Full text of DOI:10.1080/10903120190939490

EMERGENCY MEDICAL PLANNING FOR THE
2000 REPUBLICAN NATIONAL CONVENTION
C. Crawford Mechem, MD, Steven Hare, BS, EMT-P, Robert Hvisdas, MSN, RN,
David M. Berg, MBA, Ralph Halper, EMT-P, Leonard A. Cola, EMT-P
ings.4 However, in Pennsylvania, the minimum
amount of medical coverage required for an event of a
ABSTRACT
Planning for emergency medical services (EMS) coverage
for the 2000 Republican National Convention in Philadel-
phia was a complex process that involved the cooperation of
municipal, state, and federal agencies as well as local hospi-
tals. The medical needs of the delegates, members of the
media, and support personnel at the convention venue had
to be met. Contingency plans for the possibility of large,
organized political protests and associated injuries had to be
developed. Steps had to be taken to ensure the safety of
emergency personnel who may have to respond to such inci-
dents. Because of the heightened threat of terrorist attacks
on civilian populations in recent years, specialized training
and material to respond to such incidents were required.
The important role that local hospitals may play in provid-
ing care to victims of a large, multicasualty incident, espe-
cially one involving weapons of mass destruction, was rec-
ognized. Therefore, steps were taken to increase the aware-
ness of hospital staff to patient decontamination and isola-
tion techniques as well as specific therapies for the chemical,
biological, and radioactive agents that terrorists might use.
Finally, despite the focus placed on the convention, the day-
to-day emergency medical needs of the citizens of Philadel-
phia had to be met. Through careful planning, flexibility,
and cooperation, it was possible to successfully address all
of these issues. Key words: emergency medical services;
disaster planning; politics; Republican National Convention.
given crowd size is specified by state code.5 A licensed
ambulance must be stationed on site whenever there is
a crowd of 5,000 to 25,000. Two ambulances must be
present for crowds between 25,000 and 55,000, and
three or more ambulances for larger crowds. There
must also be a licensed physician directing the event’s
medical coverage whenever the anticipated or actual
crowd size exceeds 25,000. However, depending on
the nature of the event, the age and composition of the
crowd, and the anticipated weather, this coverage
may need to be augmented.6
Political conventions present unique challenges for
EMS planners.7 These can be high-profile events that
are the focus of extensive local, national, and even
international media coverage. In addition, a large
number of politicians and supporters may be in atten-
dance, requiring elaborate security plans. The latter
can be at odds with standard operating procedures for
emergency medical responders. Furthermore, prepa-
rations for such events can involve a multitude of
local, state, and federal agencies. Therefore, open lines
of communication and interagency cooperation are
mandatory to ensure a smooth operation. All of these
points are illustrated in the preparations for the recent
Republican National Convention in Philadelphia.
The 2000 Republican National Convention (RNC)
was held at the First Union Center in Philadelphia
from July 31 to August 3, 2000. The City of
Philadelphia’s plans for medical coverage of the event
can be broken down into five components. First, the
medical needs of the delegates, their guests, support
staff, law enforcement and security personnel, and
members of the media had to be addressed. Because
the venue was occupied and active during all hours of
the four-day period, medical coverage had to be avail-
able around the clock. In addition to the convention
activities held in the First Union Center, there was a
large number of other convention-related business
and social functions in the city throughout the week.
Medical coverage had to be arranged for some of the
larger events. Second, as was the case with the 1999
World Trade Organization conference in Seattle and
the 2000 spring meetings of the International
Monetary Fund in Washington, DC, the Republican
National Convention was the target of organized
protest groups. The City of Philadelphia therefore had
to anticipate the medical needs of potentially large
PREHOSPITAL EMERGENCY CARE 2001;5:344–352
The provision of emergency medical services (EMS)
coverage for mass gatherings is challenging and there-
fore requires careful planning. While recommenda-
tions and guidelines are readily available,1–3 each
event has its own dynamics. Therefore, preparations
need to be tailored accordingly. Few states set forth
standards for medical care provided at mass gather-
Received December 27, 2000, from the Philadelphia Fire
Department (CCM, SH, RH, LAC), Philadelphia, Pennsylvania; the
Department of Emergency Medicine, Hospital of the University of
Pennsylvania (CCM, RH), Philadelphia, Pennsylvania; and the
Emergency Management Strategic Healthcare Group, Department
of Veterans Affairs (DMB), Philadelphia, Pennsylvania. Revision
received April 10, 2001; accepted for publication April 12, 2001.
