the thoughts that you may have about those kinds of circumstances. Now let me turn to David Paulison, U.S. Fire Administrator FEMA--that's the Federal Emergency Management Agency. FEMA is well-known around the country and has developed really a first class reputation in the last good number of years for its ability to respond quickly and with a level of preparedness that is a product of many years of refinement. I am not going to suggest you do it perfectly yet, David. It means that you are supposed to, though. With that, let us turn to your testimony and thanks for being here. STATEMENT OF R. DAVID PAULISON, U.S. FIRE ADMINISTRATOR, FEDERAL EMERGENCY MANAGEMENT AGENCY Mr. Paulison. Thank you, Senator Craig, and I appreciate the fact you recognize that we are still working on making it better. Also, Representative Gilman, I appreciate having both sides of the Congress here. I am also pleased to be here representing Joe Allbaugh, the FEMA Director. He had previous commitments and could not be here, but he reminds us on a regular basis that FEMA should be about people helping people, and as a U.S. Fire Administrator, I share the Director's commitment to the well-being of disabled and our senior citizens. Just a little background, I had 30 years of fire service experience. I was also in my early years as a firefighter and a paramedic. Senator Craig. We need to have you pull it a little closer and speak into it so our court reporter can hear you. Mr. Paulison. As a young firefighter and paramedic, I worked mainly in an area with many elderly. I learned some of the needs that are there and to love the people that I worked with during that time. I have also handled several major incidents, particularly Hurricane Andrew, the Valujet crash several large evacuations of elderly people during hurricanes, and I will talk about those a little bit later. The United States Fire Administration worked closely with other branches of FEMA to understand, prepare for, respond to and recover from all hazards with an eye toward loss of property and loss of life. We lose 4,000 people a year to fire in this country and 1,200 of those people are over 65, so the United States Fire Administration has set a goal to reduce that by 25 percent over the next few years. Just as a side note, we also lose one firefighter every third day in this country, which is totally unacceptable. My testimony will focus mainly on what FEMA has achieved, what actions we are currently undertaking, and what FEMA intends to do in the future. The efforts by FEMA in this area was originally spearheaded by FEMA's national community relations cadres. The cadres were assigned the responsibility to locate and assist special needs population in disaster areas. Over the years, FEMA has taken a number of steps in this area, and let me briefly cover a couple of those. Since 1997 the disaster, field offices have included a special needs section to provide further aid. FEMA's national community relations operation in the New York disaster area made an intense effort to locate and assist special need populations. It is essential to provide this function. The agency hired a local person knowledgeable not only about emergency management and the disabled community. FEMA, in concert with New York City, ensured that the Disaster Assistance Service Center would be accessible to seniors and the disabled. We also prepared a special brochure for all service center employees informing them of their responsibility to assist those with special needs. It is important to remember that part of dealing with this issue is education internally so that people who are handling the disaster understand the needs of the elderly and the disabled. Right now we are developing another manual to aid first responders in dealing with disabled persons. In Miami Dade County, we put together a group called Elder Links, where we train firefighters and paramedics and EMTs to recognize when they go on calls of elderly people who are either abused or neglected, and we have 24-hour call-in line. As soon as they got back in the station, they called in the names and addresses of those people. The next day, the next day we got those people help and got the right agencies there. I think that is a model program that should spread across this country, and it is easy to put together through the local fire departments. There is an emergency management education network; FEMA has sponsored several video conferences on this subject over the years to get the word out that the local emergency managers and local fire departments have to be very responsive in recognizing the needs of the elderly in their communities. FEMA has also developed an innovative course that introduces service providers to emergency management and emergency management to the special needs population. Protecting the disabled and elderly persons from disaster is a major responsibility of the emergency management community, and that includes FEMA; but that responsibility is shared with others, with relief organizations like the American Red Cross, with fire and EMS services, with state and local governments, and with the media. We found a long time ago that we used the media as the main form of communications during our hurricane disasters. We hold four or five press conferences a day, and we tell the public exactly what we expect of them and what they need to do to prepare for these emergencies. Warning systems need to include provisions for people who are deaf and hard of hearing. Televisions stations must live up to the FCC mandate to provide emergency information in caption form and first responders they must become familiar with how to deal with the special needs of this population, and that involves training and education for our first responders. Building evacuation plans must include provisions for warning to deaf persons and special evacuation devices to assist mobilely impaired persons, You can't simply tell people that shelters are open. You have to provide services for them. In Miami Dade County we do a bus transit system--and not just regular buses, buses that can handle people with disabilities and handle people in wheelchairs and often sometimes people who are bedridden. That is what every community must prepare for. One final point every member of the adult community or disabled community must learn as much as possible what is required of them to survive in a disaster. The disability rights movement has stressed the dignity and independence of the individual as its goal. It is consistent with that philosophy that each disabled person, to the extent possible, assures responsibility for his or her own safety. So, together in a partnership with the local fire department, the state agencies and other local communities and the individuals themselves we can develop a plan to help elderly survive these disasters. Thank you, Commissioner. Senator Craig. David, thank you very much. You have someone with you? Mr. Paulison. Yes. This is Marko Bourne from the Fire Administration also. Senator Craig. Thank you. Thanks for joining us. Mr. Paulison. Thank you for your time. Senator Craig. Now, let me turn to Dr. Stephen Ostroff, Center for Disease Control and Prevention, better known as CDC to most of us at least. Doctor, we thank you very much for being here. Please proceed. STATEMENT OF STEPHEN OSTROFF, M.D., ASSOCIATE DIRECTOR FOR EPIDEMIOLOGIC SCIENCE, NATIONAL CENTER FOR INFECTIOUS DISEASES, CENTERS FOR DISEASE CONTROL AND PREVENTION, DEPARTMENT OF HEALTH AND HUMAN SERVICES Dr. Ostroff. Thank you, Mr. Chairman, and Representative Gilman. Like all other Americans, we at CDC were horrified and saddened by the events which took place in New York last fall. As the Nation's disease control and prevention agency, however, we were also immediately galvanized to action to provide assistance to our partners in the City and State of New York and in D.C. During the bioterrorism-associated anthrax attacks last fall, I was the lead field investigator of the CDC team sent to New York City to assist the public health in emergency response, so I had firsthand knowledge of the tremendous effort which took place then and continues to take place to recover from the events of last fall. In my oral comments I will provide a brief overview of CDC's activities related to September 11, but focus more on the subsequent anthrax attacks and how we worked to better prepare our Nation's states and cities for the threat of terrorism from biological agents while assuring that we meet the needs of particularly vulnerable populations such as the elderly and disabled. Within hours of the September 11 attacks, CDC deployed teams of responders to New York City to assist in monitoring the impact of the event and deployed assets of the national pharmaceutical stockpile to assure essential medical supplies and drugs would be available. By the end of that first week we had more than 70 personnel engaged in a range of activities including monitoring and documenting the patterns of illness and injuries in victims and relief workers measuring hazardous exposures at the World Trade Center site and recommending ways to protect rescue and cleanup workers. We also assisted the City Health Department in maintaining their high state of alert for other types of events. These activities were ongoing when anthrax was first recognized in Florida on October 4th and then here in New York City the following week. In response we augmented our onsite presence to assist in investigating the sources of infection and populations at risk and in providing antibiotic prophylaxis to thousands of affected persons at the various media outlets and postal facilities. Accomplishing these tasks against the backdrop of September 11 was an example of Federal-state-local corporation at its best and a credit to the diligence of our colleagues here in New York City. Overall there were a total of 22 cases of anthrax with 11 being the cutaneous or skin variety and 11 being the inhalational form. In New York City there were seven cutaneous cases and one inhalation case, with the latter being the only fatality. It is worth noting that the inhalation cases were on average significantly older than the cutaneous cases. This finding was noted even before the last case was detected in a 94-year-old resident of Connecticut. Since we have little historical data on which to base our epidemiologic information, we don't know if this difference really has a biological basis or is simply a reflection of age difference in work forces in the various locations. At the peak of the anthrax response we had more than 200 personnel in the field assisting state and local partners and hundreds more personnel at headquarters assisting the effort. While we deeply regret each illness that occurred, we are very encouraged by the fact that none of the approximately 10,000 persons who were given antibiotic prophylaxis developed anthrax, despite significant exposure to spores in many locations. Last fall's events revealed serious gaps in our nation's public health defenses against biological and chemical threats. These include inadequate epidemiologic and laboratory search capability and insufficient knowledge base concerning sampling and remediation and lack of information concerning infectious dose and post susceptibility. In addition, the public health system needs to improve its ability to convey information and provide treatment and preventive measures to large numbers of persons and a way of assuring compliance. This will require extensive preparedness planning, cooperation across agencies, and between Federal, state and local counterparts. All states and localities must be prepared to address these threats and mount an effective response. This is as true for New York City as it is for rural Idaho, although clearly the needs and solutions will be different. In late January Secretary Thompson announced that a total of $1.1 billion in funding would be provided to states and large cities to assist them in their bioterrorism preparedness efforts. Here in New York the state will receive $29.4 million in funds and the city $22.8 million in funds from CDC. Agents such as anthrax, smallpox, and botulism are prime bioterrorism threats because of their extreme virulence and ease of dissemination. If used, they would likely affect all segments of the population. However, there are certain special challenges for the elderly and disabled. One relates to the drugs and vaccines used to treat and prevent these diseases. Many have side effects such as dizziness and nausea which make them particularly difficult to use for prolonged periods in older persons. In addition, these persons are more likely to be taking drugs which have known or unrecognized interactions with our recommended therapies. These factors must be taken into consideration as our state and local partners move forward with their preparedness planning so that we can assure that we can properly care for and protect our most vulnerable populations. Additional research is also necessary to understand infectious dose of agents such as