With the new school year starting, and a return to in-person instruction, the Maryland-National Capital Region Emergency Response System (MDERS) team delivered a presentation about the Public Access Trauma Care (PATC) program to the nurses of Montgomery County Public Schools Health Services.

The PATC program aims to empower civilians to treat severe injuries in the critical time period between injury and the arrival of medical professionals. During this period, proactive aid can help mitigate fatal injuries to a victim, such as extremity bleeding, compromised airways, sucking chest wounds, and hypothermia.

The presentation outlined the resources available to nurses in every public school to respond to such injuries. In total, MDERS has placed 754 PATC bags inside Montgomery County Public Schools, with at least one bag located in each school building. Included in each bag are five individual kits, each containing a tourniquet, chest seal, survival blanket, compressed gauze, trauma shears, gloves, medical tape, and other supplies to address these injuries.

To understand how to utilize these items and identify the injury patterns that would necessitate their use, the nurses were shown several training videos that covered wound packing, tourniquet application, direct pressure, chest seal application, and body positioning. The videos are accessible for the nurses and the public to review on YouTube.

As the PATC program continues to evolve, opportunities for hands-on practice of these skills will be accessible to nurses and students. If you have any questions about the PATC program, please contact us at mders@maryland.gov.

The goal of the Finance & Logistics (F&L) Program is to develop, maintain, improve, and coordinate the fiscal, procurement, and resource management responsibilities of the Maryland-National Capital Region Emergency Response System (MDERS) staff and stakeholders.

The F&L Program works through the entire capability development cycle. From generating budgets to submitting grant proposals to purchasing equipment, the program is a vital and integral contributor to the process. Once the equipment and supplies are purchased, the program tracks, oversees deployment, and plans for maintenance and replacement of all items. The program also handles all financial matters, including seeking grant reimbursement for organization expenditures.

The F&L Program staff consists of a Program Manager, a Financial Administrator, and a Logistician. The Program Manager oversees the financial and logistical aspects of all capability development and project management plans. She also manages the purchases of equipment and resources to support the MDERS staff and its mission, and directs all related financial and logistical tracking and reporting responsibilities. The Financial Administrator fulfills multiple accounting, budgetary, and procurement responsibilities. The Logistician fulfills various duties including equipment and supply acquisition, distribution, tracking, maintenance, and replenishment.

For more information about the MDERS Finance and Logistics Program please contact info@mders.org.

The coronavirus pandemic has significantly impacted the training and exercise world, forcing many organizations to transition to online mediums, accelerating the evolution of e-learning. Prior to the pandemic, virtual learning made up approximately 10% of the MDERS training program. At the onset of the pandemic, 90% of the MDERS sponsored/funded training was either canceled or postponed. The MDERS Training and Exercise (T&E) Program shifted gears and sought virtual learning opportunities that enabled collaborative, interactive social learning experiences while still offering the same quality of instruction as one would find in an in-person instructor-led course. The T&E Program set its sights on cross-disciplinary training that supported the MDERS strategic goals and objectives.

At the onset of the pandemic, the MDERS T&E Program quickly pivoted to designing and executing virtual tabletop exercises (TTX) and workshops to accommodate social distancing requirements.  Since September 2020, the MDERS exercise planning team has successfully delivered several virtual TTXs to the ERS stakeholder community, including fire/EMS and public health.

In the last 15 months, MDERS has collaborated with Harvard’s National Preparedness Leadership Initiative (NPLI) to provide two four-part seminar series focused on various aspects of meta-leadership, including negotiation and conflict resolution. MDERS and NPLI staff are currently in the final planning phase to deliver a third four-part seminar series highlighting transformational connectivity to foster high performance in the workplace.

MDERS teamed up with the Massachusetts Institute of Technology (MIT) Short Programs to offer a two-part instructor-led online crisis management and resiliency training to the ERS stakeholder community. These courses provided ERS stakeholders with the knowledge and tools necessary to benchmark, assess, and improve their organization’s business continuity, disaster recovery, and crisis management programs.

Partnering with Antioch University, MDERS provided a series of online courses highlighting the impacts of climate change and what the emergency response community can do to become more resilient. MDERS joined forces with the International Critical Incident Stress Foundation (ICISF) Speakers Bureau to deliver training to ERS stakeholders to help them navigate the many complexities of critical incident stress management and crisis intervention.

Capitalizing on the momentum gained from the virtual TTX’s and leadership seminar series, the MDERS T&E Program launched its first-ever virtual Emergency Response Symposium in May 2021. Leveraging a virtual conferencing platform, MDERS delivered an immersive and engaging experience to a wider audience, promoting inclusivity in an online environment.