The views expressed in this article do not necessarily represent the
view of the Department of Veterans Affairs or the United States
government.
Address correspondence and reprint requests to: C. Crawford
Mechem, MD, Department of Emergency Medicine, Hospital of the
University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA
19104-4283. e-mail: <mechemc@mail.med.upenn.edu>.
344

Mechem et al. REPUBLICAN NATIONAL CONVENTION EMERGENCY PLANNING
345
TABLE 1. Medication Stocks for the
First Union Center First Aid Stations
numbers of protesters. The possibility that not all of
the protests would be peaceful also had to be taken
into consideration. Third, in the wake of the World
Trade Center and Oklahoma City bombings and the
Tokyo subway sarin attack, the city had to plan for
possible terrorist attacks targeting its citizens or atten-
dants at the convention. Fourth, preparation for an
event as large as the RNC required the cooperation
and assistance of the entire medical community in the
Philadelphia area. Therefore, efforts were made to
raise the level of emergency preparedness of local hos-
pitals. Finally, despite the focus placed on the conven-
tion, the Philadelphia Fire Department (PFD) in its
capacity as the sole 911 emergency response agency
had to ensure that the everyday emergency medical
needs of the citizens of Philadelphia were met. The
objective of this report is to describe how these five
issues were addressed in one comprehensive plan.
Oral medications
Acetaminophen
Antacids
Aspirin
Diphenhydramine
Famotidine
Hydroxyzine
Ibuprofen
Nitroglycerin
Prednisone
Prochlorperazine
Parenteral medications
Atropine
Calcium chloride
50% dextrose
Diphenhydramine
Dopamine
Epinephrine
Etomidate
Lidocaine
Lorazepam
Methylprednisolone
Midazolam
THE FIRST UNION CENTER
Built in 1996, the First Union Center is an eight-story
indoor sports and entertainment complex located in
South Philadelphia. In preparation for the convention,
it was reconfigured to include a large podium, press
boxes, delegate suites, seating for delegates on the
convention floor, and areas designated for seating of
alternate delegates and guests (Fig. 1). Following these
changes, it had a capacity of approximately 45,000. An
auxiliary air-conditioning system was installed to help
with the mid-summer Philadelphia heat and humidi-
ty. The parking lots surrounding the building were
filled with large tents serving as hospitality and press
pavilions, trailers, and railroad passenger cars that
served as hospitality venues. The sheer number of
temporary structures severely limited the ability of
emergency vehicles to navigate around the complex.
As the first day of the convention approached,
access to the First Union Center and surrounding
parking complex was limited to individuals carrying
credentials issued by the Secret Service. Obtaining
credentials was logistically complicated since there
are approximately 250 paramedics and 2,200 firefight-
ers working for the PFD, almost any of whom could
conceivably be called into service at the First Union
Center in an emergency. All vehicles, including emer-
gency vehicles, had to go through security check-
points on entering the complex. These entailed com-
plete visual inspections of the passenger and engine
compartments as well as underneath the vehicle. At
the same time, a canine team also inspected the vehi-
cle. This was a time-consuming process. All pedestri-
ans had to pass through metal detectors. Hand-held
items were scanned by x-ray machines, and all elec-
tronic devices were examined visually and turned on
to demonstrate they were functional.
Morphine sulfate
Prochlorperazine
Sodium bicarbonate
Tetanus/diphtheria toxoid
Vecuronium
Intravenous solutions
Lactated Ringer’s solution
Normal saline solution
Inhaled agent
Albuterol
nent first aid stations on the main level. Because of the
constraints of space, these rooms served as the only
patient care areas. The larger room functioned as the
primary medical facility. Both rooms contained gur-
neys as well as chairs for stable patients; resuscitation
equipment including cardiac monitors with cardiover-
sion/defibrillation capability and pulse oximeters;
suturing, surgical airway, and central venous line kits;
and a variety of prescription and non-prescription
medications and over-the-counter medical products
(Table 1). Much of this equipment had to be carried
through security checkpoints. The larger room also
had an icemaker, which proved invaluable in supply-
ing ice and cold bottled water to the large number of
attendees who were suffering from the heat. Hard-
wired telephones, cellular phones, and hand-held
radios were used to communicate between the two
stations.