anthrax and whether it is lower in older individuals than in other age groups. In conclusion, CDC is committed to working with other Federal agencies and partners, state and local health departments, and the health care community to ensure the health and medical care of all of our citizens from terrorist threats. Although we have made substantial progress in enhancing the nation's ability to prepare for and respond to a bioterrorist attack, the events of last fall demonstrate that we must accelerate the pace of our efforts. Thank you very much. [The prepared statement of Dr. Ostroff follows:] [GRAPHIC] [TIFF OMITTED] T7851.012 [GRAPHIC] [TIFF OMITTED] T7851.013 [GRAPHIC] [TIFF OMITTED] T7851.014 [GRAPHIC] [TIFF OMITTED] T7851.015 [GRAPHIC] [TIFF OMITTED] T7851.016 [GRAPHIC] [TIFF OMITTED] T7851.017 [GRAPHIC] [TIFF OMITTED] T7851.018 [GRAPHIC] [TIFF OMITTED] T7851.019 [GRAPHIC] [TIFF OMITTED] T7851.020 [GRAPHIC] [TIFF OMITTED] T7851.021 Senator Craig. Doctor, thank you very much for that testimony. Now, let me move to Assistant Chief of Fire Prevention. Alexander, I work really hard at damaging names. Pronounce your last name for me. Mr. Parzych. Parzych. Senator Craig. Parzych. Fine enough. Thank you for joining us. Mr. Parzych. Thank you for having me. Senator Craig. Please proceed. You will hold for just a moment. Please proceed. STATEMENT OF ALEXANDER PARZYCH, ASSISTANT CHIEF OF FIRE PREVENTION Mr. Parzych. I would like to thank the committee to have the fire department to have a chance to say something at it. I am reading a statement from our Fire Department New York City. Although disabled rights, laws and increased community awareness have removed some barriers to everyday life for senior citizens and people with disabilities, barriers still exist. They present an even more significant challenge during emergency conditions. September 11, once again, raises our awareness of the challenges presented to both the disabled and those challenges to assist them in an emergency. In addition to these physical barriers such as flights of stairs, change of level, no use of elevators, barriers to the acquisition of information also exist. Communication that is audible, such as TV and radio is not available to people who are deaf or hard of hearing, people who have low vision or all blind cannot get information from print media or the web site. People who have learning disabilities or developmental disability often cannot understand information when it is presented rapidly. As we review our emergency plans, we must ensure that to the fullest extent possible the needs of the disabled are considered. This includes but is not limited to: One, we must do our best to remove physical barriers. Future designs should be universal, including everything from web sites to transportation systems to escape routes. Two, do not separate the disabled from the plans, but determine how they can be included in the planning process, assuring that different disabilities are included in all emergency plans and that these plans are practiced, practiced, and practiced again. Public education can raise awareness. An example of an improved procedure would have the building fire safety warden and floor searches coordinate with a designated point of contact for each organization located in a building such as the personnel department to develop a plan along with the Fire Department to both locate and evacuate people with disabilities in emergencies. This plan may be tailored to the person's disability and effectively communicated to them. Such a plan would have to be updated on a regular basis to keep up with the changes in personnel, work status awareness, and new rescue technology. The New York City Fire Department is working with the public- private sectors to enhance its ability to serve all members of society. We must be responsible to our ever changing world and the new threats that the world may bring. Senator Craig. Thank you so much for that testimony. You are one now of several panelists who we are especially wanting to hear from because you were all here and had to deal with the circumstances of September 11 on a daily basis, Alexander, as you know and as you are obviously telling us with some of your experiences. Now, let me turn to the Director of the Office of Emergency Management, Richard Sheirer. Richard. Thank you. STATEMENT OF RICHARD SHEIRER, DIRECTOR NEW YORK CITY OFFICE OF EMERGENCY MANAGEMENT Mr. Sheirer. Thank you, Senator, Representative Gilman. I am Richard Sheirer. I am the Commissioner of the New York City Office of Emergency Management, and I am pleased to appear before you today at the request of Mayor Bloomberg. OEM's role in New York City is to coordinate and oversee the preparedness for response to and recovery from all emergencies and disasters. Our mission includes the protection of proper and the continuance of government in the face of disaster; but our most important goal is the safety and preservation of lives. OEM accomplishes its mission through the collaboration with all city, state, and Federal agencies through the use of the resources of the Mayor's Office of People with Disabilities, the mayor's Office of Aging, the Department of the Buildings, Housing Authority, Transit Authority to name a few. We work very closely with the American Red Cross, the Salvation Army, and are partnered with many advocacy service groups in the special needs community. New York City appreciates the opportunity to present information during this hearing about the unique planning and response needs of the special needs community which includes persons with disabilities and seniors and, as these populations might be impacted, language issues as well. My comments will focus on pre-September 11 issues, what happened during September 11, and where we are going after September 11. Prior to September 11 OEM employed a full-time special needs advisor since 1997 who was responsible for the development and execution of preparedness initiatives, response actions, and recovery efforts working with both the emergency management and respondent community as well as with representatives from the special needs community itself. We developed and coordinated a 4-day conference on emergency preparedness for seniors and people with disabilities held at Lighthouse International. It was attended by 500 members of the community, 25 city response and service agencies, various advocacy groups. In addition, attendance was mandated by the New York State Department of Health for all home-based agencies and residential care facilities licensed within the city. We developed and implemented the communications picture board program. This is a low tech solution which fills the immediate communication gap in emergencies between response personnel and persons with disabilities and/or non-English speaking persons. It was originally designed with special needs community in mind, but the tool has served to have broader applications and used for members of the general public. They have been placed in every New York City ambulance, in every police precinct, in every FDNY certified first responder engine company, every hospital emergency department, and with the Red Cross and Salvation Army. We convene special needs advisory panels for emergencies to advise and assist the city in emergency planning for the special needs community with representatives from all relevant agencies advocacy groups, service organizations participating. We have convened task forces in the past and we will continue to do so in the future. We have ensured that all emergency information materials produced and distributed presented or posted on the OEM web site contain specific special needs messages which would also be available in alternate formats such as braille, large type, and audio when requested and translated. We do it in multiple languages which 13 review so far. During September 11, in addition to the door-to-door searches conducted by the fire department, police department and rescue workers, an additional search was held, a follow-up search, with members of the Steel and Ironworkers, with American Red Cross and medic representatives. These teams were directed back to buildings known to have large numbers of seniors or people with special needs residing in them. We confirmed that 50 percent of all the emergency shelters that we opened were accessible to people with special needs. We confirmed that the dialysis network of which there are 90 locations was fully functional. We confirmed that the residential health care facilities, all 185 of them, were fully functional and executed all necessary parts of their internal emergency plans. We confirmed that most of the home-based care industry had initiated their internal disaster planning. Once communication was reestablished it was learned that of the city contracted agencies below 14th Street, seven operated in the evacuation zone and moved their administration functions out of the zone. These agencies continued to serve as clients with a team of staff, and every last client was accounted for. We ensured that access restriction policies in the frozen zone exempted all Access-A-Ride, Paratransit, Meals on Wheels deliveries and private ambulances. We also ensured that properly identified health care workers were allowed reentry to assist their clients and directly to provide medication. We confirmed that pharmacies honored appropriate refills from bottles without written scripts and/or insurance cards. We oversaw the mental health and crisis response activities initiated by various agencies and groups for the response personnel to direct victims and the city at large, and we worked with those groups involved to be certain that the experiences of the special needs community are accounted for in services. Post-September 11. The horrific events of September 11 tested all New Yorkers. Not only New Yorkers, people from throughout our region as Congressman Gilman has said, and people throughout the country who came here to help. There are a lot of lessons we learned from our individual experiences and from those of others. We are in the process of drafting a proposal for a comprehensive special needs emergency plan and mitigation that incorporates everything we learned. We have begun additional research into how additional notifications, communications, evacuation technologies and policies can be implemented. We will continue to convene the various task forces for the special needs community that we started long before this incident. And We are committed to reviewing existing emergency plans to incorporate the special needs community at every level. We will continue to incorporate the special needs community in each and every one of our disaster drills and our planning for coastal storms which incorporates the relocation of anywhere from 250 to 900,000 people has always included a special needs community and dogs for that community. Finally, there are a number of issues that can be looked at right now by other emergency managers and ourselves. The Federal mitigation funding available after a disaster that formally was directed only to infrastructure initiative, we are very hopeful that it is going be expanded to include more human service measures. In my conversations with Joe Allbaugh, FEMA appreciates all the problem that we have experienced and while this has been an absolute horrible event, it has given us a lot of insight into things that we can do, how we can do things better, how we can help people better and, more importantly, how we can better prepare our country working with the Governor Ridge, Joe Allbaugh, and the other agencies. Emergency managers in the public and private sector, whether they be the fire safety director at a business or a person in a high-rise office or residential building, all need to be very cognizant of the special needs community, and we will continue to work with that community to make sure that we get all relevant information out and improve our processes based on our experience as much as possible. Thank you. Senator Craig. Richard, thank you. I will come back to you. You mentioned in your testimony that you are in the process of drafting a special needs proposal or proposals with special needs elements in it. The question I will be asking you is what would be your four top four or five recommendations within that proposal. What do you see coming out of your experience that you would elevate to a level of priority that either need to be done or refined and improved. OK, Thank you. Now, let me go to Wayne Osten, Director, Office of Health Systems Management. Wayne, thank you for being with us. STATEMENT OF WAYNE OSTEN, DIRECTOR, OFFICE OF HEALTH SYSTEMS MANAGEMENT Mr. Osten. Thank you, Senator, and thank you, Congressman Gilman, for giving me the opportunity to speak with you today on the subject of New York State's emergency preparedness for elderly and disabled. The Department of Health's Office of Health Systems Management is responsible for overseeing quality of care in New York's hospitals, nursing homes, home care agencies and clinics. We