Remarks by Homeland Security Director Tom Ridge to the American Hospital Association

The Washington Hilton
Washington, D.C.

Thank you very much for that very kind introduction, and thank you for your warm reception. I'm very pleased we've had the opportunity to spend a little time with you this morning.

You know, in my new job as Advisor to the President for Homeland Security, people from time to time ask how I should be addressed -- Secretary, Director, Governor -- and I must tell you that I've always felt that the opportunity to serve as governor of a diverse and historic state was one of the more unique public service opportunities that I could have ever been afforded. And as I prepared for this opportunity this morning, I couldn't help but think that a Pennsylvania at about 250 years ago, pulled its community together to create the first hospital that the community organized in Philadelphia around the wishes of Ben Franklin.

And so, I begin by saying thanks to the invitation, but I'd like my friends from Pennsylvania to please stand up and be recognized. I hope some of you are here. Are my friends from PA here? Good. (Applause.) Thank you. Thank you.

We -- the Pennsylvania Hospital Association, Carolyn Scanlan -- governors come and go, but Carolyn's been there for quite a while and continues to do a great job with the Association in Pennsylvania.

Last year was the 250th anniversary of the American hospital itself; as I mentioned, the first one founded in 1751 by Ben Franklin. Franklin appealed to his fellow Pennsylvanians for the hospital with these words: "After death, good deeds remain eternally. Good deeds, people taking care of people."

That care and commitment has made America's hospitals the best in the world. Two hundred and fifty years later, the permanent mission of compassion and hope continues to drive the institutions and the hospitals and the people who serve in them.

Now, there are countless examples of people taking care of people: Teaching good health to high school students, providing how-to health care booklets to new immigrants, raising money for pediatric care, offering free mammograms to the underprivileged. In fact, four of your members are being honored today with the hospital awards for volunteer excellence, precisely for those kinds of deeds; people taking care of people. And I join with your colleagues in congratulating your award winners.

And we all know that America's hospitals go well beyond providing care for the sick and for the injured. You promote wellness and well-being throughout your entire communities. Your neighbors look up to you, and they also look to you for leadership.

As a country, we must come to understand the enduring vulnerability of a free and open country, an enduring vulnerability to the possibility of terrorist threat and terrorist attack. We must also understand that individuals, organizations, companies and communities all have a new role in helping to provide for homeland security.

If we are to secure our homeland -- and that is the presidential mission that has been given to me -- our hometowns must be secure. The critical role you play in that effort cannot be underestimated. The President's executive order directed our office to develop and coordinate a comprehensive national strategy to secure the United States from terrorist threats or attacks. We must protect our borders, our people, our physical and electronic infrastructure, our schools and businesses and, yes, our hospitals. And, above all, working together, we must protect our American way of life.

Now, the first components of this emerging national strategy can be found in the President's 2003 Budget. And I'd like to take a few moments this morning to talk to you about one of those components: Our ability, our expanded capacity to respond to biological and chemical weapons of mass destruction. It's one of the four initiatives in the President's budget.

The President's Bioterrorism Initiative is unprecedented. Nearly $6 billion, nearly a 300 percent increase from the previous year. His overall budget for homeland security is nearly $38 billion, nearly double the previous year.

Now, in addition to the bioterrorism initiative that I'd like to share a few thoughts with you about, the other three initiatives in this year's budget include first responders. You know, those humble heroes, those everyday heroes: The police, the fire, the emergency medical service personnel, the paramedics. Information and sharing technology is one, and border and airport security.

All four, if we do our job right, are designed to work together to interconnect. How can we expect hospitals to prepare for the threat of bioterrorism if our first responders are not properly trained and equipped? How can they learn of the threat if public health officials do not have the capacity to communicate it quickly enough to them? And how can they contain the threat if we cannot stop terrorists from invading our borders or airspace?