The first aid stations were staffed during the hours
that the convention was in session. The larger station
also opened several hours prior to each session and
remained open for an hour after the event closed for
the night. Each room was staffed with between one
and four emergency physicians as well as an emer-
Within the First Union Center, there are two perma-

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PREHOSPITAL EMERGENCY CARE OCTOBER/DECEMBER 2001 VOLUME 5 / NUMBER 4
FIGURE 1. The configuration of the First Union Center for the Republican National Convention, illustrating the podium and closely spaced seat-
ing. Reprinted with permission from The Philadelphia Inquirer/KEVIN BURKETT, Philadelphia, Pennsylvania.
gency nurse. The larger room was also staffed with a
PFD EMS lieutenant who facilitated communications
and ambulance transport, when needed. Medical
staffing was supplemented with foot patrols of para-
medics stationed on each level of the building and in
the surrounding parking complex. The teams within
the building were equipped with medic bags, a car-
diac monitor-defibrillator, a stair chair, and a Reeves
stretcher (Reeves Manufacturing, Inc., Frederick, MD).
Paramedic teams in the parking area used golf carts to
reach patients.
The majority of patients seen in the first aid stations
were walk-ins with minor complaints. However,
when First Union employees identified a patient in
need of medical assistance who was not ambulatory,
they contacted the security command post within the
building, which in turn contacted by radio the physi-
cian supervising the foot patrols. The nearest foot
patrol then was directed to the scene and transported
the patient to a first aid room, if necessary.
There were three or four PFD paramedic units at the
First Union complex when the convention was in ses-

Mechem et al. REPUBLICAN NATIONAL CONVENTION EMERGENCY PLANNING
347
sion. One was staged at the top of the vehicle ramp
leading to the venue floor and at least two were in the
surrounding parking lot. The latter could be used to
transport patients located in the parking lot or to
replace the ambulance on the ramp if it transported a
patient to hospital. It was rare for all medic units on
site to be in use at the same time. However, because of
the time delay involved in having a medic unit go
through the Secret Service vehicle check, it made more
sense to have additional units staged within the
secured area rather than wait for units to come in from
outside. In addition to the units on site, the PFD had
designated four other medic units for RNC medical
coverage, should they be needed. These were used to
back up the First Union Center and to cover dignitary
motorcades and organized protests. During off-hours,
one or two units remained on site at the First Union
Center to provide medical care when the first aid sta-
tions were closed.
TABLE 2. Number of Patients Seen at the First
Union Center, According to Diagnostic Category
Allergic reaction
Chest pain
Cold/flu
Diabetes
Fracture/sprain/strain
Headache
Heat-related illness
Hypertension
Laceration
Loss of consciousness
Major trauma
Nausea/vomiting/diarrhea
Neurologic syndrome
Obstetrics/gynecology-related
Prescription fill or refill
Rash/skin syndrome
Respiratory
Soft-tissue injury
Substance abuse
Other (fatigue, dyspepsia, palpitations/arrhythmia,
presyncope, streptococcal pharyngitis, suture removal,
eye complaint)
7
1
4
2
10
2
12
1
14
2
0
9
2
0
1
6
4*
17
0
12
A potential logistical problem arose when a patient
required ambulance transport at the same time that a
Secret Service protectee’s motorcade was already at,
or due to arrive at, the vehicle ramp accessing the
venue floor. When a protectee was arriving, no other
personnel or vehicles were permitted in the immedi-
ate vicinity. However, by discussing in advance with
the Secret Service this potential conflict between
patient care and protectee security, compromises
could be made. As an example, a patient required
immediate transport to an ambulance on the ramp
when the vice-presidential nominee’s motorcade was
about to arrive. The Secret Service agreed to hold back
the motorcade until the ambulance with the patient
had departed.
