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Medical preparation for the 2008 Republican National Convention: A practical guide

Major political conventions are classified as National Special Security Events (NSSEs) as established in 1998 by Presidential Directive 62. Under the directive, the United States Secret Service (USSS) is designated as the lead agency for design and implementation of the operational security plan, the Federal Bureau of Investigation (FBI) is designated as the lead agency or crisis response, and the Federal Emergency Management Agency is designated as the lead agency for crisis or consequence management. For all practical purposes, the USSS is the lead agency unless, and until, a federal crime is committed or a situation has to be mitigated where the FBI or Federal Emergency Management Agency would take the lead, respectively. Other examples of NSSEs include the Olympics, presidential inaugurations, and special large multinational meetings. NSSEs require different approaches from planning for usual mass gathering events as they require planning for individuals protected by the USSS, a higher probability of protest-related violence and terrorist attacks, and the potential for medical care delivery in a venue that is isolated from other medical resources due to security concerns. Planners must include preparation for low-probability, high-impact incidents such as nuclear, biologic, and chemical attacks and/or large explosions with or without structural collapse. Owing to the scale of NSSEs, they are typically held in large urban centers across the United States. St. Paul, a city of approximately 270,000 people, was considered by many to be an unlikely site for a major political convention. Fifteen to twenty thousand media alone were anticipated for the 2008 Republican National Convention (RNC), along with 5,000 delegates and their alternates, and 20,000 to 50,000 protesters including up to 3,000 individuals from various anarchist groups. A massive Labor Day protest march was planned. Because of the size of this event relative to available accommodations in St. Paul, attendees and support personnel for the convention were spread throughout the Twin Cities and communities to the immediate north and south of the metropolitan area, thus adding complexity to the planning. With the large influx of individuals into Minnesota during the weeks leading up to and during the convention, we anticipated an increase in the frequency of medical emergencies and need for general medical care in both Minneapolis and St. Paul. Many of the preparations described in this article were implemented to meet these needs. We discovered during the planning process that there was scant literature to guide us. We believe that the documentation of our planning may be of value to other communities hosting future NSSEs, although we realize that each NSSE will have specific challenges to face, thus requiring different resource commitments. As the focus is on NSSE planning, we will emphasize the unique aspects of these events rather than review general mass gathering preparedness.