A capability is the ability to complete a critical mission or function through a set of tasks, at a specific time, under a set of conditions, to a set standard.  

Building a capability is a long and arduous process.  Moreover, sometimes the direction can be ambiguous and unclear but when the results are achieved, the victory is sweet.

The Maryland-National Capital Emergency Response System (MDERS) supports the integration of police, fire/EMS, hospitals, public health, and emergency management for coordinated response to emergency incidents.  Through strategic planning, information sharing, training and exercising, and equipment acquisition, MDERS creates response capabilities.  One such capability is the recent collaboration of MDERS with the Prince George’s County Fire Department/EMS (PGFD) in the development of the Command Officers Professional Development Program (COPD).  

In 2017, PGFD participated in capability development workshops.  Each workshop assessed the department’s ability to respond to an active shooter incident. This process followed the Homeland Security and Exercise Evaluation Program (HSEEP) framework.  Each workshop group responded to a set of facilitated questions to identify needs in the areas of planning, organizing, training, equipping, exercises, and evaluating (POETEE).

A report from the workshops was developed and presented to key PGFD leaders.  The results identified three areas of need. First, PGFD supervisors and managers require clear direction on policy related to their response to active violent incidents.  Second, personnel require more situations and repetitions (scenarios and practice) to build experience, confidence, and to enhance their decision making capacity at emergency incidents.  Finally, workshop participants identified that they wanted localized training.  It was important for them to have learning opportunities at their respective fire stations.

Working with MDERS staff, tabletop exercises were developed. These exercises focused on the initial actions of the first arriving units. A set of scenarios were developed, including a single-family home fire, a multi-casualty incident, and a garden apartment fire.  The exercise objectives were threefold: incident command, allocation of resources, and medical management of casualties. 

More than 100 PGFD personnel participated in this process.  The results from the tabletop exercises validated the initial report from the earlier workshops. PGFD leadership then requested that MDERS provide assistance to design a command officer professional development program to address this identified gap. 

MDERS strategized with PGFD to establish, goals, objectives, and deliverables. MDERS staff established three PGFD workgroups, each with an individual task, including writing policy, researching equipment specifications, and identifying an appropriate simulation application for the department.

PGFD and MDERS consulted with regional partners for assistance in carrying out those tasks.  Representatives from the Montgomery County Fire Rescue Service (MCFRS) and Loudoun County Fire Department (LCFD) provided guidance. This included on-site visits to observe and gather best practice information. These partners also aided in identifying policies, procedures, methods, and lessons learned in command competency programs. 

Following those visits, the work groups identified the necessary resources. This included personnel, software, and equipment.   Additional research identified Sims U Share as the preferred simulation software for command competency and incident management.  This application uses simulation to create events that firefighters and EMS clinicians may encounter. It combines real world fire and rescue incidents with gaming elements. This cloud based user-friendly application allows members to easily build custom scenarios that can be viewed or shared within the department.

There is a set of knowledge, skills, and abilities (KSAs) required by incident commanders.  Among those KSAs is the capability to quickly and effectively manage incidents and allocate resources.  The COPD is a success story in moving PGFD forward in incident command, resource allocation and the provision of training at the station level.

This process required communication, collaboration and coordination with multiple agencies to deliver on time, task, and target.  PGFD Deputy Fire Chief Brian Frankel stated that, “This is one of the most important steps the department can invest in for the future of our personnel, communities, and region.” MDERS Director Luke Hodgson reflected, “Refining command competency will create a culture of incident management that will be applicable on every incident and will positively impact all of our residents and visitors, while protecting our response personnel.”

If you would like additional information about this program please contact Mike McAdams, Program Manager at Michael.mcadams@maryland.gov.

The Maryland-National Capital Region Emergency Response System (MDERS) provides its member organizations with the services to develop comprehensive emergency response capabilities.  This includes dissecting a problem statement, developing a desired outcome state, and reverse engineering.  The result is a full set of plans, organizations, equipment, trainings, and exercises that address the entire need.  The case below highlights the benefits received from the MDERS methodology to address local needs.

Members of the Montgomery County Fire and Rescue Service (MCFRS), Montgomery County Police Department (MCPD), Prince George’s County Fire/EMS Department (PGFD), Prince George’s County Police Department (PGPD). And Maryland ERS (MDERS) conducted a needs assessment to evaluate capabilities for off-road response to routine and large-scale events.  The team focused on after-action reports and incidents from all departments. That report identified a set of gaps that included policy development, equipment needs, and training requirements. Working with local leaders, MDERS received an allocation from the Urban Area Security Initiative to address those needs.

All departments developed a policy to address the technical rescue operations. Operational personnel completed training on the Utility Terrain Vehicle (UTV).  All vehicles, equipment, and training were purchased using Urban Area Security Initiative (UASI) funds to address gaps in response, rescue, and evacuation of casualties from a terrorist incident, while also recognizing the dual-use for routine emergency operations for each department. Montgomery and Prince George’s County police and fire departments received a combination of 17 units with equipment and removable skids. 

