industry issues

Domestic Terrorism: EMS Provider Preparedness WMD Logistical Cost Considerations

By Butch Hoffmann
Rural/Metro Medical Services, Syracuse, NY

In 1996, the Defense Against Weapons of Mass Destruction Act, more commonly known as the Nunn-Luger-Domenici Initiative, was passed. This bill recognized the lack of preparedness amongst first responders safely responding to acts of terrorism involving NBC (nuclear, biological, chemical) weapons. Hence, this bill provides Federal funding for WMD supplies and WMD training for first responders. The City of Syracuse and Onondaga County combined meet the population criteria for one of the initial 120 cities to receive Federal assistance. The County and the City of Syracuse have a combined population of 325,000 people. Syracuse has 125,000 residents alone.

The City of Syracuse and Onondaga County have completed a Domestic Preparedness Equipment Support Program application. This application includes PPE equipment and NBC detection equipment geared primarily for law enforcement and fire department disciplines. EMS has been included in on a small portion of designated WMD PPE equipment within this application. Our County and City's initial application included a cost of $350,000 worth of NBC equipment that does not exist in our coverage area. Since then a revision has been made and a second application was submitted for an estimated $150,000. Currently, New York State has seized this WMD Federal funding earmarked for NYS cities. NYS has appointed a NYS WMD Task Force that is conducting a threat & vulnerability assessment in all NYS counties. This task force has until December 15th to complete a statewide WMD county assessment. NYS will then release the WMD Federal money to each NYS county that requires additional equipment upgrade to meet their WMD response capabilities.

The above stated synopsis reveals that the Nunn-Luger-Domenici Initiative supports EMS with WMD training; however, the bill lacks any financial assistance to EMS for WMD response capabilities. Through past terrorism and tactical violence incidents, EMS consumes its resources quickly. These incidents require a push logistics system. A push logistics cache is stored and ready for rapid deployment. We already have two medical supply unit trailers (equipment caches) in Onondaga County. They are stocked for all types of disasters. These trailers need to be upgraded and in-house storage made available for WMD supplies. At a minimum, enough PPE equipment and medications should be available for first responders and mutual aid. EMS needs to be self sufficient for the first 12 - 24 hours of an incident. We must protect our EMS staff, so they are available to provide patient care.

The WMD cost considerations for EMS deal specifically with a push logistics system. So as requested, this at best is a semi-educated guess to WMD EMS logistical quantities and their respective costs in regards to equipment and supplies that will be available to the entire County of Onondaga which includes the City of Syracuse.

1. WMD TRAINING for entire Onondaga County Cost                $86,400

Department of Justice Domestic Preparedness Training Program
Domestic Preparedness Help Line 1-800-368-6498 or cbhelp@cbdcom.apgea.army.mil 1525 Countywide EMS certified personnel. This includes Rural/Metro employees. Approximately 300 are paid staff.
At minimum, offer the following courses per student.

- WMD Awareness             4 hours
- WMD Operations             4 hours
- WMD Technician EMS     8 hours
                                 total    16 hours

At average Countywide OT rate of $18 x 16 hrs = $288
                                                                                       x 300
                                                                                  $86,400

2. PERSONAL PROTECTIVE EQUIPMENT             Cost $4,301.5
(stored push cache)

3. MEDICATIONS/ANTIDOTES                                  Cost $8,400
(pharmaceutical push cache)
Prearrange with local hospital pharmacies for antibiotics & powder atropine availability for EMS usage .
Prearrange with County Health Dept. for vaccine availability for EMS personnel. Approx. 60 Countywide ambulances, staffed by two EMS personnel = staff of 120
2 Mark 1 kits per crew member. Staff of 120 x 2 Mark 1 kits = 240 Mark 1 kits

- Mark 1 kits (two autoinjectors per kit)
                   atropine & 2-Pam    one kit       @ 35.00 ea       240    $8,400

4. MEDICAL SUPPLIES                                      Cost $26,680.20
( stored push cache)

This rough draft provides the basic contents that should be included in a push cache. The items not included are additional pharmaceuticals such as atropine, valium, antidote kits, & portable ventilators. Nor does this address any radiation alert kits for monitoring personal exposure. A radiation alert monitor has a cost of $315 per monitor. Other expensive items are a 1,000 watt portable Honda generator with a 500 watt light attached. The price on similar generators are $1,500. A backup radio base with 20 portable radios bring significant costs beginning at $12,000. Logistical caches must be accessible and maintained. The budgets and political realities will always be logistics issues. Overall, we need enough equipment and supplies to protect EMS.