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.

The Maryland-National Capital Region Emergency Response System (MDERS) has offered countless training events in recent years. Some of the most popular include the Annual Maryland-National Capital Region Emergency Response Symposium and the 2019 Fall Leadership Seminar. Participants in these programs consistently requested more opportunities for leadership education and development. These requests drove MDERS, in partnership with Harvard University’s National Preparedness Leadership Initiative (NPLI), to recently host a four-part Virtual Emergency Response Leadership Seminar Series for leaders in the National Capital Region (NCR). The series included essential tools and techniques of Meta-Leadership.

Meta-Leadership is using one’s influence, rather this his or her authority, to drive action and change. This technique cultivates leadership at all levels and allows leaders to impact far beyond their established span of control.

The seminar series was led by NPLI Associate Director and co-author of the book You’re It, Eric McNulty. The series focused on three dimensions of Meta-Leadership—the Person, the Situation, and Connectivity—to help one better understand themselves as a leader, the challenges one faces, and how to bring stakeholders together to achieve cohesive action. The program was tailored to the emergency response realm, specifically the unique characteristics and nuances of the Maryland-NCR.

The program was well received by attendees and highlighted the need for further leadership development opportunities for emergency response leaders in the Maryland-NCR. As such, MDERS will again partner with NPLI to host the next portion of the MDERS Emergency Response Leadership Seminar Series: Negotiation and Conflict Resolution, which will start in March 2021.

This four-part, interactive program will explore the dynamics of conflict and present pragmatic tools for managing and settling it. The series will focus on the roots and accelerants of conflict. Participants will develop an understanding of the five different approaches to engaging in conflict, as well as the two principal approaches to negotiation. To wrap up the series, participants will work through a simulation on conflict and negotiation, drawing on the lessons they have learned in the first three sessions to solve the case.

To register for the for the MDERS Emergency Response Leadership Seminar Series: Negotiation and Conflict Resolution please contact MDERS Training & Exercise Specialist Hannah Thomas at Hannah.Thomas1@Maryland.gov.

 

Situational awareness is a critical priority for emergency response partners in the Maryland-National Capital Region. Small Unmanned Aerial Systems (sUAS) provides an aerial viewpoint of an incident in an efficient and effective manner without the use of costly standard aviation resources such as helicopters that can be easily managed at an agency level. sUAS assists incident commanders in gathering information to assist decision making at complex incidents. In recent years, the utilization of sUAS, often referred to as drones, has become prevalent in many areas of the United States to support emergency responders.

In addition to situational awareness, many sUAS platforms provide the capability for a variety of specific operations to include explosive detection, night vision, radiological detection, thermal imaging, search and rescue operations, and damage assessment.

In late 2018, Maryland-National Capital Region Emergency Response System (MDERS) began the sUAS capability development planning process with stakeholder agencies in Montgomery County following several high-profile incidents where an sUAS capability could have played a substantive role in the response. This planning process consisted of initiating capability development plan, developing policies and procedures, identifying training opportunities, developing operations manuals, and purchasing necessary equipment to meet agency needs. This process was expanded to include Prince George’s County agencies in 2019. Due to the regulations surrounding federal grant funding, each agency’s policy and equipment purchases must be submitted and approved by the Federal Emergency Management Agency (FEMA) prior to the purchase of any equipment.

As of June 2020, the sUAS capability has been operationalized by the Montgomery County Police Department, and the Prince George’s County Police Department is actively procuring sUAS equipment to begin their sUAS program.

Both the Montgomery County Office of Emergency Management and Homeland Security and the Montgomery County Fire Rescue Service have submitted their policies and equipment justification lists and are currently awaiting future approval to being procurement to operationalize their sUAS programs.

Special Weapons and Tactics (SWAT) teams are a critical law enforcement resource in the Maryland-National Capital Region. Their preparation for response to high threat, escalating law enforcement or terrorism incidents requires significant training, organization, and specialized equipment to efficiently and effectively neutralize or de-escalate threats.

Working with the Montgomery County Police Department (MCPD) Special Operations Division (SOD) Tactical Team and the Prince George’s County Police Department (PGPD) Special Operations Division (SOD) Emergency Services Team (EST), MDERS personnel have identified four sub-capabilities to form the overall SWAT Operations Capability Development. These sub-capabilities are breaching, command, close quarter battle (CQB) and sniper operations.

The breaching sub-capability includes supplies and training to support the use of hand tools, hydraulic breaching tools, and explosives. Each team established a minimum number of personnel to receive this technical training.

The command component consists of SWAT Operations specific Incident Command training ranging from tactical decision-making to escalating, expanding incidents.

CQB provides personnel with the ability to efficiently and effectively clear rooms and buildings of threats in the safest manner possible. This requires substantial team coordination.

Finally, sniper operations ensure each team can provide longer range protection for personnel from threats and the ability to safely neutralize threats from a concealed location or position some distance away. This includes training on various concealment techniques and long-range marksmanship.

MDERS has supported approximately 30+ SWAT trainings in the last several years. The addition of specialized training and equipment is necessary to fulfill the capability in both counties. Enhancement in both areas is financially intensive, requiring a multi- year, phased approach to continue development of the SWAT Operations capability.

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.

Strategic leadership development is critical to best meet the complex and evolving demands of homeland security. Recognizing this, the Maryland-National Capital Region Emergency Response System (MDERS) recently brought together a select group of mid-to senior-level leaders from in and around the Maryland-National Capital Region response community to explore core leadership principles and skills proven to have an impact in times of crisis.

The first inaugural Leadership Seminar was held on October 9, 2019 at the William F. Bolger Center in Potomac, MD.

The event featured presentations from two world renown leadership scholars; Dr. Kathleen Kiernan, homeland security expert and founder and CEO of Kiernan Group Holdings, Inc. and Eric McNulty, Associate Director of the National Preparedness Leadership Initiative at Harvard University.

The event was well received by attendees and highlighted the need for further leadership development opportunities for emergency response leaders in the Maryland-NCR.

MDERS will continue to provide opportunities for our stakeholders that will foster creativity and innovation to address the many response complexities facing organizations and the broader homeland security enterprise.

 

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.