Law enforcement and emergency and medicalresponders are already well aware that training and preparation areessential for successful homeland security. In the years since Sept.11, 2001, officials at all levels of government have been working toraise the nation’s preparedness through academic coursework, field andtabletop exercises and, increasingly, simulation and distance learning.HSToday talked to some of the pioneers in the field to see what they’re doing.
Terry Clark, president of Medantic TechnologyLLC, served as a physician in the military for 14 years. MedanticTechnology, co-founded by Clark, created a weapons-of-mass-destruction(WMD) training program after Clark realized there was a need to deliverthis specialized training to civilian medical personnel.
“My partner [Gregory Thompson] and I, bothbeing ex-military physicians, realized where the expertise was and feltit was a perfect match for distributed training through computertechnology,” Clark told HSToday. “We started putting together the plans for this in late September 2001.”
Clark was in Washington, DC on 9/11, and theterrorist attacks inspired him to combine his medical andinformation-systems expertise into conceptualizing a training solutionto address a WMD scenario.
“Most health-care providers, unless they havebeen in the military, have never been exposed to this type of topic,”Clark said. “You don’t get trained on anthrax or sarin in medicalschool.”
Medantic Technology, based in Burbank,Calif., teamed with medical publisher Lippincott Williams & Wilkinsand visualization specialists Macromedia Inc. The company consultedwith the Henry M. Jackson Foundation for the Advancement of MilitaryMedicine and the Uniformed Services University of the Health Sciencesto verify all the information developed for the distance-learningmodules.
The courseware contains both lectures and case simulations, Clark explained.
“It’s problem-based learning, case-basedlearning, so it puts the provider in a situation where the patient isan unknown,” Clark said. “They have to make decisions and, based onthose decisions, they get different results, different outcomes, aswell as feedback and educational tips to educate them as they go.”
Once a student has completed the materials,he or she can take a test. Upon successfully completing it, the studentcan use it to obtain a certificate and continuing medical education(CME) or nurse education units.
The Department of Defense (DoD) currentlyuses the Web-based training courses, as well as private companies andassociations in the nuclear power and oil industries. Academicinstitutions, such as Massachusetts General Hospital and RutgersUniversity, also use it.
“We think that what we are offering willcertainly meet the needs of the Department of Homeland Security or thelocal or state or regional agencies as they evolve in their trainingstrategies,” Clark said.
Homeland Security U.
The Department of Homeland Security (DHS) hasturned to academic institutions to provide computer training to firstresponders who require it, although some of the programs were inheritedwhen the department consolidated.
In the early 1980s, Congress created theNational Disaster Medical System (NDMS), an emergency-responseorganization that guides medical and public-health professionals in thecare of victims of large disasters. Until the creation of DHS, NDMS waspart of the US Public Health Service under the Department of Health andHuman Services.
Now, NDMS is part of the Federal EmergencyManagement Agency (FEMA). Its basic mission remains the same: Itdeploys disaster medical assistance teams (DMATs), consisting of about30 health-care professionals each, to major disaster sites whennecessary. Team members may include physicians, nurses, paramedics andeven logistics and communications specialists.
The teams are self-sufficient; they arrive ata disaster site with their own medical supplies, food and billeting,prepared to stay at least 72 hours.
In the 1990s, the Public Health Servicerecognized the need to provide the DMAT team members with uniformtraining, said Rick Bissell, Ph.D., the manager of the resultingtraining program at University of Maryland, Baltimore County (UMBC),Emergency Health Services.
“We didn’t have any kind of uniform trainingprogram for people, and it was going to be a logistical nightmare totrain people in every corner of the country and a couple ofterritories,” Bissell told HSToday. “ It came at the same time that the Internet was growing.”
UMBC was already providing Web-based graduatecourses, which inspired the Public Health Service to contact theuniversity about providing the emergency-health training. Bissell wasgiven the title of principle investigator for the curriculum, withresponsibility for developing and managing it.
Initially, the courseware extended to about10,000 emergency-medical professionals, Bissell said, but about 16,000use it today.
