Members of the 555th Forward Surgical Team rush a simulated trauma patient to surgery during training with the Strategic Trauma Readiness Center of San Antonio (STaRC) at Brooke Army Medical Center, Fort Sam Houston, Texas, May 28, 2020. The STaRC training program leverages the expertise and capabilities across multiple healthcare disciplines at BAMC, the U.S. Army Institute of Surgical Research, the Medical Center of Excellence, the Joint Trauma System and the Air Force 59th Medical Wing to provide deploying surgical teams with the most realistic and comprehensive wartime skills certification.
JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas – San Antonio Military Health System is expanding its ability to care for critically injured and ill community members to help ease the COVID-19 burden on the local healthcare system.
Over the past week, Brooke Army Medical Center has doubled its capacity for military, veteran and civilian patients in need of extracorporeal membrane oxygenation, or ECMO, treatment. BAMC is currently providing approximately 25 percent of the city’s ECMO capability, noted Air Force Col. (Dr.) Patrick Osborn, SAMHS surgeon-in-chief and BAMC’s deputy commander for surgical services.
“ECMO is a last resort for the most critically ill patients with severe pulmonary disease,” he said. “Whether due to COVID-19 or another condition, ECMO provides a life-support option to save lives when all other options are exhausted.”
The time and labor-intensive treatment requires a highly specialized and trained team, “and is best utilized in specialized centers within a larger medical referral system,” Osborn said.
In light of the COVID-19 surge, BAMC has reallocated staff and resources to increase its capacity to four patients, including civilian patients from the San Antonio area. Osborn hopes to expand further while maintaining the ability to provide ECMO treatment to Department of Defense beneficiaries or in response to global contingencies.
Lifesaving treatment
ECMO is a heart-lung bypass system used in the intensive care unit when a patient has heart and/or lung failure, said Army Maj. (Dr.) Arthur (Randy) Mielke, assistant medical director, BAMC ECMO Service.
The ECMO machine removes blood from large central vessels in a patient’s body, circulates it through an external artificial lung, oxygenates it, and delivers the blood back into the bloodstream. It essentially does the work of an injured lung and is the last line of defense against respiratory failure caused by the COVID-19 virus, Mielke explained.
“Patients with severe lung injury can have mortality rates of greater than 50 percent,” he said. “ECMO has been shown to reduce this mortality down to approximately 30 to 40 percent. Functionally bypassing the lungs with an ECMO machine can provide precious time for patients to receive anti-viral treatments and heal from COVID-19 infection.”
Established in October 2012, BAMC has the only adult ECMO center with full capability in the DoD and remains one of the few centers in the world with air transport capability.
While taking care of military beneficiaries is BAMC’s primary mission, Osborn explained, the organization is also able to support ECMO patients from the civilian population through a DoD program. The experience gained ensures the ECMO team sustains the skills required to mobilize worldwide to treat and transport patients back to BAMC.
“The sooner the patient is on ECMO and stabilized, the less time vital organs are without oxygenation or necessary blood pressure support and the quicker the recovery,” said Bernadette Elliott, adult extracorporeal life support/ECMO transport program manager. The ECMO team has traveled as far as Iraq and Afghanistan to transport a service member back to BAMC, she noted.
Steadfast trauma partner
Along with ECMO care, BAMC is also taking additional civilian trauma patients to ensure the regional trauma system remains unaffected by the pandemic, Osborn said. BAMC is one of two Level I trauma centers within the Southwest Texas Regional Advisory Council, or STRAC, regional trauma system, and the only one of its kind in the DoD.
Alongside University Health System, BAMC provides lifesaving care to more than 4,000 trauma patients each year, including 750 burn patients, from an area that stretches across 22 counties in Southwest Texas and encompasses 2.2 million people.
Last week, with the demand for COVID care increasing, BAMC began accepting additional trauma patients to help lighten the load for its Level I partner. STRAC’s redistribution of high-level trauma care has been accomplished seamlessly due to the history of collaboration between the two Level I facilities, noted Air Force Lt. Col. Valerie Sams, BAMC trauma medical director.
“We have an active and long-standing partnership with STRAC and UHS, which enables us to act as a cohesive, efficient system in times of crisis,” Sams said.
About 85 percent of BAMC’s trauma admissions are community members without military affiliation. BAMC is able to accept civilian trauma patients for care through the DoD’s Secretarial Designee Program and related special authorities.
Community commitment
By caring for the large footprint of active duty, veteran and civilian patients that meet eligibility requirements in STRAC’s 22-county area, BAMC is actively reducing the strain COVID-19 has placed on its civilian counterparts, Osborn said.
“Unfortunately, traumatic injuries and other emergent medical conditions do not stop during a pandemic so the baseline requirements of a health care system remain,” he said. “Working alongside our community and military partners, we will continue to assess our capabilities and look for avenues to assist.”
Along with providing ECMO treatment for San Antonio COVID-19 patients, SAMHS personnel are working diligently alongside their community counterparts to reduce the spread of COVID-19. SAMHS experts are serving as critical members of STRAC’s medical leadership, the Regional Medical Operations Center and the Pandemic Medical Operations Workgroup that plan and coordinate all aspects of the region’s pandemic response.
Dr. Alison Wiesenthal, chair of the SAMHS Department of Rehabilitation Medicine, serves as a member of the STRAC Pandemic Medical Operations Workgroup. “The collaboration of the entire medical community is truly remarkable,” Wiesenthal said. “Military and civilian health care experts have used their knowledge and experience to ensure that the region preserves resources and standardizes care from triage through rehabilitation.”
BAMC is grateful for its longstanding community partnerships, particularly during this national emergency, noted BAMC Commanding General Army Brig. Gen. Shan Bagby.
“We are members of this amazing community too and are absolutely committed to providing the highest-quality care in the safest way possible to our military, veteran and civilian patients,” he said. “We are grateful to work and collaborate with our civilian counterparts in this city’s world-class healthcare and trauma system.”
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