have been working to ensure that all health care providers in New York State have emergency response plans in place; and, since September 11, we have been in close communication with the New York City Department of Health, County Health Departments, the state and local emergency management organizations, and the health care providers to ensure our readiness in emergency situations. Preparing our health care facilities to be able to respond to a disaster is not a new activity. We took many steps in New York State to develop strong disaster preparedness plans in preparation for Y2K. We worked with health care providers, including nursing homes and home care agencies, to ensure that they all had up-to-date disaster plans in place. We made sure they had adequate staffing, supplies, medication, and food, as well as backup emergency generators. We saw clear evidence of the success of these efforts in response to the events of September 11 and in the days and weeks that followed. Hospitals in Manhattan and throughout New York City immediately implemented their disaster plans bringing in additional staff and making beds available. Nursing home and home care agencies in New York City also took immediate steps to ensure that those in their care were getting the services they needed. While we recognized that there were cases of individual hardship, home care agencies did an outstanding job of providing food, medication, and care to the home bound in lower Manhattan in the days and weeks following the World Trade Center disaster. Since September 11 the Department of Health has been working to update its emergency response plan, particularly as they relate to nuclear, biological, and chemical events. We have focused these activities on four functional areas: First, surveillance and detection. How our health care providers can quickly identify and report a potential event. Two, response. How our health care providers should respond to an event both individually and in partnership. Three, communication. How our health care providers can maintain communications both during and after a disaster; and finally, internal security what steps our providers can take to improve their own organizational security. The model we are working on relies heavily on creating and strengthening partnerships between state and local governmental agencies and health care providers so that we can provide a community-based response in emergency situations. The scope and magnitude of September 11 terrorist attack has firmly established the critical need for strong local public health infrastructure to serve as the first line of defense in responding to disasters whether they stem from natural or manmade causes. We plan to use this model as a prototype. We are meeting with county health departments, health care providers, EMS representatives across New York State to assure that they have emergency plans that meet the specific needs of the communities. Nursing homes and home care agencies need to be key components in this process. We recognize that the elderly and disabled are particularly vulnerable to the effects of a terrorist attack, and New York will continue to work to provide for the needs of both of these groups. New York State's current nursing home regulations require that nursing homes have written disaster and emergency preparedness response plans updated at least twice a year with procedures to be followed for the proper care of residents and staff. Nursing homes also must have plans in place for receiving and treating victims of mass casualty. All nursing homes must have plans in place for evacuating residents if it becomes necessary. This plan must include plans to transport residents to another facility or location. The plan must also include preplanning for an evacuation with the local 911 system. It should be noted that nursing homes, because they are equipped with independent generators and supplies of food and water, may be determined to be places to bring victims in the event that area hospitals reach capacity. We were in a media contact with nursing homes near the World Trade Center following the September 11 attacks to determine their capacity to handle overflow from area hospitals should that become necessary. While this was not required, we did receive a very positive and cooperative response from our nursing homes. The anthrax threat that followed the World Trade Center attacks, including the deaths of two older women in New York and Connecticut who had no affiliation with the media or the Postal Service seemed to indicate a greater vulnerability of our elderly to agents used in bioterrorist attacks. The state department of health has been in contact with nursing homes about how to handle bioterrorist incidents so that they will be prepared to protect the health of their residents and to alert public health authorities should any suspicious incidents occur within their facilities. In conclusion, the New York State's disaster response plan for the aging and the disabled will be part of our ongoing collaborative effort between Federal, state, and local agencies and health care providers to safeguard the health and well- being of all New Yorkers. Our efforts emphasize the need for a community-wide response beginning at the local levels and involving partners in neighboring communities. Several weeks ago we had the opportunity to meet with President Bush's homeland security director, Governor Ridge to discuss our emergency response plan. He was both encouraging and encouraged by the cooperative efforts that we have embraced in New York State. Governor Pataki and the Department of Health are extremely proud of the way the city of New York and New York State responded to the World Trade Center attack and the ensuing bioterrorism incidents. Our response would not have nearly been so effective without the strong leadership and coordination among many agencies at the city, state, and Federal levels. Thank you very much. Senator Craig. Wayne, thank you very much. We will be back to visit about some of those connective things that you see as necessary between that local, state, and Federal partnership that we are working on building at this moment. Now, let me go to Igal Jellinek, Executive Director, Counsel on Senior Centers and Services of New York. Igal, welcome to the committee. STATEMENT OF IGAL JELLINEK, EXECUTIVE DIRECTOR, COUNCIL ON SENIOR CENTERS AND SERVICES OF NEW YORK Mr. Jellinek. Thank you, Mr. Chairman and Representative Gilman and members of the committee. I welcome the privilege of appearing before you. By way of background, the Council of Senior Centers and Services is the premier professional nonprofit organization for the city's senior service providers representing 265 senior service organizations ranging from individual committee-based senior centers to large, multipurpose city-wide organizations. New York City's five boroughs are home to some 1.3 million seniors. Regarding the problems our members and their seniors face as a result of the most recent and horrific emergency situation on September 11 of last year, I think the good news is that we have all learned a great deal from how they coped with these problems. As you will hear, their solutions are both innovative and compassionate. But you will also hear what we feel is the most important solution of all; that is, that we as aging services providers need to join with members of the communities, members of social service agencies, with city, state, and Federal Government in the private sector to pool our resources to truly prepare for a unified integrated and effective response to emergencies. That said, there are five overarching categories of need. Getting services to the homebound person and people with disabilities, ensuring that our clients have adequate food, water and shelter, transportation of people, services, medications and food. Three-hundred sixty degree communications with staff, seniors, their families, and emergency organization and addressing the mental health issues that arise for everyone. Let me give you some examples beginning with the homebound and disabled population. At Sunnyside Community Center in Queens serving 1,500 seniors, they have an emergency planning system in place that includes setting up a triage of client needs from those who cannot function alone to those who can function independently within their home. Part of the emergency plan includes updating this information monthly and ensuring that the client's levels of need has not changed. In addition, Sunnyside keeps both a hard copy and a computer file of their clients and shares both with the Fire Department and Police Bureau Commander. Thus, in an emergency, they immediately know which of their clients need help first. When the problems arose on September 11 and in the following days, that many of the home care workers could not get to their clients because they didn't have official identification badges to get through the blockades. These are the small but critical issues that our members have alerted us to and that together we can remedy. At the Stanley Isaacs Neighborhood Center on the upper east side of Manhattan, which also provides Meals on Wheels they were serving congregate meals in their senior center on September 11 when tragedy hit, and they continued to serve their seniors that day making sure they were given their lunch. But they could not carry out their Meals on Wheels program because the trucks that brought in the food were stuck out in Queens with the bridges and tunnels shut down. These are the problems that occurred across areas of transportation issues, communications issues and mental health needs arising from the emergency. If a homebound person does not get his or her meal, it is first a physical issue but quickly becomes an emotional one as well as isolation, fear and panic set in, all with terrible consequences for the homebound person. The solution in this case a brace of some 24 corporate volunteers from Bloomberg Communications delivered Meals on Wheels by going door to door on foot, and two restaurants in the area; namely, the world famous Le Bernardin and Daniel donated food to feed the center's clients. Transportation problems became the central issue preventing people from receiving needed supplies of food and medications, keeping people away from their homes and families, given the city's need to close down all bridges and tunnels. It increased safety for the island of Manhattan and the outer boroughs but sent providers without local emergency backup scrambling to cover the necessities that we took for granted before the attack of 9/11. On the issue of 360 degree communication, that means communicating with staff, with clients, with emergency service operations, with anyone else you need to reach or who needs to reach you. Our members have asked us for help in creating a redundant communications plan; that is, multiple ways of communicating in an emergency that includes backup if one method doesn't work. This is something we need to address going forward, including the use of cell phones, backup land lines, two-way radios, a special radio band for emergency communications and broadcasting, and, of course, ensuring that every person has a portable radio with fresh batteries. Some of our members have created call down systems where people can call in to them and they can try to contact emergency services. But when the phone lines were down and cell phones not working, this fell apart. Many are worried about both what role they need to play in the event of a bioterrorist attack and how to protect their seniors. Then there are the mental health services which need to be offered in a 360 degree manner as well. All our members told us that participation in congregate facilities increased, sometimes double what it was before 9/11. Senior centers became safe havens for our city's older adults, as our members told us of the clear need seniors had to be in touch with someone and not be isolated. Each of the coping mechanisms our members designed to meet the issue raised by the terror attack is ingenious, but therein lies a larger problem. They should not have had to work on their own to solve the problems they all shared. We need a community-level preparedness plan where all stakeholders work together. I would like to make some recommendations. One develop a network of emergency pharmaceutical services that includes the means both to fill medications and get them to those who need them. Credit cards did not work for prescriptions. We need to find a way to get prescriptions to our community-based seniors as well. Two, increase in-home services for the homebound including in-home psychiatric mental health services and home health aide providers. Three, ensure that there is a team of restaurants identified in the neighborhood as willing and able to provide emergency food to a pooled resource. Four, develop an emergency support system for the in-home services including emergency respite care and communications abilities for in-home caregivers. Five, create a secure system of photo