“We put together a program with the PublicHealth Service that consists now of 200 or so courses for people totake that cover everything from how to set up a tent without injuringyourself, to public health preventive medicine issues, to concentrationof chlorine in water to make it safe, to specific medical proceduresthat have to be altered in disaster situations where the standardprotocol will not work,” Bissell said.
Students can log in and complete a courseover the Web any time during the day or night. The curriculum containsboth basic and advanced courses, which can be taken in any order.However, students must complete certain courses and pass their tests toqualify for certain gains, such as certifications or CME units.
“We are revising a number of sessions rightnow, based on interaction that we have had with DHS,” Bissell said.“Some of the sessionsthat we did early are null and void at this pointbecause so much of the management team has changed.”
Several courses require revision simply because the reporting relationships have changed with new management.
“Then there’s some stuff that we just yankedand haven’t been able to redo yet because DHS hasn’t yet stabilized,”Bissell noted.
Continuity of operations
There’s been a high rate of turnover at newagencies and new emergency operations centers at the federal, state andlocal levels—so the training of new personnel must be continuous. Onecompany is trying to come up with a solution that provides a uniformlevel of preparedness.
“There’s obviously a need to drill thesepeople, because most of the people who man these emergency-operationscenters get changed out quite frequently,” noted John Moran, CEO of GSESystems Inc., based in Columbia, Md.
GSE Systems kept a careful eye on the TOPOFFsimulated attacks as they played out in Chicago and Seattle last year.DHS staged the full-scale exercises to analyze the ability of partneragencies at all levels of government to deal with a WMD attack. Theleaders of GSE Systems noted that exercises on that scale were veryexpensive and began working on ways to provide equal realism with lessexpense.
About a year ago, GSE Systems executives metwith those of another company, General Physics Corp. in Elkridge, Md.,which trains first responders to react to different threat scenarios.
“They said, ‘Gee, if you could come up with adrill-scenario simulator, where we could exercise any number ofagencies, make it scalable, so that if you need to drill to just oneagency, fire for example, you’re able to do that, but also scale thesimulation up to the point where you could get to a full-scope andfull-scale exercise level, there could be as many as 30 or 40responding agencies,’” Moran said.
As a result, GSE Systems this year introducedthe Real-time Emergency Management Interactive Training System (REMITS)for use by emergency-operations centers. The software simulates adisaster over communications lines, prompting first responders to dealwith each aspect of the scenario as it is communicated to them.
“Fundamentally, it’s the software that shootsmessages back and forth between the agencies and coordinates theresponse to any particular threat,” Moran noted. “What we did—and wehave done this in nuclear power plants and other places—is look at thatsoftware and then we simulate it.”
The Port Authority of New York and New Jerseyused REMITS in August, training its emergency managers and firstresponders to face potential disasters at the ports. The trainingsystem mimicked the EM/2000 emergency-management software used by thePort Authority, providing the first responders with simulated threatsin a realistic environment that mirrored their own. Trainees can replaythe entire scenario after its completion to review their actions andderive lessons.
“It responded very well,” Moran said. “Thatwas our beta test site. We are now out into a number of other places.It’s generating a substantial amount of interest in the community.”
Delaware and Nevada are among thoseinterested in using the software in their emergency-operations centers.GSE Systems is also in talks with other states, Moran said.
“The idea is to create a tool that will allowthe emergency responders to practice without spending $16 million ofthe government’s money,” Moran said.
Prediction and prevention
After the attack on Khobar Towers in SaudiArabia in 1996 and on the USS Cole in October 2000, the Joint Chiefs ofStaff decided annual counterterrorism training was necessary.
At DoD’s request, Digital Sandbox Inc., arisk-mitigation company in Reston, Va., developed an antiterrorismtraining package called Awareness Training Level One. To date, about1.5 million people have trained with the package, according to AnthonyBeverina, co-founder of Digital Sandbox Inc.