Homeland security, ladies and gentlemen, is not just a federal responsibility, it is a national responsibility, a national challenge, and I might add, a national opportunity if we make the right kind of strategic investments to not only secure America and make it safer, but also when it comes to public health and working with hospitals, to make us a healthier an better and stronger nation at the same time.

The President, on several occasions, has reminded me that the opportunity within the Office of Homeland Security is very unique, because we can take a look at America through the lens of security, but he has told me on many occasions, if we can make strategic investments that not only make us safer and more secure, but better, stronger and healthier, let's make those strategic investments. And clearly, the investment, nearly $6 billion in bioterrorism money is one of those strategic investments.

Now, our national strategy relies on the blueprints and plans in all 50 states and territories. We must insist -- this is one of the coordinating roles that I have and the federal government will have -- but we must insist that the plans of individual communities and regions be part of a statewide comprehensive plan. And in developing such a plan, hospitals will be asked, among other things, to focus in working in collaboration with the first responders and the law enforcement community and everybody else to develop that local, and then that regional and that statewide plan.

In developing such plans, hospitals will be asked: Do your doctors, nurses and EMTs have the proper training and equipment? Are your standards on bioterrorism readiness adequate to meet the threat? Can you identify and track the disease at its earliest stages?

If a highly contagious patient walked into your emergency room, would you have to quarantine the whole hospital? Or is the room equipped with a separate ventilation system? Are you able to quickly communicate with your EMTs during a high-volume crisis or with other hospitals, the police, fire department or public health officials? Do you have mutual aid agreements with neighboring states or neighboring communities? Can your state issue emergency credentials to protect out-of-state doctors and yourselves from liability?

Crisis planning and preparedness is not a back burner issue anymore. It cannot be at the tail-end of our annual list of priorities -- either yours or the federal government's. Now, according to a recent AHA survey, a majority of hospitals -- two-thirds, to be exact -- have already incorporated bioterrorism into your disaster contingency plans. Two-thirds have also participated in community-wide drills. And nearly all hospitals have plans to do so in the next six to 12 months. So I congratulate the individual hospitals, but particularly your national organization, for promoting and encouraging such a quick response.

I will tell you that one of the purposes of expanded training dollars, expanded dollars in the bioterrorism area, is to subsidize the kind of local training and planning and rehearsals that we think is critical to secure your hometowns.

You're responding to the President's call to America to help meet the threat. But we certainly, I think, have a lot more work to do. In another recent survey of rural and urban emergency departments in the middle-Atlantic area, only about 10 percent said they could handle a mass casualty event of 50 to 100 patients. So, obviously, we need to focus on some of these gaps. We're certainly going to strengthen our weaknesses, but the federal government does have a responsibility, since we've elevated the issue, made it a priority, to provide some additional assistance to support you in this effort.

Included in the President's Bioterrorism Initiative is $1.6 billion to help state and local governments and health systems manage an attack. We'll help train health care professionals to recognize rare diseases and treat toxic exposures. We'll help hospitals expand their search capabilities and build new isolation facilities. We'll modernize and upgrade public health laboratories and poison control centers. We'll encourage regional mutual aid compacts and help you improve your communication networks.

Before we can combat a bioterrorist event, we must first be able to identify the enemy. It is critically important that we recognize the signs of bioterror and communicate the threat as quickly as possible. That's one of the reasons that the President has placed such an emphasis and increased the dollars available for a bioterrorism event.

Because whether or not, again, consistent with the President's goal -- let's be more secure, but if we can make a strategic investment to be better and stronger, let's do this -- because you know better than anybody else in America that whether it's the microbes of a terrorist envelope, or just a natural infectious disease occurring in your community, we need to upgrade our public health capacity in this country. So it's an excellent strategic investment. (Applause.)

It's pretty clear that we're going to rely on the hospitals to give us the first warning. You're part of that early defense system.