identification for professional health care and senior service workers, even for the Meals on Wheels providers and the drivers, that will enable them to get through to their homebound clients in an emergency. Ensure that each facility has done a risk assessment, audit of its hardware, software, insurance coverage, and physical plant. Develop a city-wide, statewide and national emergency transportation plan. Each community needs a contingency plan for moving people, including those in wheelchairs, emergency supplies, and medication. Upgrade communications systems including trunks of telephone lines and emergency response systems and develop redundancy communication plans including instructions on use of emergency communications products and tools of backups. For Meals on Wheels programs, offer a sixth meal or a shelf stable emergency pack in case of interruption of service. Ensure that on an organizational level each organization develops an emergency plan and that it is kept updated, and teach them to remain flexible depending on the nature and site of the emergency. Communicate with your clients and staff immediately and continuously as possible. Ensure that people do not feel isolated or abandoned. Understand that your staff may feel a need to offer help and to be helped. Offer group discussion sessions and if possible allow staff release time for volunteer efforts. One of the things that we found during this process is that the seniors acted as a resource because they have gone through this in World War II and other experiences, and they were sometimes a resource to the staff who have never gone through this before. In short, our message is that we never know what natural or unnatural disaster will strike, but it is never too soon to be prepared, especially for our nation's seniors. Thank you. Senator Craig. Mr. Jellinek, thank you very much. Now I am going to turn to Mr. Michael Benfante. Michael is unique in the sense that he was there, an employee of the Network Plus Company, he worked on the 81st floor of Tower One at the World Trade Center, and on September 11 Mr. Benfante helped evacuate a woman with rheumatoid arthritis with the help of an evacuation chair. So, we really do appreciate your being here today. We look forward to your testimony. STATEMENT OF MICHAEL BENFANTE, EMPLOYEE OF NETWORK PLUS Mr. Benfante. Thank you, Senator. First I would like to thank you Senator Craig and the other committee members for inviting me to participate in this U.S. Senate Special committee hearing regarding emergency preparedness for the elderly and disabled. On the day of September 11 I consider myself to be one of the fortunate ones, fortunate in many regards which I am going to relay to you and to this committee. First after the impact of the first airplane hitting the north side of Tower One above my office, I was fortunate to have the ability to stay calm to direct 28 of my sales reps out of the office and into the stairwell, fortunate to be in the highest office of the 81st floor of Tower One, to come away from that day without a casualty, fortunate to have the strength and composure to carry down Tina Hansen 68 flights, fortunate to have that emergency evacuation wheelchair there to assist me in doing so, fortunate to have my coworker John Cerqueira along with me to help me carry her down 68 flights. It was also very fortunate encounter firemen on the fifth floor where we were stuck for a while who eventually directed me out of Tower One and through the destruction and onto the West Side Highway where they further directed me to an awaiting ambulance where I was able to put Tina Hansen into, where she eventually made it to safety. I was fortunate to have about 95 of those 102 minutes that Congressman Gilman mentioned earlier, the time from the initial impact to the time of the eventual collapse of the second tower. What I will do now is try to explain to you what occurred in those 95 minutes from start to end to see if it can assist you in this hearing, if that is what you would care to listen to. Like Senator Craig said, I was located on the 81st floor of Tower One. The first plane hit above my office on the north side of the tower. I was fortunate to be in the southeastern corner of the tower, 7,000 square feet, where I had 28 of my reps there. I don't know if you are aware that the actual floors of the World Trade are about a acre large, so I actually heard my reps screaming before I actually felt the impact because I was on the south side of the floor. My office actually overlooked the Statue of Liberty. So, I heard one of my reps screaming from the impact before I actually felt the impact, and I immediately rose from my desk and ran out to the office and screamed for everybody to remain calm. I looked out my window behind me and I saw debris and fire falling from the building. And then I immediately ran out into the main office through my reps and out into the hallway to see what the destruction was like out there, and I saw that the stairwell was clear. I did not know what was occurring at that time. I thought it was a gas explosion or something, so I told everyone to get to the center of the floor where, believe it or not, they listened to me and came together and eventually made it to the stairwell and began their descent down the stairs. While I was directing them out, someone said that someone was stuck in the bathroom, so I ran back into my office, grabbed my cell phone and grabbed my bag, ran down to the men's room in the main hallway, ran over some debris, did the combination on the men's room door, opened it where there was a lot of destruction in there, but there was nobody in there, fortunately, ran back into my office and made sure everybody had already left the office, so it was just myself and an assistant branch manager. Everybody had already left and I began my descent down the stairs. I made it down about one flight and tried to assist two men that were stuck in an elevator halfway between the landing. Me and another gentleman, I don't recall who it was, we ran into an office and tried to grab something to wedge the doors open of that elevator. It was a bathroom key with a long stick at the end of it. It was one of the devices we used--I think it was a leg from a chair, and we tried to wedge the doors open, but they were buckling front to back instead of opening horizontally, so I felt that we were going to do more harm than good, so I left those devices with those gentlemen and wished them good luck. I don't know what actually eventually happened to them, and I continued on down the stairs. On my way down I passed many fire extinguishers in the stairwell. People were screaming that there was fire on the 77th floor. People still--we did not know what was going on. I grabbed the fire extinguisher on the 72nd floor and started heading back up, but I was getting nowhere fast because of the people coming down the stairs. So, I put down the fire extinguisher and continued on down the stairs. On the 68th floor I stopped out onto a floor and where there were people and I was trying to direct them out into the stairwell. As I looked down the hallway, there were large glass doors, and there were these women just standing there behind the glass doors. And it seemed to me kind of odd with all this hysteria that they were just standing there, so I ran down the hallway. I banged on the door where they eventually pressed the button to open the doors. And as I was walking in to scream at them to evacuate, one woman stepped aside and there was Tina Hansen in her motorized wheelchair. I asked her if she needed help, and I also noticed an emergency evacuation wheelchair still strapped together on the floor besides the women. Nobody was doing anything, and pretty much everybody had already evacuated except for these women, and Tina was trying to calmly tell me to use this chair, so I was frantically trying to open the chair where I eventually saw a lever toward the back, flicked the lever, the chair opened up, and I took, grabbed Tina from her wheelchair and strapped her into this wheelchair where I initially had her carrying her on the back and I had my assistant manager carrying on the front and another gentleman, and then I saw my coworker John Cerqueira and asked for his help. He took one side of the front, I took one side of the back and different gentlemen switched on and off on the back, and we proceeded to carry her down 68 flights. On the way down it was relative calm. Everybody was helpful. For the most part it was clear. It did get backed up from people evacuating the different floors and the flow of traffic coming into the stairwell. We did switch stairwells a couple of times to try and make better time. There was a, I think, an emergency. We encountered the firemen I guess around the forties full gear, tools and on their way up trying to assist people in evacuation, exhausted from climbing 40 flights with all that gear. There were people trying to help them. They did not know what was wrong with Tina. They thought maybe she was ill. They did indicate that on the 21st floor there was a medic station set up where we could set her down; maybe they could assist her. As we got closer to the 21st floor, I asked her if she would like me to put her down she was relatively calm and I asked her again I will take you all the way out, and she said OK, so we never let go, and I believe it was when we got down to the tenth floor, around the tenth floor was maybe when Tower Two was starting because we felt the rumble and some smoke started to filter into the building. Then we went into a floor landing. I believe--I don't know if it was a Port Authority or some type of maintenance floor because it was very dark. It was very narrow. There were lockers and there were no lights, but the firemen were there to assist us. They had lights and were trying to direct us. We were going a couple of different ways, but I think because of the collapse of the tower they could not find a safe way for us to get out, so it started filling up with smoke, and there was some panic there. Meanwhile we are lifting Tina and carrying her over debris or trying to move the debris and carrying her through and eventually a fireman tapped me on the shoulder and said let's try this way again, and we were like, ``We already went that way.'' We followed him and took us to a stairwell where I barely remember going down the last four flights. At that point it was myself and John Cerqueira and a firemen carrying Tina from the back, and we made it down to the lobby of Tower One on the West Side Highway side of the tower. So, if you look to your right, it is where the turnstiles are to go up the tower and the security desk to the left and massive destruction where firemen directed us through the broken glass of the tower out into the West Side Highway, where I put Tina into the ambulance. I as I was looking up trying to take in the enormity not even realizing the enormity of the situation, I still did not realize that Tower Two was down, I started to walk away and heard an explosion and Tower One was collapsing behind me, so I just ran for my life and dove under a truck. As the debris and the smoke eventually subsided, I got up and walked away. I will answer any questions that you may have regarding the hearing. Senator Craig. Michael, you have answered all the questions. You are obviously a very brave young man. We will come back to you. There are a couple questions I would like to ask you. I would like to hear from both Andrea and Marion here, who are with us. I understand, Josefina, you have to leave us to catch an airplane in the somewhat immediate future. Is that right? Let me come back then and ask you a question before we get final testimony. I had hoped we could get to Marion before you left, but I do want to ask you the question as it relates to preparing the aging network and nursing homes for disasters and the kind of coordination that is necessary. You have had past experience in dealing with seniors in emergencies. I guess my question really is what is the kind of interagency coordination that you are participating in now that is in part a direct response to the September 11 experience? Ms. Carbonell. Thank you, Senator Craig. I think my experience again goes back to, just like Mr. Paulison, Hurricane Andrew in Florida, particularly working over 29 years with the elderly community and disabled community in Miami. I think many things changed after 1992, and we are working to expand and to upgrade the material in our disaster preparedness plan based on the recent experience. But the most important thing is No. 1, that we need to do a better job of ensuring that there is a special needs roster. We developed the kinds of data that identify people that have special needs and that in case of emergency that data base is available in one location and could be spread into other areas. So, it means that we work with 56 state units on aging. We also work with 660 area agencies on aging. We have over 29,000 community providers throughout the country that work day in and day out