When EMS personnel learned in 2013 that Pope Francis had scheduled a visit to Philadelphia on his 10-day global tour in 2015, the command structure began planning for the event—or, rather, speculating. How many people would attend the highly anticipated Vatican-sponsored outdoor mass?
“The papal visit was unchartered territory,” admitted Crawford Mechem, MD, EMS medical director for the Philadelphia Fire Department, in his Gathering of Eagles presentation earlier this year, “Pontificating in Civitas Autem Fraternitatis Caritatem: Philadelphia Preps for a Peripatetic Papal Pass-Through.”
Crowds for previous masses around the world had reached nearly six million. “Pope Francis is particularly popular, and a papal event isn’t comparable to other events, so the crowd estimate was our most difficult challenge,” Mechem says. “Since papal visits aren’t very common in the States, we couldn’t find recent ones recorded in any sort of scientific fashion to give us hard and firm planning guidelines.”
Initially the crowd estimate was three million. As the event drew closer, that dropped to one million. “It was the best working number we could come up with,” says Mechem. “There was very little science to it.”
Based on that size crowd, Mechem began estimating the number of anticipated patients, while also planning staffing and first-aid tent and resource deployment. Papal visit activities would stretch from the Philadelphia Museum of Art to Independence Mall. A five-square-mile “traffic box” would close to private traffic. Among the unique challenges, mass attendees—including the elderly and infirm—would need to walk a good part of the way to the site. How many visitors would turn into patients? How sick would they be?
“In our primary planning for the event, we placed first-aid stations throughout the area and deployed foot patrols consisting of EMTs, paramedics and small all-terrain vehicles to navigate the crowd,” Mechem explains. “We deployed medical stations along the anticipated walking routes from public transportation terminals. We had tents at Benjamin Franklin Park, where Pope Francis was going to be, and also on the long walking routes from the major train stations and subway stops.”
Security measures were a major consideration. The U.S. Secret Service (USSS), in charge of security for such special events, determined the location of security checkpoints. “To make our EMS plans, I had to customize them based on those determinations. It created considerable challenges, especially getting our personnel in and out, getting ambulances to patients and patients to ambulances, especially as some security measures were changed on a fairly frequent basis,” says Mechem.
Meeting security regulations with EMS personnel was a prickly problem. “All of our providers had to pass security checkpoints like anyone else,” he explains. “We got photo IDs from the Secret Service for many staff members, but not all of them. We had a backup non-photo ID that could be handed from (uniformed) provider to provider to help pass those checkpoints. Yet it slowed down the process anyway. How our personnel were handled by security and the ease with which they got through the security checkpoints seemed very dependent on security personnel working the checkpoints.”
Because the Secret Service was stretched thin while also covering papal visits to New York and Washington, DC, personnel from the TSA and other law enforcement agencies were contracted to man some security checkpoints, Mechem points out.
“Also, much uncertainty remained about the ultimate configuration of the security checkpoints and also the vehicular traffic patterns,” he emphasizes. “Getting 1,000 providers credentialed by the USSS was very time-consuming. The Secret Service worked diligently to help us solve those pre-event issues.”
Mechem brought in a cadre of ambulances from various EMS agencies from Pennsylvania and out of state. He also recruited volunteers from local hospitals while the Philadelphia Department of Public Health helped coordinate Medical Reserve Corps volunteers.
As the event drew closer, Mechem was surprised to learn some hospitals were slow to free up staff to volunteer.
“It was an interesting phenomenon,” he says. “Any time an event of this sort is coming up, people are interested in volunteering. As time progressed and security measures became more obvious, hospitals realized that freeing up staff to volunteer would impact their own in-house operations. Until the hospital leaders had a better feel for it and ramped up their own internal planning, they were very hesitant to free up staff. In retrospect we probably could’ve been more aggressive securing outside volunteers earlier in the planning process.”
Mechem planned 24-hour coverage preceding the event, concerned that some attendees would arrive the night before to save a good spot. “In retrospect, the thought process was valid at the time,” he says.
Patient tracking was somewhat problematic. “We used a barcode-based wristband with Knowledge Center software,” he explains. “We’d used it the year before at the city’s Fourth of July celebration. Few of us were familiar with the system. We had so many volunteers coming in from so many directions; they got very quick lessons on how to use the tracking system. Allowing more time for that aspect is a lesson learned.”
On the day of Pope Francis’s visit, the city was blessed with good weather. Temperatures ranged from 60–72ºF while approximately 800,000 people attended mass. Ten medical tents treated 199 patients, with 21 transports. In “the box,” EMS personnel had 423 responses, with 129 transports. Activity for the entire citywide EMS system was “about normal,” Mechem notes.
“Given the uncertainty of the event, our preparation was appropriate,” he says. “We had more than we needed [and were] ready for much more.” Areas to improve? Communication from planners to providers, USSS credentialing and messaging to the public. “It was a unique, fun and very intensive operation,” he concludes.