SHELTER DEVELOPMENT PROGRAM The shelter survey has defined opportunities to add a large amount of low-cost shelter space to the national inventory by identifying both the location of existing shelter space and potential improvements to add shelter. Most of the municipalities and counties in the country are now in a position to know where new shelter space is needed and how to create it at relatively low cost. Federal financial help is needed to take full advantage of the survey results. This is the next logical step in the progressive development of a moderate civil defense program. It is proposed to authorize and make available Federal financial contributions not exceeding $103.3 million during fiscal year 1965 to stimulate communities to add to locally available fallout shelter space in the buildings of schools, hospitals, State and local governments and other nonprofit institutions. It is estimated that this amount would be fully used up by the lowest cost opportunities to create new shelter space. Federal financing would be limited to an average of $2.50 per square foot or actual cost, whichever is lowest ($25 per person sheltered). Payment up to $4 per square foot would be allowed for facilities included in a combined project when the average of the combined facilities is $2.50 per square foot or less. Only costs allocable to the creation of new shelter space would be allowed. tually all of the shelter space thus created would be primarily used for peacetime purposes and only incidentally as public shelters. Shelter for over 4.4 million persons is anticipated. Vir The limited amount of the Federal payment, combined with intensive servicing, education, and training of architects and engineers, is expected to stimulate increasing ingenuity in finding the lowest cost methods of meeting local shelter deficiencies. The new shelter space thus developed, while small in comparison to the results of the survey, will be of special importance in meeting the national shelter requirement. From this new shelter will come the first experience with an austere program of Federal financial assistance, depending on local initiative, planning, and in some cases, local financial participation. Planning for the best utilization of new and existing shelters will strengthen the organization of civil defense and the organization of community effort to provide minimal protection for the entire community. The result of a year of such experience will provide a basis for more accurately assessing the requirements of Federal financial assistance. The chart below is an estimate of how $103.3 million would be applied to the three main categories of low-cost opportunities to create new shelter. The chart on page 740 shows the planned fiscal year 1965 program for incorporating fallout shelter through modifications to existing Federal buildings. First attention will be given in fiscal year 1965 to exploiting low-cost opportunities identified by national shelter survey for increasing shelter capacity of existing structures located in or near those communities where the population to be sheltered exceeds the shelter space found through the survey. The minor improvements proposed include 1. Ventilation improvements: By installation of ventilation packages or improvements of existing ventilation systems, adequately shielded areas in many basements can be brought up to minimum OCD ventilation stand ards. It is proposed to use $8.6 million of fiscal year 1965 funds for this purpose, providing 745,000 additional shelter spaces at $12 per space average cost. 2. Shielding improvements: Many areas contain structural characteristics which generally provide adequate shielding, but fail to meet OCD standards because of minor deficiencies, such as unprotected openings, which can be readily corrected. It is proposed to use $7 million of fiscal year 1965 funds to correct these deficiencies, providing 308,000 additional shelter spaces at $23 per space average cost. In addition to the modification funds proposed in the OCD budget, the construction agencies of the Federal Government have included $3,581,000 in their authorization proposals and budgets for shelter space in 59 new construction projects proposed for fiscal year 1965. The authorizations and appropriations requests are based on the permissive executive branch policy of several years standing that shelter protective features, where appropriate and needed, shall be included as an inherent part of the design and construction process for new Federal facilities. RESEARCH AND DEVELOPMENT Research is a basic requirement for civil defense planning and operations and for anticipating future program requirements. In an era of rapidly changing weapons technologies and delivery systems, it is essential that civil defense countermeasures keep pace. Research provides knowledge and guidance for development of improved methods of protection, increased economy of hardware and operations, postattack recovery measures, and an integrated civil defense system. Research and development effort during the fiscal years 1964 and 1965 is designed to continue and in most cases, to expand those efforts from previous years which are both important and have shown promise of worthwhile