Council on Foreign Relations Policy Symposium: "Making New York Safer" Session 2: Assessing New York's Emergency Preparedness

Friday, September 8, 2006

LINDA J. VESTER: Welcome to today’s second session of the Council on Foreign Relations symposium “Making New York Safer.” This session is titled “Assessing New York’s Emergency Preparedness.”

I’d like to ask you a couple of things. If you would, please, remember to turn off your cell phones, your BlackBerrys, other wireless devices. Also, I’d like to remind the audience that this meeting is on the record. Participants around the nation and around the world in fact are going to be viewing this meeting via live webcast on the council’s website,

With that, I would like to introduce our distinguished speakers this morning. Kelly McKinney, immediately to my left, is the city’s deputy commissioner for planning and preparedness. He oversees the Office of Emergency Management’s Planning Departments, including Health and Medical, Recovery and Mitigation, Plan Management and Human Services.

Joe Pfeifer, in the middle, is the fire department’s chief of counterterrorism and emergency preparedness. He leads the fire department’s disaster and terrorism preparedness efforts. He’s responsible for creating emergency response plans for terrorism and major disasters.

And Dr. Weisfuse, on the end, is deputy commissioner of the Division of Disease Control of the New York City Department of Health and Mental Hygiene. He oversees programs that control infectious disease as well as diseases caused by bioterrorism.

For our panel, you have been asked to address preparedness not only for a terror attack in New York—of course, we’re all coming up on the anniversary of 9/11—but also a natural disaster—coming up on another anniversary. So we’re going to be discussing both scenarios during this session. As you might imagine, that’s a lot to get to, so I’m going to try to move this along and get to as many questions as we can during the Q&A session.

So with that, we’re going to dive right in. And it is no longer 9:20 on a Monday morning—I’m sorry, on a Friday morning. It is now 12 noon on a weekday and there has just been a truck bomb attack in midtown Manhattan. There’s a high suspicion that it is packed with some sort of RDD—a dirty bomb.

I’m going to start with Joe. What equipment do firefighters have? What do you do first? How do you detect radiation levels? Let’s start with you.

JOSEPH W. PFEIFER: Okay. What I want to do is first paint the picture. What would this look like? The bomb explodes. You have fires started either in parked cars or in the buildings. Part of the buildings are collapsed and you have a lot of injured people and people that are contaminated. That’s the picture that we’re dealt with. The call goes into 911 or from one of the fire boxes. And within four minutes, you’re going to get a response from the fire department. And the question you’re really asking is, what are you going to do? What are you going to do if I’m that person—if you’re one of those people there—that are trapped or injured?

We—(inaudible)—radiological material. But what we’ve taught our firefighters is that within a dirty bomb, there’s a low amount of radiological material, except for maybe the very immediate area. So that means that if we take the proper precautions, we can go in, put out the fires, save people and take care of medical problems.

But of course, first, the firefighters come to the scene and immediately every unit carries a radiological detection device. So they’re going to be warned right away that there’s some sort of—that this is not just an explosive, that this is a dirty bomb. What they’ll do is they’ll put on their respiratory equipment that they carry. The air masks—they’ll put that on. And then they’ll assess the scene and call more units to the scene. And we’ll go in, and we’ll rescue the people, and we’ll get them out.

Now, it’s important to know that if there’s a life-threatening injury, what we teach our medical personnel is that because their levels of radiation is low that we can take care of those life-threatening injuries and then worry about decontamination. We want to decontaminate people, but first we have to take care of life-threatening injuries.

The other aspect about an RDD is what we’ve called a radiological incendiary device. And a few months back, I talked to the council about that. There will be fires, and people will be trapped above those fires from this car bomb, and we need to put the fires out. What happens when a building’s on fire and there’s radiological material is that the fire keeps expanding the situation. So we need to tell our firefighters we can go in, we can measure radiation and rotate out personnel and still do normal fire fighting operations and normal search and rescue operations. The only thing is they need to have protective equipment, they need to monitor the radiation, and we need to rotate out people that we don’t expose the first responders to too much radiation.

VESTER: Chief, can I ask you just a couple of things? First of all, do they have handheld monitors? How do they detect the radiation?

PFEIFER: Well, there’s a number of monitors. One is a little pager device, which every unit carries. Our HAZMAT units, where we have one very sophisticated HAZMAT unit, we have seven squads, we have five rescue companies and we have 25 special operation ladder companies. And they all have more sophisticated devices where they can actually measure that.

In addition to that, every firefighter will carry a dosimeter, and they’ll be able to measure it there, the dose, the amount of radiation they receive.

“What we need to do nationally, and what we are doing nationally because of Peter King and Senator Clinton and Schumer, is that we want to tie federal assets to a time. Tell me how long you’ll get there....Let’s hold people responsible for what they say they can provide, and that’s preparedness. It’s not preparedness when you promise something and you don’t know when it’s going to get there.”
—Chief Joseph W. Pfeifer

VESTER: Okay. So if there are some people who are immediately highly contaminated, do you transport them? Do you treat them on the scene?

PFEIFER: We take care of life-saving injuries. We’ll decontaminate them and bring them to the hospital.

VESTER: How do you decontaminate them?

PFEIFER: The easiest thing with radiation is take the clothes off and wash them down; and particularly the hair area. The other thing we should be aware of, not everyone’s contaminated. If you’re within the explosion and you have that dust cloud, you’ll be contaminated with particles of radiation within the smoke. But you may be a distance away where you’re not in that cloud and you receive a radiation exposure, but you’re not contaminated. So there’s two different things. Not everyone needs to be decontaminated, and we need to make that differentiation.


Doctor? So now it comes to transporting casualties—those who are contaminated, those who are not—getting them to you in the hospitals. How do they handle them?

ISSAC B. WEISFUSE: Well, first of all, we’re going to be hearing from the Office of Emergency Management pretty quickly if there’s a detection of radiation at the event. And we have some trained first responders who can provide technical assistance to the police department and the fire department to do a couple of critical issues.

Number one, we can help confirm, through sophisticated equipment, some of the findings on the ground. We can begin to find out what areas are contaminated and what are not contaminated. And most importantly, for the medical response down the line—this is not the trauma response—is try to begin to determine what kind of radiation, what kind of isotope has actually be dispersed in this event. And the reason why that’s important is because a lot of the guidance and some of the treatment that is done by the physicians in emergency rooms will be predicated based on some of that information. So we do play a role as a technical adviser to fire, police, OEM to try to make some of those determinations.

We’ve worked to create some handheld software programs where we can actually map out radiation levels at different parts of the city, different parts of even a block to make sure we know where the zones are where there’s significant radioactivity.

