In Fiscal Year (FY) 2013, Prince George’s County Fire and Emergency Medical Services (EMS) Department (PGFD) began a pilot program to assess the efficacy of the FirstWatch real-time situational awareness application. Supported by Maryland-National Capital Region Emergency Response System (MDERS) funds, this program aimed to provide PGFD leadership with a near-real-time view of the department’s operations that could be accessed through a single platform.

Previously, leaders relied upon multiple sources of information such as Computer Aided Dispatch (CAD) Systems, electronic Patient Care Reporting (ePCR), Records Management Systems (RMSs), and other platforms to determine the status of the department’s operations and performance. The reliance on numerous sources of information to maintain a holistic view of current operations created significant challenges in maintaining real-time situational awareness. FirstWatch resolves these challenges by integrating multiple data sources and combining all data inputs into actionable information via an internet browser or mobile application.

Real-Time Situational Awareness and Data Analytics

FirstWatch connects to data feeds from CAD systems, ePCR, and RMSs to provide real-time situational awareness. The FirstWatch platform aggregates these data feeds into a single stream of actionable information that authorized users can access. Additionally, FirstWatch conducts pre-configured analyses of the aggregated data and notifies identified personnel when user-defined trigger points are met or exceeded. An example of one such trigger is when a specified number of ambulances are unavailable for dispatching due to current use on calls or based on an out of service status.

In support of its analytics, FirstWatch provides data visualization via gauges, dashboards, and other tools to provide a more user-friendly interface. Gauges, shown in Figure 1, illustrate the current capacity of an identified trigger threshold. Dashboards, as shown in Figure 2, synthesize larger, more complex data to provide a comprehensive overview.

One notable dashboard currently deployed within the NCR is the Hospital Transport Status Dashboard. This dashboard provides fire departments and healthcare facilities staff with the awareness of the current number of ambulances at or en route to every hospital within the region at any given time. Data such as arrival on scene, en route to the hospital, arrival at the hospital, and clearing the call times are available for each ambulance from every fire department, with relevant time stamps included for each status change. As many healthcare facilities operate near capacity on a regular basis, this dashboard alleviates potential capacity burdens by providing healthcare and EMS providers with the information to identify service backlogs. Once a backlog is identified, EMS or healthcare providers can divert new patients to other nearby facilities with existing capacity.

Additionally, FirstWatch provides other tools to participating agencies such as automated auditing of ePCRs to ensure quality assurance and quality improvement. Maryland-National Capital Region fire, rescue, and EMS agencies generate thousands of ePCRs annually. Previously, personnel manually audited these records for specific criteria, quality indicators, or other information. The FirstPass module within FirstWatch reviews each ePCR for user-defined criteria and sends automated alerts to relevant personnel, such as the administration of a specific medication or medical intervention. These alerts identify which ePCRs may require manual review or follow-up with providers, patients, or healthcare facilities.

FirstWatch within the Maryland-National Capital Region

In the Maryland-National Capital Region, PGFD and Montgomery County Fire Rescue Service (MCFRS) leadership utilize the FirstWatch application daily to maintain awareness on current operating status. Field personnel rely on the information collected by the FirstWatch application to make informed decisions regarding patient transport destination, offload, and transfer time, thus improving the availability of ambulances across the region.

In addition to Montgomery and Prince George’s Counties, the MDERS FirstWatch program provides FirstWatch licensing, maintenance, and access for the entire National Capital Region, including:

• District of Columbia
• City of Alexandria
• Arlington County
• City of Fairfax
• Fairfax County
• Loudon County
• Prince William County

Each jurisdiction’s fire, rescue, and EMS system can further customize FirstWatch better meet individual data needs and inform decision making. As FirstWatch develops new tools to assist public safety, agencies within the National Capital Region will continue to advance their use of the program to provide enhanced situational awareness across the region.

