Emergency Assistance

n the shadow of the Rocky Mountains, local officials have put together a surprisingly successful, federally funded program to prepare the Denver area for terrorism-but Uncle Sam is poised to cut it off.

Denver officials did nothing wrong. In fact, the program, known as the Metropolitan Medical Response System (MMRS), met all of Washington's goals. Denver shared funds with the suburbs and worked with public health agencies. But Denver's MMRS funds will run out at the end of the year, and the program's federal sponsor, the Health and Human Services Department, is balking at renewal. In other cities, MMRS programs have a reputation for excluding public health agencies, and HHS is intent on building up the public health system through a different program-to the tune of $1.1 billion in new grants this year.

Giving up on the program now doesn't make sense to Greg Bogdan, Denver's MMRS coordinator and research director at the Rocky Mountain Poison and Drug Control Center. "They developed this program and in some places it has worked well and now they're cutting us off," he says. Bogdan already is looking for new funding sources. Denver officials have grown accustomed to navigating the federal government's unwieldy system to get funding for firefighters, police officers and emergency managers to fight terrorism. But they say that first responders suffer from shifting federal priorities, bureaucratic rivalries, and poorly designed training programs.

The events of Sept. 11 were supposed to change all this. Led by President Bush, politicians pledged to funnel billions of dollars to first responders. The bureaucrats who run federal emergency preparedness programs promised to streamline applications for grants and improve programs for those on the front lines in American states, cities and towns. But problems persist. With the exception of the HHS grants, Denver-like most cities-hasn't seen any new cash. And despite new efforts at coordination, federal preparedness programs remain spread across several agencies. This means that federal aid programs only work if the Greg Bogdans of the world make them work. If local officials do a poor job of coordinating federal aid, firefighters and police officers on the front line won't be prepared. And even if local officials master the art of working with Uncle Sam, Washington still can derail their efforts, as Bogdan has found.

The Bush administration has promised to simplify federal programs and make it easy for first responders to get the training they need. But federal officials have made these promises before. A look at Colorado's experience with these programs shows the federal government is still struggling to get them right.

In January, for example, Denver officials used a grant from the Federal Emergency Management Agency to finance a major terrorism exercise at the city's old Mile High football stadium. The event was described as a success, but some participants felt it was unrealistic because of the low turnout from city agencies. "It's a little tricky to do a full-scale exercise when two-thirds of our resources are simulated," says Kelly Caldwell, a division chief with the Denver fire department. Only a few police officers showed up because the department couldn't afford to pay overtime for off-duty workers to attend, and the cost couldn't be charged to the FEMA grant. FEMA's grant for fiscal 2002, which is just now reaching local jurisdictions, does cover overtime costs, the first time it has done so.

Since 1998, the Justice Department's Office of Domestic Preparedness has distributed to state governments more than $600 million in grants for equipment, but the office never has required states to buy interoperable gear-radios and other communication devices, for example. (This will change in fiscal 2003, an ODP official says.) An interagency committee decides what equipment may be purchased, but the committee has no budget to test equipment itself. When it comes to sorting through the variety of new security products now being peddled, state and local officials are on their own.

So when James Greenwood, president of Global Specialty Chemicals, shows up at the cramped headquarters of the Denver SWAT Team on a warm morning in September, it's no surprise that team members eye him a little warily. But SWAT chief Lt. Frank Connor is happy to see Greenwood because his company makes MDF (modec decontamination formulation), a spray that purports to neutralize all known chemical warfare agents and can kill anthrax, plague and smallpox to boot. MDF is easy to use, Greenwood says, squirting a little on his arm as a few SWAT members lift weights nearby. You can spray it, mist it, foam it, put it in your laundry; a 22-ounce bottle costs only $39.95. Connor wants to include bottles of MDF in anti-terrorism "kits" that he hopes to give all officers on the street, providing the chief of police approves. Connor, of course, is in no position to do research on MDF, and neither is the federal interagency board, but Greenwood seems legitimate.

