In 2018, the Maryland-National Capital Region Emergency Response System Steering Committee identified small Unmanned Aerial Systems (sUAS) as a funding priority for capability development. To achieve this capability for the public safety agencies in Montgomery County, Maryland, a workgroup was established consisting of representatives from the Montgomery County Police Department (MCPD), Montgomery County Fire and Rescue Service (MCFRS), and the Montgomery County Office of Homeland Security and Emergency Management (OEMHS). This provided collaboration opportunities for policy development, equipment specification, and the coordination of future training.

MCPD was the first agency to work through internal processes to implement a policy and achieve the Federal Emergency Management Agency’s (FEMA) approval to purchase equipment: a required step for the purchase of any sUAS utilizing federal grant funds. Following approval of the policy, the department purchased various equipment and began its program.

 

The group continued to gain momentum in 2020, with MCFRS and OEMHS gaining FEMA approval. Both agencies then began the process of procuring equipment. All three agencies are actively crafting and implementing training programs to operationalize sUAS operations for emergency response throughout Montgomery County.

 

To add to the complexity of this project, a majority of Montgomery County falls within the Federal Aviation Administration (FAA) Flight Restricted Zone (FRZ) around Washington, D.C. The public safety agencies within this zone must work with the FAA to obtain waivers that allow them to operate sUAS within this airspace. To date, MCPD has already received a waiver, leading the way for other agencies within their jurisdiction.

 

As of Spring 2021, all three agencies are now working with the National Institute for Standards and Technology (NIST), a federal entity headquartered in Montgomery County. NIST personnel have been collaborating with public safety agencies nationwide to assist with training and mobilization of sUAS programs. Specifically, NIST provides a scalable, quantifiable framework for operator training, which the agencies are working to implement as part of their pilot training programs.

Large scale international and domestic events, both accidental and intentional, have resulted in mass casualty incidents (MCI). A mass casualty incident causes sufficient injuries to overwhelm response and healthcare resources. To prepare for these events, the Maryland-National Capital Region Emergency Response System (MDERS) stakeholders endeavored to build MCI response capability and capacity, starting with field response by emergency medical services (EMS).

Leaders from the Montgomery County Fire and Rescue Service (MCFRS) and the Prince George’s County Fire and Emergency Medical Services Department (PGFD) completed an MCI response needs assessment that identified several fire, rescue, and EMS gaps. The purpose of this needs assessment was to determine what resources are required to support a large EMS response in addition to the normal day-to-day incidents of the Maryland-National Capital Region. The assessment revealed that a plan to deploy additional EMS transport units to MCIs did not exist in either fire department.

To address this issue, EMS staff from each fire department, with MDERS assistance, formed a planning group and coordinated a series of meetings to identify a goal, develop objectives, and establish a plan of action. The goal was the safe, efficient, and effective deployment of additional EMS resources to respond to mass casualty incidents. The primary objective was the deployment of additional basic life support transport units to the scene or to backfill depleted resources within 180 minutes of notification of an MCI.

The planning team identified several key steps necessary to accomplish their goal, the first of which was to inventory supplies carried in the basic life support (BLS) transport unit (ambulance). Supplies are divided into two categories: soft supplies (e.g., bandages, other disposable items) and hard supplies (e.g., backboards, splints, other non-disposable items). Employing an inventory schedule is a critical component of sustainment and ensures supplies are utilized prior to expiration. The second step identified the need for a standardized storage methodology that would allow for the easy distribution of these resources to stock reserve ambulances when deployed into the field. The solution was a securable metal storage box on wheels that contained hard and soft supplies needed to respond to an emergency incident. In response to an MCI, the contents of this box could be placed on a reserve ambulance to transition it into a response asset.

The MDERS Steering Committee allocated funds to each agency through a scaled approach. Five kits were provided to each agency in the first phase, followed by an additional five kits in the second phase. This resulted in a total of ten BLS ambulance in a box kits for each agency. In the final phase, five kits in each county were equipped with additional supplies, such as cardiac monitors and advanced respiratory equipment to make them advanced life support (ALS) capable. These units are intended to treat the most severely injured and sick patients, who often require more invasive field treatment.

Although this capability has not yet been utilized for a mass casualty incident response, these boxes have been deployed in Montgomery and Prince George’s County to provide additional transport unit capacity during the most significant surges of the COVID-19 pandemic. They are also frequently deployed in Prince George’s County to provide dedicated ambulances for special events at FedEx Field. Using this equipment on a routine basis allows for providers to refine the process and develop proficiency so that the units are quickly deployed in the event of an MCI.