Documentation was completed for all patients
except those with very minor medical complaints. The
latter category included a large number of individuals
coming to the first aid stations requesting Tylenol for
mild headaches, Band-Aids or moleskin for blisters on
their feet, or feminine hygiene products, or wishing to
cool off from the heat. Documentation involved a pre-
existing, standardized patient care form used by the
PFD for special events medical coverage. The first
page included patient demographics, chief complaint
and brief history, past medical history, allergies, cur-
rent medications, physical examination, and treatment
rendered. There were, in addition, spaces for the
patient to sign indicating consent to treatment as well
as refusal of treatment. To this was added a second
page that contained a checklist of 20 diagnostic cate-
gories that was completed for all patients. This list was
developed in conjunction with the Philadelphia
Department of Public Health and the Centers for
Disease Control and Prevention (CDC) and was
intended to serve as a surveillance instrument that
could identify disease outbreaks or possible terrorist
*Asthma 2; other 2.
incidents involving a biological or chemical agent. It
could also be used by the PFD to assist in planning the
medical coverage of future special events.
During the four days of the official convention, there
were a total of 106 patient encounters for which docu-
mentation was completed within the First Union
Center and surrounding parking complex. Their diag-
noses were classified into the 20 different categories
on the surveillance form (Table 2). The four most com-
mon diagnostic categories encountered were soft-tis-
sue injury (17 patients, 16%), laceration (14 patients,
13%), heat-related illness (12 patients, 11%), and
“other” (12 patients, 11%). Seventeen (16%) patients
were transported to local emergency departments in
accordance with existing PFD destination policies.
By staffing the first aid stations with emergency
physicians and nurses, it was possible to provide a
higher level of care and greater flexibility than would
be possible if only paramedics were used. As an illus-
tration, on the first day of the convention a delegate
presented to the first aid station with cellulitis of the
hand that appeared to warrant inpatient care with
intravenous antibiotics. The patient did not wish to be
admitted because his delegation was scheduled to cast
their nominating vote that evening. The patient was
transported by ambulance to hospital, evaluated by a
hand surgeon, given a dose of long-acting antibiotics,
and returned to the First Union Center in time to cast
his vote. He then returned to the first aid station each
day for the rest of the convention, where he received
daily doses of intravenous antibiotics. The resolution
of his cellulitis was monitored by the same care
providers each day.

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PREHOSPITAL EMERGENCY CARE OCTOBER/DECEMBER 2001 VOLUME 5 / NUMBER 4
The city’s emergency medical plan for the RNC also
Anticipating a possible repeat of the mass demon-
strations and civil unrest in Seattle and Washington,
DC, the PFD made coordinated plans with the
Philadelphia Police Department and other agencies to
respond to medical emergencies associated with
protests, while at the same time not needlessly putting
its personnel in jeopardy. The City of Philadelphia des-
ignated a public demonstration area in FDR Park
immediately adjacent to the First Union Center com-
plex. However, the park is heavily treed and has a low
visibility. Because of this and because of the large num-
ber of historical landmarks in Center City Philadelphia,
it was felt that most protesters would congregate in
Center City. One potential area for protests was
Independence National Historic Park (INHP), which is
a federal island within Center City Philadelphia and
contains Independence Hall, the Liberty Bell, and other
historic sites. The INHP arranged for its own medical
coverage, backed up by the PFD.
included a system to refill prescriptions for medica-
tions that delegates or other attendees at the conven-
tion may have forgotten to bring with them to
Philadelphia. The Philadelphia Department of Public
Health identified several dozen pharmacies that
agreed to expedite refilling prescriptions for conven-
tioneers. Some of these pharmacies were open around
the clock. If delegates or guests forgot to bring, or ran
out of, their prescription medication they were given a
telephone number to call. A shuttle van operated by
the American Red Cross picked them up, took them to
the nearest open participating pharmacy, waited for
them while their prescriptions were refilled, and took
them back to their pickup points. Similarly, if patients
were taken to an area hospital, by either a PFD ambu-
lance or a private vehicle, and were given a prescrip-
tion that needed to be filled, they could get a ride to a
pharmacy by the same mechanism and then be taken
back to their hotel or the First Union Center.
