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Presidential debate medical coverage: 7 top takeaways

ICS, communications and pre-staging EMS personnel and equipment were critical components of the presidential candidate debate at Washington University


Sabina Braithwaite, MD Deputy Chief of Washington University EMS, and Maia Dorsett, MD 2016 Fellow in EMS Medicine, in the debate hall.

Photo courtesy of Dr. David K. Tan

Medical coverage for high-profile mass gatherings, like a presidential candidate debate, is a critical, but often overlooked element of the complex and intense preparation activities of public safety personnel.

Planning for the October 9 debate between Donald Trump and Hillary Clinton at Washington University in St. Louis began many months before the two candidates met on stage. This was the fifth debate held at the University since 1992.

Here are some of the important and shareable takeaways from my participation as the EMS medical director in planning, logistics and operations of this event.

Tight security logistics

A presidential debate is definitely a mass gathering event, but the added element of tight security posed a unique logistical challenge when planning ingress and egress routes for crews and apparatus. Because access to the debate hall itself was tightly controlled and restricted, medical coverage to immediately stabilize, treat, then transport any serious medical emergency was a high priority leading to the development of an on-site, pre-staged medical team.

Medical equipment for the on-site, pre-staged medical team also had to be brought in several days beforehand for screening and security clearance. So pre-planning for necessary medications, equipment and supplies was essential.

Debate hall medical crew

The composition of the debate hall medical crew included an EMS physician and four paramedics. If needed, the team would initiate emergency treatment while simultaneously working with the Emergency Operations Center on campus to coordinate ambulance pickup.

Multiple medical operation areas

Additionally, the debate hall was only one of several areas of operation that needed medical coverage. Large numbers of police, fire and EMS personnel were assembled in strategic areas to cover routine calls in and immediately surrounding the Washington University campus. Public safety personnel were also positioned to form a quick response contingency should civil unrest or other incidents unfold.

Strategically placed resources helped reduce response times that were significantly degraded due to the extensive traffic re-routing patterns and road closures required for security purposes.

Multi-day incident

Though the debate only lasted for 90 minutes on Sunday evening, many first responders started arriving and staging on Friday to provide medical services to the hundreds of personnel assembling for the event. Medical force protection assets were available in the various staging areas. A cadre of paramedics, along with one or two EMS physicians, formed the core element of these rapid response force protection medical assets.

Anticipating traumatic injury

Scores of protestors arrived on campus making the trauma potential from thrown objects or even biological substances a major concern. Medical response teams were created to rapidly extract injured personnel and were equipped with rapid decontamination capabilities and blunt trauma kits. Mutual aid paramedics were brought in to staff these teams and were augmented by EMTs from the university’s campus-based EMS system.

A heavy security presence to help protect law enforcement and medical teams seemed to be an effective deterrent during the weekend and throughout the debate itself.

Value of NIMS and IAP

The value of using and adhering to principles of the National Incident Management System cannot be overstated. The entire Incident Action Plan was continually updated in an organized and step-wise manner.

In addition to ensuring medical response capability, the IAP also included scheduled clinic hours for the hundreds of personnel on campus who may have sustained a minor injury or illness during their operational period. An on-site clinic made it possible for essential workers to obtain an evaluation while optimizing their chances of performing and completing indispensable tasks. The clinics were staffed by EMS physicians and at least two paramedics with arrangements made with a local pharmacy to expedite delivery of medications.

Communication to medical control

In ICS, the operational medical assets are under Operations section and force protection medical assets are under the Logistics section. Which means the medical component of such a large and complicated operation may span across an IAP making the importance of good communication and pre-planning even more crucial. Having access to direct medical control in the form of physicians experienced in the subtle complexities of field care can also be advantageous especially in the rapidly changing environment of a mass gathering event with high potential for prolonged operations and evolving hostilities.

Mass gathering principles of EMS preparation and planning become more complicated when high profile and high-security elements are introduced. Frequent plan revisions are to be expected, but can be attenuated by a well-organized NIMS approach and reliance on trusted community partners to provide assistance.

David K. Tan, MD, EMT-T, FAEMS, is associate professor and chief of EMS in the division of emergency medicine at Washington University School of Medicine in St. Louis. He is double board-certified in Emergency Medicine and EMS Medicine by the American Board of Emergency Medicine. Dr. Tan remains very active in EMS at the local, state and national levels as an operational medical director for local police, fire and EMS agencies. He is chairman of the Metropolitan St. Louis Emergency Transport Oversight Commission, vice-chairman of the Missouri State Advisory Council on EMS, and president of the National Association of EMS Physicians. Dr. Tan is a member of the EMS1 Editorial Advisory Board. He also provides medical direction to and the EMS1 Academy.