National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

Preparing for Terrorism

Tools for Evaluating the Metropolitan Medical Response System Program

Frederick J. Manning and Lewis Goldfrank, Editors

Committee on Evaluation of the Metropolitan Medical Response System Program

Board on Health Sciences Policy

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

NATIONAL ACADEMY PRESS
2101 Constitution Avenue, NW Washington, DC 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for this report were chosen for their special competences and with regard for appropriate balance.

Support for this project was provided by the Office of Emergency Preparedness, U.S. Department of Health and Human Services (Contract No. 282-99-0045, TO#5). This support does not constitute endorsement of the views expressed in the report.

Library of Congress Cataloging-in-Publication Data

Institute of Medicine (U.S.). Committee on Evaluation of the Metropolitan Medical Response Program.

Preparing for terrorism : tools for evaluating the Metropolitan Medical Response System program / Frederick J. Manning and Lewis Goldfrank, editors ; Committee on Evaluation of the Metropolitan Medical Response System Program, Board on Health Sciences Policy, Institute of Medicine.

p. ; cm.

Includes bibliographical references.

ISBN 0-309-08428-8 (pbk.)

1. Disaster medicine. 2. Emergency medical services. 3. Terrorism—Health aspects. 4. Weapons of mass destruction—Health aspects. 5. Emergency management. 6. Health planning.

[DNLM: 1. Disaster Planning—organization & administration. 2. Emergency Medical Services—organization & administration. 3. Health Planning. 4. Program Evaluation—methods. 5. Terrorism. WX 185 I59p 2002] I. Manning, Frederick J. II. Goldfrank, Lewis R., 1941- III. Title.

RA645.5 .I54 2002

362.18—dc21

2002007502

Additional copies of this report are available for sale from the
National Academy Press,
2101 Constitution Avenue, NW , Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s on-line bookstore at www.nap.edu.
The full text of the report is available on-line at www.nap.edu

For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu.

Copyright 2002 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

"Knowing is not enough; we must apply. Willing is not enough; we must do."

—Goethe

INSTITUTE OF MEDICINE

Shaping the Future for Health

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

THE NATIONAL ACADEMIES

National Academy of Sciences

National Academy of Engineering

Institute of Medicine

National Research Council

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

COMMITTEE ON EVALUATION OF THE METROPOLITAN MEDICAL RESPONSE SYSTEM PROGRAM

LEWIS GOLDFRANK (Chair), Director,

Emergency Medicine, New York University Medical Center, Bellevue Hospital Center, New York, New York

JOSEPH BARBERA, Director,

Disaster Medicine Program, The George Washington University, Washington, DC

GEORGES C. BENJAMIN, Secretary,

Maryland Department of Health and Mental Hygiene, Baltimore, Maryland

JAMES BENTLEY, Senior Vice President,

Strategic Policy Planning, American Hospital Association, Washington, DC

KENNETH I. BERNS, President and CEO,

Mount Sinai Medical Center, New York, New York

RAYMOND M. DOWNEY, Battalion Chief and Chief of Rescue Operations,

Special Operations Command, Fire Department, City of New York (from November 2000 to September 2001)

FRANCES EDWARDS-WINSLOW, Director,

Office of Emergency Services, San Jose, California

LINDA F. FAIN, Disaster Mental Health Consultant,

Auburn, California

FRED HENRETIG, Director,

Clinical Toxicology, and

Director,

Poison Control Center, Children’s Hospital of Philadelphia, Pennsylvania

DARRELL HIGUCHI, Deputy Chief,

Los Angeles County Fire Department, Los Angeles, California (from November 2001)

ARNOLD HOWITT, Executive Director,

Taubman Center, Kennedy School of Government, Harvard University, Cambridge, Massachusetts

LAURA LEVITON, Senior Program Officer for Research and Evaluation,

Robert Wood Johnson Foundation, Princeton, New Jersey

WILLIAM MYERS, Health Commissioner,

Columbus, Ohio

DENNIS M. PERROTTA, State Epidemiologist and Chief,

Bureau of Epidemiology, Texas Department of Health, Austin, Texas

JEFFREY L. RUBIN, Chief,

Disaster Medical Services Division, Emergency Medical Services Authority, State of California, Sacramento, California

