The Public Access Trauma Care (PATC) program has expanded equipment distribution and training opportunities in Montgomery and Prince George’s Counties. These initiatives will increase the accessibility of medical equipment to allow individuals to render life-saving medical aid to injured patients.

Injuries that result in traumatic bleeding events can occur in various settings throughout communities. Automobile collisions, workplace accidents, construction mishaps, sports injuries, penetrating trauma, and other medical events can all lead to significant blood loss. A victim suffering from a major bleeding incident may potentially bleed out before the arrival of medical professionals. The Maryland-National Capital Region Emergency Response System (MDERS) developed the PATC program to provide civilians with the requisite knowledge, skills, abilities, and equipment to treat life-threatening injuries.

A PATC individual kit contains the medical supplies to treat major bleeding injuries, pneumothorax, and hypothermia. The kit contains a Combat-Application-Tourniquet (C-A-T), emergency trauma dressing, compressed gauze, medical gloves, trauma shears, chest seals, a mylar blanket, a permanent marker, a mini duct tape roll, and  an instruction card. Five kits and a patient movement device are placed in a durable bag located in an accessible cabinet.

MDERS has coordinated with regional partners on the installation and placement of these medical supplies throughout the Maryland-National Capital Region (MD-NCR). In the last year, PATC 5-pack kits have been placed in Montgomery College, Prince George’s County Public high schools, Prince George’s County government buildings, and University of Maryland Global Campus facilities. Planned installations will occur later this year in Montgomery County government buildings and at the Universities at Shady Grove. The totality of these distributions exceeds 1,000 PATC 5-pack kits provided to our regional partners to create an immediate medical response capability to treat time-sensitive injuries.

In conjunction with the allocation of PATC 5-pack kits, MDERS has developed and procured training materials to educate the public to identify and treat medical emergencies. Five training videos were created to show viewers how to apply a chest seal, apply direct pressure, apply a tourniquet, maneuver a victim into the recover position, and pack a wound. A training presentation was created and provided to regional partners to allow for instruction on the basic medical steps needed to render proper aid to injured individuals. To support these trainings and promote hands-on practice with the PATC medical supplies, MDERS has established a training cache that can be utilized by our partners. MDERS has also acquired a training cache for Montgomery County Public Schools and will soon supply a training cache Prince George’s County Public Schools to teach students about the basic medical skills associated with the PATC program.

MDERS will continue investments in equipment and training for the PATC program will help promote prompt medical intervention by civilians to render life-saving medical aid. If you have any questions about the PATC program, please reach out via email to mders.org@maryland.gov.

In December 2022, the Maryland-National Capital Region Emergency Response System (MDERS) organized a Surgical Skills Lab with Montgomery and Prince George’s County Tactical Emergency Casualty Care (TECC) practitioners. The course provided TECC practitioners with an invaluable opportunity for hands-on training and enhancement of their medical wound and airway management techniques. The skills and information obtained during this course will help TECC practitioners render optimal trauma care and casualty management in civilian threat emergencies.

TECC is a set of medical treatment guidelines for trauma care in a high-threat prehospital environment. The medical lessons learned by the United States and allied military forces over the past 15 years of conflict helped develop TECC guidance for trauma care (Committee for Tactical Emergency Casualty Care, 2023). The TECC guidelines are appropriately modified to meet the needs of civilian EMS practice for medical response and treatment of the injured.

Initially, participants were given a thorough safety brief to obtain situational awareness if any hazards or risks occur while training. Upon working in four small groups, the Surgical Skills Lab provided participants with an opportunity to operate various medical equipment and execute intricate techniques on specimens donated to science and educational projects. This included the use of specialized instruments such as scalpels, forceps, and suture needles, as well as the proper application of suture materials and wound closure techniques. This is an essential skill for healthcare providers, as timely and proper wound management can prevent infection and promote healing.

During the surgical skills training, participants learned about advanced airway management techniques, including the insertion of breathing tubes through the trachea (tracheotomy), the mouth (endotracheal intubation), and the nose (nasopharyngeal intubation). At each station, participants practiced these life-saving techniques, which are critical in cases of excess air or blood in the chest and when a patient is unable to breathe. To enhance the knowledge of participants, a physician was available to provide essential guidance and instruction to demonstrate best practices and answer any questions.

