Medical Direction and DHS
The Department of Homeland Security (DHS), the newest federal secretariat, has, since its creation, been at the tip of the spear of U.S. efforts in domestic preparedness. Jeffrey Runge, MD, was appointed as chief medical officer for DHS in July 2005 when, as part of a departmental reorganization, Secretary Michael Chertoff created the position to help address biological and chemical terrorism issues. Since then, Runge and his staff have been under a public and professional microscope.
Previously the administrator at the National Highway Traffic Safety Administration (NHTSA), Runge led a staff of 700 on a mission to reduce the national highway death rate. During his tenure, NHTSA helped to reverse the alarming trend of yearly increases in driving fatalities (especially those related to impaired operators), raised public safety selt belt usage from 71% to 82%, and decreased the child highway fatality rate to its lowest level since record-keeping began. Runge is credited with stimulating the redesign of SUVs to become more resistant to rollover crashes and less damaging when involved in crashes with passenger cars. He also oversaw the revitalization and enhancement of the country's highway traffic data systems.
Prior to joining the Bush administration, Runge was director of the Carolinas Center for Injury Prevention and Control and assistant chair of the Department of Emergency Medicine at the Carolinas Medical Center, where he taught emergency medicine for 17 years. While he taught in North Carolina, his research interests included traffic injury causation and countermeasures, as well as the treatment of shock and acute brain injury. A graduate of the University of the South and the Medical University of South Carolina, he maintains the position of adjunct professor of Emergency Medicine at the University of North Carolina-Chapel Hill.
This month, I had the privilege of speaking with Runge about his position with DHS, the challenges and responsibilities he has taken on, and the future of EMS at the federal level.
As the first ever chief medical officer for DHS, what have been your goals in this department's inaugural administration?
The primary reason that Secretary Chertoff created the position of chief medical officer was to ensure that he would receive solid, science-based medical advice. We soon realized that all DHS planning processes needed to integrate medical preparedness--that is why they are an element of the Preparedness Directorate--and the position's natural progression was in that direction. DHS has set up a culture of preparedness and my position is just one more facet included in this mind-set.
Does DHS have a medical mission?
Aside from the overall preparedness discussion above, in the case of any incident in which DHS (federal) is involved (biological release, pandemics, etc.), the department is the incident manager and must also be supportive of Health and Human Services (HHS), the Veterans Administration (VA), as well as other federal and non-federal entities. The agent for that is me.
Considering your past position as NHTSA administrator, what are your thoughts on the vociferous debates seen last year regarding the creation of a lead federal EMS agency?
I believe it is bad policy to chase money around the government. That being said, it may be the perception that DHS has more dollars and has the ability to "move the ball faster," but EMS as a whole can be assisted greatly by DHS without having to actually be in it. EMS is responsible for response, treatment and transport, and the best route to pursue is to strengthen day-to-day infrastructure. Treatment is the same no matter what the cause or the need. I am personally pleased that in my position at NHTSA, I was involved with the elevation of EMS to an office status. I also think that the Federal Interagency Council on Emergency Medical Services (FICEMS)--in its new manifestation--is poised to become a major voice for EMS at the federal level, and I will do whatever I can to make it work.
For a good portion of your career, you were a hands-on emergency medicine physician, educator and researcher in one of the busiest trauma centers in the country (Carolinas Medical Center). How do you feel that the perspective gained from working in such a medical system helped you in your position with NHTSA? How has it affected your perspective in your current position?
There is no question that being on the front lines of emergency medicine for 20 years has given me a sense of urgency and consistently reminds me of why I am here. I do not take this service lightly.
At NHTSA, I dealt with the fact that car crashes are something that happen daily, and I tried to establish measures to ensure more safety on our roadways. Like most, I have seen a lot of cases. One case that sticks out in my mind in particular is that involving a popular young high school girl who had befriended several less-popular kids at her school. Well, she was driving one day, an SUV crossed over the line into her lane and killed her. The thought of her and the various factors that played a role in her tragedy--bad road design, new drivers and seat belt use--are things I carry with me constantly.
It's a little more difficult to measure now that I am at DHS--the measures of success are different--but the expectations are just as high.
Since the establishment of DHS, emergency responder education provided through the department has concentrated mainly on WMD events. Owing to the emergency operation lessons learned during recent natural disasters in the U.S., as well as infectious disease pandemics seen in other countries, does DHS have plans to refocus the training/preparation offered to emergency responders?
DHS is focused on making sure we are trained, ready and prepared for the things that do the most damage. I believe we need to reinforce, not retrain, our responders. Yes, there are gaps that still exist in certain areas (CBRNE attacks/events for one) and this is where DHS dollars will go. As I said before, the crux of preparation is strengthening the institutions that we use day-to-day.