results. In fiscal year 1964, modest increases have been made over the amounts programed in fiscal year 1963 for protection studies, fire research, radiological studies, and civil defense systems analysis. Other areas of effort continue at approximately the same level with some showing small increases and others small decreases. In fiscal year 1965, it is proposed to increase the total research and development effort on civil defense in consonance with program planning and associated organization in the fiscal years 1965-69 time frame. Effort on all problem areas will be increased with preferential increments assigned to systems analysis and integration, and to post-shelter hazards, countermeasures, and operations. Emphasis in shelter and support systems research will be given to problems expected to be serious obstacles to completion of the terminal phases of the action programs. HEALTH, EDUCATION, AND WELFARE STATEMENT OF DR. GABRIEL P. FERRAZZANO, CHIEF, DIVISION OF HEALTH MOBILIZATION, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY DR. JAMES M. HUNDLEY, ASSISTANT SURGEON GENERAL FOR OPERATIONS; ARNOLD H. DODGE, ASSISTANT CHIEF, DHM; RICHARD W. BOWMAN, EXECUTIVE OFFICER, DHM; ROBERT J. WALLACE, FINANCIAL MANAGEMENT OFFICER, DHM; AND JAMES F. KELLY, DEPARTMENT BUDGET OFFICER HEW PROGRAM AFFECTED Mr. FERRAZZANO. Right. We benefit from the same Federal-State assistance program as far as personnel is concerned, and if this is not forthcoming, of course, it would affect several of the State employees in the health mobilization program. Some of the States receive a limited amount of Federal assistance money to support health activities. Senator MAGNUSON. In other words, your program there would be affected by what happens here? Mr. FERRAZZANO. Yes. We do not have a Federal-State assistance appropriation of our own. Matching funds for health are included in this old appropriation. Senator MAGNUSON. It would be included in this ratiowise? Mr. FERRAZZANO. Right. (The prepared statement of Mr. Ferrazzano follows:) STATEMENT BY CHIFE, DIVISION OF HEALTH MOBILIZATION, ON EMERGENCY HEALTH ACTIVITIES Mr. Chairman and members of the committee, thank you for the opportunity to present the Public Health Service program for the operation of the emergency medical stockpile and the provision of emergency health services, which includes assistance to States in the development of their disaster preparedness capabili MEDICAL STOCKPILE GOALS Current tabulations from the 1963 study, "The Nuclear Attack Hazard in the Continental United States," compiled by the National Resources Evaluation Center, show that the attack assumptions used in the calculation of medical stockpile goals in 1959 are still valid. The need remains for pre-positioning 9,500 civil defense emergency hospitals in communities throughout the United States and maintaining bulk backup reserves of essential medical items at secure central stockpile depots for equitable distribution, postattack, to areas of indentified deficiency. Since the medical stockpile program started in 1953, 2,820 civil defense emergency hospitals have been authorized, approximately onethird of the goal. CIVIL DEFENSE EMERGENCY HOSPITAL PROGRAM During 1964, the civil defense emergency hospital program is being upgraded in three ways: 1. Plans are being completed for replacing all deteriorated materials known to exist in pre-positioned emergency hospitals. Maintenance of the pre-positioned hospitals in a state of constant readiness is essential to community disaster preparedness. 2. Acquisition of supply additions from funds appropriated for the fiscal year will enable attainment of about one-half of the goal of bringing older civil defense emergency hospitals from a 3- to 4-day operational capability to a 30day capability. The need for this increased self-sufficiency at the community level is based on the high probability that, following an enemy attack, communities would be cut off from outside supply sources and that severe losses in transportation capability could be expected. 3. An increasing number of community plans for the utilization of the civil defense emergency hospitals are being developed. Community plans may be structured around either a plan to use the civil defense emergency hospital to provide the supply and equipment basis for expansion of an existing hospital or a hospital-like facility, or to establish a new and separate 200-bed general medical and surgical hospital in a suitable building such as a school, recreation center, armory, or church. CIVIL DEFENSE EMERGENCY HOSPITAL TRAINING During the current fiscal year, major program emphasis is being placed on the development of plans for the use of the civil defense emergency hospitals in all communities where they are located. Placing a civil defense emergency hospital in a community serves little purpose unless there is a plan for its use and personnel are trained in its operation in the postattack situation. Because of the recognized necessity for training community personnel in the use of the civil defense emergency hospital, three training procedures in this program area have been instituted: 1. Training centers were established to instruct hospital and health department personnel in what the civil defense emergency hospital is, how it is set up and how it is used. For example, the training center established in Massachusetts in September 1963 has to date given instruction to over 500 staff members from existing hospitals in the northeastern area of the United States. 