As this course was well received by all participants, the following comments were made:

• I personally liked … [gaining] a good understanding of the human anatomy.
• It was great to learn more on small lacerations. We always focus on the big injuries and ignore others. It was [great] to learn how to use sutures, staples, and glue.
• I… learned what some of the expectations are of us as EMT supporting our Paramedics assigned to the team during critical incidents.
• This training boosted my confidence in applying medicine in the field.

The Surgical Skills Lab represents a vital component of medical education and training that equips healthcare providers with the knowledge and lifesaving skills necessary to increase patients’ survival rate. Participants gained immense experience from the course with hands-on training, wounds management, and medical airway procedures and techniques. MDERS aims to regularly work with Montgomery and Prince George’s County TECC practitioners to ensure this capability continues to expand.

References

Committee for Tactical Emergency Casualty. (2023). Frequently Asked Questions. Retrieved from https://www.c-tecc.org/about/faq

Situations involving subjects with mental illness who are suicidal are increasingly common and can be challenging for responding officers. In October 2022, the Montgomery County Police Department (MCPD) adopted General Order: Responding to Behavioral Health Emergencies and Persons with an Altered Mental Status.  Understanding the signs and symptoms of someone afflicted with mental illness, how to identify them, and the legalities of response are critical for law enforcement. MCPD recognizes the need for training to equip officers with effective communication and interpersonal skills, including stabilization and de-escalation techniques for subjects with an altered mental state.

With support from the Maryland-National Capital Region Emergency Response System (MDERS), six MCPD representatives recently participated in a one-day, eight-hour virtual training session that addressed the legalities and challenges law enforcement endure when responding to suicidal subjects (National Tactical Officers Association, 2018). The training delivered by the National Tactical Officers Association (NTOA), introduces case law and varying viewpoints on policy and response decision-making as it relates to situations involving suicidal subjects.

Students explored the legal realities, examining State and Federal law considerations, common claims, constitutional requirements, special relationships, community caretaker function, and emergency aid doctrine. The course addressed decision-making considerations, and students engaged in discussions regarding safety priorities, decision-making parameters, and jeopardy. The training concluded with a discussion on alternative contemporary response options, looking at existing law enforcement programs throughout the United States with a proven track record.

With the completion of this course, MCPD understands the need for additional training to further reinforce departmental policies and procedures regarding interactions with individuals in an altered mental state. While building on this effort, MDERS aims to expand the continuing education and training of law enforcement personnel on their response to mentally distressed individuals at risk of suicide.

References

National Tactical Officers Association. (2018, July 1). Law Enforcement Response to Suicidal Subjects. Retrieved from National Tactical Officers Association: http://public.ntoa.org/default.asp?action=courseview&titleid=351

Staff from the Maryland-National Capital Region Emergency Response System (MDERS) and stakeholders from partnership agencies recently attended the International Association of Emergency Managers (IAEM) conference in Savannah, Georgia. Each year, the IAEM conference attracts relevant speakers to address current public safety topics and practical solutions to national problems. The main goal of the IAEM conference is to improve attendees’ knowledge, competency level, and collaborative skills in the field of emergency management.

At the IAEM conference, MDERS was given the opportunity to provide a poster presentation on the Montgomery County small Unmanned Aerial Systems (sUAS) program. Training and Exercise Specialist Hannah Thomas, Battalion Chief Doug Hinkle from the Montgomery County Fire and Rescue Service (MCFRS), and Lt. Victor “Tony” Galladora from the Montgomery County Police Department (MCPD) created a poster illustrating the development of Montgomery County’s small-unmanned aerial systems (sUAS) capability over the past few years.

This poster showcased the practical sUAS experience and knowledge gained from Montgomery County pilots. The poster also addressed a wide array of relevant topics, findings, and real-world incidents for public safety agencies looking to grow their sUAS program. More importantly, attendees gained insights surrounding the operational concepts of the sUAS program that aid in response operations. This includes learning about the several advantages the sUAS program offers, which consists of enhancing situational awareness, information sharing, and search/rescue operations. The poster exhibited the stages of the sUAS program to highlight the required phases that must be satisfied to ensure an effective development and sustainment of the capability.

To highlight the impact and implications of the IAEM conference, presenters provided the following feedback:

MCFRS Battalion Chief Doug Hinkle

• This was my first experience attending the IAEM Conference. The amount of knowledge and experience of both presenters and attendees was astonishing. As MCFRS supported the Poster Showcase with MDERS and MCPD, it allowed us to demonstrate the cooperative working environment we have had from the beginning to how we are still working together both on incidents and the continual development.