Then, what we would do is get all the hospitals together very quickly. First of all, people are not only going to be coming in from the fire department ambulances; they’re going to be self-evacuating and going to emergency rooms. And they could go—we have—we are blessed with 60 to 70 acute-care hospitals in New York City, and we would consider that people might show up in any one of them. So we would quickly organize a conference call with every hospital in the city and send some alerts out by e-mail and by fax to describe the situation, let them know what we know about the explosion, about the injured and what preliminary information we have about isotopes, so they can make adjustments accordingly. They’re going to want to—the quote-unquote “worried well” they’re going to want to decontaminate. And many of the hospitals they’re going to want to decontaminate, and many of the hospitals if not all the hospitals in the city—all the hospitals—have the ability to do that decontamination before they get into the emergency department, so they minimize the risk of contamination within the hospital.

And then there are a lot of things that fall into play. Obviously, the trauma issues have to be dealt with. Lifesaving operations, for example, have to be done immediately. Then there are people who are less injured but certainly need decontamination and treatment. And then there are people who are just worried, and those people need decontamination, they need psychological support.

A dirty bomb has been called a weapon of mass disruption, and the key distinction that Joe was referring to is that it’s the radiation aspect of it is not an immediately life-threatening issue. If that’s the only problem, that can be dealt with. It’s the people who are seriously injured who really need the attention by the medical care personnel and the EMS personnel.

VESTER: Okay. Within minutes, radio stations, the all-news channels are going to be broadcasting it; it doesn’t take long. So now it becomes a question of—to borrow your phrase, Doctor—mass self-evacuation. The fear is going to kick in, isn’t it? So people are going to be not only showing up en masse in hospitals, but they’re going to fleeing. They won’t necessarily be logical in what they do. So, Kelly, where do you take it from there?

Linda Vester, Kelly McKinney, Joseph Pfeifer, and Isaac Weisfuse

KELLY MCKINNEY: Well, we are fortunate in this city to have a unparalleled response infrastructure. We have a fire department that’s second to none. We have a highly disciplined and professional police department. Our Department of Health is really the best in the world. And OEM is an agency that coordinates those assets. So immediately, we would stand up our emergency operations center. There would be representatives from city, state and federal agencies that would come together—physically sit in the same room. We’d get them together as quickly as we can.

We have an area evacuation plan—the AEP—which is designed to be implemented for just such an invent. This is a no-notice, localized event that, as you said, involves people who are directed to evacuate by NYPD and people who self-evacuate because of the fear. And so the AEP would be implemented. The response would be organized and coordinated through the emergency operations center.

The other key piece for us—New York City—is, again, that this event would be large, it would be extraordinarily disruptive, and the management, the command element is really key. And in New York, we have what’s called CIMS, which is a Citywide Incident Management System. It’s based on NIMS, which is the National Incident Management System. And it talks about who does what in an event like this, and CIMS is critical. In an event like this, it would be presumed to be a criminal act. The police department would initially be the lead. They would be the command element. But quickly, it would probably go to what we’d call a unified command with the fire department and the police department. The Department of Health would also be included in that incident—in the unified command. And that is the structure that is used to manage the event.

As Dr. Weisfuse said, this event—the life safety issues are going to be very critical very early on. The environmental issues are going to be less urgent, but those issues will grow and grow and grow. An event like this—an RDD—is, as Chief Pfeifer said, rad is a hazard. We say that with the public, sometimes the risk is inverse—sometimes the fear is inversely proportional to the risk. Right? So folks fear radiation; they fear plane accidents when the actual risks to the individual are quite small. They don’t fear bathtubs or cigarettes or McDonald’s like maybe they should.

So this particular event is unique in that the fear will be extraordinary. And so risk communication—and this is something we learned, you know, post-9/11—risk communication is really the key to everything. It’s going to be the key to managing this event.

And just one last thing. I think that New York City is unique in its level of preparedness for an event like this. But as far as risk communication goes, we have a mayor, we have a health commissioner who are just really the best at risk communication. So getting out there and getting in front of the public, talking about what you know and more importantly talking about what you don’t know, acknowledging the fears and modeling the fears, because those fears will be enormous. But modeling those fears, talking—don’t over reassure. The public in this town are pretty amazing and amazingly resilient. I mean, we saw, you know, with 9/11 just an amazing calm in this town. And so I think public officials tend to want to over reassure and sort of overstep and underplay the dangers. And that would not be, in my view, what would be a wise course. And I don’t think this mayor or this health commissioner or this fire commissioner or the police commissioner would do. They would get in front of the media.

The media in New York City is also unique and uniquely vigorous and penetrating in this town. But we at OEM, we would establish what’s called a JIC, it’s the Joint Information Center. The JIC is a mechanism for making sure that the messaging from all city agencies and all state and federal agencies—everybody that has a message that has information it’s all going through the same place. There’s a unified message. If you get into a situation where early on or even a day later or two days later you’ve got one agency saying one thing and another agency saying another, the credibility can—your credibility can be destroyed very quickly. And once that happens, it’s very difficult to get it back.

VESTER: Very quickly, I’d like to get into what messages you get to the public in terms of their own safety, what they do for their families.

But before we get there, I’d like to go back to the zone itself where the attack has occurred. And determining now that you have verified it is an RDD how you determine what the high—you know, the high blast zone is and what your evacuation radius is.

PFEIFER: The evacuation radius—imagine a number of concentric circles. One area we’re really concerned about is the immediate area—getting people out of that. That’s also the area that people are going to be trapped in. So they’re not going to be easily extracted from the area. That’s where the time will take. As you move out, people will start to self-evacuate.

Now, when an event occurs—and you’re talking about midtown Manhattan; there’s a lot of highrise buildings in the area. It may be that initially, as the—(word inaudible)—passes the buildings, we may tell people that it’s better to stay in one of those buildings that are not in the immediate area and then organize that evacuation. Since 9/11, we have enacted a local law that every building—every highrise building needs to have an evacuation plan to have the entire orderly evacuated, that everyone can leave in a safe manner. The use of what we’ve talked before—the mayor and the commissioners—that information through the news media is critical. What people want to know—and we saw it on 9/11—is what happened, what do I do, and working together with the mayor’s office and OEM and getting real information out. And part of that real information is that this is not a nuclear explosion. What people will think is that this was a nuclear device, and to come as quickly as possible in saying it’s not a nuclear device and that we are containing it and here are the areas that need to be evacuated, and have the Department of Health give some real facts. That will help us mobilize the entire city to deal with this.

