Remarks as prepared; not a transcript

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
United States Surgeon General
U.S. Department of Health and Human Services

Nashville Surgical Society

Tuesday, October 7, 2003

"Prevention and Preparedness: Medical Reserve Corps Serving America"

Thank you, Richard, for that kind introduction. [Richard B. Terry, M.D., President of Nashville Surgical Society]

Itís great to be here among friends and colleagues, fellow surgeons. As Richard mentioned, I am a trauma surgeon ó actually Iím a "recovering surgeon," but Iíll get to that later.

I was talking with my friend Senator Bill Frist about coming to Nashville, and he said, you know, Rich, youíve been around the country a few times now as Surgeon General, who do you think are the three best surgeons in the country?

Of course, when you ask any surgeon that, theyíre going to have trouble coming up with the other two names.

President Bush has assembled an incredible team. . . from Vice President Cheney to my boss Secretary Tommy Thompson to Secretaries Powell and Rumsfeld. Itís an honor for me to be a part of President Bushís team.

I have also had the honor of working with Dr. Frist, who understands the need for preparedness better than most.

Itís a tremendous privilege to serve at this level, to sit down with President Bush and Secretary Thompson and work on issues affecting the health of the American people.

And to think that a little over a year ago, I was just another guy in Tucson, Arizona, working as a trauma surgeon, a professor, and a public health officer.


When President Bush and Secretary Thompson nominated me to be Surgeon General, they asked me to focus on three priorities to maintain and improve the health of the American people.

Iím fortunate to work with these two leaders who understand the importance of health. Two leaders who insist that evidence and the best science always guide our policy and what I do.

All three of my priorities are evidence-based. They are:

  • First, Prevention. ó What each of us can do in our own lives and communities to make ourselves and our families healthier.
  • Second, and new to the Office of the Surgeon General, as none of my 16 predecessors had to deal with these issues: Public Health Preparedness. We are investing resources at the federal, state, and local levels to prevent, mitigate, and respond to all-hazards emergencies.
  • Third, Eliminating Health Care Disparities.
  • Prevention

    As I mentioned, I often tell people that Iím a "recovering surgeon."

    I say that because I strongly believe, and many of you may agree, that at times surgery can be considered a barbaric process, especially in light of the new scientific knowledge that is rapidly evolving.

    If a patient has an injured or diseased organ, or a cancer growing in her body, what do we surgeons do?

    More often than not, we cut her open, remove the organ or the cancerous area, and clamp off the bleeding. All the while subjecting her body to trauma, shock, and the possibility of infection.

    But thanks to biomedical research and the great imaginations of scientists in academic, private, and federal laboratories, treatments are being developed that will make some surgery a thing of the past.

    We are already beginning to screen genetic information and target appropriate interventions to help people avoid physical and mental conditions and diseases years before their first symptoms would have otherwise appeared.

    This is the future of medicine. Itís exciting to be alive right now, and to be able to look forward to this exciting future. We are on the brink of our next major evolutionary wave in medicine.

    Whereas we used to struggle almost exclusively with infectious diseases, in terms of numbers, chronic illnesses have replaced infectious diseases in their lethal force.

    The difference is that through behavior and lifestyle choices, individuals can exert more control over the occurrence and outcome of these chronic illnesses.

    Most chronic diseases that Americans suffer and die from today are preventable through diet, exercise, and avoiding risky behaviors.

    That is the prevention agenda that President Bush, Secretary Thompson, and I are passionate about spreading across America. And we need your help, with your patients and in your communities.

    Public Health Preparedness

    The second priority that President Bush and Secretary Thompson asked me to focus on as Surgeon General is preparedness, and I want to ask you to get involved in this effort.

    We must build a homeland defense and a public health infrastructure that can identify, mitigate, or control any weapons of mass destruction used by our enemies to attack America.

    This wonít be easy. But it is possible. And weíre doing it.

    President Bush has asked us to develop vaccines to fight anthrax and other deadly diseases, and to help states and communities train and equip our heroic police, emergency medical responders, and firefighters.

    We are doing all these things, and we are developing surge capacity in our already overburdened hospitals.

    President Bush and Secretary Thompson increased the federal investment in public health emergency preparedness by a factor of 15 from fiscal year 2001 to fiscal year 2003. The funding for public health preparedness in the past two years is the largest one-time investment in our nationís public health system. Ever.

    And President Bush and Secretary Thompson are continuing to strengthen our nation. Under the Presidentís budget request for fiscal year 2004, federal investment would increase again, with establishment of "BioShield," a new program for expanding medical countermeasures to possible terrorist threats.

