First responders are the front-line soldiers in the WMD battle. Being fully trained and capable to respond is an absolute necessity. Chief officers are the four-star generals who must coordinate WMD-specific resources and develop the WMD strategic plan.

With 122 jurisdictions nationwide, the Metropolitan Medical Response System program was established in 1996 to help with that plan by providing a systems-based approach to WMD incident preparedness and enhancing local first-responder capabilities in a public health crisis. The MMRS also provides all-hazard preparation by enhancing the local jurisdiction's capabilities within 48 hours to manage hazmat incidents, disease outbreaks and natural disasters.

Multi-national approach

The development of the MMRS and its implementation through local agencies has increased fire department WMD preparation and responsibility. This is evident in the state of Arizona, where the cities of Glendale, Mesa, Phoenix and Tucson provide the MMRS capabilities throughout the state. Also, though not recognized or funded by DHS as an official MMRS city, Tempe dedicates both fire department personnel and resources as an integral part of the MMRS in Arizona. All four cities and the Tempe Fire Department have agreed to deploy as a statewide resource through Arizona Emergency Support Function #8 for WMD protection.

A U.S. — Mexico WMD exercise was conducted on Nov. 16 to evaluate the statewide MMRS response for the first time. The exercise took place in Nogales, the southernmost Arizona city on the Mexico border. The exercise involved 72 agencies from federal, state, county and local jurisdictions. Agencies from Nogales, Mexico, also participated due to their proximity.

The exercise involved a domestic terrorist organization that coordinated an attack from both sides of the border. The exercise was conducted in two phases from first responder mitigation with minor MMRS assistance to a MMRS coordinated response with the local jurisdiction maintaining command.

The exercise involved a WMD explosive device on a produce truck traveling south toward Mexico. The device detonated on arrival at the U.S. Commercial Mariposa Port of Entry. With a large law enforcement presence and a delayed fire department response, border patrol agents completed victim extrication without any CBRNE protection prior to fire department arrival. The Nogales (Ariz.) Fire Department provided gross decontamination. Nogales, Rio Rico and Tubac Fire Departments established victim treatment.

“This exercise was very complicated and presented difficult challenges for any fire department,” says Tempe Bttn. Chief Tom Abbott, who evaluated the hazmat management portion of the exercise. “Nogales Fire Department was very prepared for the incident. The initial-arriving company from Nogales Fire Department stopped short of the incident and immediately set up for a mass-casualty decontamination effort, which proved to be a good early decision for the outcome of the incident.”

The local first responders eventually became overwhelmed and requested assistance from Tucson MMRS resources, which were deployed quickly and efficiently to establish treatment areas using simple triage and rapid treatment criteria. The equipment used provided an organized and effective means of categorizing and treating the victims.

Early detection's value

Early WMD recognition by first responders is key to activating MMRS resources. MMRS resources can assist in the management of WMD events, but will need time to deploy due to the response time and limited speed of cache vehicles. For example, while traveling to Nogales the day before the exercise to pre-stage, the Tempe Fire Department, and Glendale and Mesa MMRS vehicles experienced an extra two-hour delay due to road construction. Although this delay was not significant for the exercise, if this occurred during an emergency response it could have been catastrophic. Topography and climate also may lengthen response times.

WMD recognition is a key for life-safety issues, as well. The border patrol agents who completed the patient extrication would have been exposed in an actual incident. In addition to this exposure, a large number of personnel were congregating in the hot zone during patient extrication.

Communications continue to be a challenge. Although the MMRS cities operate on VHF radios, the local fire department and 91st Civil Support Team use different frequencies from the MMRS cities. This situation was further complicated between law enforcement and fire department communications. Communication also was delayed from the incident site to the state's emergency operations center.

The MMRS in Arizona is designated as a support function of the local incident command system. However, MMRS may provide incident command if requested. In addition to providing resources and personnel for hazmat management, decon and patient treatment, MMRS can provide command personnel to assist incident commanders.

“The command officers [from the Nogales Fire Department] should be proud of their ability to work with the numerous agencies that responded to this exercise,” says Tucson Deputy Chief Les Caid, who evaluated incident command/control and integration of the MMRS response at the exercise. “But as one would suspect, the small but well-trained staff was soon overwhelmed with the sea of responders and a lack of real experience in major unified-command operations. Setting up command and control by the proper utilization of the IMS/ICS is the first priority to allow for proper delegation of resources to meet the goals of the incident action plan.”

Establishing effective unified command will continue to be a challenge. Integrating local fire, emergency medical services and law enforcement at a WMD incident will dictate the success or failure of incident management. To assist in this challenge, a member of the MMRS incident support team will assist command staff with the integration of MMRS resources.

Success stories

Coordination between MMRS cities, the 91st Civil Support Team and local first responders was paramount in incident management.

“We spoke the same language and developed a joint operation combining the military resources of the civil support team and the MMRS,” says Lt. Col. Michael Lynch of the 91st CST. “We rapidly identified and mitigated the hazard, allowing the quick rescue and treatment of victims. What we produced wasn't a lucky coincidence, but the result of several previous exercises and training events in which we trained together and learned from each other, making it possible to integrate into an effective and safe operation.”

Activation of MMRS must be coordinated. In Arizona during a state of emergency, activation of Arizona Emergency Support Function #8 will initiate the deployment of the MMRS Incident Support Team to complete an assessment, as well as place all MMRS resources in a standby mode. Again, early activation of the MMRS will assist in the deployment of needed resources. After arriving on scene with resources, the coordination among MMRS entities will cover all aspects of scene management.

Mutual aid response is paramount for incident management, as well. The development of mutual aid for WMD incidents should be addressed. “I cannot emphasize enough the need for a written statewide mutual aid plan for all 50 states,” says Mesa Deputy Chief Paul Carbajal. “The MMRS cities responded into the existing unified command structure that was in place with the intent of supporting the ongoing operation. This integration occurred as a result of the MMRS cities cooperating with the command officers and supporting the plan that was in operation.”

Interoperability is essential for task completion. Standardization of training enabled personnel to address all incident mitigation responsibilities. Although all MMRS cities and the 91st CST don't train together, the personnel were able to function in a focused and efficient manner without complication while evaluating the resource integration.

“The 91st CST integrated into the MMRS response with the Glendale, Mesa, Phoenix, Tempe and Tucson teams under a single command structure as a cohesive group,” Carbajal says. “This cohesiveness was the result of all six agencies cooperating with each other at all levels, from task to command.”

Any WMD incident will tax first responders. The success of incident management won't depend on any one agency or resource. MMRS and civil support team response can assist first responder agencies with decontamination, patient treatment, hazmat management and incident command. The purpose of the MMRS is not to replace, but to supplement local resources in a supportive role.

First responders will be the soldiers who wage your local war against the WMD enemy. As a chief you must decide, will you blow the battle horn and summon more soldiers and resources found in the MMRS and CST? Or will you sound the retreat and allow your WMD enemy to have victory?

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Chris DeChant is a captain/paramedic for the Glendale (Ariz.) Fire Department, where he has served for eight years. He currently is the Metropolitan Medical Response System Coordinator for the City of Glendale. DeChant holds an associate degree in applied science — fire science and a bachelor degree of science — public safety administration. He can be contacted by e-mail at cdechant@glendaleaz.com.

On the Web

Additional information on the MMRS and CSTs can be found at: www.mmrs.hhs.gov
www.defenselink.mil/specials/destruction/