 

A fully stocked EMS in a Box Storage cabinet.

 

The National Capital Region (NCR) is comprised of the District of Columbia, the State of Maryland, the Commonwealth of Virginia, and 24 county and local governments within that area. The area is home to over 5.5 million residents, and is the seat of the federal government, as well as countless private enterprises. The Region, is particularly susceptible to number of threats, including terrorism and high impact disasters. Countering these threats requires a high degree of coordination across the multiple disciplines, agencies, and jurisdictions across the NCR. The Emergency Response System programs of the NCR are one of many approaches to ensure successful regional coordination.

There are three Emergency Response System (ERS) organizations in the National Capital Region, with one in Maryland, Northern Virginia, and D.C. The purpose of the ERS programs is to provide a platform dedicated to building preparedness and response capabilities in a fashion that leverages other disciplines’ strengths and missions. The approach ensures maximum efficiency and effectiveness of multiple agencies and jurisdictions operating in concert. The participating agencies include a number of response partners, including law enforcement, fire and emergency medical services, public health, hospitals, and emergency management.

The programs are supported by Urban Area Security Initiative (UASI) funds from the U.S. Department of Homeland Security. These funds provide full-time staff to support the planning and execution of emergency response capability development. The staff is comprised of subject matter experts in multiple aspects of emergency management, including discipline mission areas and tactics, capability realization, grants and financial management, training and exercise, and consensus leadership. The funding also supports training, exercises, equipment acquisition, and other expenses related to homeland security and emergency preparedness.

The NCR has been dedicated to regionalism since the late 1990s, with multiple cross-jurisdictional committees and organizations designed to address these complexities. The ERS programs bring together those various disciplines for a coordinated, comprehensive approach to emergency response. The programs are conducted at the subregional level (Maryland, Northern Virginia, and DC) to account for localized needs, threats, and constructs. The ERS programs coordinate with one another, as well as other NCR groups and governing bodies, to create region-wide capabilities to best protect the residents and visitors of the Greater Metropolitan Washington Area.

The Northern Virginia Emergency Response System (NVERS) was the first of its kind in the region. The organization started as a designated Metropolitan Medical Response System (MMRS), which was a grant program intended to build capabilities to respond to chemical, biological, radiological, and explosive events. In 2007, the program was rebranded as NVERS to focus on a more comprehensive set of emergency response capabilities. This expanded the multidisciplinary and multijurisdictional work that had begun through MMRS, and introduced new capability targets. At one point managed by the Northern Virginia Hospital Alliance, NVERS has since become a 501(c)(3) nonprofit organization, allowing it greater flexibility to address the ever-evolving needs of public safety and homeland security.

The Maryland-National Capital Region Emergency Response System (MDERS) has a history similar to that of NVERS. Both Montgomery and Prince George’s Counties, which legally comprise the Maryland-National Capital Region, were jurisdictions that participated in the MMRS program. Both programs were organized through the respective county’s fire and rescue department, but engaged other disciplines to meet healthcare objectives. In pursuit of lofty response goals that would require the cooperation of multiple jurisdictions, the two MMRS programs began working together to achieve greater capacity. In 2014, it was decided that the two programs would be combined into a single entity with a broader mission area to address additional aspects of emergency response, under the MDERS title. The organization was structured based on the successful NVERS model, with adjustments to best meet the needs of the MDERS stakeholders. Additional disciplines and jurisdictions were incorporated into the effort, and the program continues to grow. MDERS provides full capability development that includes planning, organization, equipping, training, and exercising that spans all participating jurisdictions, disciplines, and agencies. Since its inception, owing to its roots in a medical mission area, the program has been administered by the Maryland Institute for Emergency Medical Services Systems (MIEMSS).

The District of Columbia Emergency Response System (DCERS) was established at the same time that MDERS was founded. Though DC is a single jurisdiction, by its nature it has intense complexity with multiple agencies at both the city and federal level having jurisdiction within the city limits. The work of DCERS began with a heavy emphasis on response, as with NVERS and MDERS. In time, the program shifted to a goal of creating a culture of preparedness, assuming mission areas beyond response. To better reflect its mission and scope, the program was rebranded the District Preparedness System (DPS). Like its counterparts in Northern Virginia and Maryland, DPS conducts assessments to identify strategic target capabilities and capacities, and coordinates across all pertinent disciplines to achieve their goals. The program is housed in, and administered by, the D.C. Homeland Security and Management Agency (DCHSEMA) who provide a direct corollary to broader homeland security missions.

