Since the terrorist attacks of Sept. 11, 2001, millions in federal tax dollars have flowed into Maine to improve preparedness for all manner of disasters and public health emergencies. The money has come primarily to two state agencies, the Maine Center for Disease Control and Prevention and the Maine Emergency Management Agency, which have sent it to regional, county and local agencies. The funding has been invested in equipment, supplies, training and communications systems for events ranging from hurricanes and blizzards to pandemic influenza, mass-casualty transportation disasters and bioterrorism.
So far, the feared terrorist attacks have not materialized. Some of the equipment and supplies are gathering dust in storage. Others are in daily use but already beginning to need maintenance or updating. And a few, like an ill-fated hovercraft rescue boat purchased for the cities of Bangor and Brewer, turn out to have been poor investments. Nonetheless, public health, public safety and emergency response officials say the investments have paid off in important ways.
Among many other examples, the post-9-11 funds helped the state deal with arsenic poisoning at a church in New Sweden, widespread flooding in York County, a warehouse fire in Oxford County, a ski lift malfunction at the Sugarloaf resort, and the H1N1 influenza outbreak in 2009.
‘Maine simply did not have a public health infrastructure’
One place where the federal spending has made a tangible difference is in public health.
“That money has made all the difference in the world,” said Dr. Dora Anne Mills, who served as director of the Maine Center for Disease Control and Prevention from 1996 until December of last year. She is now vice president for clinical affairs at the University of New England.
The Maine CDC has received about $82.5 million since 2004 for general preparedness and another $9 million just for H1N1.
“The main objective was to prepare for public health emergencies by way of strengthening the public health infrastructure,” Mills said of the money that went to the Maine CDC. Before the Sept. 11 attacks, she said, “Maine simply did not have a public health infrastructure.”
While there were dozens of hospitals, medical practices, nonprofit agencies and emergency responder groups scattered across the state, there was no centralized coordination of services, no collaborative planning for disasters or disease outbreaks, no system for establishing a chain of command and no capacity to respond coherently to a large-scale problem.
Mills remembers attending a multistate pandemic influenza planning session in the late 1990s and being told that the most essential tool was a phone list of public health officers in every region of the state.
“It was a stunning realization that if we had a public health emergency, I didn’t have people to call,” she said. “I’m sure I turned pale.”
The Sept. 11 attacks changed all that.
Public health money started flowing to states late in 2001. Federal directives required states to improve the early detection of bioterrorism and infectious disease outbreaks, including enhanced laboratory testing and electronic reporting systems.
States also were required to improve planning so that organizations were able to mount a coordinated response to disasters and outbreaks. Collaborating agencies in Maine included Maine CDC, MEMA, Maine Emergency Medical Services, the Department of Agriculture, the Department of Inland Fisheries and Wildlife, the Maine Hospital Association, the Maine Primary Care Association, and the public health programs in Portland and Bangor.
Finally, states had to use the federal public health funding for education and training. In Maine, this has included numerous in-the-field disaster drills, frequent “table-top” planning sessions and training opportunities with newly purchased equipment and technologies.
Arsenic poisoning, H1N1 and Hurricane Irene
As early as April 2003, when one person died and 15 others were seriously sickened by a case of deliberate arsenic poisoning in the tiny Aroostook County farming community of New Sweden, the Maine CDC was in good shape to respond because of federal bioterrorism funding, Mills said.
The coordinated effort included the on-the-ground intervention of experts who recognized the symptoms of heavy-metal poisoning and were able to obtain the antidote within hours. Expedited laboratory testing confirmed arsenic before the end of the day. Community members and local health care providers were provided with information and support throughout the incident and its aftermath.
Funding also has been channeled to hospitals, ambulance services and other direct providers of health care services and has been used to set up caches of emergency medications across the state, including antibiotics, antivirals and antidotes.
At the Northeastern Maine Regional Resource Center in Brewer, director Kathy Knight said improved public health and emergency preparedness was in evidence as recently as the recent brush with Hurricane Irene, which had been downgraded to a tropical storm by the time it blew through Maine on Aug. 28.
Knight, who has been working with regional groups since 2003, said planning also paid off during the 2009 H1N1 influenza crisis, when thousands of area residents received vaccines at large-scale immunization clinics organized by local organizations and volunteers.