MCPD Lt. Tony Galladora

• IAEM was a great opportunity to meet with Subject Matter Experts (SME) from around the country. I learned about the success and challenges facing these public safety professionals working in a wide range of environments. Everyone was very willing to share information and best practices.

MDERS Training and Exercise Specialist, Hannah Thomas

• I gained valuable knowledge and presentation experience from this conference in which will be beneficial to aiding the NCR stakeholder community enhance its response capabilities. I was honored to represent MDERS at the Poster Showcase while discussing sUAS concepts and operations with public safety leaders. The Montgomery County representatives and I were able to help participants work through their jurisdiction’s sUAS problems.

The IAEM conference is an exceptional opportunity to learn about emergency management on a national and international level. IAEM continues to organize a variety of events that provide helpful emergency management resource information and knowledge from subject matter experts in different disciplines. For more information about the events that IAEM offers, please click here.

Prince George’s County Police Department has built a comprehensive training program for its Emergency Support Team (EST). With support from the Maryland-National Capital Region Emergency Response System (MDERS), three officers from PGPD EST participated in the Modern Day Sniper Positional Shooting Clinic in southwest Virginia. The course provides law enforcement with field-based training in non-traditional shooting positions often encountered in real-world situations.

The two-day training combines marksmanship fundamentals with best practices and methods for positional shooting using the operator’s issued tripod. Students explored considerations for building a supported position while learning techniques for body awareness and natural points of aim. The course emphasized wobble zone management, recoil management, and the use of a post-shot checklist. Instruction was provided by industry-leading precision riflemen who have extensive military experience in long-range shooting and sniping.

The training incorporated multiple scenarios conducted in several disparate locations to test students’ ability to operate in high-stress environments using their newly acquired skills. The officers who completed the course indicated that the training expanded their ability to utilize improvised shooting positions, develop a stable stance, and acquire targets down range faster.

Over the last several years, PGPD has expanded its sniper capability to ensure that a cadre of instructor-level officers is available on each shift to train EST members desiring to bolster their sniping skills. With the completion of the Positional Shooting Clinic, PGPD understands the need to build/enhance competency in key areas of positional shooting for long-range and precision sniping operations.

Public safety leaders from across the National Capital Region (NCR)  recently participated in a four-part leadership seminar series on approaches to improving decision-making. The Maryland-National Capital Region Emergency Response System (MDERS) partnered with the National Preparedness Leadership Institute (NPLI) to host this professional development opportunity on behalf of the NCR. MDERS collaborated closely with NPLI to tailor this program to the unique characteristics and nuances of the Maryland-National Capital Region’s emergency response enterprise. The series was facilitated by Eric McNulty, Harvard

University’s National Preparedness Leadership Institute Associate Director and Co-Author of the book “You’re It,” and featured guest facilitators:

• Anne Kronenberg, Affiliated Faculty, National Preparedness Leadership Initiative, Harvard T.H. Chan School of Public Health
• Peter Neffenger, Distinguished Senior Fellow, National Preparedness Leadership Initiative, Harvard T.H. Chan School of Public Health
• Richard Serino, Distinguished Senior Fellow, National Preparedness Leadership Initiative, Harvard T.H. Chan School of Public Health
• Darrell Darnell, Affiliated Faculty, National PreparednessLeadership Initiative, Harvard T.H. Chan School of Public Health

This interactive program introduced participants to the building blocks of sound decision-making and the tangible ways in which decision quality can be improved over time. The program explored various decision-making methods available to leaders and how to become more intentional about the use of each. Participants gained a

better understanding of how to instill and maintain decision discipline even in the challenging environment of a major incident. The series concluded with a “master class,” where participants applied the concepts and tools they learned using a scenario-based exercise highlighting a complex organizational leadership challenge currently faced within the NCR.

At the conclusion of the program, attendees highlighted the need for continued leadership development opportunities for emergency response leaders in the NCR. MDERS plans to contribute to the leadership

development of NCR stakeholders through

future training offerings.

For more information on leadership training opportunities, please contact mders.training@maryland.gov.

As COVID-19 cases began to rise in early 2020, the world shut down in hopes of slowing the spread of this unknown and deadly infection. Non-essential workers worldwide transitioned to working from home, an option not available for essential workers within the Homeland Security Enterprise. Doctors and nurses continued to work at inundated hospitals, police and firefighters never stopped responding to emergency calls, and other essential workers continued to do their job while entering an even more dangerous and unknown situation. Additionally, leadership training has become an important aspect to personnel recruitment and retention, following the massive resignations and layoffs following the COVID-19 shutdown.

