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Special Defense Department Briefing on Medical Aspects of Tsunami Relief Operations

Presenters: Dr. William Winkenwerder, Assistant Secretary of Defense for Health Affairs; Lieutenant General George Peach Taylor, Surgeon General of The U.S. Air Force; and Rear Admiral Kathleen Martin, Deputy Surgeon General of The U.S. Navy
January 04, 2005 4:35 PM EDT

            MR. WHITMAN:  Well, crowd's gotten a little smaller, it's a little later in the day.  I know this is, what, our fourth briefing today.

 

            But Dr. Winkenwerder really doesn't need any introduction.  The assistant secretary of Defense for Health Affairs here has graciously offered some of his time to come down and talk to you about some of the specific medical aspects related to the relief operation that's under way and some of the considerations that are going on within not only the Defense Department, but across the government as we look at potential challenges in the days ahead with respect to those affected areas.

 

            So like I said, I know you're all tired and it's getting towards the end of the day, so let's get right into it here.

 

            DR. WINKENWERDER:  Thanks, Bryan.

 

            Good afternoon.  I'm here also with Lieutenant General Peach Taylor, surgeon general of the United States Air Force, and with Admiral Kathy Martin, who is the deputy surgeon general of the United States Navy.  We're here today to speak about the U.S. medical and public health response to the tsunami disaster.

 

            As you know already by now, the U.S. military and particularly the United States Navy, but increasingly over the days and weeks ahead the United States Marines, are already delivering much-needed aid, food and water and other materials, and all of these will contribute in a major way to preventing a second wave of disaster and grief in the way of medical and public health problems and diseases.  However, we know that there are hundreds of thousands of displaced individuals in the affected countries at this time.  These people are, obviously, not in their homes.  They, in many cases, are in crowded conditions possibly -- and in fact, likely not living in very hygienic conditions.  All of this creates a breeding ground for disease and for epidemics, and we're concerned about the possibility of that.

 

            Let me just take a moment or two to talk about some of the diseases and public health problems that we are anticipating could happen, and that we are preparing for.  Certainly top among those are waterborne diarrheal illnesses, things like -- and I'll use a medical term here -- E. coli.  It's the same kind of thing that you would get from traveler's diarrhea.  But certainly that's part of the normal body materials that once it gets out into the water can be infectious and affect people very easily.  Also cholera, a very serious disease. Hepatitis A is another waterborne infectious disease.   And then, of course, there are respiratory diseases, the typical viruses and bacteria that affect people in general.  Certainly measles is another possibility as a disease.  And then also in the coming weeks we will have to be looking out for things like dengue and malaria.  And we'll talk a bit more about that.  There are also the problems of injuries that can occur with so much loose material around; and efforts to reconstruct or clear lots of heavy materials, people get hurt.

 

            What have we done so far?  We have assessment teams.  The DOD and the U.S. Agency for International Development, USAID, have assessment teams in all three countries looking at this issue, these issues.  As you well know, we've also transported some sick and injured in helicopters to local host nation medical facilities.  The Navy has deployed a preventative medicine team that is normally based in Jakarta, Indonesia, and certainly the fact that they were right there close at hand made it quite easy for them to go out into the field to begin to look at the possibility of these problems.

 

            Back here in Washington, we have been working with the Pacific Command; we have been working with USAID; we've been working with the Department of Health and Human Services and the Centers for Disease Control to develop a coordinated joint strategy way ahead about the best way to support these nations and also to support the nongovernmental organizations, the relief organizations as they do their work.  We are prepared to provide a significantly enhanced effort, a major effort, if needed.

 

            What we've already learned, and this just comes in today from Secretary Powell, is that there is a need for more forensics support.  We are now identifying from DOD a mortuary affairs team or teams in personnel and forensic personnel.  We are also in contact with the Department of Homeland Security, who within their purview, within FEMA has similar types of capabilities.