VESTER: Okay. So now we get back to the question—since I would imagine that most everyone in this room has a family—and one of our immediate questions is, what do I do for my family? This bomb has gone off; I don’t know what to do. How do you get the word out to people whether or not they’re supposed to go inside their homes, seal their homes, take a shower? How does the word get out in a reliable way that reaches all of Manhattan and the surrounding areas?

MCKINNEY: Well, the—you know, when we talk about CIMS and the unified command, Department of Health has the core competency in that area. They would speak to the health effects. And those decisions about sheltering in place or an evacuation would come out of Isaac’s office and the Department of Health.

But just the short answer, you know, what do you say? You say what you know, you say what you don’t know, and you talk about and acknowledge and model the fears that are out there. When in doubt, you just—you get all the information that you know and you get it out there in a straightforward way. The worst thing you can do is not know something and not acknowledge that you don’t know it, because then the public thinks you’re hiding something. And again, that goes back to the credibility issue.

VESTER: Right, but I want to press the point, because a lot of people say, what should I do? Should I take a shower? Should I take my clothes off outside my house and put them in a plastic bag? Should I wash off my kids? Should I go in the basement? What should I do? So is there like a template for what you tell people, you know, once you’ve determined it’s an RDD, it’s not a nuclear device?

WEISFUSE: You know, there are template instructions for such an event. Obviously, something like this will be quickly evolving in terms of the information. And so the template instructions may have to be adjusted based on the size of the explosion, based on the location, based on what institutions or who is there in that area—in the affected area. So although those template instructions are there on many websites, we’re going to have to quickly take the data that we can, work with fire and OEM to understand the dimensions of this particular event and adjust them or tailor them for specific rapid communications with the mayor’s office to advise people on what to do.

So, you know, for example it might be if you are in the following zone, you should take off your clothes. You should take a good shower. We’ll give some instructions about, you know, hair washing and washing, et cetera, et cetera. And bag those clothings and put them aside in a place where we can come and collect them at some later time. We might say, for example, if you’re not injured, don’t go to an emergency department because we might have a sufficient number of casualties that the emergency departments—for example, in the immediate vicinity of the blast—may be overwhelmed. And the thing we wouldn’t want is for people who are basically fine, except for that concern of exposure, to necessarily go there.

So we would—there are these templates. We have them. They’re probably available on websites. But obviously, we’re going to have to do some quick analysis to make an adjustment depending on a lot of factors. Maybe at that point, we know what the radioisotope is and can offer information on that.

The other thing that we do is try to quickly communicate with the medical community. And we have a health alert network that in New York City will push information to hospitals and doctors, because people are going to be asking their doctors, what should I do? So we’re going to try to get that information out to all physicians or as many physicians as we can electronically—the system we have already set up to get that information to them.

VESTER: One of the things that you mentioned that you would try to get the word out to people that unless you are injured don’t show up at an emergency room. My first response was nice try in my head because a lot of people—I mean, based on earlier scenarios that we’ve seen—some accidental releases of radioactive material—people convincingly have symptoms. They show up, they have nausea, vomiting, even when they are not contaminated. And you may well have in a city this densely populated a clog of people who honestly believe they’ve got contamination symptoms, and you tell them, “You’re not injured, go away.”

WEISFUSE: Well, I don’t think we would tell them to go away.

VESTER: Not literally.

WEISFUSE: I think we would try to define a strategy for them and not to say that they don’t have an issue that’s legitimate and try to give them some things that they can do for themselves, but also clearly state that in the immediate vicinity of the blast, for example, hospitals there are at full capacity, if that’s the case, and they may want to seek help elsewhere. So it’s not say don’t do anything. We need to give people accurate information as we know it at the time and what they can do to protect themselves.

VESTER: What is the fastest after an explosion that you can determine what the isotope is?

WEISFUSE (?): I can’t answer that exactly other than to say that we could make a preliminary estimate fairly quickly and then, you know, confirmatory estimates or prescriptions would be forthcoming. But we would try to do it as quickly as possible.


Kelly, according to the scenarios I am sure you have run through many, many, many, many times, how long did it take before there’s traffic gridlock? The explosion is 12 p.m.

MCKINNEY: Well, there will already be traffic gridlock. (Laughter.) So yeah, I mean, you know, the roadways are, unfortunately in this town, they are—we rely on them; we will rely on them in a localized evacuation. But we will—in an orderly evacuation, the public transit system—the trains and the buses and the subways are key. But this event, you’re going to have folks walking. The streets will be clogged with folks, and they will be walking, and they’ll be walking over bridges, and they’ll be walking north or south and east and west. So it will be managing a flow that already exists. We won’t have to—you know, we have a coastal storm plan, and we’ll have a hurricane off shore, and we’ll be telling folks, you know, get out, and so we’ll be trying to convince people to move. But in this event, you won’t have to convince anybody.

VESTER: In the hours or perhaps days afterward, how long—how do you determine when you can tell people that it’s safe to come out of the places, whether it’s out of their houses or the buildings where you said stay inside?

PFEIFER: When we tell people to shelter in the buildings, we will very soon tell them that they can leave once the plume passes them. The recovery at the site will take a little longer.

But I want to go back to what—and we have imagined what would take place, and we see it from a number of accidents around the world, and contamination of radiological material is that people want to know hey, am I contaminated? Do I still have this stuff on me even though I just took 10 showers? And I imagine what we’ll do is set up in local areas—and we have the capability to do that with monitors and in the local communities—where people can come that are not injured but are worried well. And we can, through our detection devices, say no, we are not detecting anything on you. And I think what that does, it reassures the community. You know, if they go to a place that’s set up with the fire department and the police department and we survey people. I think that’s really, really important.

So I think what we’re talking about today is how do we reassure the community that this is not the end of the world? And we need to do that by using all our resources. One of the things we saw 9/11, as people evacuated, people came together. We didn’t see this fighting. We saw people helping each other. So as a city, we have some experience of evacuating, and we know what it’s like. And we know it’s not easy, but we know we can get through it, and we know we can support each other. That experience alone should make us feel very confident that we could handle this type of event or another type of event.

VESTER: For the limited amount of time we have and all the material we have to cram in, I’m going to just fast forward. How do you decontaminate the zone that’s been affected by the blast?

MCKINNEY : You do it very slowly. I mean—

VESTER: Do you have to demolish the whole, you know, a certain neighborhood?

MCKINNEY : There will be buildings and areas that will have to be demolished. I mean, depending on what the source material is, you know, and depending on what the particle size is that result from the explosion. The problem with an RDD is that you can have particles very small in size—10 microns or 5 microns—and those particles are going to get into the air and they’re going to travel. And some are going to travel several miles downwind, so this event is going to be unique in its area of impact. Although the, you know, the radiation levels at these downwind locations are going to be extraordinarily low. But if they’re measurable, then it’s a very, very tough prospect, because if you can measure radiation, then what do you say about it? You know, folks are going to say well, then I’m at an increased risk of cancer.