No permits for public demonstrations within Center
City were issued during the convention period. This
meant that the PFD had to be prepared to provide
medical coverage for unauthorized demonstrations
anywhere in the city. Therefore, deployment of
resources had to be flexible. Two Rapid Assessment
Teams (RATs) were created, one based in Center City
and one closer to the First Union Center. The RATs
were comprised of a fire suppression officer plus offi-
cers from EMS, Hazardous Materials (hazmat), Heavy
Rescue, and the Philadelphia Police Department rid-
ing in a field supervisor’s sport utility vehicle. When
there was a fire or medical call from a protest area, the
RAT was dispatched to the scene, assessed the situa-
tion, initiated immediate medical care if indicated,
and decided what additional resources, if any, were
needed. This eliminated the need to mobilize first
responder fire trucks and paramedic units on every
call, thereby conserving resources and reducing the
chance of expensive equipment’s being damaged or
vandalized by protesters. It was also easier for a small-
er vehicle to get through crowds than a much larger
fire engine or ladder company. The RATs were backed
up by up to five paramedic units dedicated to RNC-
related activities as well as fire apparatus. Paramedics
in front-line medic units were provided with nuclear-
biological-chemical filtration canisters and adapters to
attach to their self-contained breathing apparatus face
masks. While not intended to provide protection in
the event of release of a potentially life-threatening
agent, these would allow personnel to operate in an
area in which tear gas or pepper spray was being used
without having to wear their air tanks.
THE PROTESTERS
Since 1999 there has been a resurgence in organized
political demonstrations of the style and magnitude
seen during the Vietnam War era. This was clearly
seen during the week-long World Trade Organization
(WTO) Ministerial Conference in Seattle beginning the
last week of November 1999. Peaceful protests by
environmental groups, members of labor unions, and
college students were held around the city. Ultimately
tens of thousands ended up in the downtown area.
The vast majority of demonstrators continued to be
peaceful. Some protesters formed human blockades at
major intersections or locked themselves to scaffold-
ing with bike locks. Others chained themselves to each
other with “sleeping dragons,” PVC pipes wrapped
with duct tape, chicken wire, and tar to make cutting
difficult. However, a small number of protesters
resorted to violence to make their point. Property
damage in downtown Seattle was extensive. Groups
of protesters dressed in black and wearing masks used
hammers to smash store windows.8 Others punctured
the tires of vehicles, climbed on buses, or intimidated,
and even assaulted, delegates. Their goal was to pre-
vent the delegates from actually attending the confer-
ence.9 More than 600 protesters were arrested.10 One
consequence of the disturbances was an early end to
the conference. In addition, the estimated cost of dam-
ages to downtown was $2.5 million. The cost of lost
business was another $9.5 million.11
The April 2000 meetings of the International
Monetary Fund (IMF) in Washington, DC, were once
again the target of organized protest groups. Large
numbers of arrests were made, 600 in one day alone.12
Despite this, unlike the WTO conference, the IMF
meetings proceeded undisturbed.
On August 1 and 2 large-scale demonstrations were
held throughout Center City. While most protesters
were peaceful, there were episodic violent incidents.
During these, 19 were arrested on felony charges and
270 for misdemeanors. Fifteen Philadelphia police

Mechem et al. REPUBLICAN NATIONAL CONVENTION EMERGENCY PLANNING
349
officers were injured, including the police commis-
sioner, and nearly 30 city vehicles were vandalized.13
The RATs proved to be very valuable by quickly
responding to incidents and determining the level of
additional resources needed, while at the same time
minimizing the threat to personnel and equipment.
first-responding firefighters would be at risk of being
exposed to a nerve agent without being able to admin-
ister the Mark I kits to themselves, their fellow fire-
fighters, or civilian victims. The PFD therefore peti-
tioned the State EMS Office to authorize the use of
Mark I kits by EMTs under very defined circum-
stances. Permission was granted. A training program
was developed for the EMTs, covering the signs and
symptoms of nerve agent toxicity, the use of Mark I
kits, and the appropriate number of Mark I kits to
administer to a patient, based on presenting signs and
symptoms. All firefighter EMTs went through this
training prior to the RNC.
Throughout the week of the convention, the PFD’s
assets to respond to a terrorist incident were aug-
mented. Two PFD hazmat units were deployed, rather
than the usual one unit. In addition, three engine com-
panies that had been designated and equipped as
decontamination units were strategically placed
throughout the city. These units are capable of decon-
taminating large numbers of casualties in a short peri-
od of time. These PFD resources were backed up by
the United States Coast Guard’s Atlantic Strike Team,
a federal hazmat team that was staged in the
Philadelphia area during the RNC. Additional state
and federal hazmat and medical response teams that
specialize in responding to terrorist incidents were
also deployed in the Philadelphia metropolitan area
throughout the convention.