In the wake of the COVID-19 pandemic, many public safety officials expressed feeling of being burnt out or overworked. Due to these ongoing issues, many organizations within the Homeland Security Enterprise began reevaluating staff training and retention strategies. Leadership trainings have recently been utilized to ensure that an organization’s human capital is supported in any way possible. Organizations such as the United States Capitol Police and the United States Environmental Protection Agency have created a Human Capital Strategic Plan to ensure all workforce members are utilized effectively and supervisors are provided with leadership training. These leadership classes are offered online, allowing participants to attend without leaving their desks. Such courses have proved to be beneficial, including a master class titled Leadership and Change Management featured in the FireRescue1 Academy. Maryland Emergency Response System (MDERS) continues to work with its stakeholder representatives to ensure the courses offered benefit the stakeholder, agency, and community.

To further support their personnel, many public safety agencies moved to a hybrid learning or meeting style once COVID-19 restrictions began to lift. Out of necessity, some ICS courses are offered online and in person. State Emergency Management organizations, such as Oklahoma, Florida, the District of Columbia, and California, have created online curricula for G-300: Intermediate ICS for Expanding Incidents & G-400: Advanced ICS, which were hosted exclusively in person prior the pandemic. Additionally, programs such as the Texas A&M Engineering Extension Service’s (TEEX) Active Attack Event Response Leadership course, which was previously exclusively taught in person, can now be accessed completed entirely online.  MDERS is constantly researching different options for courses which can be provided to its stakeholders in a fully online or hybrid format.  The Training and Exercise Team at MDERS has coordinated courses from the National Preparedness Leadership Institute, and the National Association of Counties High Performance Leadership Academy, which are offered online.  Additionally, the National Tactical Officers Association online course, teaches police personnel on the legalities and challenges faced when responding to suicidal subjects.

The world has changed more quickly and abruptly than imagined, and due to these changes, the workforce and training methods need to evolve. Leaders are adapting the way they lead, and trainings are adjusting to ensure they are accessible to everyone safely. However, whether it is a hybrid learning model or all online, some adjustments must be made to ensure their longevity.  MDERS has expanded their offering to stakeholders and is constantly looking to improve the learning experience and will continue to search for classes that will help the leaders of the Maryland-National Capital Region.

The homeland security threat landscape is constantly changing, requiring new and innovative approaches to incident response. The Maryland-National Capital Region Emergency Response System (MDERS) stakeholder community aims to regularly reassess their response priorities to adapt to emerging threats facing the community. To support this effort, MDERS provides training, technology funding, and planning support to build and enhance capabilities that ensure a coordinated response to emergency incidents. Threats, including cyber-attacks, active assailants, extreme weather, and mass decontamination remain as significant dangers to stakeholders. Daily reports of data breaches, or ransomware attacks taking place worldwide, show the volume of attacks are on the rise while hackers are adapting to circumvent new security measures. These attacks have proven to be economically crippling, time-consuming, and expensive to resolve.

On May 7, 2019, Baltimore City was attacked by a ransomware strike when city workers’ screens suddenly locked, and a message demanding cryptocurrency appeared on their screen. City files were encrypted and could only be accessed and opened with an access key provided by the attackers following the ransom payment. As a result, local public safety organizations began working with their Information Technology (IT) Departments to limit security vulnerabilities and prepare recovery plans. Baltimore City redirected 18 million dollars in city funds to harden its IT protocols following the attack. Even with constant updates and 24-hour surveillance, hackers are becoming more sophisticated and can infiltrate systems at almost any agency.

With the help of the MDERS, stakeholders had the opportunity to participate in a virtual cybersecurity workshop facilitated by three subject matter experts from the University of Maryland Center for    Health and Homeland Security (CHHS) and Montgomery County Office of Emergency Management and Homeland Security (OEMHS). This workshop allowed stakeholders to learn effective organizational preparedness and response capabilities, which could be applied to their agencies. In addition, MDERS continues to offer training opportunities providing its stakeholders with cutting-edge techniques to help protect their agency.