And there’s data out there—and Dr. Weisfuse can talk about that—but it’s tough. And the area immediately surrounding where the device was—many of, you know, the cleaning process is slow and laborious and so a lot of buildings will just get demolished and roads will be paved over and sidewalks will be removed and re-paved, because that’s a quicker way and a cheaper way to do it. Because some of these radioactive isotopes will react with the building materials and embed themselves, and you just can’t get rid of them. So it’s tough. It’s going to be an area that’s going to be—you’ll see the scars of that event for years and years.

VESTER: There are, obviously, going to be some questions about what you do in the longer term, and I don’t want to go off over those. I’d like to leave that open for any of you during the Q&A session. But since we’ve also been asked to address natural disasters, in the time that I have before we open it up to Q&A, I just want to go there.

So let’s just say for argument sake we have a Category 2 hurricane coming, barreling down on us. It’s made a turn that we didn’t expect. Now what happens?

MCKINNEY: I’m glad you asked that, Linda. (Laughter.) We just completed a major revision of our Coastal Storm Plan, and it’s about a 900-page document. It has a lot of moving parts. We’ve learned a lot of lessons from the past year in what’s happened in the Gulf states. And it includes a lot of operational strategies for how you would evacuate hospitals and nursing homes and group homes. It includes very detailed strategies. Chief Pfeifer and the fire department are a major piece of those evacuation strategies for special needs people—people who are homebound and can’t get out of bed, people who don’t have, for instance, family that can help them to get out.

But we have a very vigorous plan and it’s, you know, it’s ready to be implemented. We have a capacity to shelter over 600,000 people in areas that would not be flooded. So it’s—we don’t want to see it, but we’ve got Flo out there now. Flo is a very, very large hurricane right now, and it’s—in all likelihood, it will—at least we’ll see some rain and winds. But we’ve got a good plan in place for a storm.

VESTER: So she’s giving you your natural introduction to—(inaudible).

PFEIFER: In a number of ways. One of the things that was done is we partnered with other departments throughout the United States. And one particular fire department is Fort Lauderdale. And we have an agreement with Fort Lauderdale if a hurricane’s coming up their way, we’re going to send some fire officers and fire chiefs down there. Not to help them, but to learn from them. See, they do this all the time in Florida. They’re the real experts. So we’ll build this partnership where we are going to send a half a dozen fire officers down and learn how they do things.

We’ve also received their plans already, and we’ve changed our plans. One of the things Kelly was referring to is the evacuation plan, is that if people can’t get out we are actually going to put firefighters on buses that will assist in the evacuation of people before the storm hits. After the storm—you have three different parts. You have before the storm hits, and you try to get people out of harm’s way. While the storm is hitting, we can’t do any rescue operation. You just can’t walk out in 100 mph winds and do much. But after it, then we have a—we go into a rescue operation. The fire department has assets, the police department has assets. But now it’s important to look at what are the state and federal assets that we bring to the scene. And I had this conversation with Peter King, who is the chair of the Homeland Security Committee, and we spoke at length. And we were talking about how quickly an asset could get to the scene. See, on 9/11, everything happened within 102 minutes. So if you tell me you can bring an asset to the scene and three days later—oh, thanks a lot, but that’s not really helping me. And it’s the same thing with hurricanes.

What we need to do nationally, and what we are doing nationally because of Peter King and Senator Clinton and Schumer, is that we want to tie federal assets to a time. Tell me how long you’ll get there. Is it one hour? Is it two hours? Is it six hours? Is it two days? Let’s hold people responsible for what they say they can provide, and that’s preparedness. It’s not preparedness when you promise something and you don’t know when it’s going to get there.

The other aspect is that we maintain communications within the city itself, within our command structure and also with the state and federal assets. And I think we’ve learned that from Katrina. We need to have this network of communication. One of the things we have in the city, one of the things the fire department has done, we’ve upgraded our fire department operations center, which is a $20 million operations center. But it’s part of a network, and we call it network central command. What it does, it connects the network of the fire department—all the different assets we have—it connects it to OEM and it connects it to the police department, and we can connect to Homeland Security. By having a network—a synergistic network—then we can provide the best help for the city.

It’s no longer this parallel, everyone does something by themselves. It’s really coming together and using the strength of the first responder community.

VESTER: Doctor, before we open it up to Q&A, I’d like to ask you to chime in on this scenario.

WEISFUSE: The Health Department would work with OEM to help staff the shelters if evacuations are necessary. And then we would work on some of the cleanup and environmental issues that are sure to be an aftermath of any kind of flooding zone.

VESTER: What about disease?

WEISFUSE: Well, we conduct 365-days-a-year surveillance for infectious diseases in New York City. And that would certainly go on unabated. That’s our core mission, and we would be reporting that through OEM and the mayor’s office to see what disease or what infectious diseases or other health problems are associated with the evacuation, looking at things like post-traumatic stress disorder, setting up systems so that people can get counseling longer term. I would say the immediate response is getting people out of harm’s way. And clearly, we’ll work on that, but there are longer—see, with Katrina, there are many, many longer-term consequences that we would have to be dealing with just at the same time, beginning at the same time.

VESTER: Great.

We’d like to open this up now to your questions. Just a couple of notes here. If you would, please, wait for the microphone to come to you, speak directly into it. Please stand, state your name and your affiliation. And if you would, please, limit yourself to one question. Keep it concise so that as many people as possible can speak.

QUESTIONER: Bettye Musham, Gear Holdings.

Most hospitals suffer from two shortages: nursing personnel and money. In the case of a disaster, where do you plan on getting staff, and who’s going to pay for it?

WEISFUSE: I think it depends on the kind of disaster we’re talking about. If it’s a one, you know, event—in other words, a bomb in a localized area—I think through the huge resources of the hospital system we can take care of many, many casualties. If it’s a prolonged event, such as a pandemic flu, where you’re going to have a situation where hospitals are going to be strained for many, many months, then we’re going to have a considerable problem with staffing. And there will have to be some decisions made about alternative levels of care and where people get cared for.

In terms of the funding issues, you know, my understanding is if it’s a federally declared disaster, some funding comes with it. I am not an expert on the funding aspect of issues, but I think that’s a critical funding decision for first responders, city outlays and for hospitals.

VESTER: Next question.

QUESTIONER: Ken Damstrom, global head of security for Lehman Brothers.