AMY E. SMITHSON, Senior Associate,

Henry L. Stimson Center, Washington, DC (from November 2000 to July 2001)

DARREL STEPHENS, Chief,

Charlotte-Mecklenburg Police Department, Charlotte, North Carolina

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

Board on Health Sciences Policy Liaison

BERNARD GOLDSTEIN, Dean,

Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania

Study Staff

FREDERICK J. MANNING, Study Director

REBECCA LOEFFLER, Project Assistant

Institute of Medicine Staff

ANDREW POPE, Director,

Board on Health Sciences Policy

ALDEN CHANG II, Administrative Assistant,

Board on Health Sciences Policy

CARLOS GABRIEL, Financial Associate

Consultant

LAUREN SCHIFF, Incident Commander and Operations Officer,

Appalachian Search and Rescue Conference, Charlottesville, Virginia.

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

Independent Report Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The contents of the review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report:

MARTIN BLASER, Professor of Internal Medicine and Chair, Department of Medicine, New York University

GREGORY M. BOGDAN, Research Director and Medical Toxicology Coordinator, Rocky Mountain Poison Center, Denver, Colorado

BARRY S. COLLER, David Rockefeller Professor of Medicine, Physician-in-Chief, The Rockefeller University Hospital, and Vice President for Medical Affairs, The Rockefeller University, New York, New York

GEORGE R. FLORES, Director of Public Health, San Diego Department of Health, San Diego, California

VINCENT T. FRANCISCO, Associate Director, Work Group on Health Promotion and Community Development, University of Kansas, Lawrence, Kansas

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

ROBERT MALSON, President, District of Columbia Hospital Association, Washington, D.C.

PAUL M. MANISCALCO, Past President, National Association of Emergency Medical Technicians

PETER ROSEN, Director, Emergency Medicine Residency Program, Department of Emergency Medicine, University of California, San Diego School of Medicine

ROBERT E. SHOPE, Professor of Pathology, University of Texas Medical Branch, Galveston, Texas

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by LESTER N. WRIGHT, Chief Medical Officer, New York Department of Correctional Services, Albany, New York, appointed by the Institute of Medicine, and ALEXANDER H. FLAX, Consultant, Potomac, Maryland, appointed by the NRC’s Report Review Committee. These individuals were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

This report is dedicated to Ray Downey, Chief of Rescue Operations, Fire Department, City of New York, our friend and colleague on this Institute of Medicine committee, killed in the line of duty while leading rescue efforts at the World Trade Center after the terrorist attack on September 11, 2001.

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
This page in the original is blank.
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

Preface

Having a vision, a mission, and a passion are invariably seen as conditions for success. The 1995 U.S. Department of Health and Human Services (DHHS) concept of a Metropolitan Medical Response System (MMRS) demonstrated that the leaders of DHHS had a vision for an effective response to a mass-casualty terrorism incident with a weapon of mass destruction. The mission was to expand the experimental model of the Metropolitan Medical Strike Team (MMST) established in Washington, D.C., and neighboring counties into a national program.

The problem that the Office of Emergency Preparedness (OEP) of DHHS faced was the dilemma of knowing what preparedness is and determining whether preparedness could be recognized if it was achieved. Under these circumstances, OEP requested that the Institute of Medicine determine how effective this MMRS program effort is and how valuable it could become.

A typically diverse Institute of Medicine working group consisting of leaders, strategists, practitioners, and analysts of societal needs in terms of readiness for disasters and terrorism with weapons of mass destruction was established in the autumn of 2000. Over the following 18 months we constructed a diversified analytic program that emphasizes continuous quality improvement to enhance relationships, understanding, and services, and improve equipment and personnel in the pursuit of preparedness. Our approach is based on the belief that all services are valuable, that they must be integrated, and that shared leadership with democratic, open management approaches will effectively be able to use each metro-

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

politan region’s assets. We have suggested that document and data analysis, site visits by a team of expert peer reviewers, and observations of exercises and drills be used to analyze a region’s accomplishments.

