In October and December of 2024, the Maryland-National Capital Region Emergency Response System (MDERS) facilitated two tabletop exercises (TTXs) at different Adventist HealthCare (AHC) facilities with stakeholders from AHC, the Montgomery County Fire and Rescue Services (MCFRS), and the Montgomery County Police Department (MCPD). Each exercise focused on the initial actions of staff at each respective Adventist HealthCare facility and first responders during a critical incident involving an active assailant. The exercises aimed to examine AHC policies and procedures and bolster their response capabilities. Across both exercises, 35 participants were selected by their respective agencies’ leadership based on their probability of responding to an active assailant event.
For these exercises, a workgroup was formed that was comprised of subject matter experts (SMEs) from AHC, MCFRS, MCPD, and MDERS. To test AHC’s response capabilities, participating agencies determined that a discussion-based TTX would be the best approach. MDERS’s approach to TTXs is a systematic, scalable, and economical approach for developing and enhancing critical capabilities that foster interdisciplinary and interjurisdictional collaboration and coordination. The workgroup utilized agency plans, policies, and procedures as well as their background knowledge and experience to develop a scenario that tested the participants’ ability to respond to an active assailant incident at each medical facility based upon agreed objectives. The objectives were developed based on the capabilities that AHC wanted to test, such as operational communications and operational coordination.
During the exercise’s development, a master scenario events list (MSEL) was created to supply realistic injects into the evolving threat. These were accompanied by expected actions from each agency to allow evaluators to review and examine the actions taken by participants. A list of discussion questions was also developed that targeted each objective.
The first exercise was held in October 2024 at AHC Shady Grove Medical Center (SGMC) and involved the Adventist HealthCare Rehabilitation Hospital, which is located in the SGMC complex. The second exercise was held in December 2024 at AHC White Oak Medical Center. Each exercise was scheduled for three hours, during which participants worked through the scenarios and discussed the actions and priorities of their agencies during the scenario.
After the conclusion of exercise play at each exercise, a hotwash was performed with all participants, evaluators, and observers. This forum allowed MDERS to capture immediate feedback related to the exercise and facilitate discussions related to agency actions. Lastly, an anonymous evaluation form was sent with additional questions that sought additional input about the design and execution of each TTX.
Each exercise allowed participants to have open conversations about critical issues such as the ability of the hospital to maintain operations during and after a critical incident, how internal notifications are structured and disseminated to staff, and how responding agencies would integrate their operations and form a unified command (UC). The After-Action Reports (AARs) that were developed for each exercise will provide guidance to AHC for the improvement of their policies and procedures.
MDERS remains committed to providing ongoing exercise support to our Montgomery and Prince George’s County healthcare stakeholders. These exercises are tailored to bolster response capabilities, fortify our communities’ resilience, and allow for improvement through the AAR process. Through these ongoing efforts, our goal is to ensure readiness and efficiency in handling emergencies while safeguarding the well-being of our residents.
Written by: Katie Dwyer