 

            Let me describe briefly for you our concept of the way that we think that we can be most helpful.  Really two areas, and the first of that is to, where it is needed, create platforms, create facilities that can be used by host nation medical providers and also by the nongovernmental organization medical providers.  To the extent that medical infrastructure is destroyed in certain places, we can put and are prepared to put field hospitals ranging all the way from small packages that the Air Force can provide, and I'll let General Taylor describe that in a minute, to larger hospitals that could be 100 or 200 beds.

 

            The second way in which we think that we can be most helpful is to assist with the whole matter of logistics.  I think you've already been reading and hearing about the fact that getting the right aid to the right place to the right person at the right time is really the key task at hand, and certainly this applies in the area of medicines, vaccines, other medical materials.  And so we want to and are prepared to assist with that effort.

 

            I want to emphasize that we seek an opportunity to partner with host nations, with the World Health Organization and with nongovernmental organizations to get the job done.  I have already been in contact with the U.N., with the World Health Organization. We've established a memorandum of agreement about the way in which we want to work together.  And in addition to that, I'll say that they are taking a step to locate their medical response focus at Utapao, Thailand, which is where our central coordination area is.  So we'll be working right along beside them.

 

            I've also been in contact with Secretary Thompson at Health and Human Services and CDC Director Julie Gerberding, and we're working closely together and we are very well prepared to respond.

 

            So with that, let me take any questions you may have.

 

            Q     Have you seen any outbreak of disease at all so far?

 

            DR. WINKENWERDER:  We've not yet received any report of an outbreak of either a widespread disease or isolated diseases at this point.

 

            Yes?

 

            Q     How many field hospitals and how many larger facilities are you capable of setting up maximum?  And what kind of stockpiles do you have of the medicines and vaccines that you'll need?

 

            DR. WINKENWERDER:  We would be prepared to provide several, and by that I mean four, five, six, eight field hospitals, if needed.  We have that type of capability that can be flown in or shipped in relatively quickly.

 

            In the way of materials, I can't give you a specific number or amount of drugs or other medical materials, but we certainly have plenty of medical materials on hand within the Pacific Command theater that could be used to assist with the efforts.

 

            Yes?

 

            Q     How quickly can you deploy those field hospitals?  And in hindsight, should those field hospitals and Navy Mercy ship been deployed earlier?

 

            DR. WINKENWERDER:  With respect to your first question of how quickly we can deploy those, let me ask General Taylor to come up just to talk about the smallest and most nimble of those capabilities, the Air Force package.

 

            Q     (Off mike.)

 

            GEN. TAYLOR:  My middle name is Peach, and that's what I usually go by.  George Peach Taylor Jr.

 

            Q     Peach?

 

            GEN. TAYLOR:  Peach.  Like a peach, yeah.  It's a family name. (Laughter.)  When your daddy gives it to you you might as well use it. (Laughter.)  I'm a junior, so he uses the same form as I do.

 

            The Air Force over the last 10 years has -- because of the way we lay down small numbers of people in remote locations, we developed very small hospitals; gone from a fairly large hospital structure to a smaller hospital structure.

 

            So we have our hospitals ranging from -- can fit on a C-130, to our 25-bed hospitals usually take about two C-17s.  You all have seen C-17s.  And so we actually have one of those 25-bed hospitals at Yokota now that could deploy as is called for.  We need to know where to go, we need to be able to get into whatever location we're going, and we need to be able to hand it off to a competent authority.  It comes with people or without people -- both are capable.  So it's pretty much a modular build from a 130-worth of equipment, or a single-pallet position, up to this fairly large version, which is a 25-bed hospital.

 

            Q     And how long does it take to deploy it?

 

            GEN. TAYLOR (?):  They're sitting on the ramp at Yokota today -- Tokyo.

 

            Q     What about the regular like 200-bed hospital, is that --

 

            GEN. TAYLOR (?):  Yeah.  For us, if you put together two of these you get 50, if you put together three you get -- and they're modular beyond that.  The Army and the Navy have a much larger footprint.  The value of the Air Force footprint is two C-17s arrive and land with a hospital and ambulances.