Severe bleeding, penetrating wounds, hypothermia, and other life-threatening trauma can occur at any time, and require immediate medical attention. To better empower the general population of Prince George’s and Montgomery Counties to recognize and respond to life-threatening trauma in the vital minutes before first responders arrive, the Maryland-National Capital Region Emergency Response System (MDERS) developed the Public Access Trauma Care (PATC) program.

Through the PATC program, MDERS deployed trauma care kits in public buildings, schools, and government facilities across the Maryland-National Capital Region. In addition to providing the kits, MDERS is training the population on the skills and abilities required to render aid, through five training videos that were recently released.

The videos show the proper techniques and tools to treat life-threatening injuries using the equipment and supplies provided in the PATC kits. Students learn how to accurately identify the type and extent of an injury, how to render aid, and which bandages and supplies to use. The five training videos teach individuals how to apply a chest seal, apply a tourniquet, pack a wound, apply direct pressure, and maneuver a victim into the recovery position. Each video demonstrates the application of a skill with detailed narration explaining each step taken by a citizen responder.

To underline the importance and broad applicability of these skills, a propane gas explosion scenario was utilized. In this scene, two individuals applied the proper trauma care techniques on two victims before medical professionals arrived on scene. In this simulated scenario, the interventions by the bystanders saved lives.

All members of the public are encouraged to learn these simple life-saving skills. The training videos and emergency scenario can be seen on MDERS’s YouTube page. The videos can be watched for initial training and reviewed for individuals to refresh their familiarity with the life-saving PATC skills.

The MDERS team would like to extend its gratitude to the Montgomery County Police Department, Prince George’s County Police Department, Prince George’s County Fire/EMS Department, and Laurel Volunteer Fire Department for their time and expertise in creating these videos.

The 14^th Annual National Homeland Security Conference (NHSC) was recently held in Las Vegas, Nevada from August 30^th, 2021, to September 2^nd, 2021. The NHSC is an annual event sponsored by the National Homeland Security Association that is designed to bring together professionals from across the homeland security enterprise. Each year, the NHSC provides a variety of trainings, breakout sessions, dynamic keynote speakers, and tours of local target hazards or previous pertinent events to educate and provide information on topics ranging from cybersecurity to counterterrorism and grants management. The Maryland-National Capital Region Emergency Response System (MDERS) sponsored the attendance of 16 stakeholder agency personnel, as well as MDERS staff members.

This year’s NHSC participants attended presentations on unmanned aircraft systems, the COVID-19 pandemic, domestic violent extremist, cyber security, and more. The evaluations reflected that the participants benefited greatly from attending these sessions. Some comments include:

“I have a greater understanding of the capabilities and threats posed by unmanned systems. I also learned about existing and emerging technologies and the capabilities utilized to remediate these systems.”

“I enjoyed the session on planning for a multiple agency response exercise. The speaker gave me a better idea on how to get the agencies I would need in participation on board.”

Kinetic Mobile Tabletops: The Answer to Crawl Walk Run

At this year’s NHSC, MDERS Emergency Response Planner Michael Ryman, and Montgomery County Fire and Rescue Service (MCFRS) Captain Dwayne Dutrow, presented a breakout session titled: Kinetic Mobile Tabletops: The Answer to Crawl, Walk, Run. This hour-long session covered the three-year development of the MDERS Tabletop in a Box program and how it can be deployed as a systematic, scalable, and economical capability development tool across various emergency response disciplines. The presentation concluded with a review of real-world success stories from personnel who participated in various iterations of the MDERS Tabletop in a Box Program.

The MDERS Tabletop in a Box program is a coordinated effort with stakeholder agencies to provide a portable Incident Command System (ICS) training tool. The Tabletop in a Box program includes pre-scripted exercises, manipulatives, and maps of target hazard locations within their area of jurisdiction. This programs main tool is a portable box containing all materials required to run a hybrid exercise. This approach provides stakeholders with a forum to discuss, evaluate, and deconflict their response policies and procedures in a collaborative environment.

Since 2018, MDERS has delivered a total of 38 TTXs to law enforcement, fire/rescue/EMS, public health, and hospital stakeholders in the Maryland-NCR.