Spring 2002 Issue
CDC Fights Terrorism With Fast Response and Efficient Teamwork
Dr. Patrick Meehan’s observations from Ground Zero
Like most Americans, Patrick J. Meehan, M.D., watched with horror as the unimaginable events of September 11 unfolded.
But his disbelief quickly turned to action.
Minutes after the second hijacked plane struck New York’s World Trade Center, Meehan, director of the Division of Emergency and Environmental Health Services at CDC, and his team were making plans to dispatch the first emergency medical supplies to New York. Indeed, within eight hours of the attacks, CDC workers were on the scene, ready to respond to the expected medical emergencies. In addition to vigilantly monitoring New York hospitals for signs of bioterrorism and potential disease outbreaks, they collaborated with other agencies to focus intensely on rescue workers’ health. Under normal circumstances Meehan’s division is responsible for overseeing the national and international coordination, delivery and evaluation of emergency and environmental health services. In the wake of September 11, this task has become a tremendous challenge – one that his division is tackling with leadership, fast response and teamwork.
Q: What was CDC's role in the events following September 11?
MEEHAN: It’s important to note that the New York City Emergency Management Agency – which is very well organized and well funded – lost its entire operation center, which was formerly located in the World Trade Center. Facing that loss, New York opened a large operation center at one of the city piers and very quickly requested that medical supplies and pharmaceuticals be brought to the scene through CDC’s National Pharmaceutical Stockpile program
In response, CDC stockpile staff, an emergency response coordinator and CDC epidemiologists traveled by plane to New York City. To the best of my knowledge, it was the only plane in the air that day, with the exception of Air Force One. We also moved a “push package” by ground transportation as quickly as possible. Our staff was on the plane to meet the push package when it arrived. (Each 50-ton push package consists of large containers filled with pharmaceuticals, medical supplies and equipment, and is stored in undisclosed locations for delivery anywhere in the 50 states in 12 hours or less.)
At CDC, we had to mobilize a lot of people very quickly. Everyone was extremely willing to rally around the cause to help. I think this is probably one of the largest mobilizations of EIS officers in CDC’s history.
New York City’s response was very impressive. Even though the Emergency Management Agency lost everything and had to relocate quickly, they did a fantastic job. Similarly, the health department had to relocate (their main office was in lower Manhattan) and work under very crowded, difficult conditions. Everyone just rolled up their sleeves, dealt with the hardships they were facing and got the job done.
Q: What was your role in the events?
MEEHAN: On September 13, I began serving as the executive liaison for CDC. I brought a group of about 30 EIS officers to New York City; we flew on an Australian Air Force military cargo plane donated by the Australian Air Force and Lockheed Martin. Once I arrived, my role was to assure that CDC was doing all it could do to assist the very capable state and local health departments. There were a number of complex operational issues to manage, as well as needing to interact with the mayor’s office, participate in press briefings and participate in briefings with local and elected officials.
Q: What public health issues did you face?
MEEHAN: The EIS officers and CDC staff who went to New York City on September 11 immediately became involved in the health department’s very aggressive, active public health surveillance system to monitor all types of health conditions, including conditions that could result from bioterrorism and injuries.
We also set up surveillance through Disaster Medical Assistance teams, brought in by the Office of Emergency Preparedness, U.S. Department of Health and Human Services. The teams were located around Ground Zero providing medical care for rescue workers. Our surveillance there was designed to monitor rescue workers’ injuries and health problems.
Other public health issues we dealt with included working with the New York City Department of Health to assess hospital capacity issues and hospital needs. We also quickly recognized that there were occupational health issues affecting rescue workers that were not being managed, such as fitting workers for particulate masks and monitoring the safety of their food supply. We worked with the city health department, and all of their partners, to help them develop a comprehensive worker health and safety program.
Another significant issue we faced was interpreting environmental monitoring data from a number of agencies concerning asbestos levels and various environmental contaminants. We worked with both the city and state health departments to deal with those types of issues.
Q: What was your first impression upon arriving at Ground Zero?