Each ERS program is managed at the subregional level, driven by the strategic vision and direction of local emergency response agency leaders. The programs are a portion of the broader approach of the NCR Homeland Security Executive Committee (HSEC), which oversees preparedness and response in the region. The efforts performed by the ERS programs, while managed locally, are informed by the regional goals of the HSEC. In furtherance of that intent, the ERS programs work closely with one another to ensure comprehensive coordination through the region. This includes leveraging resources, assuming combined efforts, and planning together to meet the homeland security and public safety needs as defined by the HSEC. Together with other regional bodies, the ERS programs contribute to the advanced state of readiness, unique capabilities, and enhanced capacity, all of which provide superior service and protection to the area’s residents and visitors.

Immediately following the September 11^th attacks in 2001, the Freedom Corps was established in efforts to help Americans find volunteer opportunities and strengthen the nations culture of service. Shortly after the establishment of the Freedom Corps, an extension to this program, known as the Medical Reserve Corps (MRC), was created. Today, the Medical Reserve Corp (MRC) is sponsored by the Office of the Assistant Secretary for Preparedness and Response (ASPR) and housed within the Department of Health and Human Services. This federal structure supports the implementation of MRC units throughout the nation at the local government level.

The Medical Reserve Corps a national network of community-based volunteers who assist their communities in activities related to public health emergency response. The MRC is not limited to strictly medically trained volunteers; non-medical professionals are also utilized for the unique skills they bring to their communities.

In Maryland, the MRC is known as Maryland Responds. With 24 local MRC units housed within the Local Health Departments, the State of Maryland has over 22,000 volunteers registered. To screen interested individuals, each volunteer must complete all the steps required in the “Road to Readiness (R2R)” program to be eligible for deployment. The R2R program is a series of five steps created to ensure all volunteers are trained in the basic functions of the Maryland Responds program, and, once completed, provides participants with state liability protection coverage during deployments.

Throughout the country, MRC volunteers most recently have been utilized for COVID-19 pandemic response. MRC volunteers can meet the growing demand for extra medical and administrative services needed throughout this pandemic. In Montgomery County, volunteers have assisted the Montgomery County Department of Health and Human Services (DHHS) in the following ways:

• COVID-19 Testing Sites: Specimen collection and administrative site support
• Vaccination Clinics: Medical vaccinators and non-medical site flow support, registration, and vaccination documentation
• Call Center: Staffing for the COVID-19 Call Center to answer community and medical provider questions
• Health Department Operations Center (HDOC): Supplemental staffing for the HDOC
• Personal Protective Equipment (PPE) Distribution: Supplying community partners and county residents with proper PPE
• Food Security Task Force: Providing food distribution sites for individuals impacted by the economic impacts of COVID-19

With almost 1,900 volunteers county-wide, the Montgomery County team has logged over 25,000 volunteer hours since the beginning of the COVID-19 response.

Jessica Pryor is the MRC Coordinator for Montgomery County. “The volunteers in the Maryland Responds Medical Reserve Corps have been a significant resource to the COVID-19 response,” Pryor stated. “They allow us to have staffing resources and flexibility to quickly respond to the needs of the COVID-19 pandemic. For example, the volunteers have provided us with the staff to open call centers and new testing sites or vaccination sites within only serval hours’ notice. The volunteers also help to provide ongoing support to operations and help us to meet the needs of Montgomery County residents during the COVID-19 response.”

For more information on how to become a Maryland Responds volunteer, please use the following link:

• https://mdresponds.health.maryland.gov/

In 2018, members of the Maryland-National Capital Region Emergency Response System (MDERS) Steering Committee recognized the need to enhance their decontamination capabilities in fire/EMS and police operations. In response to this need, representatives from each discipline completed a needs assessment that identified gaps in policies, procedures, and equipment required for immediate decontamination on the scene of an incident. The MDERS Steering Committee allocated FY19 U.S. Department of Homeland Security Urban Area Security Initiative funds to fill these gaps, by supporting policy development and providing equipment for decontamination at the scene of an incident.

To complete this project, MDERS staff and stakeholders assembled a planning team composed of members from Montgomery County Fire Rescue Service (MCFRS), Prince George’s County Fire/EMS Department (PGFD), Montgomery County Police Department (MCPD), and Prince George’s County Police Department (PGPD). The planning team worked to develop a plan of action, identify on-scene decontamination tools, and establish metrics to measure the project’s impact while sharing information on previous efforts.