    Through this additional funding the federal government will partner with state and local governments and research laboratories across the nation to strengthen our response network and expand the availability of vaccines and drugs, while protecting our food supply and enhancing research.

    But the government cannot do it all. If weíre attacked again, our first line of response preparedness may very well be in places like Tulsa, Oklahoma; St. Louis, Missouri; or Nashville, Tennessee.

    All disasters are local events. America is a huge nation, both in terms of population and physical size. Terrorists could strike anywhere, anytime.

    The reality of this is that today, there will be no special forces elite unit immediately available from the federal government to contain a biological or chemical attack.

    Instead, local EMS, police and fire units will be the first to respond. In the case of bioterrorism, hospital personnel will be on the frontlines as the first point of contact for casualties, as we saw for anthrax.

    Local health professionals will need to be prepared to determine quickly if the event is a terrorist attack, or another type of threat.

    Medical Reserve Corps

    Thatís one reason Iím relentless about speaking with health professionals like you. No matter our specialty, we all have the same mission: to save life and to defend human health against all threats.

    Today, that means organizing and joining together in ways most of us didnít anticipate when we became surgeons.

    I encourage you to start or join your local Medical Reserve Corps. MRCs are the health component of President Bushís volunteer effort USA Freedom Corps, and the one I lead as Surgeon General.

    The Medical Reserve Corps is administered by the Office of the Surgeon General, which offers technical assistance to all MRC communities and awards small grant funds to a limited number of communities to "seed" local MRC unit development.

    In the past year since the MRC was established, over 65 communities have formed local units. Up to 120 additional MRCs will be funded very soon.

    You can learn about the MRCs at

    MRC units are formed by locally based health volunteers who can assist their communities during local emergencies ó such as an influenza epidemic, a chemical spill, or an act of terrorism ó or in day-to-day community public health needs.

    MRC Units across the nation have tapped into relationships with local emergency management offices.

    Many MRC Units are coordinating their efforts with organizations to address all hazards, including bio-terrorism issues, and with the Metropolitan Medical Response System.

    Of those MRC Units that have joined with hospitals, plans are underway to use MRC volunteers during disaster drills (acting the parts of victims) as a way to gradually integrate them into service roles during an actual disaster.

    Some communities have already integrated MRC volunteers in emergency response drills that involved mass dispensing of pharmaceuticals.

    A number of MRC units are considering non-terrorism and non-disaster incidents, too. Most are focusing on mass administration of vaccinations as their first priority and have plans for other non-crisis activities.

    Several MRC units are training their volunteers to conduct epidemiological surveys next time there is a specific need identified by local public health officials, as happened when West Nile virus first became a concern in this country.

    MRC units are also recruiting health professionals as interpreters for their local, non-English speaking populations. This includes providing support during natural or man-made disasters to first responders working with non-English-speakers.

    And these MRC volunteers are already starting to provide preventive and primary health care services in these communities. These medical volunteers are trained to complement and assist full-time emergency first responders during large-scale disasters.

    The Medical Reserve Corps nationally are critical to our efforts on preparedness. They provide assistance and depth to the good emergency teams already in place.


    The task of readying ourselves is not easy. Already it has cost billions of dollars, and thousands of man-hours. While the price of preparedness may be great, the price of not being prepared is even greater.

    Thereís a historical parallel to the situation we now face. We have the benefit of looking back to World War II with 20/20 hindsight. In fact, as those who lived through that time will tell you, it was by no means certain that the Allies would prevail.

    President Roosevelt did his best to try to keep America out of the war before Pearl Harbor, because he knew the American people, tired from the Great Depression, were not prepared to face it. But then, on December 7, 1941, Pearl Harbor was attacked and more than 2,000 soldiers and civilians were killed. The American people decided it was time to fight. At that point the threat was literally at our doorstep, and time was short.

    We had to rapidly convert our civilian industrial base to the job of building the weapons we needed to fight the war. In other words, we had to work full speed to catch up with our enemies. The historical parallels between then and now are striking.

    And 50 years from now when our grandchildren ask us about this time and the terrorist threat, we will be able to say, we responded to the call, and met the challenge of our time.

    As physicians serving a nation in the midst of another effort to protect the liberty of freedom-loving people, we must summon the greatness of generations past and grasp the hope of future generations, and ask them to guide us and protect us as a nation.

    May our beacon of liberty forever shine and may our hope in freedom never wane.

    God bless you, and may God continue to bless the United States of America.


    Last revised: January 9, 2007