Army Spc. David Pyke, medical laboratory technician, loads a patient sample for rapid COVID-19 polymerase chain reaction testing at Brooke Army Medical Center, Fort Sam Houston, Texas, April 9, 2020. (U.S. Army photo by Jason W. Edwards)
1 / 2 Show Caption + Hide Caption – Army Spc. David Pyke, medical laboratory technician, loads a patient sample for rapid COVID-19 polymerase chain reaction testing at Brooke Army Medical Center, Fort Sam Houston, Texas, April 9, 2020. (U.S. Army photo by Jason W. Edwards) (Photo Credit: Jason W Edwards) VIEW ORIGINAL
Bernadette Thompson, chief of Infection Prevention and Control Services, assists Army Lt. Col. (Dr.) Elizabeth Markelz, Infection Prevention and Control Services medical director, in removing personal protective equipment before exiting a patient room at Brooke Army Medical Center, Fort Sam Houston, Texas, April 9, 2020. Thompson and Markelz have played a significant role in organizing an infection prevention strategy to keep BAMC staff members, beneficiaries and patients safe. This includes educating the staff on the safe use of PPE, using infection prevention and control strategies, research and evidence-based practice, and collaborating with internal and external experts. (U.S. Army photo by Jason W. Edwards)
2 / 2 Show Caption + Hide Caption – Bernadette Thompson, chief of Infection Prevention and Control Services, assists Army Lt. Col. (Dr.) Elizabeth Markelz, Infection Prevention and Control Services medical director, in removing personal protective equipment before exiting a patient room at Brooke Army Medical Center, Fort Sam Houston, Texas, April 9, 2020. Thompson and Markelz have played a significant role in organizing an infection prevention strategy to keep BAMC staff members, beneficiaries and patients safe. This includes educating the staff on the safe use of PPE, using infection prevention and control strategies, research and evidence-based practice, and collaborating with internal and external experts. (U.S. Army photo by Jason W. Edwards) (Photo Credit: Jason W Edwards) VIEW ORIGINAL

JOINT BASE SAN ANTONIO, Texas -- From the very beginning, Brooke Army Medical Center has led the way in the fight against COVID-19, implementing stringent measures to protect patients and staff as the pandemic spreads throughout the nation and the world.

About a month ago, key leaders throughout the organization quickly came together to formulate a strategic plan to help mitigate the spread of the virus. The measures include limiting the entry points to the facility, leveraging virtual health for routine care, rescheduling elective surgeries, closing dining areas, and implementing curbside pharmacy services.

“Together we have led the charge on this virus, caring for our patients and each other while maintaining our vital healthcare and trauma missions, and our commitment to our crucial role in combat casualty care,” said BAMC Commanding General Brig. Gen. Wendy Harter. “We are maximizing our virtual health capabilities to protect our providers, clinics and beneficiaries and supporting the shelter-at-home national effort to slow the spread of COVID-19.”

Additionally, BAMC has restricted its visitation policy to people deemed to be essential support for patients and has been screening all visitors before they enter the facility. Screening and testing areas were also set up in the parking lot for beneficiaries with COVID-19 symptoms such as a fever, cough or shortness of breath.

“We know these measures are tough, but we believe they are absolutely necessary to preserve the health and wellness of our patients and staff, and to stop the spread of this virus,” Harter said. “We ask for everyone’s patience, support and understanding during this challenging time.”

Experienced Team

The battle against COVID-19 is taking a concerted, multidisciplinary effort.

“Our lab, pharmacy, infectious disease, public health and medical logistics teams are at the forefront of this fight alongside our nursing, Emergency Department, clinics, specialty care, housekeeping and administrative personnel,” Harter said. “It’s a tremendous effort by all of Team BAMC.”

Air Force Col. (Dr.) Heather Yun, BAMC Department of Medicine chief and infectious disease physician, said she has trained for this type of situation her entire career. Because of her background in infectious disease and outbreak management, she was chosen as a consultant to the BAMC commander and the San Antonio Military Health System director for the COVID-19 planning and response efforts.

“We are building some interdisciplinary teams that will continue to function after this crisis is over,” Yun said. “This is forcing us to look at some of our processes and understand how we could do things better in the future, more effectively cross-leverage resources across the organization, and I expect we will gain a lot from the additional experience with virtual health.”

Army Lt. Col. Elizabeth Markelz, BAMC Infection Prevention and Control Services medical director, and Bernadette Thompson, chief of Infection Prevention and Control Services, have played a significant role in organizing an infection prevention strategy to keep BAMC staff members, beneficiaries and patients safe. This includes educating the staff on the safe use of personal protective equipment (PPE) using infection prevention and control strategies, research and evidence-based practice, and collaborating with internal and external experts.

“This has brought many parts of our organization together in ways I haven't seen before,” Markelz said. “I have developed professional relationships that will endure because of the trust we have in each other. We have grown to appreciate the important role we each play in the care of patients and each other.”

U.S. Air Force Capt. Matt Bezzant, assistant program director for research for the Internal Medicine Residency program, agrees. Bezzant helped develop the triage protocols and inpatient processes for the wards that care for COVID-19 patients.

“Having a single crisis team at a hospital composed of people who are actually doing the work day to day seems to be the most efficient way to deal with pandemics,” he said. “I think we can learn a lot from what is happening now so we can stay better adapted to handling crises and be a stronger healthcare team going forward.”

Facing Challenges

Nationwide, healthcare facilities are seeing shortages in testing materials, PPE and healthcare personnel.

Yun said one of the biggest challenges for BAMC has been the rapidly changing guidance on a national level.

“We have to be incredibly agile to stay ahead of the evolving situation, and getting the entire San Antonio market to move on a dime within hours of new guidance is really important to keep everyone including our patients on the same page,” Yun said.

Another challenge has been keeping up with the demand for testing.

“The materials we use to perform the test have been in national shortage,” said Army Lt. Col. Robert Cybulski, director of Microbiology, Department of Pathology and Laboratory Services at BAMC. “It’s been a challenge to maintain enough materials on hand to be able to provide the testing support the clinicians need.”

For Markelz, “The biggest challenge has been dealing with a lot of unknowns regarding this virus, particularly with transmission.”

“This is reminiscent to my time deployed in environments where you don’t have all the resources you may need,” Cybulski added. “You are having to make regular adjustments to try to find the best way to support the people you need to support.”

“We are very fortunate to have the expertise, support and knowledge needed to surmount obstacles as we combat this virus,” Yun said.

The Way Ahead

In the coming days, BAMC will continue to work closely with its mission partners at the 59th Medical Wing, the Medical Center of Excellence, the Medical Education and Training Campus, and service members at Army South and Army North to fight the pandemic.

“Preparation is critical,” Harter said. “We are bringing in some of our partners and enhancing BAMC’s capabilities in preparation for what we think may occur in the future.”

BAMC also is in close coordination with its community partners, to include the South Texas Regional Advisory Council (STRAC). “We are poised to support an increased need for trauma and acute patient care while maintaining protections for our patients and healthcare workers,” Harter said.

Team BAMC will continue to rise to the challenge in support of the military and the nation, she added.

“The coronavirus has taken our entire world, and our nation by storm,” said BAMC Command Sgt. Maj. Thomas Oates. “We must do our part and ensure that we combat this virus with everything possible. Our healthcare professionals are the most important people in the world right now.”

Someday our grandchildren will ask us what it was like during the COVID-19 pandemic, Yun said. “We will tell them about how we all worked together so hard and took care of each other.”