I’m interested in this hypothetical in a sense we’ve talked a little bit about if the building’s not on fire and there’s no construction-related collapse, you may ask people to shelter in place. I think that’s a foreign term to most people. I don’t think people truly understand it. When the little hairs on the back of your neck stand up, it’s a flight mechanism. So how are we going to get the message out about this whole concept about shelter in place? Because when we talk about CBR kind of activities, there will be sheltering in place for a length of time.

And as a follow-up to that, I think we need to expand the dialogue. We’ve learned, I think, post-9/11 that people that are evacuating, some of them, even if told that they’re putting themselves in harm’s way by doing it are doing it because they don’t know what’s happening with their children, so moms and dads will put themselves in harm’s way and evacuate. And so what are we doing to expand the dialogue around the issue of public schools, specifically, if these events happen during the day, so that people when they get municipal direction to shelter in place will know that my children are safe and I should heed that message?

VESTER: Excellent question. Who wants to take it?

WEISFUSE: Well, I’ll start out. You know, about the—just about the latter part of your question about the children—I mean, clearly, if the children are in the area of the blast and, you know, or they’re outside, then they need to be, you know, dealt with appropriately just like anybody else in that area. But again, this is going to be—in this scenario—a localized issue. So children will stay in school and that, you know, if you’re not in that area, there are thousands of schools across the city, and that will be stated very early on. So people aren’t going to feel that they have to run home to deal with their children. In fact, on 9/11, even then, you know, schools stayed open until the last child was picked up. So it wasn’t a matter of, you know, you have until 2:00 to come pick up your child. So that will have to be stated quite directly. Obviously, if it’s in the blast zone then that’s a kind of a special case.

PFEIFER: Yeah, we know that people will self-evacuate. I had a—a little after 9/11, we had just a small fire in one of the highrise buildings. It was a wastepaper basket. It took a fire extinguisher to put it out, but the entire 50 stories were evacuated. That’s going to happen. Within the immediate area, we’re aware that people will evacuate, and that’s a reality.

VESTER: And they’ll freak out if you tell them to shelter in place.

PFEIFER: Right. And it won’t happen, and they won’t stay, not matter what who tells them. But as you move further and further out, then there’s a chance that people can shelter in place or to evacuate in a slow manner. So we do need to get that word out to people to really have confidence in government. And that’s what we’re talking about today.

What we’ve painted was a picture in the beginning and little bit here on fear. What hopefully we’re painting now is that fear level subsides a little bit, that there’s confidence in the first responder community, and there’s also confidence in, in particular, city government that we can respond and we can respond quickly.

VESTER: The burgundy shirt and jacket back there.

QUESTIONER: Yes. My name is Jim Dingman from the INN World Report.

You know, we’re being deluged by one book after the next and one study after the next about the level of incompetence at the national level during Katrina. And I was wondering how you all in New York City are responding to these discussions and analyses of, you know, just one incompetent response initially to what happened down there in New Orleans that seems—and you talk about exercises. Hurricane Pam was an exercise that seemed to have been ignored. So the gentleman from the fire department just raised the issue of confidence in government. We’ve just had a disaster at the national level that was not a surprise, but a predictable disaster moving towards us, where we had a complete collapse, initially, of the response of all the billions of dollars we’ve spent. So I wonder what we’re critically thinking about that locally.

MR. MCKINNEY: It’s a great question. And I think, you know, New York is a home-rule state. And what that means is that, you know, the response and the responsibility for the response lie on us, on New York City. And we, you know, if you take our coastal storm plan, for instance, we don’t operate under the illusion that FEMA is going to be here when the sky clears after the storm passes. We know we’re going to be on our own. We are on our own two days to three days pre-storm. We’re going to be on our own three to five days post-storm. We plan for that. We have the resources and the plans in place to be self-sufficient for that period of time. And after that, I mean, we know and we have worked with FEMA very well—FEMA in Region 2; we work closely with them on a day-to-day basis. And we know how to request those assets through the state, through (CIMO ?) and through FEMA, and we get those assets moving very quickly toward us.

A lot of it has to do with—you know, if—again, if you operate under the assumption that the feds are going to come in and save you, you’re going to be very quickly disabused of that. That’s not going to happen. We’re going to save ourselves, and FEMA’s going to help.

QUESTIONER: John Hayes from the New York Life Insurance company.

I’d be interested to hear the panel’s viewpoints on the nuclear or dirty bomb scenario. What is the right thing for big business to do? I understand the obligation of big business, but what’s the right thing for a big company to do to prepare for and respond? For example, we view our tower in almost all scenarios as a safe haven, not just for employees but for the community to come to. But we have an obligation to protect those already inside and not contaminate the assets of the building, et cetera. But I’d just like to hear, should we have HAZMAT teams on site? Should we—I’m kind of curious as to what is the right thing for a company to do?

PFEIFER: The—for a company—we’re talking that there’s some companies out there looking at nuclear radiological detection devices. So in other words, if you go into that building, you have to pass a portal. I think what we’re asking the private sector to do is to be aware. And the more you could help in that awareness—whether you have a detection, whether you have security, some buildings do bag searches, that’s all part of the awareness. To have a HAZMAT team—well, you have a response now in the city of four minutes to your building. I’m not too sure that it’s economically wise to do that when you have such a strong infrastructure of first responders—but your awareness and your communication to people within your company, your building. The other thing I would suggest is to have a plan to—a continuity of operations plan. What happens if you cannot occupy your building? How do you move your resources around? That’s a lot of work just by itself, and probably more important than trying to be the first responder to the building.

QUESTIONER: Thanks. Brett Zbar with Aisling Capital.

First, thanks for making us safer.

Kelly, question—you had mentioned the importance of command and control. And in the setting of the bomb going off in midtown, clearly there’s a crime scene and the police taking an initial lead role makes sense. But what about the setting of either a pandemic outbreak or a bioterrorist event where it may take several days for surveillance in the emergency rooms to pick up what’s going on. But once we know what the situation is, the need for fast action is just as great. Should we have just as much confidence in that setting?

MCKINNEY: It’s a great question, and we should, and one of the reasons is because we have Dr. Weisfuse in the Health Department here. So I’ll let Isaac take that.

WEISFUSE: We’ve—since—way since even before 9/11, but certainly it’s much accelerated after 9/11, we’ve put in a lot of complementary surveillance systems across the city to help detect the initial signal, if you will, of a bioterrorism event. First and foremost, we’ve really tried to strengthen our ties with physicians. If you recall in 2001 in New York City, all those anthrax cases came to us not by any high-tech means, but by alert physicians who called the Health Department.