 

            Q     How many do you have?

 

            GEN. TAYLOR (?):  The problem is we're in the middle of reconstructing.  We've deployed a lot of these out to the war, and we've been in the process of reconstructing them all.  And we can get you the information and we can let out to you exactly what we have of each of these types -- what the types look like and what capacity we have in the system today.  And then it depends on where they're located.

 

            Q     What about the personnel, the staff?  You said you don't have the personnel.  Have you got the equipment?

 

            GEN. TAYLOR (?):  Oh, we have personnel to do that, yes.  If you want to just hand the equipment off -- bring your people, hand it off to the local authorities:  Here's how you set it up and here's how the equipment works; we're out.

 

            Q     But you can get the whole package?

 

            GEN. TAYLOR:  Right.  We can put the people in as well.  It's about 85 or 90 people that go in there.

 

            DR. WINKERWERDER (?):  Let me just say again, one of the reasons we think it's so important to work closely with the host nation is when you get into the -- at times a rather complicated process of interacting with a patient, language is a very important issue.  So being able to utilize the medical providers who are from those regions and who live and work there is much to everyone's advantage.  So we want to take advantage of that, work it together with them.

 

            Q     You're offering these medical facilities, but no one has actually asked for them yet?  Is that where we stand on this?

 

            DR. WINKENWERDER:  I don't think that's quite correct, in the sense that we have the assessment teams who are out in conversation with various authorities out in the region, they're developing those assessments, and we hope to have them very, very soon.

 

            Q     Do you know where they're going to go?  Can you tell us where they're going?

 

            DR. WINKENWERDER:  I can't give you a specific answer on that just yet.

 

            Q     Okay.  Then also to follow up, you mentioned the need for more forensics and you were looking at DOD personnel.  Do you have any idea how many may be deployed over there?

 

            DR. WINKENWERDER:  It would probably be in the range of 100 to 150 people.

 

            Q     Is that in addition to the two teams that have already gone from Hawaii?

 

            DR. WINKENWERDER:  Yes.

 

            Q     A hundred more?

 

            DR. WINKENWERDER:  Yes.

 

            Q     Following up on that, just from what you're saying here, it sounds like you're saying the one thing that everybody is asking for right now is mortuary affairs people.  Is that correct?

 

            DR. WINKENWERDER:  That's correct.

 

            Q     And probably one of the questions you were asked is about the Mercy.  We were told earlier that there's serious consideration being given to putting it into operation.  Can you bring us up to date on that?

 

            DR. WINKENWERDER:  There is consideration of that.  I've had discussion with Admiral Fargo.  That is being evaluated.  And we don't have any decision to announce right now on that, but we're looking at that.  And if we do deploy that asset it's a major capability, but we want to do it in a way that we, again, work together with the host nations and with nongovernmental organizations.  We want to do it in an innovative way.

 

            Q     Is there a legal question there on the NGO connection with --

 

            DR. WINKENWERDER:  We've asked that and -- a good question -- and the answer is we believe we can do this.  Our legal affairs team has looked at this and does not see any legal reason for why we cannot invite them into our facilities or into our ships if need be.

 

            Q     I understand they've asked to be accommodated on that, is that right?

 

            DR. WINKENWERDER:  Who?

 

            Q     NGOs, at least one.

 

            DR. WINKENWERDER:  Yes.  Yes, that's correct.

 

            Q     What would be the trip's travel time to the region?

 

            DR. WINKENWERDER:  The large ship, the Mercy, would take two and a half to three weeks transit time.

 

            Q     Has there been consideration to getting it under way and then making decisions as it's en route?

 

            DR. WINKENWERDER:  Well, as you may already know from the discussions with Admiral Fargo, it has been out sort of doing checks to make sure it's sea-ready, and then so it is awaiting deployment if so ordered.