Connor and other SWAT team members would very much like someone to make chemical/biological protective suits they can use. Level A suits-the fully enclosed suits firefighters wear to extract victims from contaminated zones-have bells that ring if you stay still for too long. But the bells could reveal the location of SWAT members trying to take out a target. Level B suits, which provide less protection, also have bells. In Denver, the police criticism of the protective suits is well known, but the ODP official in Washington never has heard this complaint before.

Connor has one more wish. He wants all Denver police officers to get training on weapons of mass destruction. Until now, only a few police units in Denver, like the SWAT team, have been trained. Ideally, he'd like to fly out instructors from Texas A&M's National Emergency Response and Rescue Training Center, an academy funded by the domestic preparedness office. But the Denver police department can't afford it and won't receive enough funding from the fiscal 2002 ODP grant to pay for it.

TRAINING DAZE

What's striking about first responder preparedness in Denver is that the city has received more federally sponsored weapons of mass destruction training than perhaps any other city in the country, yet some first responder groups, such as police and public health workers, still are largely untrained.

In 1997, Denver responders went through the original federal training program, known as Nunn-Lugar-Domenici after its sponsors in the Senate. Then, in March 2000, the city was a lead participant in Operation TOPOFF, an exercise funded by the Justice Department that simulated three simultaneous terrorist attacks across the nation-Denver was hit by an imaginary release of plague that quickly became a statewide epidemic. The city received training grants from Justice and the Federal Emergency Management Agency from 1999 to 2001.

But many first responders were left out. The Nunn-Lugar-Domenici program was inconvenient-training lasted four days, making it hard for some officials to attend. In Denver, the program was well attended by firefighters and emergency management technicians, nearly all of whom have received a basic level of preparedness training. But few police officers turned out, and hardly any public health workers participated.

In October 2000, in a bid to improve the Nunn-Lugar-Domenici program, Congress moved it from the Defense Department, its original home, to the Justice Department's preparedness office (then known as the Office for State and Local Domestic Preparedness Support), which had started its own overlapping training program for cities. Officials at Justice were committed to improving the program. They pored over every program review they could find, including scathing reports from the General Accounting Office and the Henry L. Stimson Center, a think tank in Washington. Justice ended up redesigning Nunn-Lugar-Domenici, providing more administrative assistance and helping cities complete threat assessments so they could customize training.

Justice also created a network of sites across the country where first responders could get training, including Texas A&M, the Center for Domestic Preparedness at Fort McClellan, Ala., and Louisiana State University, among others. FEMA launched its own first responder training at its Emergency Management Institute facility and National Fire Academy in Emmitsburg, Md. FEMA and Justice courses sometimes overlapped, although both agencies say this problem has been solved. But none of these courses have been much use for Denver, which lacked funds to send first responders out of state or to bring in trainers.

Justice and FEMA are starting to collaborate in their first responder grants to states. For years, FEMA's grants focused on planning, while Justice's covered equipment; to get these grants, states had two fill out two lengthy sets of paperwork. For the first time ever, Justice and FEMA will use a combined application for their fiscal 2003 grants.

But FEMA and Justice never were the only players in the preparedness game, and a third agency is moving quickly to stake out its turf: HHS. Last fall's anthrax attacks put the spotlight on the decrepit state of the nation's public health agencies, which generally were left out of first responder training programs. In January, President Bush signed a bill to funnel $1.1 billion in bioterrorism grants from HHS to the states, and by April 15, HHS received from nearly every state and U.S. territory two detailed applications-one for public health and one for hospitals. Working 18 hours a day and seven days a week, HHS was able to sign off on these plans in 12 days and release the funds, says Jerome Hauer, acting assistant secretary for Public Health Emergency Preparedness at HHS, who led the effort. "We don't know of any other time in the history of the federal government that so much money has gone out that quickly with as much accountability and without compromising the integrity of the process," he told members of the HHS Council on Public Health Preparedness in late August.

Hauer, is a blunt, effective administrator who pulls no punches about the failings of federal preparedness. "So much of the federal money over the last three years that has come out of the terrorism programs has gone for toys . . . [not] for building systems," he told the HHS Council in August.

