to respond in the event of a disaster. However, they are also the least supported in fulfilling this role among all public safety personnel nationwide, lacking both adequate training and proper equipment for disaster response. According to New York University’s Center for Catastrophe Preparedness and Response, more than half of emergency medical technicians (EMTs) and paramedics have received less than 1 hour of training in dealing with biological and chemical agents and explosives since the terrorist attacks of September 11, and 20 percent have received no such training. In 25 states, moreover, fewer than 50 percent of EMTs and paramedics have adequate equipment to respond to a biological or chemical attack (Center for Catastrophe Preparedness and Response NYU, 2005).

In the aftermath of September 11, President Bush promulgated a set of Homeland Security Presidential Directives designed to ensure a coordinated response to a national emergency. But the absence of effective federal, state, and local coordination following Hurricane Katrina demonstrated just how far we have to go in this regard. The integration of emergency care, trauma systems, and EMS into the overall disaster planning process has proven even more problematic. EMS providers and state and local EMS directors are often excluded from critical disaster planning efforts (Center for Catastrophe Preparedness and Response NYU, 2005). Federal programs dealing with medical aspects of disaster preparedness are dispersed among multiple agencies, including the Department of Homeland Security (DHS), the National Highway Traffic Safety Administration (NHTSA), and the Department of Health and Human Services (DHHS). And there are no EMS-specific standards and guidelines for the training and equipment necessary to respond effectively to a terrorist attack or disaster (Center for Catastrophe Preparedness and Response NYU, 2005).

This lack of coordination is reflected in the haphazard funding of preparedness initiatives. EMS and trauma systems have consistently been underfunded relative to their presence and role in the field (Rudman et al., 2003; Center for Catastrophe Preparedness and Response NYU, 2005). Recent audits have found that EMS systems have received only 4–6 percent of federal disaster preparedness funds from DHS and DHHS (GAO, 2003b; Center for Catastrophe Preparedness and Response NYU, 2005). One recent survey revealed that 58 percent of responding ambulance agencies had not been allocated any federal funding for terrorism preparedness. Nearly 60 percent stated that their organization had not benefited from indirect access to items purchased with federal funds. Fully 82.8 percent of respondents had encountered either extreme difficulty or difficulty in obtaining federal funding and access to items purchased with federal funding (AAA, 2004).

This chapter reviews the array of threats faced by the United States and describes the medical responses to recent disasters both here and abroad.

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