In the event of a terrorist incident involving a chem-
ical agent, the PFD would be the lead emergency
response agency. However, if a biological agent were
used, the Philadelphia Department of Public Health
would be the lead medical response agency. Unlike an
incident involving a chemical agent, a biological agent
attack would evolve over a matter of days, due to the
agents’ incubation periods. Depending on the scope of
the incident, there would be an increased number of
patient visits to emergency departments, public clin-
ics, or private physicians’ offices for symptoms of
infection. Public health personnel would be in the best
position to recognize and respond to this. Prior to the
convention, the Philadelphia Department of Public
Health, in cooperation with the CDC, made plans to
augment the local medical community’s capability to
respond to a terrorist incident involving a biological
agent, should the need arise. In addition, an emer-
gency department-based surveillance system for dis-
ease outbreaks was established that included 60 hos-
pitals in Philadelphia and surrounding areas. This
was similar to a surveillance system set up by the CDC
for the 1996 summer Olympics in Atlanta.16
THE TERRORIST THREAT
The bombings of the World Trade Center and the
Alfred P. Murrah Federal Building in Oklahoma City,
coupled with a large number of aborted terrorist
attacks in this country in the past decade, have made
it clear that the threat of terrorism has become an
American reality.14 The Nunn-Lugar-Domenci Act of
1996 set aside federal funds to train and equip emer-
gency responders at the local level to recognize and
respond to a terrorist incident involving weapons of
mass destruction.15 The Department of Defense was
designated the lead agency for this program.
Philadelphia was one of the first cities in the country
to receive this training. Beginning in 1997 PFD fire-
fighters and paramedics attended two- to four-day-
long sessions on the recognition and response to inci-
dents involving chemical, biological, or nuclear
agents. To put this training into action, in September
1998 the city held a multiagency field training exercise
in which the scenario was a sarin release at a political
fund-raising event. This was followed in June 1999 by
a large table-top exercise involving the terrorist
release of plague in the city.
In addition to undergoing this training, the PFD
used federal funds to purchase medications to
respond to a terrorist incident involving a chemical
agent. These included a large number of Mark I anti-
dote kits (Meridian Technologies, Columbus, MD),
which consist of two pocket-sized autoinjectors, one
loaded with 2 mg of atropine and the other with 600
mg of pralidoxime. These are intended for use on
patients manifesting toxicity from nerve agents such
as sarin. The PFD also purchased autoinjectors loaded
with 10 mg of diazepam, which would be adminis-
tered along with Mark I kits to patients with evidence
of severe nerve agent toxicity. In addition, a smaller
number of cyanide kits, antidote kits used for the
treatment of cyanide poisoning, were obtained. Medic
units and other PFD vehicles were stocked with large
numbers of Mark I kits as well as cyanide antidote kits
during the RNC.
The purchase of the Mark I kits raised a medical
control issue. In the event of a large terrorist incident
involving the release of a nerve agent, most of the ini-
tial emergency responders on scene would be PFD
firefighters, many of whom are cross-trained as emer-
gency medical technicians (EMTs). However, in
Pennsylvania the administration of medications is
beyond the EMT’s scope of practice. Therefore, these
THE HOSPITALS
An integral component of the plan to respond to ter-
rorist incidents, or any multicasualty incident,

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PREHOSPITAL EMERGENCY CARE OCTOBER/DECEMBER 2001 VOLUME 5 / NUMBER 4
involved raising awareness of local hospitals to the
importance of emergency preparedness. There are
approximately two dozen acute care hospitals in met-
ropolitan Philadelphia. The nine-county Philadelphia
area, including southern New Jersey and northern
Delaware, has more than 60 hospitals including more
than ten trauma centers, five children’s specialty hos-
pitals, and four burn units.17 Throughout 1999, con-
cerns over utility failures and other consequences as a
result of the upcoming Y2K helped focus the attention
of hospitals to be prepared. With the relatively
uneventful arrival of the year 2000, the focus of hospi-
tal preparedness efforts was redirected to the RNC.