Hauer also says HHS will handle the bioterrorism portion of first responder programs from now on. It has requested $4.3 billion in terrorism aid for fiscal 2003. "This is our responsibility," he says. While HHS distributed its funds with remarkable speed-particularly when compared with Justice-it also, perhaps unavoidably, created another assessment process.

"That's the way [first responder programs] were set up until now," says FEMA preparedness office Director Bruce Baughman when asked about HHS' process. "Long- term, do we see this going into one grant application process? Yes. That's what we'd like to see." But turf issues persist. HHS has not agreed to join FEMA and Justice in using a joint process for the fiscal 2003 grants, and FEMA officials say HHS is not cooperating with them. Hauer did not answer requests to comment. In the meantime, states have another process to deal with.

ONE SYSTEM

In Colorado, the government's inability to streamline first responder assistance has an upside: It forces state and local officials to cooperate. Bogdan, coordinator of Denver's Metropolitan Medical Response System, attends meetings with Denver's Office of Emergency Management, which compiles the city's annual application for the Justice grant, to make sure the Justice application doesn't overlap with his MMRS request to HHS. City departments also draw up wish lists for equipment.

When Colorado Gov. Bill Owens created a state homeland security office in August, officials hired state agency experts who administer the federal grants to coordinate Washington's far-flung programs in one office. But they can't track everything. Kerry Kimble has a firm grasp of FEMA and Justice preparedness grants, but he has a hard time tracking federal money that goes straight to cities. For example, Kimble found out from a newspaper story about a new Environmental Protection Agency security grant that goes directly to water treatment facilities.

Since each program requires states to complete some kind of strategic plan, states must reconcile these strategies or pursue several different visions of preparedness at once. In early September, The Washington Post reported that the Washington metropolitan area had received $432 million in supplemental preparedness funds-$71 million of which went to Virginia-but had no comprehensive strategy for spending the money. Many states do have comprehensive strategies. They just haven't been followed, at least not yet. To understand why is to understand why it's so hard for federal, state and local governments to coordinate their efforts on behalf of first responders.

In 1999, Justice's preparedness office began working with the Centers for Disease Control and Prevention, the Agriculture Department and other agencies to craft a state assessment process for the fiscal 1999 equipment grant, as required by Congress. States were to base their requests on an assessment of terrorism threats, an inventory of critical infrastructure, and a survey of their public health systems. This assessment, in turn, was to guide a three-year strategy for training and outfitting first responders in the state.

But only four states turned in the assessments before Sept. 11, and they were the only states that could receive funds through the fiscal 1999 grant or the fiscal 2000-2001 grants for equipment, which Congress also linked to the assessments. As a result, by January, only $141 million out of $243 million available for equipment grants from 1988 through 2001 had been awarded, according to an April report by the Justice Department's inspector general. States placed little priority on conducting the assessments before Sept. 11, but Justice also failed to set an application deadline.

What's more, the assessments didn't work as planned. Colorado officials directed counties to assess their own threats and critical infrastructure. One county counted an office desk as critical infrastructure. Tiny Alamosa County, which has few government facilities and is dwarfed by the Denver metro area, said it had more targets for terrorists than any county in the state. The Colorado State Patrol wanted to review the threat analyses before the state sent them on to Justice, but counties turned them in late and Alan Turner, the State Patrol agent assigned to look them over, had trouble accessing the Justice office's Web site. "Whereas the system on paper wasn't too bad, the way it was administered was broke," says Turner, who now works for Colorado's Homeland Security Office.

State officials didn't think much of the public health assessment. It consisted of Yes/No questions such as, "Are the necessary laboratory services available to the local public health agency to support investigations of adverse health events?" Answering these questions revealed little about the capacity of the public health system, according to Dr. Lisa Miller, a lead author of the state's HHS grant application. "[Preparedness] is almost never black and white, it's almost never zero or 100," she says. "And people may have felt with [ Justice] that they should answer a certain way in order to get grant funds, and we want to take out that incentive." The state is doing its own assessment of public health as part of the HHS grant.