with individuals both in the congregate senior center settings but also that serve homebound clients. So, we make need to make sure that in the process of revising our disaster preparedness manual, we take in recommendations from experts, such as many around this table today, to incorporate those recommendations into our technical assistance manual. We can never be too prepared. We don't know where and when our next emergency will hit, whether it is manmade or whether it is natural disaster. So, definitely being able to have protection in place and surveillance like we heard from Mr. Osten and being able to have a response plan and a backup system, better communications and ensuring that we work collaboratively like we are doing at the department level right now with CDC, with HRSA and CMS and other partners with FEMA and the local emergency preparedness folks to integrate all of those plans together. It starts at the Federal level, Senator Craig, and that is what we are beginning to do right now, and we hope to have a more up-to-date plan in place hopefully by the end of this year that will address not only a manual on how to, but will also increase the training of the individuals on the field to the 660 AAAs throughout this country. Senator Craig. Thank you very much. Let me turn to Congressman Gilman. The Congressman is going to have to leave us in a few moments, so I want him to ask any questions he might want to and any comments he would want to make, and then we will come back to you ladies for final testimony and the balance of the questions I have to ask. Ben. Rep. Gilman. Again thank you, Senator Craig, for conducting this hearing on behalf of the Special Committee on Aging. I think the recommendations coming out of this will be helpful to every agency throughout our nation who is trying to prepare properly for emergencies of this nature. I want to congratulate Michael Benfante for his dedication and his heroism and what he described to us of the method of saving one of the disabled. I think that will stand out in our memory as we recall this hearing, what we have to do to try to perfect our systems. Please excuse me, our good nursing folks, Andrea and Marion. But I have your testimony and I will look at it very carefully. I have to go to another meeting very quickly, but I want to ask just two quick questions, Senator, if I might. Dr. Ostroff, you talked about all your recent initiatives on behalf of the center, but I heard a report recently that there was a toxicity found in the air following the 9/11 tragedy, and it had not been publicly released nor disseminated to those who were in need, particularly our rescue workers. Is there some substance to that. Dr. Ostroff. I don't know all of the details of that, Congressman. I work in the infectious part/disease part of the agency. I know that there was an a hearing that took place this morning that discussed many of those issues, and I know that there are ongoing concerns about some of the air quality issues around the World Trade Center. Rep. Gilman. Well, then, let me ask Wayne Nelson from our New York State Health Department. Wayne, can you tell us anything about that toxicity and why the information was disseminated to the rescue workers? Mr. Nelson. No. Unfortunately, Congressman, I don't know the details of that. Rep. Gilman. I hope that maybe you can provide it to both of us, Senator Craig and myself, and we would welcome knowing more about it. Mr. Sheirer, on behalf of the--with regard to the FEMA---- Senator Craig. Richard just stepped out. Rep. Gilman. Oh, Richard stepped out? Well, I am sorry. I would like to know just more about, and I will ask our FEMA fire coordinator, what about the joint meetings of all of the interested parties? How often do you get together to review what our good Deputy Secretary was saying about coming together to make plans? How often do you bring your agencies together? Mr. Paulison. I don't know the answer to that. I have been in FEMA a few months. But I can tell you that what I testified before is absolutely accurate. It starts at the top with the Federal Government. We have to get our act together first if we are going to expect the local responders to act. That is the message that we are taking back to the FEMA Director. FEMA should take the lead in gathering some of these agencies together to come up with some definitive plans. Rep. Gilman. I hope you follow up on that. Mr. Paulison. Absolutely. Rep. Gilman. I think interagency communications and planning is so important in what we are doing. Mr. Paulison. It has to be. Everybody has to take ownership in this. Everybody has to take ownership from the individual all the way up to the top. If we do that--the ideas are out there. Everybody around the table has the same message. We listened very carefully. Laid out the same steps, the five or six steps of what had to be done. We know what the issues are, and I am sure we are going to have another testimony to tell us very clearly what the issues are, what they see from their end of it, and we just have to get together and resolve it. That is a message that I am going to take back to the FEMA Director. Rep. Gilman. Hopefully they will listen. I want to thank you all for your recommendations, for being here today, Senator Craig for conducting this hearing. Mr. Jellinek, you had good recommendations. I hope there will be other good recommendations of that nature passed on to us from both the Senate and the House. Thank you very much. Please forgive me for having to go to another meeting. Senator Craig, thanks again for inviting me to participate. Thank you. Senator Craig. Congressman, thank you very much. We are pleased you could join with us today. Let us now complete the testimony before I follow up with some questions. I would like to ask Andrea Dale, a nurse with the Visiting Nurse Service of New York to offer her testimony at this moment. If you could pull that mike as close as is comfortable. There you go. Ms. Dale. Mr. Chairman and members of this committee, I am Andrea Dale. I am a registered nurse. Senator Craig. Andrea, we are going to ask you to hold until the tape gets changed. All right. Thank you. STATEMENT OF ANDREA DALE, VISITING NURSE SERVICE OF NEW YORK Ms. Dale. Mr. Chairman and members of this committee, I am Andrea Dale. I am a registered nurse appearing before this committee for myself and on behalf of the Visiting Nurse Service of New York. I am joined today by Marion Anello, a resident of lower Manhattan. I welcome the opportunity to join you today along with the other witnesses in your efforts to learn firsthand experience of the September 11 disaster and the days that followed. I hope my experiences during those days as a field nurse working in lower Manhattan will help the committee better understand the environment and the challenges at that time. There are many things to be learned from September 11 terrorist attacks, too many to list here. I would like to take a few minutes to highlight what to me are important lessons to learn. First is that emergency preparedness planning must recognize that homebound patients are spread throughout our neighborhoods. As an example, VNSNY provides home care services to over 24,000 patients each week throughout the five boroughs of Manhattan, of New York City, and in Nassau County. Many of our patients are homebound, chronically ill and elderly. Many live alone. They are dependent on receiving services such as wound care and medication administration on a daily basis. This required home health aides to help them perform the activities of daily living. Particular concern must be given to those who are wheelchair bound and unable to leave home without assistance. Before September 11 I was one of 20 visiting New York nurses assigned to see active home care cases in lower Manhattan. My area extended from Canal Street to Battery Park, from Church Street to the Hudson River. I care principally for elderly patients and I recognize my responsibility to care for them. Many of my elderly patients have few surviving family members and small circles of friends. I must go to them. They do not and cannot come to me. VNSNY realized early on September 11 the challenges we faced given our patient population and the fact that 1,600 of our patients lived in the restricted area below 14th Street. I was responsible for 30 of these patients. No public or private transportation was available in this area for many weeks. Phone lines, land and mobile, did not work or they were unreliable. Stores, including grocery stores and pharmacies were closed. Resident and emergency workers wore masks. People were instructed to keep their windows closed due to the heavy smoke. In the area below Canal Streets there was a lot of physical damage and access was very limited. Essentially it was a war zone. On September 11 many of my patients saw from their windows the collapse of the World Trade Center buildings and the devastation and chaos that enveloped the area. For many it provoked memories of World War II and other traumatic events they had experienced over the course of their lives. As my colleagues and I continued to provide nursing therapy and other home care services, we were struggling to meet the mental health needs of our patients. Second, emergency preparedness must include the resources to transport care givers to their patients as well as being able to transport patients to the medical care facilities. On the morning of September 11 I was a few blocks north of the WTC en route to my patients when the second airplane crashed into the tower. I immediately contacted my team manager who advised me to return home, and I was able to get home quickly, as my home was a little more than a mile north, and I watched from my balcony as the towers collapsed. I contacted some of my patients living in Tribeca, and hearing the distress in their voices as we talked, I decided I needed to get back downtown I packed a backpack with some supplies and I headed back downtown on foot to them as all transportation had already stopped below 14th Street. After my checking my patients door to door and caring for those who were scheduled to be seen that day, I began to follow up on those who had been evacuated. By the end of that first week a pattern was established--miles of daily walking to care for the sick and help provide for their basic needs such as food. Where possible we contacted patients' relatives, passed along news of their family members or arranged for patients who had been staying in shelters to be brought to their family members' home. The point is that I was only able to get to my patients because I could walk the distances that separated us and I knew where they had been evacuated to or where they lived. Emergency preparedness cannot always assume this will be the situation. Three, emergency preparedness will depend on reliable and predictable communications. My cell phone worked for a few hours immediately following the attack and then became useless. Our residential phone service lasted a little bit longer and then became less and less reliable. Using these phones for a while I was able to remain in contact with my team manager in the hours following the attack. During these critical hours immediately after the attack I was essentially operating without depending on means of communicating with our central office. This indicates I believe that it is such service be made dependable and reliable in a time of crisis with a wider use of radio communication be adopted for care givers. A corporate lesson is to be prepared. VNSNY learned many lessons from this tragedy. We are working with government agencies to address public health issues that might arise in the immediate future. For fine-tuning our disaster planning, we have developed our comprehensive bioterrorism readiness plan. Most important, out of our disaster recovery plan was done as soon as the first plane hit, all our field staff knew their first priority was to their patients. Management did turn to the jobs to help the field staff do this. Senior management communicated with the city, state, and Federal agencies to request permission to enter the frozen area. New York City Office of Emergency Management, Police Department Centers for Medicare and Medicaid Services all offered greatly appreciated assistance and support. In the days after the attack it was essential to communicate with field staff to make sure they had all the necessary information on their patients, especially new ones. Masks were obtained to wear in the ``frozen'' zone. Our information technology unit had a backup system in place so that no data were lost in communication. Patient information was maintained with the staff through portable computers. As noted, there were problems with communicating with staffs since our phone lines broke down. In response VNSNY is in the process of formalizing a business continuity plan. We are developing policies procedures to ensure that business operations can continue in the face of outside forces affecting our buildings, our systems, our communications with