The transition to virtual training and exercises is not without its challenges, and each instance has allowed the T&E Program to adjust and improve future offerings. While it will not completely replace face-to-face instruction, e-learning is here to stay, and the MDERS community will continue to adapt.

For more information about the MDERS Training & Exercise Program, please contact Training and Exercise Program Manager Nicole Markuski at Nicole.Markuski1@Maryland.gov.

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.

The Urban Area Security Initiative (UASI) grant lifecycle is the ten-stage process that UASI grants in the National Capital Region (NCR) go through from beginning to end.

Each year, the Department of Homeland Security (DHS) awards UASI grants to enhance regional preparedness, and build capabilities in 31 high-threat, high-density urban areas. DHS awards these grants to State Administrative Agencies (SAAs) to administer and provide funds to localities and other eligible subrecipients to implement grant program objectives. The SAAs have a 3-year period of performance to complete UASI grant projects. Subrecipients of the SAAs are provided much shorter periods due to the time required to carry out the many grant lifecycle phases from application to closeout period. The District of Columbia Homeland Security and Emergency Management Agency (DCHSEMA) is the SAA that issues UASI subawards to the NCR, which includes the Maryland-National Capital Region Emergency Response System (MDERS).  DCHSEMA provides its subrecipients an 18-month period of performance to carry out their projects, with occasional extensions for unique circumstances.

Since its inception, MDERS has become the single point of coordination for response partners across Montgomery and Prince George’s Counties. The Maryland Institute for Emergency Medical Services Systems (MIEMSS) is the sponsoring agency of the MDERS program. Agencies within the counties receive funds to purchase equipment and supplies that will be used for their organization’s emergency response capabilities. UASI is a reimbursement grant; therefore, MIEMSS and the counties fund the initial purchases, and are later reimbursed by DCHSEMA. MDERS is often working on four grant years at once: one in the planning stage, two open grant years, and one in the close-out process.

Lifecycle Stages

The stages of the Grant Lifecycle for NCR UASI grants are as follows:

1. Call for Proposal (January, Year 1) – The Homeland Security Executive Committee (HSEC) invites proposals from government and other eligible organizations within the NCR. Proposals must adhere to the criteria laid out in HSEC’s Regional Guidance, including linking to priority capability objectives, having a clear nexus to terrorism, and benefitting operational areas.
2. Project Selection (April, Year 1) – After careful consideration, the HSEC selects projects that align with the criteria and will advance regional priorities by focusing resources to address risks.
3. Grant application (May, Year 1) – DCHSEMA completes DHS’ regional grant application, demonstrating how proposed projects address gaps and deficiencies in current capabilities.
4. Federal Award to SAA (July – September, Year 1) – Upon completion of the application review process, DHS awards UASI funds to the SAA based on risk and the anticipated effectiveness of the proposed use of grant funds.
5. SAA issues Subawards (October, Year 1) – The SAA issues subaward letters. Once they are signed by all parties, the period of performance begins for the subrecipients. The period of performance is generally an 18-month period in which the project must be completed. Occasional extensions may be granted depending on the status of the project.
6. Completion of Project Management Plan (PMP) (October, Year 1) – Subrecipients must complete or update the PMP for each award, as per the requirements of the SAA.
7. Project Implementation (Approx. 18 months: November, Year 1 – May, Year 3) – Subrecipients implement their projects as per the approved PMPs, while following the terms and conditions of the subawards, and all applicable federal and local laws, policies, and procedures. Subrecipients should submit reimbursement requests to the SAA as the goods and/or services are paid.
8. Monitoring – The SAA conducts monitoring throughout the grant’s period of performance by requiring Quarterly Status Reports (QSRs), which include updates on programmatic and spending progress. Additionally, DHS and the SAA have the right to make site visits to monitor and review project accomplishments and to provide any required technical assistance.
9. Project Closeout (June – August, Year 3) – Subrecipients must meet all project closeout reporting requirements as per the terms and conditions of the grant award, including submitting final QSRs, and providing proof of deliverables, Equipment Purchases form, and all reimbursement requests are due no later than 30 days after the end of the performance period.
10. Audit or Site Visit – Both external and internal audits or site visits could potentially take place after the project is closed out. It is vital that the subrecipient maintains subaward files that contain complete and up-to-date records. These files may be paper or electronic, if they are easily and quickly accessible and available for review.

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.