While most Y2K plans were single-hospital or health-
system efforts, the RNC required a broader coopera-
tive effort among not only the hospitals but also gov-
ernment agencies and other organizations. Monthly
meetings of the hospital subcommittee of Phila-
delphia’s Local Emergency Preparedness Committee
(LEPC) provided a forum to help prepare hospitals for
potential mass casualty or hazmat/weapons of mass
destruction incidents.18 In group discussions and
training modules several issues were discussed. These
included: 1) the need for hospitals to be able to func-
tion independently for 72 hours or more without
municipal services, utilities, or fuel; 2) recognition of
signs and symptoms of chemical or biological agents;
3) ways for hospitals to decontaminate large numbers
of victims; 4) hospital security; and 5) stockpiling of
antidotes for nerve agents and antibiotics to treat vic-
tims of biological agents. Attendance at the last LEPC
meeting before the RNC was at an all-time high. This
was indicative of the importance hospitals placed on
this critical subject.
ly event that 911 medical call volume would ever be so
high during the RNC as to overwhelm the resources of
the PFD, arrangements had been made in advance
with the non-municipal ambulance companies to con-
tribute their resources to assist with patient care and
transport. This was in accordance with existing city
protocols and emergency plans. Along similar lines,
during the months preceding the convention, meet-
ings were held between the PFD and representatives
of EMS systems from the four Pennsylvania counties
immediately adjacent to Philadelphia. Similar mutual
aid agreements were reached. Therefore, plans were
in place to ensure that the emergency medical needs of
the citizens of Philadelphia would be met even under
the most dire circumstances.
To support the enhanced medical coverage for the
RNC, the city’s emergency communication system
was also augmented. Dependable communications
were felt to be crucial for the RNC plans to be suc-
cessful. The PFD Fire Communications Center (FCC)
is located in the basement of the Fire Administration
Building. Anticipating an increased volume of emer-
gency calls, FCC staffing was increased by two super-
visors and two dispatchers per shift. Innovative meth-
ods of dispatching were developed to address the
enormity of convention-related activities. Additional
communications equipment, including radios, pagers,
and cell phones, also had to be purchased to supple-
ment the FCC equipment inventory.
To assist the FCC in processing the enormous num-
ber of convention-related communications, support
communications centers were established. Three for-
ward, mobile command posts were added to facilitate
incident monitoring and communication with on-
scene commanders. Command Post 1 (CP1), the city’s
newest mobile command vehicle, was stationed at the
Police Administration Building (PAB) and was staffed
with command and dispatch personnel from the
police and fire departments. This unit responded to
the scene of numerous tense, heightened-activity
areas. Command Post 2 (CP2) was also stationed at the
PAB and was staffed with police and fire dispatchers.
CP2 also had the mobility to relocate anywhere in the
city, as needed. Command Post 3 (CP3) was a mobile
unit assigned to a fixed position at the First Union
Center. Staffed with command and dispatch person-
nel from the Pennsylvania State Police, Philadelphia
Police Department, and the PFD, CP3’s responsibility
was communications for the secured area in and
around the First Union Center.
THE CITY
While much of the city’s attention was focused on the
RNC, the PFD still had to ensure that the everyday
emergency medical needs of its citizens were met.
Philadelphia Fire EMS operates 27 full-time advanced
life support (ALS) units. These are augmented by ten
ALS units that operate 12 hours a day during peak-
volume hours. In addition, all 90 of the PFD’s fire
engine and ladder companies function as first-respon-
der units. In anticipation of an increase in call volume
during the RNC, all 12-hour ALS units were upgraded
to operate around the clock. These 37 units that consti-
tute the PFD’s normal fleet were supplemented by the
eight ALS units dedicated to RNC coverage. Therefore,
throughout the week of the convention, there were 45
full- or part-time PFD ALS units on the streets.
All three command posts had the ability to commu-
nicate on police, fire, and municipal frequencies as
well as an 800-megahertz frequency allocated for RNC
use. In addition, CP1 had the capability of receiving
real-time video transmissions down-linked from
Philadelphia Police Aviation Unit helicopters. This
In addition to the medic units operated by the PFD,
there are 32 non-municipal ambulance companies
operating in Philadelphia with a total of 36 ALS and
219 basic life support (BLS) ambulances. In the unlike-

Mechem et al. REPUBLICAN NATIONAL CONVENTION EMERGENCY PLANNING
351
proved extremely valuable in tracking the movement
of organized protesters traveling on foot throughout
Center City.
