Civil unrest while managing a pandemic: Lessons learned in Minnesota

By A.J. Plunkett (aplunkett@decisionhealth.com)

This year has been brutal on many levels, especially in healthcare.

There’s the coronavirus pandemic. The cold and snow of winter, the broiling heat of summer, the fury of hurricanes and wildfires, earthquakes and riots. And now finally Election Day and its aftermath, which promises at least extended stress during the vote counting and at worst, civil unrest.

Hopefully not.

But CMS requires an all-hazards approach to emergency management. So here are some lessons learned in Minneapolis during the civil unrest earlier this year after George Floyd died during a police arrest, the details of which went viral on social media.

The Department of Health and Human Services’ Assistant Secretary for Preparedness and Response (ASPR) offered up these observations from its Technical Resources, Assistance Center, and Information Exchange (TRACIE), which gathered the information from two key experts in the area: ASPR TRACIE’s Senior Editor, Dr. John Hick, also serves as an Emergency Medicine Physician for Hennepin County Medical Center, located in downtown Minneapolis, and Seth Jones, Hennepin Healthcare system’s Emergency Preparedness Program Manager.

Here are some highlights from ASPR TRACIE’s four-page “Civil unrest during a pandemic: Notes from Minneapolis”:

• Two hospital incident command structures (HICS) operated simultaneously—one to manage COVID-19 and the other managed the civil unrest response. Depth in each HICS position developed during the COVID response facilitated the transition of team members to the new HICS.
• Daily regional COVID-19 calls temporarily became civil unrest calls. Plans to quickly ramp up emergency department (ED) and security staff and ensuring staff access to Hennepin County Medical Center (HCMC) were top priorities.
• Highways leading into the city were closed to deter people from entering and to reduce the rapid movement of demonstrators, but this also impacted staff commuting to work.
• Many staff used public transportation to report to work. When the system shut down, HCMC allowed staff to park in a designated lot for free.
• HCMC provided staff food, drinks, and cots. Many staff stayed over the weekend and could take cots to the space of their choosing (while adhering to social distancing guidelines) or a conference room set aside for this purpose.
• Continuous and accurate communication to staff was vital to ensure staff had the information needed to feel safe coming to work during this time.
• The hospital was not damaged, but three offsite locations were. Staff watched via security cameras as these clinics were broken into; one sustained fire and water damage and may eventually be declared a total loss. As they watched protesters demolish and raid one pharmacy, the HCMC Security Operations Center dispatcher announced that the police were on their way over the intercom system. Staff called 911 numerous times but could not get through (capacity could not keep up with call volume). The next day, staff secured the medication at multiple community pharmacies, agreed that life safety was the priority, and made the decision to keep security resources at HCMC’s main campus rather than at the community clinics knowing these clinics would be “soft targets” going into the weekend.
• Looting and fires contributed to patients reporting with multiple gunshot wounds, injuries from falls, and burns. Rubber bullet wounds were very common and included soft tissue, skull fracture, and eye injuries. Issues associated with other riot control agents (e.g., pepper spray and tear gas) were not that common. There was also an increase in patients with stab wounds.
• Rapid and accurate internal messaging was crucial because the situation changed so quickly. Bringing in the National Guard and implementing the curfew was helpful; when the curfew was announced, staff could choose alternate routes and plan for parking. Once officials realized that some of the “bad actors” were waiting for sunset on the outskirts of town, the governor closed access to the highways and changed the curfew time on the fly. While this undoubtedly prevented criminal behavior, it caught some staff off guard. HCMC encouraged staff to report early, offering them sustenance and a place to rest.
• Maintaining staff morale is important, particularly when multiple incidents occur simultaneously. HCMC has a “warm line” staff can call for behavioral health assistance. Social distancing has changed how some of this care is delivered. HCMC recently opened a wellness center in the library. To encourage self-care and communication, posters ask staff to share what they are using (e.g., movies or television shows) to get through this challenging time.
• Healthcare facility access controls were already in place for COVID-19; many facilities implemented additional controls and occasionally sheltered in place.
• Supplementing EMS personnel was more difficult than usual due to staff off due to COVID-related quarantine.

Visit ASPR TRACIE’s website for more lessons learned.