STATEMENT OF
THE HONORABLE FRANCES M. MURPHY, M.D., M.P.H.
DEPUTY UNDER SECRETARY FOR HEALTH
DEPARTMENT OF VETERANS AFFAIRS
BEFORE THE
HOUSE COMMITTEE ON VETERANS' AFFAIRS
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
ON VA'S ROLE IN EDUCATING HEALTH CARE PROFESSIONALS
TO DIAGNOSE AND TREAT CASUALTIES OF WEAPONS OF MASS DESTRUCTION

November 14, 2001

Mr. Chairman, I thank you for the opportunity to testify before the subcommittee on VA's role in educating health care professionals to diagnose and treat casualties of terrorist attacks involving chemical, biological, and radiologic agents (CBR). I am accompanied today by Dr. Susan Mather, VA's Chief Public Health and Environmental Hazards Officer and Mr. Kenneth Mizrach, Director of VA's New Jersey Health Care System.

The recent incidents involving anthrax exposure and infection have made clear the possibility of an attack on the United States with unconventional weapons, including chemical, biological, or radiologic agents. Such weapons are capable of inflicting serious harm that could be both widespread and sustained.

The medical consequences of attacks of this kind include both the immediate trauma inflicted and the potential long-term health consequences resulting from that trauma. The types of trauma inflicted could include not only the more obvious physical harm the victims may suffer, but the less visible and often unrecognized psychological trauma, such as post-traumatic stress disorder. Such psychological injuries may manifest themselves only long after the event.

We believe it is of paramount importance that health care professionals throughout the nation receive the education and training that will enable them to better understand and respond to the potential health threats from such unconventional weapons. At a minimum, health care professionals should be able to:

• recognize the chemical, biological, and radiologic agents that may be used,
• identify the potential symptoms of those agents,
• provide emergency treatment where needed,
• assess and implement preventive actions that can be taken to protect victims, providers, other persons, and the treatment environment against contamination from chemical or biological agents,
• understand as fully as possible the potential long-term health consequences that may result from the use of these agents, including psychological effects,
• provide an appropriate course of follow-up treatment, supportive care, and referral,
• understand (and work with state and local public health officials in the areas of) surveillance, decontamination, quarantine, and other issues unique to care of patients exposed to weapons of mass destruction,
• understand how to seek consultative support and report suspected or actual use of these weapons, and
• understand the details of any local emergency response plan.

Since physicians (medical students, residents, and practitioners) are not the only health care professionals who would be involved in providing treatment, we strongly believe that education and training programs should be developed that are appropriate for health care professionals at various levels of their careers. All health care professionals, including, but not limited to, physicians, nurses, nurse practitioners, physician assistants, pharmacists, emergency personnel, and health profession students should receive training.

Under Presidential Decision Directive 62, the U.S. Public Health Service (PHS), in collaboration with VA, works to ensure that adequate stockpiles of antidotes and other necessary pharmaceuticals are maintained nationwide and to train medical personnel at hospitals in the National Disaster Medical System to appropriately treat victims of CBR incidents. VA recently received $832,000 from the Department of Health and Human Services to begin development of the training program. The first phase of this program will involve a comprehensive needs assessment of the U.S. hospitals enrolled in the NDMS and the development and piloting of the proposed training model.

VA has long provided ongoing training for health professionals to recognize and treat the victims of chemical and biological agents, but recently we have significantly enhanced our training efforts to better prepare our employees to recognize and respond appropriately to terrorist attacks. We have developed satellite broadcasts covering biological and chemical warfare issues and other educational tools and programs for those who may be charged to render care to victims of CBR incidents. I will describe some of these initiatives.

