Arlington County Fire Chief James H. Schwartz on his lessons learned as the Pentagon's Incident Commander on 9/11.

When a hijacked jetliner crashed into the Pentagon in Arlington, Va., on Sept. 11, 2001, James H. Schwartz, the incident commander at the Pentagon that day, had a plan of action as the disaster unfolded. That plan, the Metropolitan Medical Response System (MMRS), was first developed in the Washington metropolitan area in the late 1990s.

An MMRS, in brief, gathers all parties involved in responding to mass-casualty emergencies so they can plan and prepare for such an event, rather than scrambling to figure out what to do when it happens. Since the system's inception in 1996, the federal government has provided funding to 124 cities nationwide so they could adopt it.

The federal government stopped directly funding the program in fiscal 2012. Governing spoke with Schwartz (now Arlington County's fire chief) about what exactly a Metropolitan Medical Response System is and what the funding change could mean for cities' emergency response efforts in this edited transcript.

What is a Metropolitan Medical Response System?

MMRS, as it's known, is an effort to build operational plans and capabilities through a collaborative process that includes all of the operational stakeholders. So you bring together the fire, EMS [Emergency Medical Services], hazardous materials, law enforcement, emergency management and health officials, and instead of each of them developing a plan or a capability around a particular threat, you instead do that collaboratively to develop one plan and one integrated capability that is reflective of the way the system will react to that kind of a crisis.

In each city, who oversees the response system?

The requirement is that the system have a steering committee, so typically it will be executive level people from the law enforcment agency, the fire department, the emergency management agency, the health department, and the last -- but by no means insignificant actor in this -- is the local hospital or hospitals. ... The hospitals play obviously a critical role in the management of casualties associated with a large-scale event. And since a good deal of the hospitals in this country are private health-care entities, the great advantage of MMRS is it creates a space where we can actually bridge the divide between what government is going to do during a crisis and what the community resource of our health-care system is going to bring. There isn't anything else that we're doing in the homeland security space that fosters that relationship as much as MMRS does.

Where and when was the first MMRS developed?

In 1995, after the sarin attack in a Tokyo subway, the Washington metropolitan area ... grew concerned about chemical terrorism as a threat to our own Metro [train system]. So we crafted a letter that was ultimately signed by [D.C. Councilman] Jack Evans who at the time was the chair of COG [the Metropolitan Washington Council of Governments]. The letter went to [President Bill Clinton], and it simply observed that what happened in Tokyo could happen here; and if it did, our communities did not have the training, the equipment or the knowledge necessary to deal with just such an emergency.

The president tasked the Department of Health and Human Services (HHS) ... to work with the national capital region on just such a problem, and what resulted was at the time called the Metropolitan Medical Strike Team (MMST). ... It was about a years worth of work that examined the problems -- mostly around chemical, radiological [and] to a lesser degree biological -- and at the time that project involved the development of a response team that was fire, EMS, hazmat and law enforcement. ... When that project was done and MMST was operational, it was already actually envisioned to be replicated. New York was the second one. Seattle was early in there, too. ... Then, it became very clear that we had left out in those early efforts public health and hospitals. ... So MMST was done in 1995. MMRS really began out of that in 1996-97. And over the course of several years, cities were added to the program. New funding was given to HHS to go out and contract with new cities and bring them on board. So the first MMRS ended up being the Washington metropolitan area. ... So the MMST is simply the response team ... whereas MMRS was about how the system was going to function.

What problems, if any, has your city or other cities encountered while developing and/or operating this system?

I don't know that there have been a lot of problems. What is very special about MMRS is that it places the decisionmaking about building capabilities at the local level, which is where crises happen. So the  local leaders [have the ability] to say 'Well, here's what we think is of the greatest threat and where we have gaps that need to be filled.' ... That's been the great advantage of something like MMRS -- [it's] hugely flexible and adaptable to local needs.

What are the financial and operational benefits of this system?

The operational benefits are that you are doing integrated planning across each of the disciplines, and in some cases, jurisdictions that need to work together in a crisis. You're not waiting until the crisis happens to get the fire department and the public health department together to figure out how they're going to manage the release of biological material, which is both a hazardous materials incident and a public health emergency. ... You are certainly socializing the different disciplines and the different organizations, and to some extent, you are bridging the cultural divides that can separate entities that really need to be working very closely together once the crisis occurs.

In terms of finances, the original contract [between HHS and each city] was $600,000 -- a modest sum to achieve these kinds of gains. For a number of years, there was no sustainment. The localities had to sustain the system on their own. And then the feds decided that they would begin to bring some sustainment money to it. That typically was between $250,000 and $300,000 a year out of the federal budget to 124 cities. So I think the highest the budget ever got to was $70 million, which is a very modest amount of money, and other than perhaps replenishing pharmaceuticals because they have expiration dates ... what the money really was doing was fostering that space where the different organizations could come together and figure out together how they were going to solve problems that threaten their city.

How is a Metropolitan Medical Reponse System funded today?

The cities are still getting that modest amount of money ... but the system or the program has been under threat of budget cut for many, many years. [George W. Bush's administration] never had it in its budget. Congress always restored it. ... I know it's not in [the Obama administration's] current budget. But the way that it is now proposed to be administered is that the states are going to get Homeland Security Grant [Program] money, and if they decide to pursue or to continue MMRS, it has to come out of that larger grant. There won't be a separate grant going to those 124 cities any longer and that's [fiscal year] for 2012 and beyond. ... There's the real sense that that money's going to get lost in the larger grant programs.

How do you think localities will deal with the loss of funding?

I think that many localities are going to continue to work with some semblance of this collaborative organization. In Arlington, we have regular meetings [between] the agency heads of fire, police, emergency management, public health [and] our hospital chief operating officers participate as does our IT director because IT is a big component of our preparedness efforts. So if Arlington is any example, we'll continue to meet because ... there is work to be done across these agency boundaries that at least some of which can be accomplished without money. Money typically goes to fund a staff person to manage meetings and to manage efforts that the steering committee may direct. Jurisdictions are gonna have to make a decision: Do they slice off something from another portion of their budget to continue to fund the support for this or is just the leadership of the various agencies coming together on a regular basis and figuring out how they're going to work together at their preparedness efforts another alternative?

Do you know of any cities that stopped running the system because of funding issues?

Money in these grants is available to the localities up to three years, so 2011 money may not be exhausted until 2014. Right now as the change in the funding is beginning to occur [because] Congress gave the [HHS] Secretary more latitude in how she was going to allocate grant funds in 2012, we're only now beginning to figure out what the change is actually going to mean. ...But presumably they'll [localities] be wrestling with that in the next several months.

Here in Arlington, we have begun the conversation, but it's been part of a conversation that really has been the larger grant conversation, which is: As we see grant amounts decrease and we have capabilities that need to be sustained, what in our judgment needs to be absorbed by local budgets.

How do you think emergency response will suffer without this system fully in place?

I do worry that without that small amount of money as a way to organize local stakeholders, that we risk regressing back into professional and jurisdictional silos that are not helpful to the overall planning effort or the building of capabilities.