In December 2022, the Maryland-National Capital Region Emergency Response System (MDERS) organized a Surgical Skills Lab with Montgomery and Prince George’s County Tactical Emergency Casualty Care (TECC) practitioners. The course provided TECC practitioners with an invaluable opportunity for hands-on training and enhancement of their medical wound and airway management techniques. The skills and information obtained during this course will help TECC practitioners render optimal trauma care and casualty management in civilian threat emergencies.

TECC is a set of medical treatment guidelines for trauma care in a high-threat prehospital environment. The medical lessons learned by the United States and allied military forces over the past 15 years of conflict helped develop TECC guidance for trauma care (Committee for Tactical Emergency Casualty Care, 2023). The TECC guidelines are appropriately modified to meet the needs of civilian EMS practice for medical response and treatment of the injured.

Initially, participants were given a thorough safety brief to obtain situational awareness if any hazards or risks occur while training. Upon working in four small groups, the Surgical Skills Lab provided participants with an opportunity to operate various medical equipment and execute intricate techniques on specimens donated to science and educational projects. This included the use of specialized instruments such as scalpels, forceps, and suture needles, as well as the proper application of suture materials and wound closure techniques. This is an essential skill for healthcare providers, as timely and proper wound management can prevent infection and promote healing.

During the surgical skills training, participants learned about advanced airway management techniques, including the insertion of breathing tubes through the trachea (tracheotomy), the mouth (endotracheal intubation), and the nose (nasopharyngeal intubation). At each station, participants practiced these life-saving techniques, which are critical in cases of excess air or blood in the chest and when a patient is unable to breathe. To enhance the knowledge of participants, a physician was available to provide essential guidance and instruction to demonstrate best practices and answer any questions.

As this course was well received by all participants, the following comments were made:

• I personally liked … [gaining] a good understanding of the human anatomy.
• It was great to learn more on small lacerations. We always focus on the big injuries and ignore others. It was [great] to learn how to use sutures, staples, and glue.
• I… learned what some of the expectations are of us as EMT supporting our Paramedics assigned to the team during critical incidents.
• This training boosted my confidence in applying medicine in the field.

The Surgical Skills Lab represents a vital component of medical education and training that equips healthcare providers with the knowledge and lifesaving skills necessary to increase patients’ survival rate. Participants gained immense experience from the course with hands-on training, wounds management, and medical airway procedures and techniques. MDERS aims to regularly work with Montgomery and Prince George’s County TECC practitioners to ensure this capability continues to expand.

References

Committee for Tactical Emergency Casualty. (2023). Frequently Asked Questions. Retrieved from https://www.c-tecc.org/about/faq

Situations involving subjects with mental illness who are suicidal are increasingly common and can be challenging for responding officers. In October 2022, the Montgomery County Police Department (MCPD) adopted General Order: Responding to Behavioral Health Emergencies and Persons with an Altered Mental Status.  Understanding the signs and symptoms of someone afflicted with mental illness, how to identify them, and the legalities of response are critical for law enforcement. MCPD recognizes the need for training to equip officers with effective communication and interpersonal skills, including stabilization and de-escalation techniques for subjects with an altered mental state.

With support from the Maryland-National Capital Region Emergency Response System (MDERS), six MCPD representatives recently participated in a one-day, eight-hour virtual training session that addressed the legalities and challenges law enforcement endure when responding to suicidal subjects (National Tactical Officers Association, 2018). The training delivered by the National Tactical Officers Association (NTOA), introduces case law and varying viewpoints on policy and response decision-making as it relates to situations involving suicidal subjects.

Students explored the legal realities, examining State and Federal law considerations, common claims, constitutional requirements, special relationships, community caretaker function, and emergency aid doctrine. The course addressed decision-making considerations, and students engaged in discussions regarding safety priorities, decision-making parameters, and jeopardy. The training concluded with a discussion on alternative contemporary response options, looking at existing law enforcement programs throughout the United States with a proven track record.

With the completion of this course, MCPD understands the need for additional training to further reinforce departmental policies and procedures regarding interactions with individuals in an altered mental state. While building on this effort, MDERS aims to expand the continuing education and training of law enforcement personnel on their response to mentally distressed individuals at risk of suicide.