Some committee members’ theoretical approaches to the requirements of this project as well as the limited cooperative spirit seen in some MMRS program efforts were initial concerns for the committee. These limitations to the committee’s potential were dramatically altered by the September 2001 assault that toppled the World Trade Center and paralyzed the U.S. aviation system and by the mailing of anthrax-laden letters in October 2001 that almost toppled the U.S. public health and postal systems. The events led to the tragic death of a fellow committee member, Ray Downey, Chief of Rescue Operations, Fire Department, City of New York, and thousands of other Americans. These terrorist acts led to a disruption of the equanimity not just of New York City but of our entire country. Our committee, recognizing the timeliness and exceptional importance of our task, responded with the necessary passion to complete the tasks of this analytic process.

We believe that this product will allow OEP, state and federal governments, and all who create preparedness teams to offer a more informed, qualified, and integrated approach to preparedness and public health. This report will be an essential tool in analyses of the depth and breadth of governmental performance and interagency collaboration. This effort—and in particular, U.S. society’s recognition of the importance of our goals—will allow us to save lives and property in future biological, chemical, and radiological terrorist events. The vision was of vital importance. We hope that our passion has allowed us to accomplish the mission and that OEP will have the tools that it needs to determine if we in America are ready to protect ourselves from unknown potential assaults and will remain so for the future.

Lewis R. Goldfrank

Chair

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

Acronyms and Abbreviations


ARC

American Red Cross


CAR

Capability Assessment for Readiness

CBR

chemical, biological, and radiological

CBRDT

Chemical/Biological Rapid Deployment Team

CDC

Centers for Disease Control and Prevention

CDP

Center for Domestic Preparedness (U.S. Department of Justice)

CHER-CAP

Comprehensive HAZMAT Emergency Response-Capability Assessment Program

CSEPP

Chemical Stockpile Emergency Preparedness Program


DHHS

U.S. Department of Health and Human Services

DMAT

Disaster Medical Assistance Team

DMORT

Disaster Mortuary Team

DOD

U.S. Department of Defense

DOE

U.S. Department of Energy

DOJ

U.S. Department of Justice

DVA

U.S. Department of Veterans Affairs


ED

emergency department

EOC

Emergency Operations Center

EOP

emergency operations plan

EMAC

emergency management assistance compact

EMI

Emergency Management Institute

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

EMS

emergency medical services

EPA

Environmental Protection Agency

ESF

emergency support functions


FBI

Federal Bureau of Investigation

FEMA

Federal Emergency Management Agency

FRP

Federal Response Plan

FY

fiscal year


GAO

General Accounting Office


Hazmat

hazardous materials

HDS

Hazardous Devices School

HMO

health maintenance organization


IOM

Institute of Medicine


JCAHCO

Joint Commission for Accreditation of Healthcare Organizations


LCAR

Local Capability Assessment for Readiness

LEPC

Local Emergency Planning Committee


MEMA

Maryland Emergency Management Agency

MMRS

Metropolitan Medical Response System

MMST

Metropolitan Medical Strike Team

MOU

memorandum of understanding


NAPA

National Academy of Public Administration

NCP

National Contingency Plan or National Oil and Hazardous Substances Contingency Plan

NDMS

National Disaster Medical System

NDPC

National Domestic Preparedness Consortium

NDPO

National Domestic Preparedness Office

NEMA

National Emergency Management Association

NMRT

National Medical Response Team


OCFD

Oklahoma City Fire Department

OCPD

Oklahoma City Police Department

ODP

Office of Domestic Preparedness (U.S. Department of Justice)

OEP

Office of Emergency Preparedness

OES

Office of Emergency Services

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

OMB

Office of Management and Budget

OSHA

Occupational Safety and Health Administration

OSLDPS

Office of State and Local Domestic Preparedness Support


POC

point of contact


REP

Radiological Emergency Preparedness Program (Federal Emergency Management Agency)

ROC

Regional Operations Center


SOP

standard operating procedure


USAR

U.S. Army Reserve

USNRC

U.S. Nuclear Regulatory Commission


VA

Department of Veterans Affairs

VMI

vendor-managed inventory


WMD

weapons of mass destruction

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
This page in the original is blank.
Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
   