FEMA's Baughman says the states are to blame for problems with the strategies. "All they did is roll all those municipalities and counties up into one grant application at the state level," he says. "That's really not the way that they ought to be doing that. And ODP did not encourage them to do it that way, by the way." Whatever their faults, the strategies are the first comprehensive attempt to gauge the preparedness of the states, and Justice officials think states should use them accordingly. "The Office for Domestic Preparedness expects that the states would use these strategies to guide their overall domestic preparedness efforts," says Tim Beres, assistant director of the Justice preparedness office.

But officials in Virginia don't see it that way. They regard the Justice strategy as one of several federal planning documents they must link together. George Foresman, state homeland security director, says the state is writing a broad strategy to encompass all the federal grant programs. "Our Justice strategy represents just one small part of the overall approach," he says.

In Washington, the assessments continue to proliferate. Following Sept. 11, Homeland Security Director Tom Ridge had the Justice Department's preparedness office conduct a classified survey of state preparedness that will be repeated next year. But the joint FEMA/Justice assessment for next year's grants could bring federal agencies a step closer to creating the one-stop process for federal assistance that everyone professes to want. At least it will make the assessment process something more than a paper drill. Dave Sullivan, acting director of the Denver's Office of Emergency Management, is incredulous when asked if the Justice strategy or the FEMA terrorism plan have made the city better prepared. "Not really," he says. "This is what we do to get the funds."

REALITY CHECK

Robb Pilkington remembers when anti-terrorism training was not seen as Washington's responsibility. Before the Nunn-Lugar-Domenici program was created in response to the Tokyo subway attacks, Pilkington conducted chemical training and other first responder courses in his job with the Missouri State Office of Emergency Management. Pilkington, now a training instructor with the University of Missouri-Columbia's Fire and Rescue Training Institute, thinks states are too dependent on federal subsidies. "Before they do anything they have their hand out. They've got to have their federal money before they do a program."

But states won't be off the dole for first responder training anytime soon. Forty-three states face deficits this year. Colorado faces a $228 million deficit and Gov. Bill Owens carved that amount from the state budget in late May, including $5.2 million from the public health department. By law, states cannot use the HHS bioterrorism grant to replace their own funds, though the larger aim of HHS' program is to build the capacity of public health systems. Colorado plans to hire 13 epidemiologists using the HHS money, but some of these new hires may simply replace employees to be laid off because of budget constraints.

"Forty-three states going through significant budget reductions makes this whole exercise kind of like pouring water into a leaky bucket," says Thomas Milne, executive director emeritus of the National Association for City and County Health Officials. Milne says that as long as states are cutting their public health budgets, the $1.1 billion in HHS bioterrorism grants won't buy dollar-for-dollar enhancement of state and local preparedness; more likely the money barely will stanch the loss of capacity.

Colorado received $16.4 million through the HHS grant, $1.9 million of which will go to hospitals to buy equipment and pay for bioterrorism exercises. That comes to $24,000 per hospital, which won't go very far, according to Robin Koons, director of the hospital component of the HHS grant for the Colorado Department of Public Health and Environment. Lately, Koons has been hard at work on a plan to vaccinate Colorado's entire population against smallpox within three to five days, a requirement under the HHS grant. Colorado's terrain makes statewide vaccination a particularly tall order. Some small towns are more than a two-hour drive from the nearest hospital, and that's in good weather. For residents in especially remote areas, Koons is exploring ways to fly in vaccination teams. "It's more like where would we go versus where would [residents] go."

In Colorado, state and local officials ultimately will determine the response to terrorism. But federal agencies can help or hinder this process, depending on how they run their assistance programs.

Members of the Denver SWAT Team know what they need. "To make weapons of mass destruction experts out of every grunt on the team doesn't make sense," says Sgt. James Gose. "All he needs to know is: This is my chemical gear, this is my gun, this is the target." Across town, Bogdan is hopeful that state funds can sustain MMRS, but this may not happen. Most of all, he wishes Uncle Sam would make it easier to run these programs. "Now we'll have to be creative or not exist," he says.