References

National Tactical Officers Association. (2018, July 1). Law Enforcement Response to Suicidal Subjects. Retrieved from National Tactical Officers Association: http://public.ntoa.org/default.asp?action=courseview&titleid=351

Staff from the Maryland-National Capital Region Emergency Response System (MDERS) and stakeholders from partnership agencies recently attended the International Association of Emergency Managers (IAEM) conference in Savannah, Georgia. Each year, the IAEM conference attracts relevant speakers to address current public safety topics and practical solutions to national problems. The main goal of the IAEM conference is to improve attendees’ knowledge, competency level, and collaborative skills in the field of emergency management.

At the IAEM conference, MDERS was given the opportunity to provide a poster presentation on the Montgomery County small Unmanned Aerial Systems (sUAS) program. Training and Exercise Specialist Hannah Thomas, Battalion Chief Doug Hinkle from the Montgomery County Fire and Rescue Service (MCFRS), and Lt. Victor “Tony” Galladora from the Montgomery County Police Department (MCPD) created a poster illustrating the development of Montgomery County’s small-unmanned aerial systems (sUAS) capability over the past few years.

This poster showcased the practical sUAS experience and knowledge gained from Montgomery County pilots. The poster also addressed a wide array of relevant topics, findings, and real-world incidents for public safety agencies looking to grow their sUAS program. More importantly, attendees gained insights surrounding the operational concepts of the sUAS program that aid in response operations. This includes learning about the several advantages the sUAS program offers, which consists of enhancing situational awareness, information sharing, and search/rescue operations. The poster exhibited the stages of the sUAS program to highlight the required phases that must be satisfied to ensure an effective development and sustainment of the capability.

To highlight the impact and implications of the IAEM conference, presenters provided the following feedback:

MCFRS Battalion Chief Doug Hinkle

• This was my first experience attending the IAEM Conference. The amount of knowledge and experience of both presenters and attendees was astonishing. As MCFRS supported the Poster Showcase with MDERS and MCPD, it allowed us to demonstrate the cooperative working environment we have had from the beginning to how we are still working together both on incidents and the continual development.

MCPD Lt. Tony Galladora

• IAEM was a great opportunity to meet with Subject Matter Experts (SME) from around the country. I learned about the success and challenges facing these public safety professionals working in a wide range of environments. Everyone was very willing to share information and best practices.

MDERS Training and Exercise Specialist, Hannah Thomas

• I gained valuable knowledge and presentation experience from this conference in which will be beneficial to aiding the NCR stakeholder community enhance its response capabilities. I was honored to represent MDERS at the Poster Showcase while discussing sUAS concepts and operations with public safety leaders. The Montgomery County representatives and I were able to help participants work through their jurisdiction’s sUAS problems.

The IAEM conference is an exceptional opportunity to learn about emergency management on a national and international level. IAEM continues to organize a variety of events that provide helpful emergency management resource information and knowledge from subject matter experts in different disciplines. For more information about the events that IAEM offers, please click here.

Prince George’s County Police Department has built a comprehensive training program for its Emergency Support Team (EST). With support from the Maryland-National Capital Region Emergency Response System (MDERS), three officers from PGPD EST participated in the Modern Day Sniper Positional Shooting Clinic in southwest Virginia. The course provides law enforcement with field-based training in non-traditional shooting positions often encountered in real-world situations.

The two-day training combines marksmanship fundamentals with best practices and methods for positional shooting using the operator’s issued tripod. Students explored considerations for building a supported position while learning techniques for body awareness and natural points of aim. The course emphasized wobble zone management, recoil management, and the use of a post-shot checklist. Instruction was provided by industry-leading precision riflemen who have extensive military experience in long-range shooting and sniping.

The training incorporated multiple scenarios conducted in several disparate locations to test students’ ability to operate in high-stress environments using their newly acquired skills. The officers who completed the course indicated that the training expanded their ability to utilize improvised shooting positions, develop a stable stance, and acquire targets down range faster.

Over the last several years, PGPD has expanded its sniper capability to ensure that a cadre of instructor-level officers is available on each shift to train EST members desiring to bolster their sniping skills. With the completion of the Positional Shooting Clinic, PGPD understands the need to build/enhance competency in key areas of positional shooting for long-range and precision sniping operations.