• Following the September 11 terrorist attack, we acquired educational programs from the Department of Defense (DOD) and broadcast 12 hours of instruction on biological agents and terrorism and 12 hours of instruction on chemical agents and terrorism. These programs are being broadcast repeatedly at different times of the day so as to be available to all VA employees.
• A 1-hour overview of the medical consequences of biological and chemical agents used in terrorism was first aired on October 16th. The program included expert faculty from DOD and the Department of State. It has been rebroadcast several times and at various hours to assure that all VHA clinical and administrative staff has access to it.
• A 1-hour broadcast on providing treatment for victims of exposure to radiological agents will be aired for the first time tomorrow (November 15th). It features experts on this topic from the private sector, DOD, and VA.
• We are developing a two-part broadcast on chemical agent decontamination. These broadcasts will be aired on November 20 and November 27, 2001. They will be repeated thereafter. The first broadcast will focus on how to quickly and economically establish a decontamination capability at VHA facilities. The second broadcast will focus on decontamination operations. The object of these two broadcasts is to instruct VHA facility leaders, managers, and clinicians on how to establish a decontamination capability for less than $10,000 and in less then 30 days.
• We have developed a one-hour education program on "The Laboratory Diagnosis of Bioterrorism Agents." This program was developed by Aileen Marty of the Uniformed Services University of the Health Sciences and will be broadcast in the near future.
• We have produced pocket cards on chemical agents and biological agents. They will help our employees identify actions to take when confronted with patients presenting after contamination. These cards are now being printed and will be available within days to all VHA clinicians and others who serve on emergency management or safety teams. A similar card on radiological agents is being developed. Additional information on responding to biological and chemical threats and on decontamination has been distributed.
• We are planning a conference on Weapons of Mass Destruction for VHA staff and clinicians and emergency managers from outside VA. This conference entitled PREPAREDNESS through PARTNERSHIP: Integrating Medical Mass Care Management in a WMD Incident will be held in St. Petersburg FL, on January 11th -14th, 2002. The conference will feature expert faculty from the United States and several other nations and will focus on HAZMAT training, clinical training for healthcare providers, and training in emergency management for managers and administrators. (This is but one example of professional conferences and exercises on emergency management and CBR that VA has sponsored or co-sponsored with DOD, the PHS, and other departments and entities.)
• We are developing an Emergency Management Academy that will include continuing medical education and continuing educational unit accredited modules in tracks targeted for clinicians, clinical leaders, health care facility managers, and emergency managers. One aspect of this academy is a web-based knowledge management site where the most current emergency management-related policies, procedures, and information, including those relevant to CBR will be posted.
• We are currently collaborating with DOD on and will co-sponsor and provide VA faculty for 12 hours of live satellite broadcasts on November 28, 29, and 30, 2001. This series, entitled "Biological and Chemical Warfare and Terrorism: Medical Issues and Response," will be aired throughout the United States at VA and DOD facilities. It will focus on biological and chemical agents that can be used as terrorist weapons, how victims will present to healthcare facilities, appropriate care modalities and how to protect healthcare facilities and staff from contamination while providing timely and quality care. As with previous programs in the series, the program will be videotaped and made available to VA employees who were unable to view the live presentations. It will also be rebroadcast in December.

We have the capability, through our education infrastructure and our education and research cooperatives, to share the programs that we produce with others, thus creating an even better return on investment in terms of preparing the healthcare community to effectively respond to terrorist acts.

We are currently exploring the feasibility of undertaking an effort with DOD and our medical school affiliates to develop and share curriculum for undergraduate and graduate health professionals to prepare them to recognize and respond to the needs of patients who may be the victims of CBR use.

In addition, the Association of American Medical Colleges, in conjunction with other health education organizations and federal agencies including VA, has announced a bioterrorism initiative to help educate and prepare the nation's physician workforce to respond to terrorist attacks. This initiative will focus on the need for information, resources and educational experiences to help medical students and residents deal with the victims of terrorism now and in the future.

VA is well situated to reach a wide audience of practitioners and students through its academic affiliations. VHA is extensively involved in the nationwide training of physicians, medical residents, medical students, nurses, and associated health care professionals. Through partnerships with affiliated academic institutions, VA conducts training and education programs to enhance the quality of care provided to veterans within the VA health care system. Through these long-standing and close relationships, VA also plays a leadership role in defining the education of future health care professionals to help meet the rapidly changing needs of the Nation's health care delivery system. Today, more than 150 VA facilities have affiliations with 107 medical schools, 55 dental schools, and more than 1,200 other schools across the country. More than half the physicians practicing in the United States have received part of their professional education in the VA health care system. Additionally, VA doctors conduct hundreds of research studies in conjunction with their facilities' affiliated medical schools.

Mr. Chairman, in conclusion let me state that VA is a valuable national health care resource. We stand ready to use our considerable expertise in clinical care, education, and research to benefit veterans and other Americans in this time of need. I will now be happy to respond to any questions that you or other members of the subcommittee might have.