Center. This raised another level of confusion that was
resolved only days before the start of the event.
Finally, some PFD members never went through any
credentialing at all. While it is assumed that if a major
multicasualty incident were to have occurred within
the First Union Center they would have been granted
access, this was not explicitly stated. It would there-
fore have been helpful to have had a clearer under-
standing of the security clearance and credentialing
process earlier in the planning phase.
Third, the communications system for emergency
responders, as well as law enforcement agencies, was
built on redundant resources, which at face value may
have seemed excessive. Contingency plans were for-
mulated in the event that the FCC were to become
inoperable. Mobile command posts had backup com-
mand posts, most of which were staffed by both emer-
gency and law enforcement personnel. This would
ensure uninterrupted communications in case one
center had failed. Staffing each with representatives
from multiple agencies further facilitated cooperation
and minimized the impact of different agencies com-
municating on different radio frequencies. While for-
tunately not needed during the convention, the dupli-
cations in the communications system provided for
greater flexibility if a major incident were to have
occurred.
To further facilitate communications, planning, and
emergency response between all city departments and
support agencies, Philadelphia’s Emergency Opera-
tions Center (EOC) was activated for an eight-day
period around the convention. Located immediately
adjacent to the FCC in the Fire Administration
Building, the EOC has 43 stations that were staffed by
representatives from municipal, state, and federal
organizations around the clock during this period.
LESSONS LEARNED
The success of the RNC was in part the result of more
than a year of careful planning and in part pure luck.
Despite concerns over terrorism or disruption by pro-
testers, the week’s activities proceeded without inter-
ruption. While a large number of patients were treat-
ed, the medical resources devoted to the convention
were sufficient to handle the volume without difficul-
ty.
Several lessons were learned from the experience.
First, because of the event’s high profile and atten-
dance by political dignitaries, a multitude of munici-
pal, state, and federal agencies were involved in the
planning process. Shortly after Philadelphia received
word that it had been selected to host the RNC, a
seemingly endless series of meetings involving repre-
sentatives from these different agencies began. By
opening lines of communication early in the process,
the groups were able to learn each other’s needs,
requirements, and constraints, while at the same time
getting to know each other’s faces. This helped to min-
imize conflict or tension later in the planning process.
The nearly uniform use of the incident command sys-
tem or a variation of it further facilitated this coordi-
nation of efforts.
Second, the security requirements of the law
enforcement agencies at the First Union Center pre-
sented a level of complexity that was not initially
anticipated. The significant time delay in getting
emergency vehicles through the security checkpoints
forced a modification in staging of resources dedicat-
ed to the event. In addition, all PFD personnel who
could potentially be at the convention site had to
undergo Secret Service background checks prior to
being issued identification tags that had to be worn
while in the complex. While the credentialing process
went smoothly, the logistics of getting the majority of
over two thousand firefighters and paramedics cre-
dentialed in a short period of time were complicated.
In addition, shortly before the convention began, uni-
formed personnel were told they might need a second
type of credential in order to enter the First Union
Finally, the rapid assessment teams proved to be
invaluable in responding to emergency calls in the
parts of the city where organized protests were being
held. The RATs added a level of flexibility that tradi-
tional apparatus could not provide. A similar deploy-
ment should be considered whenever emergency
responders may be called into situations where there
are large crowds, especially if the crowds may be hos-
tile and could jeopardize employee safety or equip-
ment.
CONCLUSION
Planning for the 2000 Republican National Conven-
tion was a complex process. Beginning 18 months
prior to the event, multiple meetings between munici-
pal, state, and federal agencies were held to coordi-
nate the effort. The resultant plan addressed emer-
gency medical coverage for the venue itself while also
ensuring that there was adequate EMS coverage for
the rest of the city. Organized demonstrations during
the event were anticipated, and resources were allo-
cated to cover these if needed. Contingency plans for
a possible terrorist incident were formulated. Finally,
there was an organized effort to enhance the emer-
gency preparedness of local hospitals. Thus, the RNC
offered the health care community of Philadelphia
and surrounding areas an unprecedented and unique
opportunity to work together to ensure that hospitals,

352
PREHOSPITAL EMERGENCY CARE OCTOBER/DECEMBER 2001 VOLUME 5 / NUMBER 4
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