Training for vehicle operation requires two full days of hands-on instruction by staff in challenging remote locations.  All personnel were required to complete online training and driving courses.  The course is designed to provide the vehicle operator the knowledge and experience for trailer connection, operations, and maintenance.  Personnel complete twelve hours of driving preparation, skills practice, and written evaluation. This capability offers first responders a rapid response platform to deliver personnel, medical equipment, and patient transport access to remote areas.

The MCFRS and PGFD assigned these assets to various stations.  The police department’s assigned these vehicles to their Special Operations Sections. Each UTV is stored in a weather-protected trailer with supporting supplies for quick deployment. Each department secured funds to allocate support vehicles to tow the trailers, establish facility upgrades for the electrical power source to charge all equipment, and to provide designated interior storage space.  This cooperative arrangement provides the community of Montgomery and Prince George’s County the resources necessary to respond to an emergency incident, even in austere terrain.

Each UTV provides seating to deliver four personnel to the scene of an off road or remote incident.  The frame design allows easy configuration changes for load carry, emergency medical service response, and protected patient transport.  Designed as an off road vehicle, the frame is lightweight, extremely durable, and equipped with a winch capable of moving 3,000 pounds.  Lighting for the vehicle is provided by an energy efficient LED mounted system.  These features provide safety benefits to the rescuers, patients, and bystanders.

The Maryland-National Capital Region Emergency Response System (MDERS) is a federally-funded grant program administered by MIEMSS. Please contact Mike McAdams, Planning & Organization Program Manager, at michael.mcadams@maryland.gov for additional information.

The mission statement of Maryland-National Capital Emergency Response System (MDERS) is to support the integration of fire, rescue, emergency medical services, law enforcement, emergency management, public health, and healthcare systems to ensure a coordinated response to emergency incidents through strategic planning, information sharing, training, exercises, and equipment allocation. While each discipline has unique requirements to build capabilities, all share the common need to manage and coordinate resources at an incident. The tool that connects the emergency response disciplines is the Incident Command System (ICS).

The Montgomery County Public Health Emergency Preparedness Program and Response (MCPHEPR) program recognized their need to expand their capacity to use ICS processes. The review of several after-action reports showed that coordination and communication were a consistent challenge. Specifically, public health response often has a limited number of staff with knowledge of field operations and incident command experience. This makes it difficult to coordinate a broader or multi-site response while also providing direction in the field.

To address these capability gaps, public health officials and MDERS staff reviewed strategy plans, current documents, and reports. From this examination, the group identified the plans, organization, equipment, training, exercise and evaluation elements (POETEE) needed to remedy areas of improvement. This action produced a capability plan that mapped out the steps for change.

Following the plan sequence, a set of activities and tasks were developed. Both fixed and mobile ICS resources were identified and requested as a part of the allocation request from the Urban Area Security Initiative grant. These included a command center, a vehicle to assist in deployments, and equipment and supplies to support ICS operations.

The first step was to expand ICS training. MDERS staff worked with Montgomery County Office of Emergency Management and Homeland Security to sponsor and instruct a series of ICS 300 and 400 level courses. Select public health staff also completed command staff position-specific training. This set of trainings prepared the public health members to exercise and drill with the correct tools.

To test these capabilities, MC-PHEPR partnered with School Health Services to operate three simultaneous flu vaccine clinics. The objectives for the exercise included staffing all ICS positions, developing the incident action plan with all supporting documents, delivering just in time training to the on-scene staff, and coordinating situational awareness between sites to ensure efficient use of limited vaccine resources.

The locations for the activities were Montgomery County’s public high schools with all events occurring after normal school hours. Using the mobile command equipment, PHEPR was able to coordinate personnel and supply deployments, track available resources, and provide updated direction to each facility.

The results from this exercise included a throughput process of more than900 patients in three hours. The exercise was a success and demonstrated proficient use of ICS to manage complex public health scenarios.

For additional information on this project or questions about MDERS please contact Michael McAdams, Maryland ERS Planning & Organization, at Michael.mcadams@maryland.gov

The Maryland-National Capital Emergency Response System hosted the Emergency Response Symposium: Multidisciplinary Response to Emergency Incidents on April 18, 2019. This event, hosted on an annual basis, is intended to bring lessons learned from national and international leaders who have responded to challenging incidents in order to provide lessons learned to the local Maryland emergency response community. The real-world experience, coupled with a different means of strategizing and operating, stimulates thought and paradigm shifts locally to optimize multiagency, multidisciplinary, and multijurisdictional approaches in the National Capital Region and beyond, supporting the mission of the Maryland Emergency Response System.

This year’s event brought leaders from multiple disciplines that responded to the numerous 2017 terrorist attacks in the United Kingdom, each of which led to a mass casualty event. The Ariana Grande concert, London Bridge, and Westminster Bridge attacks were the topics for the year. These attacks introduced vectors rarely seen in the US, such as mass stabbing attacks, improvised explosive devices, and vehicle rammings. In the days preceding the Symposium, the presenters from the UK were introduced to Maryland and the broader National Capital Region. These activities included a trip to the Maryland Institute for Emergency Medical Services Systems (MIEMSS). Personnel from the London Fire Brigade and London Ambulance Service met with Dr. Delbridge and Dr. Chizmar to review the Maryland System approach and discuss medical protocols. Following the MIEMSS briefing, our guests completed a tour of the R. Adams Cowley Baltimore Shock Trauma Center.