2. Prototype emergency hospital training units which can be easily transported from community to community and contain a representative selection of items in the full-scale civil defense emergency hospital have been developed and are being field tested to ascertain their effectiveness in training personnel at the local level in the operation of the hospital. As soon as the evaluation of these prototype units is completed, necessary changes in design will be made and additional units will be procured. 3. During 1964, manuals and guides to assist communities in planning and training for the operation of civil defense emergency hospitals are being developed and distributed. These include: "Checklist for Deveoping a Civil Defense Emergency Hospital Utilization Plan" and "Establishing the Civil Defense Emergency Hospital." Specific manuals on the operation of the central supply section, the X-ray section, the laboratory section, and alternate power equipment are ready for publication. After communities have developed plans for the use of the civil defense emergency hospitals, they are encouraged to conduct periodic test exercises. During 1963, more than 50,000 individuals participated in a total of 145 reported civil defense emergency hospital exercises. It is estimated that twice this number of persons will participate in civil defense emergency hospital exercises to be conducted during the current fiscal year. National organizations have shown increasing interest in participating in these exercises. INSPECTION PROGRAM The continuation of the civil defense emergency hospital inspection program during 1964 is showing improved storage conditions, correction of a large proportion of the deficiencies reported on the prior inspection, strengthening of security procedures, and a significant increase in community awareness of the emergency hospital objectives. During the current fiscal year, prepositioned hospitals that had been found, as a result of the 1963 inspection, to be in poor storage sites are being moved to suitable locations. Concurrently, additional storage space is being sought to accommodate supply additions for the older prepositioned hospitals. The difficulty of finding additional suitable space has delayed the shipping of some of the supply increments. PREPOSITIONING PROCEDURE Allocation schedules by State have been worked out for the 750 civil defense emergency hospitals approved during 1962. Storage sites are being inspected and evaluated. If the locations for prepositioning the hospitals meet the Federal storage criteria, including consideration of attack logistics, release of the hospitals will be approved and shipment made. MEDICAL SUPPLY DEPOTS Paralleling the upgrading of civil defense emergency hospitals, high priority has been given to the replacement of deteriorated material in the medical stockpile depots. Funds provided in 1964 will permit the replacement of a portion of the deteriorated items, but an accumulation of about $18 million worth of deteriorated material still remains. A quality control program evaluating all stockpile material is in continuous operation. No item is destroyed until thorough assay has determined that it has no usability. Progress has been made in developing stock rotation programs with medical supply depots of other Federal agencies and the implementation of these programs is expected in the near future. Attempts will be made to find other areas where rotation is feasible and economic. UNDERGROUND STORAGE Two underground medical stockpile depots are now in operation. A third underground facility is being developed and will be activated in 1964. Selection of two additional underground locations is now in process. REGIONAL AND STATE ASSIGNMENTS Public health advisors assigned to regional offices and to 46 States and the District of Columbia continue to increase awareness of communities for the need of emergency disaster plans in many areas where plans did not previously exist. Public health advisors guide and assist communities to (1) institute emergency health plans; (2) conduct training courses in health mobilization activities; (3) maintain civil defense emergency hospitals in a continuous state of maximum usefulness; (4) obtain program support and assistance from medical associations. allied medical societies, and civic groups; (5) determine needs and expand emergency resources of health manpower and medical supplies; and (6) prepare local informational and instructional materials. The achievements of the public health advisors are attained through extensive personal contacts throughout the regions and States. MEDICAL SELF-HELP During 1964, the number of persons trained in medical self-help has already increased significantly. The medical self-help course has been introduced into the high school curriculum in a majority of the States. The American National Red Cross has made medical self-help an instructional course augmenting its |