Pittsburgh Pulls off EMS Coverage during G-20 Summit

• Robert J. McCaughan, BS, EMT-P
• 2009 Oct 30

On June 23, 2009, the U.S. Department of Homeland Security declared Pittsburgh's G-20 summit in September a "National Special Security Event" (NSSE.) This declaration marked the start of a three-month planning process for one of the largest and most complex events to ever take place in western Pennsylvania. The direction from U.S. Secret Service was straight forward: create and implement a medical plan for the Sept. 24 and 25 G-20 Summit.

The first opportunity to formally meet and discuss this event was during a July 7 meeting. At that meeting, the Secret Service brought together what was to become the Executive Steering Committee, which was to "oversee the development and implementation of a comprehensive, integrated security plan."

Executive Steering Committee
This committee included command-level representatives of the Secret Service, FBI and FEMA, as well as federal, state and local representatives, including the Pittsburgh public safety director and the chiefs of the bureaus of EMS, police and fire. Oversight was accomplished by 21 subcommittees, each charged with specific tasks and areas of responsibility.

The EMS component of the planning effort fell under the Health/Medical Subcommittee. Its mission was to "develop a plan and provide medical support to assist, and if necessary, relocate law enforcement and other public safety personnel, protectees, event participants and the general public." As the home service, the City of Pittsburgh Bureau of EMS (PEMS) led the planning process and co-chaired the Health/Medical Subcommittee.

Preparing for large events is relatively common in the City of Champions because Pittsburgh is home to many events with hundreds of thousands spectators, including the 2006 Major League Baseball All Star Game, and Steelers Super Bowl and Penguin Stanley Cup victory celebrations. But, as we were to find out, these all paled in comparison to planning for and executing this NSSE.

Small Event, Big Plans
With only about 5,000 official attendees, the G20 Summit would be a relatively small event. However, the attendees would include the political leaders of the world. It would require stringent security measures because of an expected but unpredictable number of protestors and average citizens desiring to exercise their free speech rights. The medical plan also needed to address the risk of a terrorist attack with weapons of mass destruction, the ongoing H1N1 influenza virus pandemic, and the health and safety of the thousands of public safety professionals covering the event.

After it became obvious that local, regional and statewide assets would be required to provide adequate medical coverage as well as maintain daily response levels, PEMS reached out to EMS agencies in Allegheny County, the 10-county EMS region, and the Commonwealth of Pennsylvania for support. Once officials realized the magnitude of the medical resource needs for the G20 Summit were similar to those of a community, the event was referred to as the "City of G20," separating it from the "City of Pittsburgh" and helping distinguish between the two.

For its part, PEMS modified staffing for the two days of the Summit – days off were cancelled Sept. 24 and 25 so PEMS paramedics could provide the following coverage:

• 24-hour ALS ambulance coverage for President Barack Obama, as well as other protectees;
• Two rapid-deployment teams with two paramedics and one emergency physician each within the summit site, the David L. Lawrence Convention Center (DLLCC);
• Two additional ALS ambulances assigned to the DLLCC;
• A heavy-rescue truck assigned to the DLLCC;
• A HazMat response team staged for the DLLCC;
• 12 mobile medic crews with two paramedics each deployed to the police mobile field forces. This also included four teams assigned to ambulances and eight teams assigned to gator-type vehicles;
• Three disentanglement teams of Pittsburgh paramedics, police officers and firefighters who would safely remove protestors from lockdown devices;
• Pittsburgh river rescue, U.S. Coast Guard and U.S. Navy river rescue boats;
• ALS ambulances at the various G-20 social venues;
• One paramedic assigned to each of five public safety rehab sites; and
• Two motorcycle units used to supplement routine city calls.     

Although the majority of the attention for safety/security planning was directed to the summit itself, several other high-profile events that also demanded EMS coverage took place. Each venue had unique medical and security issues. These included a dinner reception on Sept. 24 at Phipps Conservatory for visiting diplomats and their spouses.

Upon completion of that event, First Lady Michelle Obama, along with the other spouses, proceeded to another reception at Rosemont Farm. On Sept. 25, the day of the summit, Obama hosted two more events: a tour of the School for the Creative and Performing Arts followed by a private tour and luncheon at the Andy Warhol Museum. Each event required several ALS ambulances, a heavy-rescue truck, an on-site PEMS team and a venue support team, which included a physician, paramedic, nurse or EMT (one of which had to be female.)