staff. It must include the assessment of the current environment, development of business and technology requirements, strategy and planned development and planned validation through mock exercises. A dedicated VNSNY project team was formed in November 2001. This practice was to provide project oversight to represent all corporate entities. Contingency plans need to be developed which show redundancy based on a variety of scenarios: fires, floods, bomb scares, and bioterrorist attacks. Bioterrorism readiness--Home Care and VNAs must play a role. As our nation begins a major readiness initiative in anticipation of an unimaginable attack, it is important to recognize the vital role to be played by home health agencies. VNS and VNAs across the country have more than 100 years of public health and immunization experience that should be brought to bear on the local bioterrorism, readiness and immunization planning process. Home health care is not just an alternative to inpatient care. It is a front line defense to any biological or chemical threat this country may face and a key component to the public health system. For over 100 years VNAs have immunized and vaccinated hundreds of thousands of people in their homes and at community sites. VNSNY under contract with the CDC screened and immunized postal workers against anthrax in New York City. In the event of a widespread epidemic VNAs and other health agencies in each city can provide the experience and the infrastructure to deliver care to every community. During the days and hours following September 11 VNSNY staff---- Senator Craig. Andrea, could you sum it as quickly as possible. Thank you. Ms. Dale: We have developed a bioterrorism readiness plan as part of our overall disaster planning and will be doing drills and regular correspondence as it will be periodically updated. We thank you. [The prepared statement of Andrea Dale follows:] [GRAPHIC] [TIFF OMITTED] T7851.023 [GRAPHIC] [TIFF OMITTED] T7851.024 [GRAPHIC] [TIFF OMITTED] T7851.025 [GRAPHIC] [TIFF OMITTED] T7851.026 [GRAPHIC] [TIFF OMITTED] T7851.027 [GRAPHIC] [TIFF OMITTED] T7851.028 [GRAPHIC] [TIFF OMITTED] T7851.029 [GRAPHIC] [TIFF OMITTED] T7851.030 [GRAPHIC] [TIFF OMITTED] T7851.031 [GRAPHIC] [TIFF OMITTED] T7851.032 [GRAPHIC] [TIFF OMITTED] T7851.033 [GRAPHIC] [TIFF OMITTED] T7851.034 [GRAPHIC] [TIFF OMITTED] T7851.035 [GRAPHIC] [TIFF OMITTED] T7851.036 [GRAPHIC] [TIFF OMITTED] T7851.037 [GRAPHIC] [TIFF OMITTED] T7851.038 [GRAPHIC] [TIFF OMITTED] T7851.039 [GRAPHIC] [TIFF OMITTED] T7851.040 [GRAPHIC] [TIFF OMITTED] T7851.041 Senator Craig. Well, thank you very much. I do want to get Marion's testimony and then I have several questions I want to ask and still try to keep us all on schedule here. Next our last testifier and I must tell you, Marion, certainly not our least. We thank you for your patience in being with us. Marion Anello, an elderly patient of Ms. Dale's, has her own personal experience to tell us out the very experience and circumstances that Andrea Dale found herself serving. So, if you would please proceed. There you go. Thank you. Ms. Anello. I thank you for having me. I am Marion Anello. I am 80-years old. I live a block and a half away from the World Trade Center. I was working that day on the Board of Election in my building on the second floor. When the first plane hit the tower everything shook: the windows, the blinds, everything. We didn't know what happened. When the second one hit, the maintenance man came downstairs and said the World Trade Center was just hit. We have a 60-inch television downstairs in the senior citizens room, pulled it out, and we put it on. When we saw what happened, it was a terrible thing. We closed up the Board of Election because there was nobody coming down any more, so we got a phone call to close it. Put everything in the back of the machines and we closed it and went upstairs. I live on the fourth floor with my husband. When I sat down on the chair I saw the second building come down. It crashed right in front of my face. It was terrible. All I heard was glass crashing, crunching. It was a terrible thing to see. Not to see the other two buildings over there was more disaster. Well, my husband and I were talking about it. What could we do. These are crazy people anyway. Two weeks later I landed in the hospital with a lung infection from all the smoke and the debris and everything from downtown. I was in the hospital for 8 days. I came home after the eighth day. Now my husband wanted to come and see me in the hospital. I told him not to come because he is blind. I told him I am coming home, but he came anyway. He came home. He was on his way home in a taxi, somebody got him a taxi downstairs. He got to Canal Street, the cop wouldn't let him pass. So the tax driver said I have a blind man here. He lives at 310. He's got to get home. So he said, you are very fresh for a blind man. He said, ``What do you want me to do? Walk? I can't walk.'' Anyway, another police car passes and says what is the trouble? He said--the taxi man said I have a blind man over here. he said he has got to get home. He lives at 310. He said go ahead. Anyway, he called me in the hospital. I said how did you get home. Why are you so late? He says they wouldn't let me through beyond Canal Street so anyway, that is my story. Oh, yes, excuse me. I am a little nervous, you'll have to excuse me. OK. That night of September 11, getting back to my story, they evacuated us from the house. All of us had to get out. We had no hot water. We had no heat, no water. We all had to get out of the building. Five hundred tenants had to get out. They had three buses waiting for us outside to take us to the Washington Irving High School. I lived in the shelter for 8 days. I tell you, it wasn't very nice and that is nothing like home. They brought us home after the eighth day, and I came home I was so glad to have my house and to sleep in my own bed. I slept on a cot for 8 days. I don't know how the homeless do it, but God bless them anyway. That is all I have to say. I am just happy to be home, that is all. I hope it doesn't happen again. Senator Craig. Marion, thank you for your testimony. That is extremely valuable because for those of us who attempt to look at it through papers and reports and policies sometimes, in all fairness, we miss the emotion, and it is very important that we understand that as we work through these difficulties and develop and coordinate programs. Andrea, you obviously serve the area that Marion lives in, and you talk about the preparedness or the efforts now at greater levels of preparedness and coordination. If I were to ask you what would be the top two or three lessons you have learned and things would you want to change to improve the circumstance you were in following September 11, what would that be? Ms. Dale. Well, of course we had difficulty with the communication. I had two---- Senator Craig. My notes said communications right off the top. Ms. Dale. I had two phone services at home, one local, one long distance, and the service at home is undependable. I had my cell phone and that wasn't working downtown at all. My cell phone worked the first day, so I wasn't able to make contact with my office. We have computers. We communicate by phone lines, and we also had trouble with the phones at my office, so an alternative means of communication that would be more dependable would be one thing I would consider very important. Second, you know, I don't mind walking and I had it very easy compared to a lot of people, but I had to walk miles and miles every day just to get to the checkpoint, through the checkpoint, and to my patients and back and then to go see some who were evacuated. So, I got it all done in the course of a day. I had some all the way over in the shelters on East 17th Street because their care needed to be continued despite the evacuations. I felt if there could be a better way to compile a central list of knowing who had been evacuated. There were certain people I had to put in more efforts to try to determine whether or not they had actually been evacuated because they had the right to refuse. It wasn't mandatory, and some had to be persuaded. So as it turned out, there was one gentleman I had in the Battery Park City area and Tribeca. I had a very large area at that time. My resident in Battery Park City had refused to be evacuated and I think it was probably because he couldn't take his dog with him. He landed up on the floor and I wasn't allowed to go down there, and I had been assured everybody had been evacuated. He was eventually found on the floor and he had sustained a fracture having fallen when it was dark. Those would be three key items. We have, of course, emergency disaster planning. I don't think we had anticipated anything quite like this. Senator Craig. Well, I doubt that any of us could possibly have imagined this, and you are right. Although our planning must encompass worst case scenarios as best the human mind can create them and then develop systems for them. You mentioned an elderly fellow staying behind because his dog could not go I assume. Ms. Dale. Pets were not allowed to go. They were not brought to the shelters, although the ASPCA did establish a plan to go around collecting pets if you could give them a house key. Lots of people in New York City are so devoted to their cats and dogs. Senator Craig. We all are. I have pets and I am just wondering in your recommendations where in the case of evacuations not being mandatory and people not wanting to leave because of their pets is there anything that mentioned that or talks to that as to how we might be able to deal with that sides of the dimension of people's willingness to participate? Ms. Dale. No, there is nothing mentioned I just mentioned because I did spend a lot of time just investigating after I had determined where most of my patients were then I went to look for people I had a harder time finding. I interviewed a lot of people. I spoke to police officers and military police. We were going to try to enter a locked building. The second day I found a military policeman who was able to tell me that this couple I was concerned about had been persuaded to leave because they were going door to door as had been mentioned earlier. They did a really good job. They went around and told everybody you have 5 minutes to leave. Get your medicine and we will be back for you. Well, they didn't state it was--I think eventually it was mandatory in one of my buildings in that building. I think they had mentioned something about it. They suspected gas leaks or something. Ms. Anello. That is right. Ms. Dale. I think they mentioned suspected gas leaks. Ms. Anello. That is why we were evacuated. We had gas leaks. No water, no heat. Senator Craig. Thank you both very much. That is valuable testimony, to have firsthand testimony as to the actual area itself and people your age and needs, Marion, and how they got served. Thank you very much. Ms. Anello. She was very helpful to me. That is right. Bless her heart. She is a good girl. Senator Craig. Michael, prior to your experience on September 11 had you ever had any emergency training or any kind of training within your office complex that assisted you? Mr. Benfante. Other than routine fire drill to the extent where you leave your office and you were shown where the stairwells are on each level. Senator Craig. Were those fire drills taken seriously by your office and your staff? Mr. Benfante. Yes. For the most part, we all followed the procedure. I do remember that you are supposed to have a designated fire marshal, so to speak, for each office and then a secondary one. Just might want to consider where there are offices with turnover, you might want to consider just someone that is always there not so much as an outside sales office. I happen to be one of those I think I was more of a secondary one than a tertiary one, but other than just routine fire drills. Senator Craig. The wheelchair that you used to bring Tina out, obviously you could not have brought her out on her electric wheelchair. Mr. Benfante. She was actually adamant about bringing that down, but it was too big. I just told her to leave it behind. Senator Craig. Well, now was that portable or emergency wheelchair part of the office or was it there because of her situation? What caused that wheelchair to be there at the time? Mr. Benfante. It was actually because of Tina. From what I understand, Tina was also working at the World Trade Center during the 1993 attack and as a result of that attack, there were certain procedures put in place, I think one of them being that emergency wheelchair. Now, I think it should be mandatory that any person with a disability that is confined to a wheelchair, whether they remember to have one or demand to have one there or not should be there, should be required. So I don't know if it was part of a requirement or, if it was just part of Tina requesting it be there. Senator Craig. Well, I am sure it is fortunate for both Tina and you and your partner that it was