And I wanted to segue briefly that we’re all—on that issue—that we’re all very concerned and remembering of September 11 th. We also ought to remember October 4 th—the fifth anniversary of October 4 th is coming up. And for those of you who don’t remember, that, I recall, is the date of the first anthrax case in Florida. He is somebody who is a perpetrator, who is capable of creating weapons-grade anthrax, who is still at large. This to me is a huge police and public health problem that we shouldn’t forget about and shouldn’t forget about all the responses and all the lives that got lost due to that anthrax attack.

QUESTIONER: Carol Evans from the U.S. Navy Center for Asymmetric Warfare.

One of the assets that we’re very familiar with but we haven’t heard a lot today is the civil support teams under the National Guard. And I’m wondering how much interaction you’d had with them, whether you think they’ll be able to support you in the timelines that you need, and just maybe elucidate a little bit for this audience some of the capabilities that they bring?

VESTER: Excellent question.

PFEIFER: We deal with the civil support teams all the time. New York state has one and in pre-planned events we bring them down. They have a capability, they have communication capability, they have detection capability. And they have a mapping of (true ?) modeling capability. They’ve (ridden ?) with the fire department and the police department. They’re a tremendous asset.

What I’ve talked about before about time—well, they’re up around Albany, and they could be in New York within three hours. When we get an asset like that that can help us, that’s a real asset. Three days is a little difficult. Three hours is a real asset for us.

QUESTIONER: My name’s Bill Scherer. I work at Houlihan Lokey.

Like the other gentleman, I want to say I’m grateful for you folks standing point for us. But in a way, we can point our finger at you guys and say, what are you going to do for us—four fingers point back the other way. As you wander around the city educating us and preparing your organizations, I’d be curious—anecdotally in general—how much is the private sector stepping up to the challenge? When you go home at night, do you say to your wife they get it, or people aren’t getting it, and what should we be doing? I’m a cubicle dweller. How should I be pushing my organization to step it up, or they’re doing a good job?

MCKINNEY : That’s a great question, and I think the question isn’t do they get it or they don’t get it? I think for the most part, they don’t get it, and I think it’s human nature. I think the people—you know, the folks in this room—accept that most companies in the private sector deal, you know, with their day-to-day issues that take up, you know, 12 hours in an 8-hour day. Do companies prepare enough? Do companies have really updated and workable business continuity plans? Do they know where their employees are? Can they contact their employees? Do they know how they’re going to operate if 30 percent of their staff go out sick in a pandemic flu? I think for the most part the answer is no that they don’t.

And it’s true not only in companies, it’s true just folks in their homes. You know, one of the things that we do is we have a Ready New York program. We tell folks, you know, you need to know. You need to have in your head a plan about what you would do if—you know, the gentleman’s point about, you know, I’m at work and my wife’s at work and my kids are at school and a dirty bomb goes off. What do I do? People need to think about that today, but it’s hard. It’s human nature not to think about that. Do you have a go bag? Do you have some food stockpiled in your home? If you were told to shelter in place, you know, is the Chinese food takeout in the fridge going to get eaten the first meal and then you’re done? You know, what happens? And this is Manhattan. This is what would happen in most apartments. You know, folks don’t have big kitchens. They don’t have places to store food.

I think, in general, the preparedness is not what it should be. And we’re working on that.

VESTER: Do you mind if we do a little experiment here? I’d like to ask everyone in the room raise your hand if you have an emergency supply kit immediately available to you in your apartment or home.

MCKINNEY (?): Wow.

VESTER: That’s impressive. Do you have a gallon of water per person?

MCKINNEY (?): And pets. (Laughter.)

VESTER: And pets. Good on you. Do you have cash—whatever you need—for evacuating? Have you rehearsed a family plan on how you meet up in case of an event? Fewer. That’s where a lot of people fall down, because it’s hard for us to talk about it with our families.

MCKINNEY (?): Well, you think you’re going to scare them and you think that—you know, I’ve got a 10-year-old and a 6-year-old, and do I want to sit them down on a beautiful Saturday afternoon and start talking about disasters? It’s a tough sell, you know.

VESTER: Right. Sir?

QUESTIONER: Allen Hyman, Columbia University Medical Center.

I actually just want to follow up on the very last points. Some people in this room with gray hair remember during World War II, and long into the Cold War, there was a national effort to educate people what to do in a disaster. There was a civilian defense corps. Some people called them air raid wardens. But every block had somebody on that block who knew what to do in the event of a real emergency. And we were taught in schools as to what to do. Our parents knew what to do.

This country is not prepared that way. We’re not teaching our young people what to do in the event of a real emergency. And so I want to know how can we improve your ability to communicate with the people of the city of New York.

MR. (?) : I just—Chief, go ahead. (Laughter.) I don’t want to take up the whole time.

PFEIFER: (Inaudible)—right into it. We have a different type of community. Our community now is—my kids get on the Web and on Facebook and this, that and the other thing. That’s how they communicate. You know, it’s not walking down the block; it’s like, “Let me talk to my friends, and I can talk with three or four friends at the same time.” And I think that’s one way we can communicate to them.

I know—and this is your (chief ?) here—is that OEM has things on the Web that are real important. And I’ll turn it—

MR. MCKINNEY: Well, we have the CERT teams. I mean, you know, we keep talking about how New York is unique. It is unique. It’s unique because it’s a great city, but we also suffered some unfortunate tragedies that have taught us lessons. And we have what’s called the CERT team, which is a Community Emergency Response Team. I think we have over 40 of them in the city right now. These are folks who are trained to assist and respond in emergencies. We have CorpNet (sp), which is a way that corporations can get direct communication from OEM on emerging issues. So I think New York is somewhat more prepared.

And, you know, what do we do nationwide? I think that’s a really pressing issue. And, you know, post-9/11 there was a lot of momentum for that. Five years later I think it’s diminished somewhat, and there’s a need there.

WEISFUSE: I want to add that we also have a medical reserve corps that’s the largest in the United States for all licensed professionals—health care professionals, who can join to prepare for—help the city prepare, so that’s something that we are always actively recruiting for.

VESTER: Okay. I want to just jump in and remind everyone that the next session is actually focused specifically on what organizations and individuals can do to prepare for emergencies. So I don’t want to steal their thunder. We’ll hold on to those questions and save those for the final session. So for those of you who are raising your hands, please keep it focused on the immediate aftermath of disaster.

QUESTIONER: Michael Berkowitz, Deutsche Bank. Your panel treated terrorism and natural hazards separately, but one of the great innovations of the last 20 years in emergency management is sort of this all-hazards approach. I’m wondering if the panel could give us each one concrete example of ways that you leverage terrorism preparedness to support your natural hazards response or vice-versa.

