The Medical Intelligence Officer

Many jurisdictions are charged with protection and oversight of mass-assembly events. These events can range from college and professional football games to parades or marathons and everything in between. It is always a challenge to provide the types of emergency medical services required, as the planning and deployment can be expansive. In a post-9/11 world, we must all be acutely aware of the proper planning, communications and relationships that go into a safe, successful event.

On February 1, Tampa hosted one of the world's most popular sporting events, the Super Bowl. The city had hosted three previous Super Bowls, but this was the first since 9/11. On the heels of a presidential election and at a time of great global and domestic upheaval, Super Bowl XLIII would provide its own unique challenges.

Like many departments, Tampa Fire Rescue has for years utilized the Incident Command System. In 2005, city emergency management was realigned under Tampa Fire Rescue and Chief Dennis Jones. This provided a stable base from which to apply the concepts of emergency management and the National Incident Management System (NIMS) across a range of stakeholders, including local, state and federal partners. With planned events of this magnitude, it is common to be designated a National Special Security Event (NSSE), and this was the case for Super Bowl XLIII. When a NSSE designation is given, it denotes special linkages and responsibilities, including for the local government to interact with partners at the local, state and federal levels.

In a large-scale planned event, the term operational intelligence is commonly associated with law enforcement, and indeed law enforcement was the lead agency in Tampa. But for Super Bowl XLIII, Tampa Fire Rescue was going to build on that operational intelligence concept with the position of Medical Intelligence Officer (MIO). In reality, the MIO concept is not new, but its application is widely varied. The key is to understand the value of the MIO position and to bring awareness, implementation and change to other stakeholders in the event. The challenge for Tampa Fire Rescue was to integrate the MIO position within the established command structure to reap the best benefits possible. We've all heard the adage "Establish your relationships prior to the incident"--truly words to live by; having established relationships prior to planning and executing an event of worldwide significance helps tremendously.

For the MIO position to be successful, it was clear to us early on that information-sharing had to be a priority, and during the planning phase we built on that concept, focusing on developing a solid process for it. As planning progressed, questions arose. We asked ourselves, "What will it look like? Will it complement the unified command structure we've established?" The answers were for the respective agencies to resolve, but for Tampa Fire Rescue they centered on a few very important concepts.

Secret Security Clearance

Due to the sensitivity of the issues and materials discussed, our fire rescue personnel had to have secret security clearances. These were required to ensure our law enforcement counterparts, both local and federal, were able to exchange information. In our case, five individuals received security clearances. At any time at least three of them were on duty.

Personnel Requirements

It was clear we needed someone assigned to the MIO position who had a strong medical background but also commensurate command and control experience--in short, a chief officer. Additionally, our requirements included operational experience as a hazardous-materials technician and WMD training and operations. These requirements were extremely important, as the person(s) assigned would be working in a time-compressed environment as particular intelligence was vetted. It was vital that they had the skill sets to facilitate sharing appropriate, functional information and knowledge with our local and federal law enforcement counterparts. As we narrowed the list, we identified several chief officers who met our benchmarks.

Organizational Structure and Information Flow

We established a multi-agency coordination center for the event. This housed all partners under one roof. Organizationally the MIO was placed in the joint operations center (JOC) as an asset to our federal partners. Within the JOC, the MIO had a work station with a computer alongside our federal partners and complete access to the various software programs and other intelligence information tools established for the event. The MIO received law enforcement intelligence training, as well as access to resources not attainable under a normal ICS. The MIO was responsible for gleaning relevant intelligence information and, if appropriate, entering information suitable for distribution in an unclassified emergency management software system. That info was ultimately published as part of the Incident Action Plan (IAP) for the operational period. The MIO took part in situational and law enforcement intelligence briefings. The timing of these was structured to allow the MIO to move from one briefing to another without their time being competed for. It is important for all to comprehend, with respect to the MIO, that there is no room for a nebulous chain of command or freelancing.

Tying this back to NIMS and the command structure, the MIO reported directly to the Operations Section Chief. To ensure the communications loop was maintained, the Operations Section Chief also had a secret security clearance that enabled a level of redundancy and immediate access to federal partners in the JOC. The advantage gained by having the Operations Section Chief hold this clearance was twofold: One advantage was achieving a level of redundancy, which is critically important. The other was that in the event a particular information analysis was ongoing, the MIO had the opportunity to speak directly to the Operations Section Chief about it without a breach in security. This gave the Operations Section Chief the opportunity to consider tactics and strategies for the scenario presented, whether it entailed redeploying assets or just reevaluating minimum levels of equipment.

Game Week

After two years of preparation, it was time to put our plan into action. During game week our EOC came to life. The week of activation proved to be hectic, as there were a multitude of events occurring throughout the city in addition to the stadium site. Many private and corporate events occurred within the city, and local, national and international media coverage was intense. Events required varying degrees of public-safety oversight. The most notable attraction at the game site was the NFLX, set up directly south of Raymond James Stadium. The NFLX was an interactive area where fans of all ages could engage in realistic sports drills that mirrored what the professionals engage in. More than 20,000 people a day attended the NFLX. As you can imagine, there were a number of minor problems that occurred, many of them minor illnesses and orthopedic-type injuries.

Response and coordination are the bottom lines of any mass-assembly event. How you react and respond to "events within the event" is the key. On January 31, the day before the big game, our response plan was tested at the NFLX. A grease fire broke out in a trailer-mounted rotisserie cooker just a few feet from a concession tent. Cardboard boxes adjacent to the tent caught fire. The response plan worked perfectly. Suppression and medical assets assigned to the NFLX were on scene in moments, and the fire was extinguished. Two patients, workers in the tent, were treated for minor smoke inhalation. During this incident the position of the MIO played a critical role. The MIO was able to relay the scope and severity of the situation to our federal law enforcement partners in real time. Initially, two very important questions loomed: Was this an intentional act? And could this be a terrorist act? Within minutes the MIO was able to provide additional information as to the cause of the fire, thereby assisting law enforcement and ruling out any terrorism possibility. The presence of the MIO enabled law enforcement and intelligence assets to remain focused on other tasks.

On game day, most of the medical issues we encountered were minor. Tampa Fire Rescue responded to approximately 68 calls for service, with 12 patients transported. The most significant was a male patient "not feeling well." Upon evaluation, the patient was found to be experiencing an ST-elevation myocardial infarction (STEMI). He was brought to our first aid room, where a STEMI protocol was initiated. He was transported from the stadium directly to the catheterization lab. Although the patient was unable to see the game, he did have successful resolution of his ailment.

Conclusion

In summary, planning and preparation for any event of mass assembly can be difficult. It is essential that all personnel charged with planning and operations of such events appreciate the gravity and value of appropriate medical planning and resources for mass care. Understanding the importance of environmental detection and monitoring, epidemiological surveillance and medical diagnostics cannot be stressed enough. The MIO position is a conduit and requires an in-depth knowledge of how information is shared and applied.

Though sometimes complex, the medical intelligence process, when followed appropriately, gathers essential information even before an operation begins. In situations of mass assembly and special events, a well executed information-sharing process will enable command staff and unit leaders to continuously modify operations plans to incorporate new data in the most efficient and cohesive manner possible. Establishing an information-sharing system or process is a key component to executing a successful large-scale event. The position of Medical Intelligence Officer should be considered a best practice for jurisdictions faced with an NSSE or large mass-assembly operation.

Nick LoCicero, EMT-P, CCEMT-P, BS, is the rescue division chief for Tampa Fire Rescue. He was Operations Section Chief for the Super Bowl XLIII event. Contact him at nick.locicero@tampagov.net.