Those representatives coordinated to write department policy and procedures, create a workflow for all personnel to be decontaminated, and identified a plan for program implementation. The interjurisdictional and interdisciplinary approach assured that decontamination would take place seamlessly during large scale events that involved multiple agencies.

The planning team enlisted managers from the apparatus and logistics sections from each fire/EMS department to provide input for the placement of the equipment on apparatus. The group chose simple tools to conduct basic decontamination on scene. Both fire/EMS departments chose to outfit each of their engine companies to carry the supplies, including buckets, hoses, wipes, and soap, to execute the decontamination function. Both police departments assigned their Special Operations Divisions (SOD) to facilitate the deployment of the decontamination supplies, including wipes and solution.

In December 2020, MDERS completed the FY19 fire/EMS and law enforcement equipment purchase, and delivered all decontamination equipment. Supported by policy, training, and equipment, all responders now have ready access to on-scene decontamination capabilities, minimizing threats to their health and safety.

For additional question please contact Michael McAdams at Michael.mcadams@maryland.gov

 

 Firefighter decontamination supplies are stored in a five-gallon bucket. Each bucket contains (1) pump panel hose adapter, (1) 25’ section of hose, (1) nozzle, (1) scrub brush, and (1) container of Dawn dish soap. All engine companies within the Montgomery County Fire and Rescue Service and Prince George’s County Fire/EMS Department carry these supplies, in addition to 1000 gallons of water. Firefighters from the engine company assemble and connect the equipment. The engine officer coordinates the assembly of personnel, sequence of flow, and completion of the action. This firefighter decontamination project provides safe, efficient, and effective decontamination services at the scene.

 

The decontamination process is initiated by the incident commander. A “Decontamination Team” is then assigned, and personnel are expected to follow the department policy and procedures of gathering equipment, deploying the hose, and connecting the nozzle. After the Decontamination Leader tells command the site location, personnel (in their firefighter gear) walk the decontamination line. Teams apply a soapy mixture with a brush and scrub exposed personnel head to toe. Each member exits the line after a complete water rinse down. Once complete, the crews reassemble to return to their fire station for additional clean-up activities. The unit and incident commander document the activities in the fire record management system.

Each engine company is supplied a tub of wipes to aid in the decontamination process meant for personnel to wipe down exposed skin areas after exposure in a fire. These supplies are part of the normal fire/EMS and police department supply inventory. All supplies in this project are sustained by the local department after the initial deployment.

In spring 2021, police officers in the Special Operations Division of MCPD and PGPD received a set of individual decontamination wipes. These products provide point of exposure tools to clear off any substances as early as possible. Combined with the brush-off supplies, these items start the decontamination process. The police officers training plan includes the use of these products in combination with the fire/EMS supplies. Once exposed, the officer uses the wipes and quickly moves to fire/EMS resources for a head-to-toe soap and water scrub down. Additional decontamination measures are completed with medical assessment and treatment.

With violent attacks increasing in frequency and severity throughout the United States, and victims experiencing time-sensitive, life-threatening injuries, the importance of providing everyday civilians the ability to care for one another is essential for life safety. It has become clear that victims of these catastrophic events experience injuries that need rapid treatment prior to traditional emergency medical services (EMS) arrival, often in austere environments. Through much research and planning, the Maryland-National Capital Region Emergency Response System (MDERS) is providing emergency medical training and supplies to the public, empowering civilians to act as first responders and provide initial care. This program has become known as Public Access Trauma Care (PATC).

In December 2018, the MDERS kicked off the initial planning process for what would become referred to as the PATC Program. The Montgomery County planning team is comprised of representatives from the Office of Emergency Management and Homeland Security (OEMHS), Department of Health and Human Services (MC DHHS), Fire and Rescue (MCFRS), Police Department (MCPD), and Montgomery County Public Schools (MCPS). The team identified several time-sensitive traumatic injuries that that should be addressed by the capability: massive hemorrhage, penetrating wounds, airway compromise, and hypothermia. The group designed a kit that consists of a tourniquet, compression bandage, gauze, chest seals, thermal blankets, medical tape, gloves, scissors, and instructions. The kits are packaged to treat five patients with a single bag.

