Role of State and Local Responders The national exercises that have incorporated assessment for the deployment of the SNS included TOPOFF 2. In May 2003, the Department of Homeland Security and the Department of State, in cooperation with Federal, state, local, and Canadian partners, completed a five-day, full-scale exercise and simulation of how the Nation would respond in the event of a weapons of mass destruction (WMD) attack. The exercise consisted of simulated attacks in the Chicago and Seattle metropolitan areas. There remain somewhat conflicting reports about the efficiency with which the SNS was deployed and distributed during exercise play. In general, it appears that the activation, deployment, and distribution of the SNS were extensively played during TOPOFF 2. The exercise tested the ability of all levels of government to make decisions, allocate resources, coordinate and communicate, and inform the public regarding this critical SNS resource. The state of Illinois tested its ability to break down and secure the antibiotic stocks. Local jurisdictions tested their abilities to distribute supplies of antibiotics to their first responders and citizens. Overall, the request, receipt, breakdown, distribution, and dispensing of the SNS during the exercise were completed successfully. It is important to note, however, that the exercise includes significant artificialities that make the simplify and detach the process from the problems that may occur during deployment in a real crisis. 9 Findings from TOPOFF 2 include the following: Determining a prophylaxis distribution policy for first responders and citizenry across local jurisdictions was challenging. This was due, in part, to the enormous logistical challenges of distributing medications to a large metropolitan area, as well as the very real limitation of the amount of medication that was immediately available. Inconsistent information was given by different jurisdictions as to the locations of the suspected plague release sites, as well as who should seek prophylaxis and when. The bifurcated roles and responsibilities of HHS (CDC) and the DHS were another area of concern. 10 During TOPOFF 2, officials at HHS and the DHS were uncertain about how to meet a state request for disaster medical supplies. As a result, regional and national officials were unable to respond rapidly to an urgent request for supplies from the Strategic National Stockpile. Federal government officials insisted that the request for supplies come from the governor, despite the governor having already announced a Declaration of Emergency and a formal request for assistance under the Stafford Act. 11 It was recommended that the DHS and HHS sort out these responsibilities and provide clear instructions to state health officials on how to obtain supplemental medical supplies in times of emergency. 12 The publication of the Interim National Response Plan (Interim NRP) in September 2003 clarified these issues. 13 The Interim NRP supercedes the Federal Response Plan and other Federal emergency response plans. Under the Interim NRP, HHS remains responsible for execution of Emergency Support Function Eight. 14 This issue has sometimes been a source of confusion because while the Office of Emergency Response—the HHS organization responsible for managing ESF-8 responsibilities—was transferred to the DHS, the responsibility for execution of ESF-8 was assigned to HHS as a department, and is still retained by HHS under the Interim NRP. While there remains ambiguity regarding the exact lines of that authority, the Secretary of HHS believes that he retains considerable legal authority for decisions to deploy the SNS. 15 Some of the current ambiguity is scheduled to disappear next fiscal year, since the Administration's budget returns funding and ownership of the SNS to HHS starting in FY’05. 16 In recent months further exercises have been held that focus on the deployment and distribution of the SNS. According to published reports, “Scarlet Cloud” an exercise hosted by the National Defense University (NDU) in November 2003, showed that the government still “needed to improve plans for delivering vaccines and antibiotics.” 17 It is clear that the continued emphasis on this aspect of a response to an escalating incident will result in improved plans, policies, and procedures for effectively using the SNS. 9. Similar concerns have been expressed in other exercises
that involve SNS “play” – it is very difficult to recreate
the reality of a crisis during large scale exercises that have been months
in the planning.
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