Last October, Physician Susan Matcha of Inova Fairfax Hospital treated a postal worker who had a fever and swollen lymph nodes. Because she took it upon herself to research bioterror following the 9/11 attacks, she recognized the symptoms as being anthrax. Again, this continuing education of both hospitals and physicians within your hospitals around the possibilities of bioterrorist events is a critical, important role, and we must accept the responsibility to do that together.

Earlier this year, President Bush and I visited Pittsburgh's Real-Time Outbreak and Disease Surveillance System, or RODS. I think it's a good example of a successful partnership between government, the academic community and the medical world. The system collects and analyzes data on patients' symptoms from area hospitals to find patterns that might be examined, and therefore explaining an outbreak, whether naturally occurring or manmade.

A similar system was used and available at the Winter Olympics. Every five minutes in Salt Lake City, a computer displayed syndromic data from dozens of venues around the community, including emergency rooms and clinics. The President's budget will help fund disease surveillance systems based on these very successful models.

It also provides $20 million to modernize and strengthen the Epidemiological Intelligence Service at the Centers for Disease Control in Atlanta. And I think some of you are familiar that the EIS system was established in 1951, following the Korean War, as an early warning system against biological warfare. It's never been needed -- never been needed more than now.

And once the threat is communicated, the success of our response depends on the quality and effectiveness of our vaccines, our therapeutics, and our diagnostic tests. The President's budget proposes $2.4 billion in research and development investments to update our medical tool kit for fighting diseases associated with bioterrorism. Nearly three-fourths of that is dedicated to a public-private academic partnership led by the National Institutes of Health.

Now, communities and hospitals will not have to wait until this measure is approved for initial assistance. Health and Human Services Secretary Tommy Thompson, because of the bipartisan support in Congress from the 2002 budget, as well as a supplemental, is presently distributing over $1 billion to help states improve their bioterrorism response capability.

We're asking the states to work with us toward a seamless national strategy on bioterrorism to tell us how and when they'll develop their statewide, regional and local plans, and to ensure that at least by the end of this year, 90 percent of the population is covered by the Health Alert Network, and to make sure that hospitals are given the opportunity to work and plan, whether it's in a community or within a region, to collectively handle, at a minimum, a 500-person casualty event.

Now, we're also asking hospitals to conduct frequent drills and we'll subsidize the cost of those drills as you work with your first responders. It's the only way to strengthen our preparedness.

Let me give you an extraordinary example. Once a year -- there's a health clinic located at the Pentagon -- and once a year, they stage an emergency drill. One day last spring, the clinic commander, Air Force Colonel John Baxter, watched the planes fly over from National Airport through his office window, and wondered aloud if one lost an engine and flew into the Pentagon, how would they respond. So he suggested that they drill for a 757 crashing into the Pentagon.

The lessons they learned during that mock event undoubtedly saved many lives when the real thing happened on September 11th. Communication and information-sharing are also key to our response. In my meeting last December with your organization, President Davidson and several others stressed the importance of getting better and more timely information from us. So we've developed a Homeland Security Advisory System. It gives us a common vocabulary to identify the specific nature of potential terrorist attacks and quickly communicate them to the public.

You know, you've seen some of these political cartoons. Once we've announced the threat advisory system, it's a color-coded advisory system. You know, I haven't been in Washington that long, but I guess when you're the subject of a caricature, that may mean that you've made it. (Laughter.) I wish they had made me look a little thinner and a little younger, but I guess you can't do anything about that.

But the fact of the matter is, with good and appropriate humor, we've said to America we're now working on a system based on information that we could say to America: This is the level of threat we have in this country.

But what is not revealed in the color code as we're going to be working with local communities and regions and states to make sure the public and the private sector, that there's a level of preparedness that matches every level of risk, that there are certain protective conditions that we would expect schools, hospitals, plants, companies to be able to gear up to depending on the level of risk. So we will have a threat advisory system, but we also have to match it with protective conditions.

