On 21 January 2013, the United States celebrated the re-election of the 44th U.S. President and Vice President with a swearing-in ceremony at the Capital, a parade along Pennsylvania Avenue, and – later that evening – a number of Inaugural Balls in the Nation’s Capital.
These activities, along with various related social events before and after that date, brought nearly a million tourists of all ages into the greater Washington, D.C., area – and, with them, a broad spectrum of planning challenges, particularly from a healthcare perspective.
As is almost always the case with other types of national security events, the key to successful planning for a presidential inauguration requires considerable advance preparations done by committees – more than 30 of them for the inauguration! Each committee was given a specific area of planning responsibility. Health and Medical Planning, co-chaired by a senior official of the D.C. Department of Health and the National Capital Region Coordinator for the U.S. Department of Health and Human Services (HHS), was one of the largest committees. A multidisciplinary group of representatives from D.C., Maryland, and Virginia were members of the committee and met regularly as a group starting back in the early fall. However, much of the detailed work was done by the 11 task forces staffed by committee volunteers.
Each health and/or medical-related task force met on a weekly or biweekly basis to draft the list of planning materials they were given to carry out their work. All completed draft materials were posted on a secure website, where members could access materials and read the work done by other task forces. At the large group meetings, each task force reported on its progress; additional information, and potential conflicts or other problems, also were discussed. The participants then reached a consensus on the recommended practices and passed them on to the D.C. government and Presidential Inaugural Committee.
Major Medical Issues
There are obviously a large number of medical planning issues that had to be addressed for each of the three major geographical areas of inaugural activity: (a) the swearing-in at the Capitol; (b) the inaugural parade; and (c) the major inaugural balls. Common to each location was the planning required to address credentialing – by the U.S. Secret Service – of the medical and other staff designated to work at each site.
Vital to the provision of medical care to the sick and injured at any one of the sites was determining the number and strategic location for the medical aid stations (MASs). Each MAS was staffed by personnel qualified to perform advanced life support; teams of doctors, nurses, and a paramedic were assigned to many of the stations. The parade-route MASs were staffed jointly by D.C. Fire and EMS (emergency medical services) staff, along with HHS and DOD (Department of Defense) medical teams. Some of the other sites were staffed by volunteer American Red Cross and D.C. Medical Reserve Corps personnel.
Complementing the personnel at the MASs were roving medical teams – on foot and on “Gators” (small motorized transport vehicles); the members of those teams were often the first to get to a patient. Depending on the nature of the problem, they would either render aid and release the patient or take the patient to the closest MAS. The personnel at a MAS had a variety of medical equipment, medications, and supplies available for performing the appropriate examination and treatment of each patient, thus minimizing the need to transport patients to a local hospital.
D.C. Fire Department and EMS ambulances and other mutual-aid units from Maryland and Virginia were strategically located at each venue. Patients requiring transport to a hospital were taken (usually by Gator) to the nearest available ambulance. Hospital destinations were determined by a central ambulance coordination center, headquartered at a local firehouse, that maintained close contact with other personnel (stationed at the D.C. Department of Health’s own Command Center) who monitored hospital bed availability throughout the region.
No less important to planning for medical care at any and all venues was the planning that focused primarily on the hospitals themselves. Each facility, including those in the Maryland and Virginia suburbs, was asked to ensure that adequate medical equipment, supplies, and medications were on hand. Staff planning proved particularly challenging, though, because Inauguration Day was a holiday for many hospitals and maintaining normal daily or surge staffing added certain costs that would not be reimbursed.
Among the other security precautions put into place were countless city road closures, traffic detours, and security checkpoints – all of which impacted the ability of staff getting to work and, for some facilities, of supplies being delivered on time. The monitoring of blood product utilization and conduct of epidemiological surveillance began before the actual inauguration and continued after it ended.
Standard information sharing among the National Capital Region hospitals was carried out by use of the intranet-based systems and policies used on a daily basis. Patient tracking, another planning priority, included issuing a disaster tag with a unique number assigned to each patient seen at any site venue. Periodically, logs with patient demographic details were submitted by radio or telephone to the D.C. Department of Health Command Center.
Moreover, at each venue, an experimental system – transferring the same patient information via handheld scanners and the intranet – served as a redundant patient tracking system. Hospitals posted the names of the patients they treated related to the inauguration on the patient tracking systems used regularly in D.C., Maryland, and Virginia. The D.C. Department of Health Command Center maintained a composite picture of hospital bed status and the inaugural-day patients being seen, along with the available blood supply. Staffing at the Command Center included public health, EMS, hospital officials, and epidemiologists from across the region.
Medical planning also addressed a variety of other issues – including, for example, inspections for all food vendors at each venue. Because the parade participants included hundreds of horses, extensive medical planning to address their needs also was carried out, as were pre-parade checkups and, to deal with an emergency situation, the strategic placement of veterinarians and horse ambulances near the parade route.
The Game Plan
The end product created collaboratively by all 33 committees was a written comprehensive concept of operations plan. This “game plan” served as the guidance document for all that was done before, during, and even after the inauguration by each and all of the numerous participants. Prior to the final version of the game plan being accepted, it was rehearsed in a series of tabletop exercises (several of which led to some helpful revisions being made). The final version of the plan was distributed to the senior leadership of each participating agency and organization involved to help their own decision-making, communications, and problem-solving processes.
The principal objectives of preplanning for a major event are: (a) to be ready for any contingency that might occur; and (b) to prevent problems, if possible, as part of the process. The after-action reviews have yet to be completed; however, if nothing “untoward” happened during the inauguration activities, the final assessment is likely to be that everything went “according to plan.”
Craig DeAtley, PA-C, is director of the Institute for Public Health Emergency Readiness at the Washington Hospital Center, the National Capital Region’s largest hospital. He also is the emergency manager for the National Rehabilitation Hospital, and co-executive director of the Center for HICS (Hospital Incident Command System) Education and Training. He previously served, for 28 years, as an associate professor of emergency medicine at The George Washington University. In addition, he has been both a volunteer paramedic with the Fairfax County (Virginia) Fire and Rescue Department and a member of the department’s Urban Search and Rescue Team. An Emergency Department PA at multiple facilities for over 40 years, he also has served, since 1991, as the assistant medical director for the Fairfax County Police Department.