Page 92 - Journal of Special Operations Medicine - Fall 2016

home, so even relatively minor medical care needs must stress on the local emergency healthcare infrastructure,
otherwise be sought at urgent care clinics or hospital and minimizing operational personnel downtime at
emergency departments. The capability of MSTs to an NSSE take on ever greater importance against the
manage routine and urgent medical conditions effec- backdrop of a disturbing nationwide trend of violence
tively and expeditiously on site can ideally prevent the specifically directed against law enforcement. Effective
progression of illness or injuries and avoid having to mission preplanning, development of a highly adapt-
take operational personnel offline amid the highly com- able medical loadout, and deployment of personnel ca-
plex NSSE security considerations. pable of managing the breadth of illnesses and injuries
encountered in the NSSE environment are all critical
For the duration of both the RNC and DNC, requests to MST mission success. The principal objective of law
for MST assistance by NSSE law enforcement personnel enforcement safety is achieved through an MST model
were made through a Multiagency Coordinating Center that optimizes personnel health and effectiveness while
(MACC), staffed by representatives from all participat- maintaining operational security and thereby enhancing
ing law enforcement agencies including the USSS ESS the overall success of the primary mission.
chair of the event HMSC. Each respective MACC served
as the principal 24-hour public safety communications Disclosures
and coordination center throughout both events. USSS
8
MSTs were dispatched principally based on physical The authors have nothing to disclose.
proximity to requests. When not actively engaged with
medical responses, teams conducted preventative medi- References
cine surveillance activities. These included routine and
systematic field assessments of law enforcement person- 1. Levy MJ, Tang N. Medical support for law enforcement-
nel, typically regarding the nutritional and hydration extended operations incidents. Am J Disaster Med. 2014;9:
127–135.
status of those posted to outdoor assignments function- 2. US Secret Service. National special security events. http://www
ally remote from the main convention sites. Delivery of .secretservice.gov/nsse.shtml. Accessed July 31, 2016.
water and electrolytes to operational personnel at fixed- 3. US Department of Homeland Security, Center for Domestic
duty posts is a routine expected activity for every MST Preparedness. Training support. https://cdp.dhs.gov/training
during hot weather NSSEs. /nsse-nle-support. Accessed July 31, 2016.
4. US Department of Transportation. National special security events.
http://ops.fhwa.dot.gov/publications/fhwahop11012/nsse7
One fundamental operating principal common to MSTs _0.htm. Accessed July 31, 2016.
in service at NSSEs is the express understanding that 5. US Department of Homeland Security, Federal Emergency Man-
this resource does not replace or supplant the activation agement Agency. National response framework. http://www
of appropriate “9-1-1”–type EMS responses as required .fema.gov/media-library-data/20130726-1914-25045-1246/
by the nature of specific incidents. MSTs are principally final_national_response_framework_20130501.pdf. Accessed
August 07, 2016.
designed for NSSE law enforcement personnel support 6. National Incident Management System. Intelligence/investiga-
and operate by vehicle or on foot as situationally man- tions function guidance and field operations guide. http://www
dated. Moderately variable response times are intrinsic .fema.gov/media-library-data/1382093786350-411d33add
to this model and may be expected. Appropriate safety 2602da9c867a4fbcc7ff20e/NIMS_Intel_Invest_Function
_Guidance_FINAL.pdf. Accessed August 07, 2016.
protocols mandate that EMS be activated whenever 7. Tang, N, Kubit J, Berrett OM, et al. A multiyear analysis of the
medically necessary and it is common for an MST to clinical encounters of the ATF tactical medical program. J Spec
also respond to specific incidents. This occurred on mul- Oper Med. 2013;14.3:102–106.
tiple occasions at both recent conventions. MSTs are not 8. US Department of Homeland Security Press Office. Medial
designed with patient transport capability and, if so re- release: Secretary Johnson Inspects Convention Security Op-
quired, this most often occurs by conventional EMS am- erations in Cleveland. https://www.dhs.gov/news/2016/07/15
/secretary-johnson-inspects-convention-security-operations
bulances with MST personnel accompanying. -cleveland. Accessed July 31, 2016.

Conclusions
Force protection medical support through resources Dr Tang is vice chair for Operational Medicine at the Johns
such as the USSS MSTs represent a unique and highly Hopkins University, Department of Emergency Medicine, and
specialized operational medicine approach designed to the medical director of the US Secret Service.
mitigate, identify, and treat medical contingencies that E-mail: ntang@jhmi.edu.
may arise amongst the subpopulation of law enforce- Dr Margolis is faculty in the Division of Special Operations
ment personnel deployed to an NSSE. The intrinsic at the Johns Hopkins University, Department of Emergency
capabilities of managing complex medical scenarios, Medicine, and the associate medical director of the United
delivering advanced on site care, preventing additional States Secret Service.

74 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2016