Behind the Scenes: Medical Coverage at the Trump/Kim Summit in Singapore

Edited by Anantharaman V, MD.

The most watched political meeting of the year, the first ever meeting between the President of the United States Donald Trump and North Korean leader Kim Jong Un, took place in Singapore on Tuesday, 12 June 2018. This momentous summit was arranged on short notice after having been initially cancelled via Twitter by President Trump. The local medical support arrangements for the event were a prime example of close cooperation between the visitors and the local healthcare system. They included not only arrangements in the event of personal injury or illness to the delegation leaders and members of their entourage, but also contingency plans in the event of mass casualty incidents. The following is a brief synopsis of how the event’s medical coverage was arranged.

Concept of Medical Coverage

• It was decided that both delegations would be responsible for the initial personal care given to their Heads of State and would only refer to the local healthcare system in the event further emergency care is required.
• Local medical arrangements would be on standby, ready to be activated at short notice.
• The country would also be on standby for unexpected mass casualty incidents related to the conduct of the Summit meeting

Principal Considerations

• The need to ensure prompt response of Singapore-based rescue elements and medical teams
• The need to ensure availability of comprehensive medical facilities in the public healthcare sector for the members of either delegation in the event of need.

On-site Medical Coverage Plans

The existing medical facilities at the airports receiving or sending off the two Heads of State were on standby during the periods of arrival and departure with appropriately trained medical staff in position for rapid response, if required.

The two delegations had their own medical elements, who, in turn, were in close contact with the main hospitals designated to manage their members, if required, with evacuation facilities on standby.

For mass casualty incident coverage, medical teams from hospitals were pre-located close to the summit location on Sentosa Island, where the actual meeting took place. Sentosa is a small resort island just to the south of the main Singapore island and linked to it by a grand causeway and also by cable car, pedestrian boardwalk and monorail.

Hospital Medical Coverage Plans

In addition to designating the two public academic healthcare centres in the Republic (the Singapore General Hospital, an acute-care, tertiary, 1785-bed hospital and the National University Hospital with 1217 beds) as the two main hospitals to be available for managing members of the two visiting delegations, a third hospital, the Tan Tock Seng Hospital, an acute-care 1,400 bed hospital was designated as the second alternate hospital for trauma incidents.

The heli-landing pads of the two tertiary hospitals were also on standby with medical teams designated to support the landing phase of heli-casevac operations, if activated.

Each of the designated hospitals arranged for senior physicians and surgeons and ancillary staff, on a 24/7 basis from the Departments of Emergency Medicine, General Surgery, Orthopaedic Surgery, Cardiology, Cardiothoracic Surgery, the Cardiac Catheterization Laboratory, Neurology and Neurosurgery, to be on standby within the hospitals during the period of the medical coverage which was from 10 June to 14 June 2018. This was to ensure an immediate response in the event of need.

The Preparedness and Response Departments of each of the hospitals coordinated these arrangements and were in close touch with the Ministry of Health’s Operations Centre throughout the period of coverage.

The hospitals even catered rest areas for these senior staff who were physically in the hospitals during their provision of coverage.

In each hospital, primary and alternate entry points were designated for visitors.

Standby arrangements for mass casualties

Throughout the period of medical coverage, all public hospitals in the country were on standby for provision of on-site and hospital-based medical support in the event of mass casualty incidents.

During the actual summit meetings on 12 June 2018 at the Capella Hotel on Sentosa Island, field medical teams were positioned in forward areas with the appropriate medical command elements and rescue and other agencies to ensure rapid response in the event of a mass casualty incident.

Since modern day mass casualty scenarios can also include chemical, biological and radiological incidents, resources for the management of these, including on-site decontamination teams were also made available.

In addition, the automated mass-casualty decontamination stations in the public hospitals were placed on standby for immediate use in the event of any suspected CBRD incidents occurring during the summit meeting. Singapore is probably the only country in the world with practiced, large, automated mass-casualty decontamination facilities in all public hospitals. These can be made operational within a couple of minutes after activation. Hospital-based decontamination teams were also physically present on standby on 12 June 2018 during the hours of the summit until the two country leaders left Singapore.

Additional ambulances were physically available in the hospitals during the period of medical coverage to better ensure their availability in the event patient transfers and other evacuations were required either within or between healthcare institutions.

Conclusion: The need for preparedness

In the end, the event went by without any medical incident. The two leaders met, shook hands, had their discussions and gave press statements at the end of their deliberations. They left Singapore for their home countries the same evening. That said, the ability of a very small country (just 721.5 square kilometers in land area) to rapidly mobilize medical resources to support a hastily arranged major world meeting is dependent on its intrinsic level of preparedness. Such preparedness has not been created just for the Trump-Kim Summit meeting, but has been largely due to the evolution of emergency planning arrangements and regular practice not just within the healthcare sector, but also with other agencies in the country, so as to better ensure a coordinated response. Such a system of regular practice to better ensure preparedness has been a regular feature of the country’s healthcare emergency response system for more than thirty years. This event was a great reminder that preparedness for contingencies are crucial and can only be achieved through planning and regular and frequent practice.