MEEHAN: Within a few days of my arrival, I spent about three or four hours driving around Ground Zero with the medical director for New York City’s Emergency Management Services. My first impression was that it was like a “Mad Max” movie – very smoky, dusty, chaotic. There were people without proper credentials who were providing volunteer medical care and handing out medical supplies. One of the first things we did was remove a makeshift medical station. Standing in the middle of it all, completely surrounded by destruction, is more than you could possibly capture in a photograph. The other thing that is hard to appreciate without being there is the scope of the tragedy. There were “missing” posters all over the city, and memorials of flowers and candles were everywhere.
Q: Were there any challenges that you were unprepared for?
MEEHAN: Yes, this whole episode has been a good lesson for the need for public health at the federal, state and local level. We recognize that we’re now dealing with a new type of public health event and a new paradigm for addressing these events.
We learned that we need to prepare for, and be ready to manage, extremely large, long-term, complex public health emergencies, in addition to the more traditional individual, isolated outbreaks. There were so many environmental and occupational issues – especially at the World Trade Center – that need to be addressed at the federal, state and local level.
In many ways we’re not prepared. For example, we need to improve our ability to collect environmental samples, to analyze them, to interpret the data, to provide useful public information based on those data, and to have the necessary toxicological expertise available. I think we’re woefully understaffed in all of those areas, at all levels of government.
Q: Looking back, were there any resources that would have improved your team’s ability to deal more effectively with the crisis?
MEEHAN: Almost all state and local health departments need resources to better manage complex public health emergencies. Although New York is better prepared than most, resources in areas such as communications, occupational health, environmental sampling and monitoring were limited. It certainly would have been much more effective to have a planned, prepared system that was adequately staffed in advance. Fortunately, since one issue we were dealing with was worker health and safety, we were able to draw upon NIOSH’s (CDC’s National Institute for Occupational Safety and Health) expertise – their folks were just fantastic. The staff of other CDC agencies including the Agency for Toxic Substances and Disease Registry and the National Center for Environmental Health, were also extremely willing to come up and help with the environmental and toxicological issues we faced.
Q: The CDC Foundation has established an Emergency Preparedness & Response Fund to help provide resources for future crises. How might you have used the resources of the Fund?
MEEHAN: I think the fund is a great idea. Having the ability to procure consultants and equipment rapidly will be very useful. The fund will also help us with issues like analyzing and interpreting environmental contaminant data, and then communicating that to the public. Being able to identify potential contractors or consultants “on the fly” who could help with those kinds of issues would certainly be useful, because we could get much more done, more quickly.
Q: What is CDC doing to prepare for future crisis situations?
MEEHAN: We’re doing a lot. For example, we have received a supplemental appropriation of several hundred million dollars for emergency public health. While the appropriation will not cover immediate needs like the CDC Foundation’s new fund, it will allow us to provide far more funding to state and local health departments for emergency public health preparedness and response capacity building – that’s where frontline public health care happens, so the more prepared and ready they are, the more effective the whole system will be.
We’ve also received more than $600 million this year to rapidly expand our National Pharmaceutical Stockpile. That will help us make the stockpile better prepared for large-scale public emergencies, bioterrorism and other terrorism events.
Another example of preparation is setting up better systems of response within CDC. We’re also beefing up laboratory capacity, both within CDC and at state and local health departments, to better address laboratory issues associated with terrorism.
It’s important to be prepared for all types of public health emergencies and hazards. If we have a system in place, and we’ve identified and developed the staff that can deal with a wide array of issues in advance, then we can be better prepared in the future.
Previous to joining CDC, Dr. Meehan was director of the East Metro Health District of Georgia, serving as county health officer and chief executive for three Georgia counties with a population of nearly 700,000. He also served as director of the Georgia Division of Public Health in the Department of Human Resources for over three years and as director of the New Hampshire Division of Public Health. A board-certified family practitioner, Meehan has completed a preventive medicine residency and the Epidemic Intelligence Service (EIS) program with CDC. His publications range from suicide and violence epidemiology to foodborne illness, vectorborne viral diseases and surveillance.
- Lisa Splitlog