Election 2024: Hospitals, emergency leaders plan for possibility of unrest

Hospital leaders are hoping that the 2024 election doesn’t make their emergency departments busier.

Nick Cozzi, MD, EMS & disaster medicine medical director at Rush University Medical Center, said hospitals must be prepared for the possibility of unrest tied to the election.

At the same time, hospitals and emergency organizations say they have made the necessary preparations in the event that there is violence or unrest stemming from the 2024 election.

Nick Cozzi, MD, EMS & disaster medicine medical director at Rush University Medical Center, told Chief Healthcare Executive® that the system has prepared for all eventualities with the election. The Chicago medical center has some fresh experience with big events, as Rush had to plan for the Democratic National Convention in the Windy City in August.

“We have to be prepared for everything,” Cozzi said Tuesday afternoon. “And whether you're in a big city or you're in a smaller town, I think we have to have a preparedness for all hazards and all types of situations.”

For health systems, planning has gone beyond Election Day. While Donald Trump has been re-elected to a second term in the White House, some congressional races remain undecided.

Cozzi, a member of the American College of Emergency Physicians, noted that hospitals are preparing as best they can if the outcome is uncertain for a period of days.

“It’s hard to plan, and it's hard to fully understand what type of unrest might be experienced, irrespective of who wins,” Cozzi said. “I think it's incumbent upon us as physicians, as healthcare leaders, to be prepared for whatever scenario should arise. You know, there's not a lot of logic to a lot of these things. There's a lot of emotion. It's a very divided country. And so I think we have to just be prepared at all times.”

“However long this goes and whatever the situation arises, we'll be prepared,” he said.

Preparations and readiness

The Virginia Hospital & Healthcare Association held a webinar last month to talk about preparing for the potential of violence on or after Election Day. The organization serves 26 health systems representing 111 hospitals in Virginia.

Julian Walker, vice president of communications for the Virginia Hospital & Healthcare Association, told Chief Healthcare Executive® the group talked with hospitals about being ready for potential problems.

The webinar with health systems stressed the importance of “being aware of the potential impacts of civil unrest and what that could mean in terms of healthcare facilities, healthcare settings,” he said.

“While no one wants to see any kind of unrest or any kind of widespread public health challenge, it is imperative, and our members understand this, to be prepared and to have strategies in place, resources in place, tactics and plans in place to be able that can be activated and mobilized if a response is necessary,” Walker said.

Hospital leaders acknowledged the highly charged political climate, as seen through the battle between Kamala Harris and Donald Trump for the White House.

While the presidential race has commanded the most attention, voters also cast ballots in congressional races. Several states had ballot questions on abortion and 11 states featured gubernatorial contests. So Americans had plenty of motivation in this election.

The Ohio Emergency Management Agency has activated its emergency operations center and is monitoring any potential problems on Election Day, said John Palmer, director of media and public relations for the Ohio Hospital Association.

“Hospitals are regularly monitoring their local community and are in contact with state agencies through the state’s hospital preparedness program to respond to community disturbances that may result in surges in patients and community health needs,” Palmer said in an email.

To prepare for the election, the Oregon Department of Emergency Management activated its State Emergency Coordination Center “out of an abundance of caution.”

“This activation is a proactive measure to ensure readiness and support for communities and local leadership across the state,” the department said. “It is not in response to any specific threat or situation but is part of OEM’s ongoing commitment to support safe and secure elections.”

Healthcare leaders and physicians have noted that doctors and nurses have encountered violence in their facilities from patients and family members with disturbing regularity since the COVID-19 pandemic. Those experiences have also informed some of their plans for dealing with possible emergencies, including any issues stemming from the election.

“In addition to the ongoing emergency management, emergency preparedness activities that we do, we've also been very engaged in working to raise public awareness about healthcare, workplace violence, and appropriate behavior standards and conduct and behavior expectations in clinical settings,” Walker said.

• Read more: Understanding the scope of aggressive incidents in hospitals

‘Dust off their playbook’

Rush University Medical Center has developed robust plans for dealing with any potential emergencies.

“We would be able to quickly open up an entire new area of our hospital just for those patients,” Cozzi said.

In addition, an ambulance bay could be turned into a mass decontamination center. Some preparations were developed for the Democratic National Convention, but those plans can be utilized for any unexpected emergency, Cozzi said.

Although Cozzi stressed that he hoped there would be no violent incidents with the election, he said that hospitals and health systems should be prepared for any eventuality in the coming days.

Health systems should be thinking about dealing with an influx of patients and what must be done to protect their clinicians and staff.

“I think it's incumbent upon emergency physicians and hospitals to really dust off their playbook, and dust off their emergency procedures,” Cozzi said. “Calling in extra staff, being able to accelerate and open up additional spaces within the hospital where patients can go, call trees, just disaster preparedness, less about being a tabletop exercise, and more being about an actual event … How would you actually respond in the moment?”

“Those are important things that all hospitals and hospital leadership, and really the buy-in of not only emergency departments, but healthcare, hospital leadership, in understanding why this is important,” he added. “Because, as we saw in 2020 during COVID, large-scale civil unrest occurs anywhere. And I think it's incumbent upon us to be prepared.”