The other advantage of this system, ladies and gentlemen is, again, it's an information-based system. Based on what we know, we can alert America. One thing we do know, however, is that an attack can come without warning. But if we do have warning, if we anticipate, based upon -- we're able to prepare based upon credible information, corroborated information, we know that if we prepare, we can minimize the loss of life.

And part of what homeland security is all about is recognizing the need to prepare, to coordinate, and communicate with one another like we've never done before. And I'm confident we'll get this done.

The other advantage of the national system is its flexibility. Because we may get specific information dealing with a community, a particular site, a particular company, where we can keep the country on alert at one level, but we could drill down into that community, to that site, to that company and say, well, we have corroborated, credible evidence that you may be a subject of an attack, so ramp up to the next level of protection.

I must say that the Attorney General has a comment period, and I suspect that as your organization looks at the threat advisory system, I know he would be anxious and we would be anxious in our office to learn from you, get an assessment from you, and we'll encourage your organization to take a look at it and make some recommendations to us.

We don't want to tell the state or communities what to do. We do want the states and communities to tell us what they will do. Some of your members have already very appropriately suggested that we need to give you the flexibility with your money at the local level to fill in gaps, shouldn't be so prescriptive that once you plan, that you don't have the flexibility to implement your plan. And I think that's a very constructive suggestion, and I look forward to additional comments from AHA along those lines.

Now, as you can see, homeland security is not just about how much money we spend. No amount would be enough to eliminate the terrorist threat entirely. It's about making the right choices with expanded, but not unlimited, resources. We're not looking, nor will we be able to find a perfect, failsafe system. We're looking for intelligent, responsible, professional action and continuous cooperation toward a common goal: Protecting Americans. Good deeds, yes; but smart deeds as well.

Again, I want to thank the American Hospital Association for your hard work and your commitment to this effort. Your new Partnership for Community Safety is exactly the kind of response we were hoping to encourage. You're also working on a best practices bank to share innovative solutions at the local level, and you're continuing to inform the public as to your findings. All of these things working in that mix together as people are really thinking differently about preparedness.

I must tell you, I've said this before and I will continue to say it: It's too bad that we can't bring 280 million Americans to work with me every day. It would be a very reassuring experience. Because they would be able to learn firsthand what hospitals are doing to prepare. They would see what's going on in the private sector. They would be able to get a glimpse of what's going on in the national labs. They would be able to hear from technology companies that are working on the technology of detection. They could see what different Cabinet members are doing as they work with different components of America to make sure that we're safer and stronger.

They would get a sense of how, literally, millions of Americans are engaged in securing the homeland. And I think, in that sense, it would be a very reassuring quality to the days they would spend with me.

So I want to continue to encourage you with these public information efforts that you've undertaken. It is very reassuring to the public that their friends and neighbors, whether they're in hospitals, the corporation, the corner, the local police, the fire, are engaged collectively together, making those hometowns more secure.

I believe Ben Franklin would agree -- your deeds are very good deeds, and smart deeds as well.

Let me conclude by taking you back to September 11th. One of the more heartbreaking sights that day was the wait for survivors in New York City. Hospitals throughout Lower Manhattan literally emptied out, preparing for America's worst mass casualty event.

Doctors and nurses in their scrubs and masks stood on the streets waiting to treat the injured, ready to do what hospitals and doctors do best: Taking care of people. As one doctor said, no one came.

Now, we wait as a nation for the next terrorist attack. It may be through conventional weapons, it may be through weapons of mass destruction. We really don't have any idea. We cannot be certain of the future. But we can be certain that we are prepared. We cannot simply wait. We must mobilize, we must train, we must plan and we must communicate.

And I believe if we take these steps, we will be prepared. We'll be ready to take care of an entire nation. And I believe, together, we can reach that goal.

I'm grateful to your organization for extending the invitation to me this morning to have an opportunity to spend this time with you. I think we have a little time left on my time, and I would be happy to try to respond to any questions you might have.

Thank you and God bless. Thank you. (Applause.)

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