Rothstein Associates Inc.

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

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.

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Contents


EXECUTIVE SUMMARY
Charge to the Committee
Chemical, Biological, and Radiological Weapons
The MMRS Program
Existing Emergency Response Systems
Other Federal Programs to Strengthen Local Capabilities
Feedback to OEP on Program Management
Feedback to OEP on Program Success
Closing Remarks

1INTRODUCTION
Chemical, Biological, and Radiological Terrorism
The MMRS Program
Charge to the Committee
Methods of the Present IOM Study
Organization of This Report

COMMUNITY EMERGENCY MANAGEMENT AND AVAILABLE FEDERAL ASSISTANCE
Emergency Management Terminology
Emergency Management in the United States
Local Emergency Management
State Assistance
The Federal Emergency Response Plan
The National Contingency Plan
The Federal Radiological Emergency Response Plan
Terrorism-Specific Federal Support Teams
Conclusion

FEDERAL EFFORTS TO INCREASE STATE AND LOCAL PREPAREDNESS FOR
TERRORISM
ODP Programs
FBI Programs
CDC Programs
FEMA Programs

METROPOLITAN MEDICAL RESPONSE SYSTEM PROGRAM CONTRACTS
Functional Areas Covered
Products Demanded
Contract Deliverable Evaluation Instrument

MEASUREMENT AND DATA COLLECTION IN
EVALUATION
Evaluations of Various Types
Management Functions of Evaluations in the MMRS Program Context
Summative and Formative Uses of Various Evaluation Types
Why an Adequate Written Plan Is Not Sufficient Assurance of Preparedness
Evaluation Measurement for Low-Frequency, High-Stakes Events
Evaluation Measurement: Performance Measures and Proxies
Criteria for Selection of Evaluation Methods

PREPAREDNESS INDICATORS
Existing Standards
Existing Assessment Tools,
Performance Measures Versus Preparedness Indicators

FEEDBACK TO OFFICE OF EMERGENCY PREPAREDNESS ON PROGRAM
MANAGEMENT
OEP Help to MMRS Program Contractors
Survey for MMRS Program Contractors

FEEDBACK TO OFFICE OF EMERGENCY PREPAREDNESS ON PROGRAM SUCCESS
Essential Response Capabilities
Preparedness Indicators for Evaluation of Written Submissions, On-Site Inspection,
and Observed Exercises
Preparedness Criteria
Exercises and Drills
Site Visits and Peer Evaluators
Scenario-Driven Group Interaction
Summary

CLOSING REMARKS
Strategic Uses of Evaluation Data: Implementing the “Layering Strategy”
Committee Critique and Suggestions for Program Amendments

REFERENCES

APPENDIXES
A Committee and Staff Biographies
B Selected Information About Federal Chemical, Biological, Radiological, Nuclear
Consequence Management Response Teams
C Metropolitan Medical Response System Program Cities
D 2000 MMRS Contract Deliverable Evaluation Instrument
E Preparedness Indicators for Metropolitan Medical Response System Program
Contract Deliverables,
F Scenarios and Discussion Materials for Use on Site Visits

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LIST OF TABLES, FIGURES, AND BOX

TABLES

1-1 Chemical Agents and Their Effects
1-2 Biological Agents, Effects, Characteristics, and Medical Countermeasures
8-1 Preparedness Indicators and Mode of Evaluation of MMRS Plan Elements Relevant
to Each of 23 Essential Capabilities

FIGURES


ES-1 Relationships among essential capabilities, preparedness Indicators, preparedness
criteria, and data collection methods,
1-1 Flow chart of probable actions in a chemical or overt biological agent Incident
1-2 Flow chart of probable actions in a covert biological agent incident
2-1 Key federal consequence management response teams for CBR terrorism
5-1 MMRS program participants, policy instruments, development activities, emergency
capacity and follow-up activities,
5-2 Accountability relationships for federal grantees and Grant-making agencies

BOX

ES-1 Example of Preparedness Indicator for One Essential capability, First Responder
Protection

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2002, 310 PAGES. Order #DR704.
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