Page 91 - Journal of Special Operations Medicine - Fall 2016

operations, these incidents now routinely include hos- 2016 Republican and Democratic
tage/barricade situations, civil disturbance incidents, National Conventions
mass gathering event security, and executive protection The Republican National Convention (RNC) held in
missions. While the time durations of specific incidents Cleve land, Ohio, July 18–21, 2016, and the Democratic
are situationally dependent, extended operations typi- National Convention (DNC) held in Philadelphia, Penn-
cally span hours to days. In civil disturbances and disas- sylvania, July 25–28, 2016, were the 49th and 50th de-
ter scenarios, the ongoing operational medical support clared NSSEs, respectively. Under the auspices of the
needs can extend for weeksto months with responsibili- USSS Emergency Services Section (ESS), multiple force
ties spanning large geographic areas. Even brief NSSEs, protection MSTs were deployed to each venue, opera-
such as a 1-day summit or address, involving highly tional from 3 days before the start of each convention.
complex security operations with preparatory logistics In the weeks immediately before the 2016 conventions,
that begin weeks to months in advance, may be consid- multiple incidents across the United States involving
ered extended operations. Maintaining adequate force organized lethal attacks on police officers escalated the
protection through the provision of dedicated opera- threat matrix and safety concerns for law enforcement
tional medical support is a key component impacting personnel at both the RNC and DNC to unprecedented
overall mission success.
levels. Deployment of vetted medical assets functioning
with strict adherence to principles of operational secu-
The provision of dedicated force protection medical rity was an intentional objective of the highest priority
support can be a critical factor toward enhancing in- for both venues.
dividual law enforcement personnel health sufficient to
maintaining effectiveness for the duration of incidents. The USSS has deployed formal NSSE medical support, in
Intrinsic medical support assets are often the sole medi- its current configuration, since the 2002 Winter Olym-
cal resources to which law enforcement personnel have pics in Salt Lake City, Utah. Barring unconventional
access during extended operations. The more conven- logistics or extraordinary venue requirements, standard
tional approach of standby areas for staging of EMS MST configuration includes a USSS agent/officer EMT,
personnel or the establishment of fire-ground type rehab ESS paramedic, and an operational physician. Deploy-
zones may not be feasible or appropriate in this type able physicians draw from the academic emergency med-
of environment for multiple reasons. Ongoing active icine faculty of the USSS-designated national medical
threat levels, lack of familiarity with individual agency control institution thereby ensuring unified command
standard operating procedures, physical access control and streamlined communications. MSTs are mobile with
restrictions, and provider scopes of practice not directed security access permitting medical response to law en-
toward sick call medicine are real imitations. Further, forcement personnel at all assigned posts of duty. The
7
should the need for true emergency medical care be re- medical loadout is optimally configured to address com-
quired, potential delays due to legitimate operational mon sick call–type medical complaints but equally capa-
security concerns over the introduction of nonvetted ble of managing most routine and emergency conditions.
response elements into a secure environment may occur.
The spectrum of clinical scenarios encountered during
force protection medical support of NSSEs is diverse and
A key tenet of tactical and operational medicine em- care must be rendered through a portable and highly
phasizes the importance of mission preplanning, often adaptable platform with a low visibility profile appro-
functionally accomplished through the completion of a priate for the USSS protective environment.
medical threat assessment (MTA) for the intended site
of a planned mission. This process entails a detailed and For the 2016 RNC and DNC, scheduled MST shifts
timely analysis of local safety and environmental condi- were 12 hours with periods of intentional overlap cor-
tions, determination of active potential health threats, responding with peak staffing of NSSE-assigned law
identification of resources for routine, urgent and emer- enforcement personnel. Teams alternated overnight on-
gency medical care, assessment of EMS system capabili- call coverage, ensuring off-hours and off-duty access to
ties, and designation of receiving hospitals and trauma medical support often provided at ad hoc locations to
centers. For NSSEs, the USSS designates an Emergency include command posts, “down” rooms, hotels, and
Services Specialist to serve as chair of the Health and even vehicles. Adhering to core principals of operational
Medical Subcommittee (HMSC), responsible for devel- medical support, the central safety objective of the MST
oping a comprehensive plan to address all aspects of approach is to deliver medical care, as appropriate, to
public health and medical response for the designated law enforcement personnel that may otherwise not be
events. The resulting compendium of information, well relieved of duty to seek medical attention at healthcare
beyond the elements composing a standard MTA, subse- facilities. The vast majority of federal law enforcement
quently becomes immediately accessible to medical sup- personnel assigned to NSSEs are deployed remote from
port teams (MSTs) in operation at an NSSE.

Medical Support at National Special Security Events 73