PFEIFER: If we have a terrorist event or a natural hazard, the consequences are going to fall into really four categories. You’re either going to have a fire; you’re going to have a health problem or casualties—people are going to be injured or sick; the third is a contamination of some sort or some hazardous material; and the fourth is structural collapse or to be trapped. Those are the four things you’re going to see. They’re going to fall into some category of results of whatever it may be. Or the fire department, if you look at the fire department of the city of New York, our four competencies are fire, pre-hospital care, collapse rescue, and hazardous material.

What terrorism has done for us is helped us enhance those core competencies. They were there before 9/11, they’re there after 9/11, they’re there with funding, they’re going to be there without funding. But the funding helps us to strengthen it, because those are perishable skills and we need to train all the time.

One of the things that allowed us to do the—Fire Commissioner Nick Scoppetta, he started in the fire department a Center for Terrorism and Disaster Preparedness. See, we don’t separate the two. We put them both together. And what the commissioner wants the center to do, and we are doing it, is writing emergency response plans for both, exercise that, try them, see if they work, and also to deal with critical infrastructure protection, and then to deal with the city and state and the federal government on a strategic level, where do we move.

But as you see, they’re all together. We’re not separating. It is this all-hazards approach. And the funding definitely helps us to enhance that. But it’s very real. It’s what we do every day.

QUESTIONER: Thank you. Al Puchala from Signal Equity Partners. We’ve discussed a lot of points on evacuations. In the spirit of discussing uncomfortable topics, what if the attack or disaster involved a contagious disease? Would there be a quarantine? Who would decide how to do it, how it would be communicated and how it would enforced?

VESTER: Good questions. Doctor?

WEISFUSE: You know, first of all, I think quarantine gets a little bit overblown in terms of a public health measure. It can be useful for certain circumstances. It depends on the actuality of it. If a quarantine was deemed to be useful by the Health Department, we would recommend it to the mayor.

We’d get information out about how to do that. But again—and we do have—we did have worked on our public health laws to allow that to be effectively done, and so we have revised some of our legal situation.

But that being said, there—if there is a widespread disease transmission in the city, if it’s gotten to that stage, for example, there’s no reason to quarantine. The downside of quarantining is also there. The unintended consequences of quarantining a block or a burrow or part of Manhattan are very, very large.

So the decision would be made by the Health Department, transmitted and communicated to the mayor, NYPD, OEM to try to enforce it. We’d have to get information out to explain why we’re doing, how we’re doing it, et cetera. But again, it’s not high up on our list of the armamentarium and would only be done if the specific disease really suggested it was amenable to that kind of approach and only early on. He really talked to me about a handful, one or two cases, where you can really keep things contained. If it’s widespread, you know, we really don’t see a need for it.

QUESTIONER: Thank you. Roland Paul. I’m a lawyer. Very good presentation. What—you mentioned shelter in place. What is needed to be done other than having a, you know, a supply? I’m thinking of the much ridiculed statement by Secretary Ridge about duct tape, probably falsely ridiculed. And what is the rim—I think that’s the term—what’s the breakpoints between—below which you don’t have to do anything, above which, next level maybe take a shower, and above which that you should evacuate? And can contaminated people contaminate uncontaminated people—to what—unprotected—to whatever extent you want to answer those, I’d appreciate it.

PFEIFER: I think we talked a little bit about having rings around the incident or zones around the area, and what we would do is get information in each of those particular zones of what you should do out to the public.

Do you want to—

MR. (?): You know, I think that, you know, there will be specific information about how to decontaminate, where to put your clothes. I think that, you know, clearly the people who are outside during the event are really—that’s really the message for them. The people who are inside presumably are, you know, in a much better shape because they’ve been shielded to some degree by the effects of the radiation. So there will be some nuanced messages about that. Not everybody will be at the same risk of contamination.

QUESTIONER: Marty Krall with Pillsbury Winthrop Shaw Pittman. What’s your wish list—despite the great job that you guys have all done, what haven’t you been able to do, either because you don’t have enough money or you haven’t gotten the federal support or you haven’t gotten the state support?

MCKINNEY : That’s a great question. I would—I guess one of the immediate things for OEM, we would like to have more room to store stockpiled food and water and blankets and cots. That would be first. We have a lot of—I think that’s my Blackberry—we have a lot of pretty detailed plans in place, but we also—in my department we have a vision for what the end point is to have, really, a plan in place for every incident, and we’re not quite there. So my wish list is to get to that point.

VESTER: But first on your list is more room to stockpile food, blankets, cots?

MCKINNEY : That would be—that just leaps to mind.

VESTER: Okay. Chief, what’s on your wish list?

PFEIFER: For us, to do, to train every firefighter for one day, one eight-hour day costs us $10 million.

VESTER: Per firefighter?

PFEIFER: No, no, no, that’s not per firefighter!~ (Laughter.)

VESTER: Mighty expensive crowd!

PFEIFER: Really! Everybody becomes a firefighter. But to do the entire department, firefighters, emergency medical personnel, costs about $10 million. So it’s very difficult for us to do training. So the more money we get, the better we can train our people. We’re still buying equipment. We have—we’ve talked earlier this morning about port security. We have—using money for new fireboats. Our fireboats are 50 years old now. They need to be upgraded, and thankfully, we have—getting some Homeland Security money for that.

But the wish list isn’t just money; we also need technology. And that’s a challenge—if I could just throw out—the challenge to this community for the next discussion is that there are certain things that we need as first responders to do our job better.

And one comes to mind is firefighter tracking, or how do I know where a firefighter is in the building? On 9/11, we had this magnetic board, where we tracked, where we deployed units. And as you may have saw in the documentary is that when the buildings collapsed, we weren’t able to take that with us.

What we want to do is have that all electronically, and the technology isn’t there. How do I know where people are deployed? And if something bad occurs, how do I know where they are so I could send resources to that? So we’re challenging now the technology community to come up with that technology that we can track people within a building, within a high-rise building, which is a very difficult environment to work in.

The other thing that we’re—the good news in one sense when we talk a chemical attack—we are working with people in Washington in a technology workgroup, (Twosquick ?) (sp), on new firefighter gear. See, if I could go into a chemical-contaminated area, the chemical device goes off, and I don’t have to take 20 minutes to put on my moon suit, but I could use my regular firefighting gear, then I could get you out quickly. Then I could just put on the respiratory equipment, keep the bunker gear on my back and go in and make the rescue. And right now, there’s—they’re working on that, that technology, and we’re hoping within a year or so we’ll have a prototype. But that’s what we need from the private sector, to help us in the technology field.

VESTER: Do you have secure, interoperable communications equipment now?

