EMS Preparedness and Operations (EMSPO) provides leadership and support to the statewide EMS system by cultivating 16 strong relationships with system stakeholders, ensuring that the system is effectively prepared and responding to the prehospital medical needs of the residents and visitors of Maryland. EMSPO includes EMRC/SYSCOM, Field Operations, Regional Coordination, the Critical Care Coordination Center (C4), and Critical Incident Stress Management.

EMRC/SYSCOM
The Maryland EMS Communications Center is a statewide coordination and operations center for Maryland’s EMS system composed of two integrated components, Systems Communications (SYSCOM) and the Emergency Medical Resource Center (EMRC), which function 24 hours a day, 365 days a year. SYSCOM receives requests and coordinates helicopter resources for medevac missions. The Maryland State Police Aviation Command (MSPAC) Operational Control Center is located within SYSCOM, and SYSCOM personnel coordinate missions with MSPAC Duty Officers involving medevac, search and rescue, law enforcement, homeland security, and disaster assessment. EMRC provides communications linkages and facilitates medical consultations between prehospital EMS clinicians and emergency departments, trauma centers, and specialty centers. It maintains and shares situational awareness of the activities, capabilities, and capacities of hospitals and the prehospital system. Additionally, EMRC provides initial alerting and coordination of resources and the distribution of patients during major medical incidents. In FY 2023, EMRC handled 187,686 telephone and radio calls. These calls included communications involving administrative/operational support issues, single patients, incidents with multiple patients, and calls involving online medical direction. SYSCOM handled 22,438 telephone calls and approximately 14,478 radio calls. The majority of those calls were related to requests for medevac helicopters. EMRC/SYSCOM staff also monitors EMS system activity, so as to alert key MIEMSS staff of significant or extraordinary major medical incidents that may require MIEMSS support.

Emergency Medical System Situational Awareness and Operations
EMS Preparedness and Operations (EMSPO) works directly with internal and external departments and agencies to respond to incidents and collect information that is used to inform EMS. This requires 24/7 staffing, collecting data, and integration of multiple systems to support Maryland EMS operations and emergency management.

• Emergency Medical Resource Center (EMRC) and Systems Operations (SYSCOM) are staffed 24/7. • EMSPO is responsible for the management of the MIEMSS portion of the Administration for Strategic Preparedness and Response (ASPR/HHS), Hospital Preparedness Program (HPP) grant and funding.
• The Maryland Emergency Medical Resource Alerting Database (MEMRAD) is Maryland’s statewide health and medical alerting and resource tracking system. Administered by EMSPO, this system connects daily with hospitals, EMS, Public Health and the Chesapeake Regional Information Sharing Platform (CRISP) interface, allowing EMS patient care reports to be viewable across the healthcare continuum, directly increasing patient’s primary care providers access to EMS encounters.
• The Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) interface links EMS patient encounter data alongside other healthcare data securely shared to ESSENCE from across the state. This combination of EMS, Hospital, Primary Care, Pharmacy, and other data sources gives public health partners enhanced warning on potential epidemics.
• The Research Interest Group (RIG) is composed of members from MIEMSS, the National Study Center (NSC), and other partners including higher education institutions, EMS Operational Programs, regional partners from Washington, DC, and Northern Virginia, and others. In FY 2023, MIEMSS-RIG members published several articles and presented their work at national and international conferences related to EMS and public health. Additionally, members serve on MIEMSS committees in support of the agency’s mission.
• EMSPO received, stored, allocated, and dispersed PPE for public safety and commercial EMS operational programs. PPE from the Strategic National Stockpile and from state purchases was received by MIEMSS via MDH and distributed multiple times. MIEMSS likewise assisted EMS/Fire personnel with COVID-19 testing by providing access to test kits when requested.
• National Disaster Medical System patient reception preparedness; High-consequence infectious disease (HCID) planning and preparedness; Critical incident stress management/peer support team development and coordination; CHEMPACK program maintenance, awareness, and operations; Healthcare facility evacuation preparedness and exercises;
• Participated in the State Incident Management Team (IMT) meetings and training sessions; • Coordinated agency Continuity of Operation (COOP) planning;
• Management of the MIEMSS portion of the ASPR/HHS Hospital Preparedness Program (HPP) grant programs and funding;
• Participated in the Maryland Department of Emergency Management Association in-person statewide EM conference; 17
• Maintained ongoing situational awareness of the EMS and Healthcare systems through frequent communications with federal, state, local, and other stakeholders; EMRC reports things like mass casualty, nursing home fires, where support from Commercial Ambulance or other resources is needed. • Daily gathering of hospital intelligence on bed availability and ED census data began during the COVID-19 to understand the number of available beds and data points.
• Participated in multiple planning efforts preparing for the 2023 Gubernatorial Inauguration. On Inauguration Day, MIEMSS personnel were deployed to incident command post as well as local and state emergency operations centers; • Participated in multiple exercises throughout the state, including a full-scale Calvex exercise.

Regional Coordination
MIEMSS Regional Offices are geographically dispersed throughout the state and staffed by regional coordinators and administrative staff. Each office is responsible for monitoring the operation of their assigned region of the statewide EMS system. They serve as technical advisors to EMS jurisdictions, hospitals, and other system partners on EMS systems coordination and development. Each regional coordinator works with jurisdictional EMS programs to ensure efficient and effective emergency care is available at all times. Regional staff work with Local jurisdictions to support programs such as Maryland Integrated Health.