“It’s easier to write the policy that everyperson in the armed forces and every member of their families over 14years old and every civilian that works for DoD needs annual one-hourtraining on terrorism preparedness,” Beverina said. “It’s easier towrite that policy than it is to actually implement it. They were outlooking for a training-technology way of solving that problem.”
Digital Sandbox established a Web-based training program at ATAwareness.org a week before the terrorist attacks of 9/11.
“Then, after 9/11 happened, the demand on thesite was overwhelming, and we had to end up really jacking up thecapacity,” Beverina said.
Currently, only trainees with a dot-miladdress can access the site. Upon completion of the hour-long course,trainees receive a certificate that enables commanders to verifycompletion of the training.
“It’s been a success in the amount of moneythat it has saved, because they used to train using personnelresources,” Beverina said. “Now they can forgo all of that expense andjust let people do it at home or on their lunch hour.”
Digital Sandbox has discovered thatcase-based computer simulations extend beyond the classroom training ofindividuals. Software technology and markets have evolved to supportthe missions of large organizations, like government agencies and bigbusiness, in sweeping ways.
Once a large enterprise understands the risksit faces and has identified the source of the risk, it can target itsresources at strategies to mitigate those risks, Beverina said.
To that end, Digital Sandbox offers anapplication called Site Profiler that runs computer models fororganizations to help them determine where they would be mostvulnerable to terrorist attacks or other manmade catastrophic events.
“We have tools for people in the organizationto do threat analysis, and we also have tools for assetcharacterization,” Beverina said. “We have vulnerability-assessmenttools for baseline security assessments. It all comes together in theenterprise. Analytics allows them to constantly understand those risks.”
Early customers of Site Profiler were peoplewho had been working on terrorist issues long before 9/11, according toBeverina. With some seed money from the government, Digital Sandboxexpanded its customer base so that today anyone with a wide range ofassets to protect can use Site Profiler.
“What you end up getting are results thatsay: ‘Here are all of your risks plotted against alikelihood-of-consequences set of axes,” Beverina said. “You can sortof see all of the risks together and, by setting thresholds, see whichthings are above the line that need to be addressed. Then you can startto drill down into the analytic results to see if you have avulnerability issue that you need to shore up, or if you have anability to respond to a crisis.” HST
Baltimore County Prepares
In an exercise conducted on Aug. 14, emergencyresponders in Baltimore County, Md., tested their ability to respond toa terrorism situation. Designed to test the ability of federal, state,local, private and non-governmental organizations to work together, itwas the second such regional exercise since Sept. 11, 2001, andincorporated the standards established by the National IncidentManagement System and lessons learned in a similar simulation in theBaltimore subway in November 2003.
The exercise began with a 911 call for a sickperson on a light-rail car. As Baltimore County Police officersarrived, yellow and red smoke could be seen pouring from the area ofthe light-rail train. The situation dramatically changed when victimssimulating a wide range of injuries began running from the train,seeking help from responders and running to a nearby shopping mall. Afrantic train operator placed numerous calls to Baltimore County’s 911Center and the Maryland Transit Administration requesting assistance.
More than 40 organizations participated fromlocal and federal government, including commercial emergency medicalservices (EMS), area hospitals, Amateur Radio Emergency Services (ARES)and the nearby Wal-Mart and Hunt Valley Mall. The Baltimore County FireDepartment was assisted by the Maryland Institute for Emergency MedicalServices Systems, which provided a multi-jurisdictional EMS responsethat included commercial EMS and over 200 “victims.” The BaltimoreCounty Office of Emergency Management organized and oversaw the drill.
“We test periodically to make sure publicsafety agencies from across the area are ready to work as a team in theevent of a disaster,” said Richard Muth, Baltimore County’s Director ofEmergency Management.
Since the exercise, many responding agencieshave been meeting to correct issues of concern. A tabletop exercise isscheduled for December to walk all agencies through theemergency-response process, and a PowerPoint presentation on thelessons learned will be distributed to frontline personnel.
Jimmy Artis Jr., Paramedic firefighter, Baltimore County Office of Emergency Management