As mass shooting events around the United States are occurring more regularly, active shooter training has become a higher priority for public safety agencies. MDERS has continued to facilitate tabletop exercises, full-scale exercises, and training for all stakeholder disciplines to ensure members of the Maryland-NCR community are prepared for such an event. Within the past year, MDERS has facilitated tabletop exercises and a full-scale active assailant exercise at Prince George’s County Police Department (PGPD) Training Facility and Firing Range. Additionally, MDERS worked with Prince George’s County Police Department and Montgomery County Police Department (MCPD) Special Operations Division’s (SOD) leadership to create a tabletop series to ensure a cohesive response in an interdisciplinary multi-jurisdictional incident.

Over the past decade, weather challenges in the Maryland-NCR have become more unpredictable due to increasing in intensity. However, public safety agencies have learned to adapt and become resilient to climate change. More importantly, MDERS ensures to provide climate resiliency training opportunities and fund traveling expenses to allow stakeholders to attend climate emergency preparedness conferences. Participants learned about best practices from a variety of organizations and disciplines throughout the United States. In preparation for the winter weather, regional agencies have also conducted extensive tabletop exercises to ensure no gaps in their plans or capabilities.

Mass decontamination, the removal of dangerous substances or radioactivity by scrubbing a patient with soap and water, is becoming one of the essential facets of hospital, law enforcement, and fire/rescue/EMS preparedness and response. The training and equipment used for decontamination are highly adaptable, which allows public safety agencies and healthcare facilities to adjust their use for specific response operations. Decontamination shelters can be rapidly deployed in any location and easily stored away. Stakeholders may use decontamination shelters to establish incident command posts, support field triage, and other public safety response operations.

MDERS is regularly advised of new training and equipment requested by its five stakeholder disciplines: law enforcement, fire, rescue, EMS, emergency management, public health, and the hospital systems in Montgomery and Prince George’s Counties. Together these disciplines, and MDERS, collaborate to provide the Maryland-NCR with innovative training and exercise initiatives to combat the ever-changing threats facing the Homeland Security Enterprise.

The Maryland-National Capital Region Emergency Response System (MDERS), through its affiliation with Yale New Haven Health, recently implemented online First Receiver Operations Training (FROT) courses to assist local healthcare facilities maintain Occupational Safety and Health Administration (OSHA) requirements. MDERS is supporting first receiver awareness, safety, and annual review training at various hospitals in the National Capital Region, including Suburban, Holy Cross Health, University of Maryland Capital Region Health, Medstar Montgomery, Luminis Health Doctors Community Medical Center, and Adventist Health.

First receiver awareness level training is a 30-to-60-minute introductory course engaging participants in principles and procedures of decontamination, protection from specific chemical agents, respiratory protection, and personal safety issues. This training is required for healthcare personnel who work in the contaminant-free hospital post-decontamination area. Participants include emergency department clinicians, clerks, triage staff, and security staff members responsible for notifying hospital authorities of arrivals. An estimated 1,050 hospital-based first receivers will participate in the online training course to obtain contemporary awareness of mass decontamination operations.

The best practices for the protection of healthcare facility-based first receivers operations level training is an intermediate 8-hour online and instructor-led course providing healthcare personnel who have direct patient contact with lessons on decontamination topics. At the culmination of the course, participants acquired a comprehensive understanding of exposure to hazardous substances, hazard awareness, personal protective equipment (PPE), and special decontamination considerations. The practical session consisted of a demonstration of ambulatory and non-ambulatory decontamination during a mass casualty incident. A total of 1,125 healthcare workers will receive the training course to enhance the care of patients before and after thorough decontamination.

Ensuring the consistent training of hospital-based first receivers is reinforced by an annual 5-hour refresher for all hospital staff and healthcare personnel who completed the awareness and operations level courses. The online and instructor-led review will be provided to 1,125 participants who can be directly or incidentally exposed to a contaminated victim.

With the support of MDERS, hospital stakeholders have online access to the following courses:

• EM120: Best Practices for the Protection of Healthcare Facility-Based First Receivers, Awareness Level
• EM220: Best Practices for the Protection of Healthcare Facility-Based First Receivers, Operations Level
• EM220R: Best Practices for the Protection of Health Care Facility-Based First Receivers, Operations Level Refresher

Facilitating an online learning platform to a large and diverse staff audience in an accessible manner enhances emergency preparedness operations necessary to effectively respond to mass decontamination at various levels. While building on this effort, MDERS aims to expand the continuing education and training of healthcare personnel to uphold the quality of patient care.