Critical Care Coordination Center (C4)
The Critical Care Coordination Center (C4) continues to provide adult critical and specialty care patients with placement assistance at hospitals and specialty centers throughout Maryland. This service has experienced a change in the trends as compared to the height of the pandemic in the past years. Since its inception in November 2020, C4 has managed a total of 5,583 calls for adult critical care and pediatric patients. Of these, 2,746 occurred over the past fiscal year, which represents a 30% overall increase from FY 2022. Thirty percent (30%) of the total call volume received in this reporting period was for pediatric patients, with most occurring during the surge of respiratory illness between September and December 2022. The C4 for Pediatrics (C4-P) managed 1,331 requests from Maryland hospitals and urgent care centers for pediatric patients. C4-P adjusted to the increased demand of the surge by implementing new procedures, including expert medical consultation to assist clinicians at hospitals without pediatric intensive care units. C4-P increased coordination and clinician staffing to allow for more frequent follow-up of cases and prioritized based on need. Children whose conditions worsened gained higher priority. C4-P was able to load-level limited resources and retain critical beds for the sickest children. Medical Protocols for managing children on high-flow nasal cannula outside of tertiary hospitals and C4 CAPPs guided and supported clinicians managing these patients. C4-P was able to place 67% (898) of the patients during the surge, while the remainder were managed in the hospitals. At the onset of the pediatric surge, C4 expanded its management team. And nearly doubled its coordinator staff. This promoted four lead coordinators for and assigned two senior staff to oversee operations and administrative management of the program. In June 2023, the projects’ research, entitled “The Maryland (USA) Critical Care Coordination Center (C4): From Pandemic to Permanence”, was published in Prehospital and Disaster Medicine, highlighting the successes of the program and its applicability to other systems, worldwide. In FY 2023, the C4 adult service received 1,280 calls, showing a 28% decrease from FY 2022. Of the 1,280 calls, 64% of those patients were successfully transferred for care. The number of COVID-19 related adult transfers decreased from 32% in FY 2022 to 10% in FY 2023, understanding that recording and reporting of these cases reduced in priority with the disease transitioning to endemic. Though this transition reduced COVID-related adult transfers, the use of the C4 adult service for subspecialty calls has increased, resulting in neurological cases encompassing nearly 30% of adult call volume. C4’s evolution experienced a paradigm shift resulting from the variety of specialty consultations. C4 identified more services to support hospitals across Maryland, and has placed greater emphasis on providing medical direction that improves patient care while finding placement.

Critical Incident Stress Management (CISM)
Critical Incident Stress Management (CISM) offers crisis support services to EMS clinicians, firefighters, law enforcement officers, dispatchers, and other emergency services personnel involved in stressful emergency incidents. It is designed to help accelerate recovery of those individuals exhibiting symptoms of severe stress reaction. CISM offers education, defusings, and debriefings conducted by psychosocial and EMS professionals well-trained in critical incident stress management. Volunteer regional coordinators act as points of contact for local 9-1-1 centers and EMRC/SYSCOM. MIEMSS works closely with local CISM/peer-support teams and the International Critical Incident Stress Foundation to improve capabilities throughout the state. Legislation signed into law in 2022 provided confidentiality protection for peer-support team activities, provisions, and required the Behavioral Health Administration (BHA) to study and provide a report on specified items for peer support teams. MIEMSS and members of local CISM and peer-support teams consulted and supported BHA’s work on the required study. Additionally, MIEMSS sponsored a two-day International Association of Fire Fighters peer-support course at the annual EMS Care Conference in Ocean City.

CHEMPACK
EMS Preparedness and Operations (EMSPO), in conjunction with the Office of the State EMS Medical Director, coordinates the CHEMPACK program for first responders in the State of Maryland, in partnership with the US Department of Health and Human Services Assistant Secretary of Preparedness and Response and the Maryland Department of Health Office of Preparedness and Response. Originally an initiative of the CDC’s Strategic National Stockpile (SNS), this program enables EMS clinicians to access time-critical antidotes for intentional nerve agent attacks and large-scale organophosphate poisonings. The nerve agent antidotes are strategically deployed at secure locations throughout Maryland to ensure rapid accessibility when requested through EMRC. The CHEMPACK inventory is closely monitored; MIEMSS Regional and Emergency Operations personnel, using the new Drop Ship Program, replaced near-expiring medications in FY 2023.

Automated External Defibrillator Registration
Public high schools, middle schools, and county or municipality-owned or operated swimming pools are required to have AEDs, as are some public/semi-public pools and health clubs, per local ordinances. However, the voluntary Maryland Public Access Automated External Defibrillator (AED) Program permits facilities that do not provide health care but meet certain requirements to have an AED onsite for use in the event of a sudden cardiac arrest (SCA) until EMS arrives. Through the online Maryland AED registry (www.marylandaedregistry.com), MIEMSS received and approved 362 public access AED applications in FY 2023, placing 1,710 AEDs. As of June 30, 2023, 9,475 locations in the state have AEDs onsite. Registered users can receive automated notifications regarding battery and electrode expirations, program renewals, and AED recalls. The registry also integrates with AED Link, an application that displays all registered AEDs within a certain jurisdiction without having to manually enter site addresses. Since its launch in 2000, the AED program has had 273 (23.2%) successful AED uses out of 1,179 reported incidents. Success is measured by the patient having a return of pulse at EMS arrival, during EMS arrival, or during EMS transport. Of the overall arrests, 643 were witnessed, and 201 of those witnessed arrests regained a pulse at the time of EMS arrival, for a 31.3% save rate for witnessed cardiac arrests.

Updated: 2-20-24