Civil Unrest

Background Information


Hospital Staffing Considerations:

  • Perform early trauma team notification, and notify on-call staff as situation requires.
  • Consider notification of vascular surgery and interventional radiology if not already included in trauma team activation.
  • Consider notification of transport services for emergent transfers, if at non-trauma facility.
  • Increase security staffing
  • Consider utilizing non-security personal for some security tasks such as traffic direction and supervision of hospital entrances.
  • Consider requesting local law enforcement for hospital security, however, do not rely on these personnel, as they may be preoccupied with management of the civil unrest in the community.

EMS Staffing Considerations:

  • Perform early up-staffing of additional ambulances 
  • Consider utilization of mutual aid resources
  • In the event of a mass casualty event, consider dispatching of buses or other means of transporting large numbers of patients.



  • Protection of the hospital staff and property from violent agitators is of upmost importance.
    • Be prepared for external and internal protection as well as total facility lock down.
  • Security and crowd control are specifically important in triage, decontamination and treatment areas.
    • Consider separate treatment areas for the public and for those involved in the civil unrest.
  • Be prepared to manage large numbers of visitors, injured protestors, and their personal effects.
    • Also be prepared to handle increased numbers of persons in police custody.


  • Don appropriate PPE, including APR/PAPR with riot agent canisters, or customary PPE used by receiving healthcare workers.
  • Focus on preventing further contamination of the patient and secondary contamination of healthcare workers.
  • Perform decontamination prior to entering the main Emergency Department.
    • e.g. in the field (by EMS), or in designated hospital decontamination areas.


Identify areas for:

  1. Triage
    • Set up triage outside of the ED (such as the parking lot) to immediately assist in controlling the flow of patients and resources in the ED 
      • Assign a senior doctor exclusively to triage duty 
  2. Decontamination
    • Designate area for clothing removal and proper disposal
    • Occur on site of incident or outside of emergency department/hospital
  3. Treatment
    • Most severely injured patients are brought into the ED to start treatment immediately. 
    • The less injured victims should be directed to other areas of the hospital
  • Another area of the hospital should be sectioned off to increase capacity such as outpatient surgery units and PACU.
  • Canceling elective surgeries promptly 

Consider separate treatment areas for the public and for those involved in the civil unrest.




  1. PPE (ideally APR/PAPR with riot agent canister or “receiving” healthcare worker PPE)
  2. Brushes
  3. Soap and Water for skin decon; Water or Saline for eye decon
  4. Trauma shears and bags for patient belongings 

Trauma Care:

Customary trauma supplies, with preparations for:

  • Penetrating trauma 
  • Blunt trauma 
    • From Blunt Impact Projectiles (e.g. rubber bullets), thrown bricks/rocks, impact objects (bats, crowbars) or Vehicular Rammings
  • Respiratory Difficulty
    • From Riot Control Agents, although severe symptoms requiring advanced airway management are rare
  • Eye Trauma
    • From handheld Laser Pointers