The Federal Radiological Emergency Response Plan,

 

48

   

Terrorism-Specific Federal Support Teams,

 

48

   

Conclusion,

 

50

3

 

FEDERAL EFFORTS TO INCREASE STATE AND LOCAL PREPAREDNESS FOR TERRORISM

 

52

   

ODP Programs,

 

53

   

FBI Programs,

 

57

   

CDC Programs,

 

58

   

FEMA Programs,

 

60

4

 

METROPOLITAN MEDICAL RESPONSE SYSTEM PROGRAM CONTRACTS

 

66

   

Functional Areas Covered,

 

67

   

Products Demanded,

 

68

   

Contract Deliverable Evaluation Instrument,

 

74

5

 

MEASUREMENT AND DATA COLLECTION IN EVALUATION

 

75

   

Evaluations of Various Types,

 

76

   

Management Functions of Evaluations in the MMRS Program Context,

 

78

   

Summative and Formative Uses of Various Evaluation Types,

 

81

   

Why an Adequate Written Plan Is Not Sufficient Assurance of Preparedness,

 

82

   

Evaluation Measurement for Low-Frequency, High-Stakes Events,

 

85

   

Evaluation Measurement: Performance Measures and Proxies,

 

86

   

Criteria for Selection of Evaluation Methods,

 

87

6

 

PREPAREDNESS INDICATORS

 

91

   

Existing Standards,

 

92

   

Existing Assessment Tools,

 

94

   

Performance Measures Versus Preparedness Indicators,

 

97

7

 

FEEDBACK TO OFFICE OF EMERGENCY PREPAREDNESS ON PROGRAM MANAGEMENT

 

100

   

OEP Help to MMRS Program Contractors,

 

102

   

Survey for MMRS Program Contractors,

 

105

8

 

FEEDBACK TO OFFICE OF EMERGENCY PREPAREDNESS ON PROGRAM SUCCESS

 

113

   

Essential Response Capabilities,

 

115

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

Figures

ES-1

 

Relationships among essential capabilities, preparedness indicators, preparedness criteria, and data collection methods,

 

13

1-1

 

Flow chart of probable actions in a chemical or overt biological agent incident,

 

20

1-2

 

Flow chart of probable actions in a covert biological agent incident,

 

22

2-1

 

Key federal consequence management response teams for CBR terrorism,

 

49

5-1

 

MMRS program participants, policy instruments, development activities, emergency capacity, and follow-up activities,

 

77

5-2

 

Accountability relationships for federal grantees and grant-making agencies,

 

79

Box

ES-1

 

Example of Preparedness Indicator for One Essential Capability, First Responder Protection,

 

12

Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×

Preparing for Terrorism

Page xxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
This page in the original is blank.
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR1
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR2
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR3
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR4
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR5
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR6
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR8
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR9
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR10
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR11
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR12
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR13
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR14
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR15
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR16
Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR17
Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR18
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR19
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR20
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR21
Page xxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2002. Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: The National Academies Press. doi: 10.17226/10412.
×
PageR22
Next: Executive Summary »
Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Get This Book
×
Buy Paperback | $64.00 Buy Ebook | $49.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

The Metropolitan Medical Response System (MMRS) program of the U. S. Department of Health and Human Services (DHHS) provides funds to major U. S. cities to help them develop plans for coping with the health and medical consequences of a terrorist attack with chemical, biological, or radiological (CBR) agents. DHHS asked the Institute of Medicine (IOM) to assist in assessing the effectiveness of the MMRS program by developing appropriate evaluation methods, tools, and processes to assess both its own management of the program and local preparedness in the cities that have participated in the program. This book provides the managers of the MMRS program and others concerned about local capabilities to cope with CBR terrorism with three evaluation tools and a three-part assessment method. The tools are a questionnaire survey eliciting feedback about the management of the MMRS program, a table of preparedness indicators for 23 essential response capabilities, and a set of three scenarios and related questions for group discussion. The assessment method described integrates document inspection, a site visit by a team of expert peer reviewers, and observations at community exercises and drills.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!