The planning team chose to implement this capability in a phased approach due to the magnitude and potential growth of this project. The phased implementation, which was charted over several years, would allow for flexibility throughout the planning process, as well as provide the opportunity for incremental successes along the way.  The planning team developed the following three-phased approach to equip buildings with the PATC supplies:

Phase 1: Montgomery County Public Schools

Phase 2: Government Buildings

Phase 3: Community & Public Areas

The planning team decided that the Montgomery County Public Schools (MCPS) would be the first to receive the PATC kits. Given the current vulnerabilities at schools throughout the country, the planning team decided the installation of the PATC kits in every school in the county would be a major accomplishment and set the tone for jurisdictions throughout the region. To continue implementation with MCPS, the workgroup needed to obtain approval from MCPS Executive Leadership, the final decision-makers of new initiatives impacting their students and faculty. The planning team proposed the following PATC kit allocations for the different levels of schools:

• Elementary Schools – (1) 5-pack kit per school
• Middle Schools – (3) 5-pack kits per school
• High Schools – (20) 5-pack kits per school

The planning team established the following parameters to help determine their PATC kit distribution: populations at risk, the amount of time it would take someone to get to a bleeding control kit, and the number of potential students and faculty utilizing these supplies. MCPS Executive Leadership understood and appreciated the benefit this would provide to their students and faculty, allowing the workgroup to continue their planning efforts and complete Phase 1.

Once the MCPS Executive Leadership gave the authorization to move forward with the project, MDERS worked diligently to begin the Federal Emergency Management Agency’s (FEMA) process to obtain approval for installation in all school buildings, which is a requirement to expend Urban Area Security Initiative grant funds. In Montgomery County, there were a total of 165 schools (102 elementary, 46 middle, and 17 high schools) that were built prior to 1975 that needed to be approved by FEMA before any purchasing and installation occurred. The process to complete the approvals included visits to all 165 schools and documentation of the specific locations where the bleeding control kits would be mounted. MDERS staff divided the county into sections and completed the photo documentation as teams. This process took roughly 4-5 weeks, with MDERS staff coordinated with the school principals and security personnel to ensure a school staff member was able to provide an escort. The grant approval documentation was finalized over several months, and MDERS obtained FEMA approval in November of 2019.

Simultaneously during the FEMA approval process, implementation for Phase 1 continued by providing training to all school nurses and health room technicians. The training was coordinated by MDERS, MC DHHS, and MCPD Special Operations Division (SOD). Several members of MCPD SOD provided in-person training to all school nurses and health room technicians over the course of a few days to ensure they all were comfortable in performing the proper application of the supplies included in the bleeding control kits. Training consisted of a PowerPoint lecture, as well as hands-on skills practice in which trainees were taught how to successfully apply tourniquets and chest seals, identify different wound patterns, and pack deep wounds on trainer devices.  At the conclusion of the training, 126 Registered Nurses (RN) and 214 Certified Nursing Assistants (CNA) were trained in PATC, which was a significant first step towards success for MCPS. The positive feedback received after this training guided the workgroup into the next steps of the implementation process.

 

Another important cadre of professionals in the school system is the school security staff. They are assigned to both middle and high schools throughout the county, and their job is to assist school faculty during the day. To enhance this growing PATC capability, MDERS and the planning team realized that the security officers were most likely going to be one of the first on-scene in an emergency. Due to their important responsibilities, all security officers were outfitted with a tourniquet and holster, and emergency trauma dressing to always carry on them. They were also provided with the same training as the school nurses and health technicians. MCPS plans to provide this training to teachers and staff, and has included these skills in their curriculum for high school students in the coming years, building a large cadre of trained responders.

Once training for the nurses, health room technicians, and security officers was complete, PATC workgroup participants began mapping out the extensive operation of installing the bleeding control kits and cabinets throughout the school system. The first rooms to receive bleeding control kits were the health rooms. From there, MCPS Systemwide Safety and Emergency Management helped MDERS manage the installation of the remaining bleeding control kits with support from the MCPS Division of Maintenance and Operations. MDERS worked with the Division of Safety and Emergency Management and the Division of Maintenance and Operations to assist with providing the approved FEMA locations for each kit. There were many ad hoc partners that played a defining role in determining the appropriate cabinet and proper placement to ensure MCPS was compliant with the American with Disabilities Act (ADA). Installation for all schools took approximately five weeks. As of December 2020, all MCPS schools have been outfitted with bleeding control kits.

 

While Phase 1 in one jurisdiction may be complete, the PATC program is just beginning. The program’s ability to immediately render aid during life-threatening emergencies, as well as providing additional responders during mass casualty events, is an important step in building a resilient community. Provision of kits and training to the general public will continue as MDERS strives to bolster emergency response capability and capacity in the Maryland-National Capital Region.