PFEIFER: Not within the fire department. Secure communications—

VESTER: I mean, it light of the lessons learned from 9/11?

PFEIFER: Well, I think—okay, depending on what you—when I think “secure,” I think of a clearance level, all right, and we don’t have a SCIF, right, like the FBI or NYPD has. What we do have is personal contact. I get briefed once a week on the threat by the FBI.

We have also other communication equipment. We have satellite phones, and we built a communications system within the buildings, we put our own communications system. And presently, the fire department has a consulting company that’s looking at our entire communications, and that report will probably be out within—maybe by the end of the year. We’re just finishing up. We’re looking at how do we build an infrastructure in the city to move communications.

The city is also working on a secure Internet. Once that is established—and there’s some pilot programs going on now—we’ll be able to push information to all first responders. But those are very large, very, very expensive projects and will take some time to do.

VESTER: Doctor, I wanted to get back to your wish list.

WEISFUSE: Money for hospitals for preparedness, money the hospitals in New York City are really right on the margin—that was alluded to in one of the questions before. And when we ask them, go to them and say, “We want this, we want that in order to get New York City better prepared,” they totally agree with us, but it costs money to do that, and we certainly don’t have enough of that.

VESTER: Okay. So just a reminder that, you know, again, that the longer-term preparedness questions will be in the next session, and—but I wanted to make sure that we answered your immediate question.

Other questions?

QUESTIONER: Stephen Flynn, a senior fellow here at the Council on Foreign Relations. I got to ask some of these questions at the next panel, I guess, so I’ll put you on the spot here on this one. But specifically evacuation—one of the things that—I’m also a retired Coast Guard officer, and one of the things that drove me to distraction in New Orleans, particularly with people trapped in the convention center, is it’s right on the Mississippi River. We move a lot of stuff up and down on the Mississippi River. You could’ve taken people on the barge up to the Great Lakes if you wanted evacuation. We were looking at school buses. This is an island. It’s surrounded by water. It’s got one of the best waterfronts in the world for access for evacuation. To what extent have we formalized vis-a-vis 9/11 that was an informal Dunkirk kind of evacuation down at the bottom of the island? To what extent have we formalized the use of the waterfront to support evacuations?

MCKINNEY : Boy, that is a great question.

VESTER: Mm-hmm. (Laughter.) So let’s go after it.

MCKINNEY : You know, it is—you know, we’ve got a couple of really vigorous evacuation plans. Again, we have the Coastal Storm Evacuation Plan, which talks about roadways and public transportation and how everybody plugs into that; we’ve got the Area Evacuation Plan. We are just starting to talk about that issue. We’ve talked with the Naval militia in New York State. We have—again, we have—we’re fortunate we have with the New York City Police Department, we have I think the 10 th-largest navy in the world, so—but are they in the plan now? They’re not today in the plan.

One of the reasons for the Coastal Storm Plan, for instance, is because, you know, you—you know, in pre-storm, what does the water look like? But that—I guess if there’s a wish list, that’s going to be on a wish list. We’re not quite there yet with water, waterborne evacuation.

VESTER: That could be the fly in the ointment here. But shouldn’t we be—shouldn’t we have considered that one already?

MCKINNEY : Probably. But, you know, again, it’s—we also are a city that has tremendous transportation assets. We have, I think, 3 million people enter the city from outside the city each and every day. There’s a—we have completed a transportation analysis, a study that talks about how long it takes to clear a borough. We know how long it takes from when we actually can give an evacuation order, how long it takes in different situations, whether it’s heavy background traffic or light background traffic, how long—how many hours does it take from an evacuation order until we’ve cleared the borough. We have the ability to evacuate, we have it today. So is the waterborne going to make the difference between an effective evacuation, a non-effective evacuation? It is not. But it’s still an asset that we need to plug in.

PFEIFER: But there’s two ways of looking at it. You can look at this mass evacuation which Kelly has spoken about, but what happens if you don’t have this mass but you’ve got to evacuate a boat? We have—we call it a “wetvac”—it’s almost like, you know, a vacuum cleaner. But we have a plan where we have sites located around the city, and we’ve given this to OEM, the police department and our fire boats, where do we take somebody off a boat, where do we bring them that we can get them to an ambulance, that we could get them to the hospital? And we have a colored booklet that shows where the closest evacuation point is, what the pier looks like from the water side and from the land side. So we know—well, there’s a problem on a ferry and we need to evacuate people, here’s the closest site. If people are injured, this is where we can bring the ambulances to get them off.

So evacuation is, yes, a massive evacuation of the city or a portion of the city, but also, very particular, where do we bring people if there’s a crisis on the waterways.

VESTER: Noticing the clock. We’re running out of time. If anyone has a really pressing and short question that they would like to present before we wrap it up, please.

Sir, in the back. And then we’ll close it.

QUESTIONER: My name is Dr. Stuart Weiss. I’m from the Center for Health Care Preparedness. I have a quick question about health care and maintaining the integrity of our health care system in the event of an acute disaster. You know, if you look at most disaster data, most of the victims arrive to hospitals within an hour, maybe, you know, 90 minutes, if you look at Tokyo and past disasters. So how—what’s the plan for supporting health care? While you’re ramping up, while it’s taking time to put on your Level A suits and get into the zone and do all the measurements, my hospitals are receiving patients—hundreds, thousands, whatever. What’s the plan to support health care in New York, and then across the river in New Jersey where a lot of the evacuation plans you just talked about—waterborne—you’re bringing thousands of patients across the river to New Jersey. How are those hospitals being supported and/or communicated with?

MR. WEISFUSE: Well, first of all, in New York City, you know, as Kelly said, we consider ourselves for the first number of hours, or even days, on our own. So we’re not necessarily—although there are many federal assets that could come to bear for medical issues, for the first six, 12 hours, they’re probably not going to be here, so we have to deal with it as best as we can.

We’re going to get—first of all, we need to get information out to hospitals. We have a computerized system here in New York state that allows us to look at the bed situation, allows us to look at critical supplies so that we can manage that and make some transfers, if possible. We have communication systems set up with hospitals so that we can get medical information out about what’s going on and, you know, do it that way. But ultimately, if there’s a large-scale disaster, we’re going to need some support from outside the city as well.

VESTER: Okay, with that, we are out of time.

Doctor, Chief, Deputy Commissioner, thank you very much. (Applause.)








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The Balkans have long been a source of tension between Russia and the West, with Moscow cultivating allies there as the EU and NATO expand into the region. The war in Ukraine might be shifting the calculus.



The consequences of the COVID-19 pandemic and the rise of China have prompted renewed debate about the U.S. government’s role in shaping the economy.