there. Mr. Benfante. Yes, very fortunate. It just made the evacuation a lot easier. Senator Craig. Well, Michael, your testimony is special. I am sure that many people have praised you, as they should, for your help and persistence under those most difficult circumstances. I think all of us when we hear of people like you and testimonies given question ourselves over whether we could have performed as well under those circumstances. My congratulations to you. Mr. Benfante. Thank you, Senator. Just one thing. Senator Craig. Please go head. Mr. Benfante. All things considered, I agree with Congressman Gilman that it was a tremendous emergency response. I know there were many lives lost, but I think just in the way that our Fire Department and Police Department and rescue workers responded there were more lives saved and it just should be acknowledged. Senator Craig. Well, I appreciate you for saying that. Certainly I am not critical and I don't know of many who are. We look at the circumstance and the magnitude of the situation and recognize really how well everyone performed. What we are in pursuit of now whether it is FEMA or CDC or others is where do we go from here. Several of you mentioned our preparedness for 2000 and a suspected problem, and there was a major investment nationwide at that time for communications systems and computerized systems as related to a potential shutdown which did not occur. But it did create a preparedness that obviously has helped us and helped this situation to some extent. No, I don't think anyone is being critical, and I thank you for saying that. The question is where do we go from here to improve upon both services coordination and Federal, state, local systems working together thank you. Mr. Jellinek, you mentioned your experience with a private- public environment. I guess my question to you is what obstacles did you encounter as it relates to the cooperation between the public-private sector? Mr. Jellinek. I think overall it was a tremendous response working together. I think New York is such a heavily populated city and we are broken up into 59 different community boards. There needs to be more of a community-based response. For example, if you worked in programs in the community and sometimes you don't--a lot of people don't live in that community. Those people did not know where to go. They could have gone to other communities and other programs to lend their help. So I think there is also these informal relationships where you have at the post office or you have with the different businesses in the community. I think to begin to work that a little more in terms of making sure the relationships are there if things break down that you can work with a very local level. I appreciate the need to have Federal interagency responses as well as state responses. But at the city level the action occurs on a local level and unless the people on the ground floor of the meal deliveries are trained as to what is going to happen and who they go to--and nobody was prepared--at least I wasn't prepared, let's put it this way, for this kind of magnitude of tragedy. The thing that I raise is that as time goes by that we keep diligent in terms of putting these preparedness plans in place and take them seriously, and so I would urge that there be some sort of mandate on a very local level that people work together. Senator Craig. Well, I appreciate you saying that. I come from a very rural setting. I grew up. My nearest neighbor was seven miles away in a rural ranching environment. While we think of help coming in from the outside, it always would get there too late. We really had to think locally and think neighbor to neighbor and always did. I think that while I agree that Federal, state, local cooperation is tremendously important as it relates to training and communication and we are finding out that the right hand in some instances on September 11 did not know what the left hand was doing. There is no question that those who are there if properly trained at the moment the circumstance occurs can save lives as we know and be that first line. Of course, fire departments certainly were doing that in part immediately in the first instants. But I think your admonishment or at least observation that local is as critical as national is very true as we coordinate that. Thank you. Mr. Jellinek. May I say one thing. Senator Craig. Yes. Mr. Jellinek. It is not an admonishment but an observation. Senator Craig. No, no, no, I appreciate that. It really isn't. But it is a valuable observation and I agree with that. Wayne, again, coordination state, Federal agencies, one or two of your remaining thoughts. If you had the ability to say tomorrow this would be different because I know it would improve the circumstance I have to operate under, what might that be? Mr. Osten. Senator, I think the one area that needs to be incredibly close coordination between Federal and state is on responding to a biological event. I mean as bad as the Trade Center was and the effects of that, the concerns of a biological event going undetected for a period of time and how you respond to that, that needs an--and I am sure Dr. Ostroff would agree with that--that needs to be close corporation between the Federal Government and state as well as the locals because its the locals that will immediately deal with the problem. That would be my No. 1 priority. Senator Craig. Wayne, that is something we worry about. Doctor, I am going to jump across the table to you with this observation and I would appreciate your reaction from where CDC is today versus where it was at the beginning. I just got back into our office building 2 weeks ago. I was in the Hart Building. My offices and some of the staff around you were in the Hart Building. One of the things I observed is that the best knowledge that was available after the anthrax exposure in the Hart Building when there was a determination to evacuate--and I say this as no criticism--the best information that was available and the advice that was given us by CDC on that day to communicate to our staffs was advice that was invalid 30 or 40 days later as we began to pick up knowledge and experience based on the woman here in New York and certainly the woman in Connecticut. This tremendous change in knowledge occurred based on the type of anthrax, the size of the spores, the airborne character of them. Would you comment not only in relation to what Wayne has just said but where CDC is at this moment in cooperation with FEMA in not only better coordination but programs in relation to new knowledge. Dr. Ostroff. Thank you, Senator. I will start my comments by saying that when the anthrax episode happened, an event like this had never happened before. We were relying primarily on scientific information that was in most cases decades old from totally different types of settings. We were trying to use that information and base our decisions on information that in some cases turned out to be quite accurate and in some cases certainly did not. I can tell you that here in New York, as well as in Washington, DC. on a day-by-day basis as we went through this episode, we learned every single day. We refined what we were doing on a day in and day out basis as we acquired more information. Here in the city of New York, certainly the way we responded at the various media outlets, from NBC to ABC to CBS and the New York Post was different each time. We learned from each experience. If we don't do that, then I think we are foolish because you have to learn from that experience. Senator Craig. Would you hold for just a moment. We need to change another tape. Dr. Ostroff. So we did certainly learn a lot. I will also say that we have a lot to learn. We will continue to try to massage the experience that we had over the last several months so that we can make the best informed decisions as we move forward. I think the good news, and I will say this quite frankly, is that most of the decisions that were made, in retrospect, were the right ones. We did I think, by and large, protect most people during this episode and I think that is much to our credit. I will say if I may, as opposed to some of the other comments that were made, I am a bottom-up guy. I think that, at least in public health, the responsibility as well as the expertise is as much at the Federal level as it is at the local level. The solutions and the infrastructure here in New York City may be very right for New York City, and may be very wrong for a place like Idaho. I think it is going to be quite important for each place to come up with solutions that are appropriate based on what they have to work with and what they have to build. The one other thing I will mention is one of the things we also learned: while it may be fine for New York State to develop their plan and for Connecticut to develop their plan and for New Jersey to develop their plan, many of these episodes as we went through them were multistate; that was true within Washington, DC., and certainly that was true here in New York City. It affected people in New Jersey, it affected people in Connecticut. While the facilities may have been here in New York, the people were in a different state. The same was true in New Jersey with people in Pennsylvania and Delaware. That is why we need to be able to coordinate these types of activities. Senator Craig. Doctor, thank you very much. FEMA is going to have to leave us and catch an airplane. David, while we always look at FEMA after the disaster to help, to bring in resources, to direct and then, in some instances, to help rebuild on a individual basis. One of the things that in a previous hearing last week I heard from you all and Joe was there speaking about his training and a substantial new role for all of that and coordination, recognizing your time and you can be very brief, I appreciate that because our time is up here also, you just might broach that for a second as I think it is a new role for FEMA to be participating in. Mr. Paulison. That is an excellent observation. Three things came out of the World Trade Center that we kind of knew were out there, but it really came to a head: One, is communications and interoperability, you know. One agency couldn't talk to another agency, even through a command post, and that is intolerable; we have to deal with that. Two, is a nationwide instant command system. All of the fire departments use the same instant command system, and it has been nationally recognized as the one we want to use, but other agencies are not on board yet. That creates some problems when you have your command post set up where everybody is participating and we have to deal with that. Also mutual aid. What happened in New York is the same thing that happened in Miami during Hurricane Andrew. We had people coming from everywhere who were not asked to come in, and it overwhelms the local system. You can't feed them, you can't house them, you don't know what their credentials are, whether they are really firefighters or whether they are really paramedics or what their expertise is. They are just coming in to help. We have to stop that. Somehow we have to be able to deal with just an overwhelming response--people who want to come in and help but may not be the right people to help. Third, and I do agree with the doctor, that we have to have more robust local planning or emergency plans at the local level because that is where the rubber hits the road and that is what FEMA's role is, to help with that, and we are going to be doing that through training; the President's proposal on his budget for three and a half billion dollars to go to first responders is geared to deal with that, and that is where we are in that, and we are ready to roll as soon as the Congress approves that. Thank you. Senator Craig. David, thank you and your associate for being with us. Alexander, let me turn to you before I conclude with Richard. There are so many things that I would love to ask you, and we have had some of your associates down and firefighters from other departments around the country visiting with Congress since the September 11 situation. But here in New York is there any view of or do you sense a need as it relates to training within your professional ranks to deal more with the prioritizing of seniors as it relates to their needs and to those people who are the disabled, any new stuff coming out of the September 11 experience that you would suggest would become a part of your training? Mr. Parzych. Well, I think our training is adequate in that we are staying with our standard procedures except for like a September 11; that isn't standard procedures. In other words, most of our procedures are if the people are not in danger in a high-rise building or a fireproof building, we do not remove them, you know, for a fire or some kind of an emergency. We have had areas to be evacuated which were larger than just let's say a whole building because of gas leak or something like that, but nothing on the scale of September 11. I think it is hard to be prepared for that. I think the