The symposium opening remarks were delivered by Director Luke Hodgson. The Opening Keynote address was presented by Jim Schwartz, Deputy County Administrator and former Fire Chief for Arlington County, Virginia. Jim was the Incident Commander at the Pentagon on 9/11 and has since devoted his passion towards better preparing the NCR through collaboration across disciplines and jurisdictions. His message to the audience was to communicate with government leaders on a regular basis, collaborate with other agencies before the incident, and invest the time and effort to build relationships.

A group of subject matter experts presented from the United Kingdom provided the audience with an explanation of terrorist incidents that have occurred in the last five years. These events are thousands of miles away but the information presented and lessons learned can be applied in your community.

Mr. Brian Dillon provide a guided lecture about security, risk assessment, and critical incident management. Chief Inspector Scott Thorne of the London Metropolitan Police Service delivered information focused at the tactical personnel reviewing a series of high threat incidents and lessons learned in response. His direction was become familiar with all buildings in your area, preplan all buildings and know the ways, systems and obstacles into and out of the buildings, with focus on the basic skills.

Assistant Commissioner Graham Ellis of the London Fire Brigade delivered information from the fire suppression lens. His key points were to communicate with your law enforcement partners to share information about tasks and activities that are critical for the fire service. Second, was to educate key leaders and elected officials about the resources required to maintain constant state of readiness. In closing, he stated the three ways that the fire service could reduce injury with active fire prevention programs, smoke detector installation, and requirement for home fire escape plans.

Ms. Pauline Cranmer is the Head of Emergency Care Services for the London Ambulance Service and offered her unique perspective offered insights that local departments must include in planning. Ms. Cramner described the Westminster terror attack, where a driver drove a car into a crowd killing and injuring people, then exited the vehicle to stab others. Her lessons learned include preparing crews to act swiftly in response to an unplanned event and calculate the resources required to assist local hospitals in response to the wave of injuries that arrive other than by ambulance. In closing, she emphasized the need to communicate the same message from police, fire, EMS, and other allied agencies.

A post-symposium event occurred in which the panel experts answered questions in a smaller group setting. This session had several dozen local leaders from various disciplines in attendance. Each question was met with a comprehensive answer that included perspectives from all disciplines. The session was of great value to those that attended.

These speakers represented a unique set of views from departments that are experienced, trained, and engaged in daily active terrorist threats. The lessons learned and direction from these subject matter experts are recommendations are applicable locally to best protect our communities. Now is our time to take action at the local, county, and regional level. That action must incorporate direction form our elected officials, and key leaders to assess our capabilities, determine gaps, and allocate resources to meet needs.

The Maryland Emergency Response System is available to assist you with emergency response and capability building. Please contact Michael McAdams, Program Manager at Michael.mcadams@maryland.gov for additional information.

The Maryland-National Capital Region Emergency Response System (MDERS), working with the Prince George’s County Fire/EMS Department (PGFD) and Montgomery County Fire and Rescue Service (MCFRS), delivered six Tabletop in a Box training sessions for the Emergency Medical Services Supervisors. This regional training was in response to a joint request from both departments. The goal was to assess the EMS supervisor’s ability to use the incident command system and develop a virtual action plan through simulation and repetition. All the sessions were delivered in February and March 2019.

MDERS staff worked with subject matter experts from both fire departments to develop a series of tabletop drills focused on the EMS Supervisor and manager. Incidents were identified from the most common type of events that occur in both counties. These included a single-family house fire, a motor vehicle collision, and a garden apartment fire. The exercises grew in complexity to include mass casualty incidents and an active violence incident.

All the scenarios contain multiple patients which require the coordination of fire and EMS resources. A total of four incident types were created, each one more complex than the previous.

Each scenario was designed using a crawl, walk, run approach to introduce the players to this type of exercise. This progressive method allows the participants to get familiar with the sequence and build confidence in a no fault learning environment. All materials for the exercises were based on real addresses, maps, vehicles, and tactical worksheets that are used by the departments. Incidents were designed to replicate an incident occurring on the Montgomery and Prince George’s County line, requiring multiple departments to work together. A mutual aid incident provided realistic play for the participants from both counties.

MDERS staff scripted each scenario to include a time sequence for the events, a set of activities from each unit crew, and expected actions from the EMS Supervisor. A checklist of tasks and activities accompanied the event. This provided the leader with an easy way to check progress and provide feedback. Both departments participated in two exercises a week totaling six exercises. Exercises were held at alternating locations.

Feedback from the exercises was very positive, prompting leaders to request a second round of development and delivery planned for the fall and winter. MDERS will continue to build and support the program, facilitating optimal command and control of a variety of incidents, especially those requiring a complex medical response by multiple departments.

If you have any questions, please contact Planning & Organization Program Manager Michel McAdams at Michael.mcadams@maryland.gov