EPM caught up with Thomas Collins, MD, the medical director for the department of Public Safety for the City of Cleveland, and talked about recent RNC prep, and how an ounce of prevention is worth a pound of cure. Interview by Logan Plaster.
EPM: What public health concerns did you have going into the RNC that were unique to Cleveland?
Collins: We approached it from three perspectives. One was the true event medicine component; where you had lots of people coming into an area for a special event and you needed to have the medical components in place to do routine care for this group but also to respond to emergency care for this population in this unique space. Unlike many special events, just about all the attendees were coming from out of town. So not only did they need care, they needed coordination in how to get plugged into the health systems. The second component we looked at was this as a national special security event and we needed to make sure that we had all the consequent management components in place in case there was some calamity. EMS working in conjunction with all the hospitals, as well as our local hospital association, on making sure the hospitals were properly looking at their staffing models, looking at their vendor supplies, looking at making sure that we had good knowledge of what our surge capabilities were within the region. Finally, there was the fact that the event was taking place in Cleveland in June and July. We knew that temperatures could reach the upper 80’s and low 90’s. The last day of the Convention the temperatures were in the low 90’s. Making sure we had proper attention to rest and rehydration was critical. We had predesignated law enforcement rehab areas throughout the venues and the area outside of the venues; so law enforcement could get into a cool area, could hydrate.
EPM: Did the preparations for this event allow your public safety teams to create new systems or infrastructure that will benefit the city after the RNC moves on?
Collins: We really didn’t need to invent any new techniques in mass casualty management. But what we did do is increase the volume of how often we were communicating the plans, not only with our own staffs at each of the hospitals but also communicating and taking turns managing the plan. In our city’s Emergency Operation Center, we had a hospital section that was staffed 24-hours-a-day starting on the Friday before the RNC. And we had senior leadership from each of the hospitals take turns managing the hospital component of the EOC. So there was always somebody interacting with the City leadership from the hospitals that could help advise the City on what the surge capacity was in the region. They could also serve as a subject matter expert if the City had questions on what the hospitals are capable of doing.
EPM: After all your prep work, did anything surprise you once the RNC finally came and you were rolling it out?
Collins: While it was a lot of work leading up to the event, the thing that was personally most surprising to me was just how smoothly everything worked. I think one of the things that’s important to understand when you have a large scale security event like this is that because of security fencing being put in place, your normal patterns of patient movement get disrupted. So even though you may have been in and out of a venue a thousand times, because of the security concerns your normal paths aren’t there. So you need to make sure you are coming into these events a couple days beforehand, knowing exactly what your patient movement plans are going to be. I would say that was our biggest learning curve.
EPM: The RNC was certainly a polarizing event politically. Did you have to coach your medical teams to put politics aside during the event?
Collins: I will tell you that that issue didn’t come up once. When you talk about All Lives Matter, that’s my EMS team day in and day out for the last 30 years. Lives matter to them. So they didn’t get caught up in politics. They’re there to take care of anybody and everybody, just like they do every day of the year.
EPM: How do you think that becomes a part of a medical team’s DNA?
Collins: I’m fortunate that I work in the emergency department at Metro Health, which is a pretty busy urban ED. Not only do I see the paramedics and how they take care of people but they see me and how I take care of my patients and how our incredible team at Metro Health takes care of patients. It’s a lot easier to mimic behavior when you see your partners working equally hard to provide great care, just going the extra step to do the right thing for patients.
EPM: You talked about the value of cohesiveness with the police. How did you cultivate that ahead of this event?
Collins: We’ve been engaged with the Cleveland Police for over a year now, taking all of our police officers through some basic First Aid training; so that as they come across someone that’s got a critical injury, they can easily do things like tourniquet and chest seals and some sort of hemostatic dressing. Now what happens is the RNC rolls into town and the paramedics already have that relationship that’s even stronger with the police because of the training. A strong relationship with law enforcement going into a big event like this certainly makes the execution of the event much, much easier. Our law enforcement community appreciates and needs our support. And that translates into their ability to more effectively do their job. And then that leads to decision making on their part or the community’s part that leads to potential patients not ever even coming into the ED. I tell our medics all the time that public safety and public health are sort of the exact same thing; they just work at different paces. So our support of our law enforcement community I think leads to an overall healthier community.
EPM: What does support look like on an everyday level?
Collins: First of all, it’s advocating that law enforcement has some baseline knowledge of what to do if someone’s been critically injured. So, if they’re on the scene of a traffic accident, motorcycle accident; they roll up on the scene after somebody’s been shot or stabbed, you know, what should they do? You want to make sure that they feel comfortable doing something. We’ve already had examples of our officers putting tourniquets on and putting hemostatic dressings on at the scene of a crime that have impacted patients’ outcomes. If they’re in the ED with you, ask them: Do you know how to use a tourniquet? Let me take two minutes and show you how. It’s a tough job being a police officer in this country right now. And I think they need to know that not only do we have their back if they ever get injured but we also have their back helping them help the public.
EPM: Any final thoughts?
Collins: One of the things that makes me very proud as the Medical Director is there’s a culture of kindness among our medics that I see them demonstrate to patients and families all the time. I have phenomenal faith in their technical skills and their knowledge about patient care. But when you have a culture of kindness in a division, it makes your job as Medical Director a lot easier.