Additional Support
As all PEMS resources were stretched to the limit, Allegheny County Emergency Services and the Allegheny County EMS Council provided 20 additional ambulances, personnel and equipment to support the event. This additional support included the following:

• 10 ambulances were placed in the downtown area; eight supported first aid stations and were placed within the hardened security perimeter;
• 10 were staged in two groups of five immediately north and south of downtown to provide quick response from either side of the summit site;
• 25 to 30 were placed on standby for the event; and
• A forward aid support team, which included one physician and five paramedics, was made available for response via an EMS van.     

Given the potential for having to treat both law enforcement officers and the general public, four first aid stations were established downtown and two more near the university corridors. Of the four in downtown, two were for public safety professionals and two for the general public. Of the ones near the university, one was for public safety and one for the general public. The EMS Institute provided paramedics, EMTs, nurses and a physician for each of these stations. Most of the physicians and nurses were provided by Allegheny General Hospital and the University of Pittsburgh Medical Center, which also brought its SMART Van to the DLLCC.

MCI Pre-planning
Because the summit brought world leaders together, officials had to plan for a mass casualty incident (MCI). This response strategy involved an overlapping command structure from the PEMS chiefs and Allegheny County operational chiefs. In the event of an MCI, many of the patients would likely have been transported to one of three trauma centers in Pittsburgh. When those and other regional hospitals reached capacity, patients were to be transported to a mobile field hospital capable of moving 150 patients per hour. This mobile field hospital was deployed at a high school about three miles from the DLLCC by the Pennsylvania Department of Health, Southeastern Pa. Specialized Medical Response Team. There was also a plan to airlift patients from that location to hospitals outside of Pittsburgh.

Execution
Normal EMS operations weren't affected despite the magnitude of the summit, possibly because PEMS divided operations at the 9-1-1 center into the "City of Pittsburgh" and the "City of G-20." Having a city and county chief sitting between the two dispatch consoles enabled them to direct resources to either event based on information received from telecommunications operators or the field. Their sense of the bigger picture was further reinforced by real-time information/intelligence flowing from the Multi-Agency Coordination Center (MACC), which was staffed with key command from all involved agencies and operated within the same building.

As always, safety and security of personnel was paramount. Therefore, given the nature of the event and the potential for conflict, all PEMS paramedics and many Allegheny County paramedics assigned to the event received additional training, which included:

• Cultural differences/sensitivity and treatment awareness;
• Mass casualty plan/triage review;
• Legal issues;
• WMD awareness/review; and
• PPE review and decontamination.     

In addition, PEMS paramedics assigned to the mobile medic crews and cut teams, which were embedded with the police mobile field forces, also underwent additional training. They were outfitted with riot-type helmets that had PEMS emblems and the Star of Life, which aided in quick differentiation between law enforcement and EMS; ballistic vests; and MSA millennium gas masks with riot agent filter canisters and a complete change of clothes and toiletries kit. Auto injectors were also available to all personnel.

Each EMS provider was required to wear a high-visibility vest at all times, which helped with identification from a command standpoint and allowed police officers being able to identify EMS providers at all times. Positive comments were also received from some protestors and individuals who provided first aid/and general care to the protestors, called "street medics."

Although police escorts were available upon request, one was never used. No vehicles or equipment sustained any damage. More importantly, none of the more than 400 prehospital care professionals who worked the event sustained an injury or were targeted by protesters. EMS did provide service for 22 patients with non-life-threatening conditions, 11 of whom required transport.

Lessons Learned
Preparing and planning to provide EMS coverage for this event in just three months was challenging. With more than 400 prehospital care professionals, it was the largest EMS mobilization in the history of the Commonwealth of Pennsylvania: the Pittsburgh Paramedics, Allegheny County Paramedics and EMTs, regional paramedics, nurses and physicians, public health professionals and others from around the Commonwealth of Pennsylvania. Success was built on several directives.

1. Reach out early to those whose help and support you'll need, and make them an integral part of the planning process.
2. Seek input and advice from other agencies and cities that have planned for and experienced events similar to yours.
3. Share as much information as possible with your field forces and update them as new information becomes available or as plans change.
4. Think "out of the box" by seeking those whose approach to working such events is different than that of the traditional EMS community (i.e., street medics).
5. Ensure flexibility and mobility. For example, plans and directions changed daily up to Sept. 23. Protester events didn't always occur at designated areas.
6. Make sure you can handle injuries at aid stations or by mobile medic crews.     

Robert J. McCaughan, BS, EMT-P, is chief of the City of Pittsburgh Emergency Medical Services. Contact him at robert.mccaughan@city.pittsburgh.pa.us.

PEMS Medical Director Dr. Ron Roth and District Chief Jim Holman assisted the author with this article.