Fire Department an outstanding job getting so many people out with the help of the people themselves, and I think the cooperation has to come with the community, with the disabled and the aging to with not having laws, but we do have procedures in a high-rise building, as you say, and here is a problem: The Port Authority doesn't have to comply with our laws because they are a state agency that are in the city. So the bombing on 1993 sort of made them open their eyes to comply with our laws, which made this time much better. Having fire safety directors, having fire drills and as fire safety directors fire wardens and our fire marshals, but that is a minor point. But in my building I am a fire warden, and we do take it very serious, especially--we just had a drill. If I don't take it serious, no one will, and it is important. So, the laws we have on the books now are very good. There are improvements, but I think it is a cooperation with in high rise buildings the fire safety plan, which is a mandated plan for these hotels and office buildings to require to give us the location of where the handicapped people are and what shifts there are. There is no real coordination of training or anything more specific than that. We are probably going to look into that and maybe make that a little more specific, but we are supposed to have when we arrive there a list of who needs help and where they are. We may not know exactly what the handicap is, we might have to refine that, but again, depending on what the circumstances are, we may not want to get 50,000 people out of a building. That is going to be very unusual, and I think my only personal opinion is the next one may be biological which you have 50,000 people just walking out and spreading it further, which we are involved with with hazmat, so hazmat and that training I think has to be beefed up. As far as mutual aid and recall, we had a system there. I was not at the World Trade Center. Our command staff went there. I had them be back, and we instituted our total recall and we had mutual aid with every community we had, which is a designed plan as OEM said; we didn't have people just coming in and volunteering. They had to get approved to come in with our dispatcher. At the World Trade Center, that was a different circumstance. It was tough to control who was coming in. But for the rest of the seven and a half million people we had a system that came in to protect them at the time. Senator Craig. Thank you very much for those thoughts, those ideas and some of what you are employing. Let me turn to you now, Richard, and we will ask you to be our last as I ask this question. You had mentioned in your testimony you are in the business of drafting a special report or special proposals on special needs folks. If you could share with us some of the three or four let us say top recommendations that will be involved in that draft that might--not only are they going to work here in New York, but might be something that we would want to look at at a Federal level whether it be with FEMA or the health and welfare, health and human services and aging. Mr. Sheirer. Well, as we went around the table today you heard a lot of recurring: communications, the registry. It is very, very important. One of the things we use almost every day is those persons who could be affected by power outages and the utilities in our town are mandated to have a list of anybody in every building who would be affected if they lost power; so when we do have a power outage, those are the first things we check on are those what we call LSEs to make sure that they are OK. How we expand that to include every person with special needs in New York is going to be a real challenge, but it is a real necessity to make sure people like Marion and her husband get what they need and we know where they are; to try and be able to get them their medication so they don't have to leave their home if we can avoid it. In this instance there was no way of avoiding just the enormous relocations that we had to do. I mean, there were tens of thousands of people in Battery Park City in north and south that we moved out and people north of the Trade Center. We had no recourse in that; it was just absolutely essential. But having a registry of those persons with special needs like the man that Andrea spoke of who refused to leave or didn't tell us that he wasn't going to leave is very important so we can do a follow-up. A little thing, a little aside, we do have a plan for pets and we have tried to incorporate it, but no plan that we had could encompass the numbers that we experienced. Even with our coastal storm planning, we asked people ahead of time to start thinking about what you will do with your pet because it is going to be impossible for everybody to take their pet to a shelter. The communications issue is a critical one for everyone, for people who live in the buildings and reside, the public health community, the public safety community, and the number of responders that we had at the World Trade Center and the number of frequencies, there was frequency overload that just could not be helped because of the number of messages. How you address that, we don't have the answers yet. In terms of telephone communications, this being Murphy's law, the one building that was probably most affected other than the Trade Center buildings themselves was the Verizon building which knocked out virtually all communications in lower Manhattan right away. We had to get them back to even get the financial markets back. So, there were a lot of things that happened, and we are all looking at that including Verizon. The transportation issue, we had to close Manhattan and we have to find a way to get people in and out. IDs are a problem. There were a number of people that we had to have arrested with false IDs who went into the site. We had a couple reporters who posed, one as an ATF agent and one as a firefighter to try and get in and get stories and pictures and there were just individuals who were up to no good. We caught a few in the access to the concourse, so it is a very difficult problem. The need to identify caregivers, Meals on Wheels, people have a universal identification is something we are going to look at and hopefully will never have to use to the extent we would have had to now. The sheltering system. Marion's experience of being there for 8 days, that is very difficult. We have done everything we can to try to make it as habitable as possible, but it is virtually impossible. These are the issues we want to look at. We do have--I will leave you a copy of it--our all hazard plan which specifically deals, has a section. It is web-based on people with--seniors and special needs people planning. But having it web-based alone is not enough, and we go further than that. How we can expand it and get community involvement with it is very important. Many of the people around this table are the people that sit on our task forces for various things, and we would like to bring them all together on this particular issue. Liz Davis, who is my special needs advisor, will probably reach out to everybody. So, there are a number of things, many recurring. One thing I just want to say about what Michael said. I was at the bombing in 1993, and Chief Cowan, who was just here and left, we were in the lobby of Number One on September 11. There was a marked difference between the way people left that building in 1993 and the way people left that building on September 11. 1993 whether it be because the bomb was at the base of the building or whether there wasn't adequate preparation or training, there was a lot of panic, a lot more chaotic. This time we didn't have the chaos. People were just absolutely terrific. People like Michael will never know how many people like Michael were there helping people get out of that building. We know how many firefighters and police officers and court officers and EMTs did what they did, but the number of just average citizens who helped their fellow citizens, an amazing number. It was just an amazing community effort, and that is something that is lost in New York. New Yorkers really--we may be eight million people, but we are all very real communities, much like small towns. While Idaho may be different being rural, you can go to York Village which has its own character, you can go to the Village, you can go to Bay Ridge, and these are all it communities are very much, very similar, more like small towns, just happen to be part of a big city. On the issues for bioplanning, Dr. Ostroff and I spent a lot of time together, much more than I had ever thought we would these last few months. One of the things we have in New York City that gives us a little bit of a heads up, we have a syndromic surveillance system that monitors EMS calls by the category they are and gives us an indication that something is out of whack before it would be readily available. Then we have CDC epidemiologists and Department of Health epidemiologists work back to make sure that the operation we are seeing is not bio, that it could be flu, it could be just whatever it is, but we want to know what causes it. That works very well in New York, and we have expanded it, but it would not necessarily work in Idaho or other communities because you are not ambulance based. But those surveillance systems in terms of hospitals in terms of doctors. We worked now with the large pharmaceutical chains. They cooperated and gave us--we knew the sales of over-the-counter medications so if anything was out of whack in terms of flu medications and then prescribed medications with anonymity, we knew where the big sales of Doxy and Cipro were going and what was going on. These type of systems are worth their weight in gold. It is transferable, but it takes a little work, and that is the way to go. But we will be working on a lot of different issues for the entire special needs and senior community because they're the most vulnerable people in our town and we have the highest obligation to them amongst all others. Senator Craig. Richard, to you, to all of you, a very special thanks for your time here today and your patience, because none of us in Washington have an answer. We are in the business of collecting those from all of you so that we can help prioritize and hopefully supply what is necessary, whether it be organization or resource that will assist you. I truly agree with you; what will work in New York City will not work somewhere else, but what you learn here may be something that someone else won't have to learn by the sheer experience that you have had. I think that is extremely valuable as we work our way through this. This committee, as I said at the beginning, is not an authorizing committee. But our records and what we supply and what we can provide for other members of the Senate or all of us who serve on this committee also serve on authorizing committees. It will be extremely valuable as we search our way through this, and we hope that we can develop a system that can respond quickly to biological kinds of terrorist attacks because I hope you are wrong, Alexander. I hope that will not be our next one. But there is a strong likelihood that at some time in the future that could occur, and certainly preparedness will mean in the end less-- fewer of our citizens will lose their lives, more will be prepared, and my guess is, you are right and Michael is right. Something worked because from the initial attacks at the Tower until the tragedy of the final numbers, within the first 24 to 48 hours those of us on the outside looking in were expecting a much worse situation from the standpoint of human life lost than did occur. To be able to evacuate that many people out in the short time that was given before those towers came down was, in itself, a remarkable thing. While I think it is missed by some in the reports of aftermath, I remember at the time we were talking of 25,000 or 30,000 potential lives lost, only to have it now where it is, although that is tragic. Ladies and gentlemen, thank you very much, and I will ask that this committee stand in adjournment. I must tell you also, and I forgot to thank staff for all the work, but I thank them for working with you in preparing for this hearing and again thank them. [Whereupon, at 4:05 p.m., the committee was adjourned.] A P P E N D I X ---------- [GRAPHIC] [TIFF OMITTED] T7851.042 [GRAPHIC] [TIFF OMITTED] T7851.043 [GRAPHIC] [TIFF OMITTED] T7851.044 [GRAPHIC] [TIFF OMITTED] T7851.045 [GRAPHIC] [TIFF OMITTED] T7851.046 [GRAPHIC] [TIFF OMITTED] T7851.047 [GRAPHIC] [TIFF OMITTED] T7851.048 [GRAPHIC] [TIFF OMITTED] T7851.049 [GRAPHIC] [TIFF OMITTED] T7851.050 [GRAPHIC] [TIFF OMITTED] T7851.051 [GRAPHIC] [TIFF OMITTED] T7851.052 [GRAPHIC] [TIFF OMITTED] T7851.053 [GRAPHIC] [TIFF OMITTED] T7851.054 [GRAPHIC] [TIFF OMITTED] T7851.055 [GRAPHIC] [TIFF OMITTED] T7851.056 [GRAPHIC] [TIFF OMITTED] T7851.057 [GRAPHIC] [TIFF OMITTED] T7851.058 [GRAPHIC] [TIFF OMITTED] T7851.059 [GRAPHIC] [TIFF OMITTED] T7851.060 [GRAPHIC] [TIFF OMITTED] T7851.061 -