“We had been practicing for [pandemic influenza] since 2004 with trial clinics for seasonal flu,” she said. “Each year it was about doing it faster and better.” That practice made it possible for more than 5,000 people to get the H1N1 vaccine on the first day of the public clinic at the Bangor Civic Center. There were some glitches, such as the simultaneous arrival of busloads of students from area schools and the long line of people who stood outside in the frigid morning air on the first day. But by the second day, the line had been moved inside and the crowd was moving more smoothly though the site.
Knight said there always are preparedness lessons to be learned and questions to be answered. One of her concerns is that some of the equipment and supplies purchased with post-9-11 funds are in storage and may be outdated if and when they are needed.
For example, hospitals in the Bangor region have acquired kits that allow a regular hospital room to be converted to a negative-pressure isolation room; sealed, clear-plastic body-sized pods for transporting patients with highly infectious diseases; an inflatable auxiliary hospital ward; and high-tech battery-operated personal respirators for health care workers.
“We know we need to have [this equipment] … but it sits and it waits,” Knight said. “Hospitals may not be able to repurchase and replace [items] as the technology changes. … But you have to get it, you have to have it on hand, or else you’re unprepared.”
Post-Sept. 11 dollars also have been used to beef up states’ disaster preparedness.
Since 2002, the Maine Emergency Management Agency has received about $128 million from the Department of Homeland Security. A great deal of that amount has been invested in upgrading communications equipment for police, fire and other emergency response units across the state, according to MEMA director Robert McAleer.
“We bought an awful lot of radios,” McAleer said — also towers and base stations, along with pagers, surveillance cameras, satellite phones and other devices. The investment in communications systems has assured that nearly all emergency responder groups can communicate with each other, he said, as well as bringing Maine into compliance with federal narrow-band requirements that will take effect in 2013.
MEMA also used funding to purchase four self-contained “mobile command centers” — RV-like vehicles loaded with the latest in communications and surveillance technology, one each assigned to the Maine Forest Service, the Maine State Police, the York County Emergency Management Agency and the city of Bangor.
The mobile command centers, which cost about $331,000 apiece, are called into use regularly. One was deployed to the site of a major fire at a paper warehouse in South Paris in 2009 to coordinate emergency responders from a dozen surrounding communities. In coastal York County, plagued by flooding in recent storms, the command center has become a familiar sight. This summer, one has has been stationed on and off at the Bangor Waterfront Concerts site, keeping a digital eye on the fun-seeking crowds and ready to diffuse any trouble spots.
MEMA has allocated funding each year to maintain the vehicles and upgrade the advanced technology systems they carry.
Homeland Security funds also have been invested in bricks-and-mortar upgrades to county-level emergency operations centers, as well as a brand new state-level center in Augusta with a price tag of about $445,000.
Some purchases have not been so well founded.
For example, in 2006, MEMA funneled $59,000 to the cities of Bangor and Brewer to purchase an ill-fated hovercraft to be used in water rescues and other emergency scenarios, but it suffered a series of propeller-related mishaps and was retired last year. At last word, it had been sold for $6,000 to a private individual in New Hampshire. The Bangor Fire Department is in negotiations now to purchase a more versatile 25-foot aluminum boat at an anticipated cost of about $184,000 using post-9-11 funding from MEMA.
Ten years out from 9-11, funding is likely to decrease
Faced with the likelihood of decreased funding in coming years, McAleer said MEMA will continue to strengthen longstanding ties to its county-level partners as well as new collaborations with local law enforcement, public health and other groups. While continued big-ticket spending won’t be possible, MEMA is committed to maintaining the strengthened preparedness infrastructure enabled by the post-9-11 funds, he said.
At the Maine CDC, director of public health emergency preparedness Kristine Perkins said Maine has made great strides in building a working public health system after Sept. 11. Though funding is likely to flatten out now — until the next big crisis, at least — she said the Maine CDC will continue to expand digital communications and disease reporting technology, maintain existing investments in equipment and supplies, and strengthen its partnerships with public and private organizations statewide.
“This type of money is often event-driven,” she said. “Something bad happens, and they throw money at it.”
That money, Perkins said, has allowed Maine, other states and the nation as a whole to significantly strengthen essential public health and emergency preparedness programs as they prepare for the future.