 

            Q     Sir, could you give us just a little more detail on what sort of skills and resources U.S. military and mortuary affairs people can bring to the table?  And what sort of experience does the U.S. military have with dealing with this kind of a mass-casualty event like this?

 

            DR. WINKENWERDER:  Well, certainly this is a mass-casualty event of the greatest proportion possible, and so -- but any set of deaths is -- let me put it this way.  Our mortuary affairs people are prepared to assist and to help, and we believe that they'll do a fine job.  I don't know that there's anything specific relative to the scope and size of the event that one -- that requires a specific set of skills.  It's dealing with people who have died, bodies who have died, and how to dispose of them and how to take care of all those issues.

 

            Let me mention one other thing because I know there has been a couple of news reports and I would like to at least offer some caution, and that is the health risk posed by a dead or decomposing body in the water.  And I know there have been a couple of reports that this is a setup for a large disease.  We've had our people look at that, and they don't believe that that is a major health risk situation, that alone.  Certainly it's possible that disease could emerge from a dead body, but that is -- it's not a major concern for us.  Far more likely is disease that could be passed among the living in the way of infectious disease from one person to another.

 

            Yes?

 

            Q     Could you remind me again how many military doctors there are in the region now and how many more you're considering putting in the region?

 

            DR. WINKENWERDER:  I don't have a number for you.  We can get that for you on the number in the region.  And we don't have a specific number on who might be deployed because we're awaiting those final assessments.   Message is that we're prepared and we're ready. We've looked at the situation, the assessments are coming in, and we want to work with -- plan to work with very closely nongovernmental organizations, with host nations and with others, and work in a very cooperative way and do the things that we're most effective at doing.

 

            Q     Do you anticipate calling anyone out of the Reserve units to get medical personnel for --

 

            DR. WINKENWERDER:  No, I don't anticipate that now.

 

            Yes?

 

            Q     On the portable hospitals, am I correct in assuming that the infrastructure in Iraq is now sufficiently built that they're not going to be called into that theater in the event of another increase in the insurgency?

 

            DR. WINKENWERDER:  I'm not sure I --

 

            Q     Is there any danger that the hospital sets that are being refitted right now and might be sent over to Asia could be pressed into service for Iraq?  Will -- or are there hospitals set up in Iraq --

 

            DR. WINKENWERDER:  Is there a problem with competing requirements?  And the answer would be no.

 

            Q     Because your Iraq infrastructure is strong enough?

 

            DR. WINKENWERDER:  We're sufficiently supplied and capable and have all the equipment we need to conduct all the medical operations in Iraq and Afghanistan.

 

            MR. WHITMAN:  Let's take one more here.

 

            Q     Is there -- yeah, since the September 11th attacks of 2001, there's been a lot of speculation or concern about a possible human attack of this -- that could end up with casualties of this scale. Have you developed any response capabilities since then that are going to be able to come into play with this?

 

            DR. WINKENWERDER:  Are you speaking about a domestic disaster?

 

            Q     Well, yeah, domestic.  Yeah.  I mean, it was focused for domestic, but this is clearly an international disaster.

 

            DR. WINKENWERDER:  Right.  Well, we continually plan and work together with the civilian authorities, principally the Department of Health and Human Services and the Department of Homeland Security.

 

            And I would just take the opportunity to say that quite a lot of exchange has gone on, mutual learning, mutual work, establishing communication relationships and plans for how to deal with a mass casualty event in the United States.  There is a national response plan that comes out of the whole federal government.  There's a medical annex or piece to that.  We've been quite involved in working with these other authorities to develop that.  And so from my perspective, we are better prepared for such an event than we've ever been.

 

            And so we certainly obviously don't -- hope that there's never such an event, but I think this event and the great unfortune that's happened in Southeast Asia ought to give all Americans a sense for just how significant a major disaster could be.

 

            And our hearts and thoughts go out to the people of that whole region.  We're here to help.  We want to help.  We're prepared to help.

 

            Thank you.

 

            Q     Thank you. 

 

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