JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas —
Brooke Army Medical Center is continuing to aid the San Antonio community in the midst of a COVID-19 surge across the region.
“Over the past few months, BAMC and the San Antonio Military Health System as a whole have agilely adapted to continue to provide service to our 250,000 active duty and military beneficiaries in a COVID-19 environment while sustaining our Level I trauma support of our region,” said BAMC Commanding General Army Brig. Gen. Shan Bagby.
From easing the city’s testing demand to taking on additional critically ill patients, BAMC’s response to this ongoing crisis has been “nothing short of amazing,” Bagby noted.
Lifesaving trauma care
BAMC is the only Level I Trauma Center within the Department of Defense and one of two within San Antonio. Alongside University Health System, BAMC administers lifesaving care to more than 4,500 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.
Of the over 4,500 trauma patients admitted each year, about 85 percent are community members without military affiliation. The Secretary of the Army Designee, or SECDES, program enables BAMC to receive civilian trauma patients in a military treatment facility. Traumas range from gunshot wounds and stabbings to vehicle accidents and severe burns.
“Our close partnership with Southwest Texas Regional Advisory Council (STRAC), University Health System (UHS) and the other local healthcare systems allows BAMC to seamlessly integrate into community crisis responses,” said Air Force Col. Patrick Osborn, deputy commander for surgical services. “In essence, it allows us to train as a system within a system.
“We are training to receive patients with the most severe injuries in a way that is very translatable to our combat casualty care role. Being a leader in a very mature trauma system sets the trauma mindset for our entire organization,” he said.
Working alongside STRAC, which coordinates the region’s trauma and disaster relief response, and UHS, BAMC is fully integrated within the local trauma network, Osborn said.
This has been evident in recent days. With local hospitals nearing capacity, BAMC has been taking additional trauma patients through STRAC to ensure the region’s trauma response remains unaffected by the pandemic.
Additionally, BAMC is increasing its ability to care for the area’s most critically ill COVID-19 patients, to include beneficiaries, veterans and civilian patients, through the expanded use of extracorporeal membrane oxygenation, or ECMO, treatment, Osborn noted.
ECMO is a heart-lung bypass system that circulates blood through an external artificial lung, oxygenates it, and delivers it back into the bloodstream. Rather than treat the condition, ECMO performs the job of the patient’s heart and lungs, buying the patient precious time to respond to treatments and heal.
Established in October 2012, BAMC has the only adult ECMO center with full capability in the Department of Defense and remains one of the few centers in the world with air transport capability. Requiring a highly specialized team and equipment, BAMC is one of a few hospitals within the city with this capability, and as with trauma, accepts civilian patients through the SECDES program.
“As much as able, BAMC is easing the burden on local healthcare resources by admitting civilian ECMO patients and seeking out military beneficiaries that can be transferred from community hospitals,” Osborn said.
“Functioning as a trauma center for the region each day, coupled with the deployment experience of many, BAMC remains ready to respond to any contingency,” he continued. “We will continue to collaborate with the local healthcare systems to coordinate the region's response to COVID-19 and are honored to provide safe, quality care to all of our patients.”
Hidden healthcare heroes
BAMC also provides community support through its drive-thru screening and testing operation. Operational since the earliest days of the COVID response, BAMC has eased the burden on the city’s overtaxed testing sites, screening more than 9,100 patients and testing more than 7,500 personnel as of July 7. Additional screening and testing are provided by the 59th Medical Wing on Joint Base San Antonio-Lackland and JBSA-Randolph.
“By providing on-site testing for our beneficiaries, we eliminate the need for them to seek alternative testing locations furnished by state and local health officials,” said Army Col. Betsy Stanley, who oversees the operation. “We also have testing conveniently located on campus with results within 24 hours.”
The operation started out in an adjacent hospital parking lot but soon moved to the first floor of the parking garage to prevent heat and weather exposure for the screeners. The operation has grown from about 25 to 60 personnel.
“Our screening and testing operation is vital to our mission here at BAMC,” said Air Force Col. Richard Palmer, deputy commander for health readiness. “By providing this service, we’ve kept thousands of potentially infected patients out of the hospital, minimizing the spread of the virus to other healthcare workers and enabling the BAMC team to continue to see other patients.”
For testing, BAMC uses the CDC-recommended COVID-19 test called a nasopharyngeal swab, which involves using a swab to take a sample from inside the nose. The samples are sent to the BAMC Department of Pathology to process.
Testing by the thousands
Upon receipt of the swabs, lab technicians begin the intensive work of processing tests. Based on demand, technicians from the Department of Pathology and Area Laboratory Services, or DPALS, run tests for up to 24 hours a day, seven days a week. As of July 7, BAMC has processed more than 25,000 COVID-19 tests.
“Our technicians have been amazing and, fortunately, this has been a team effort from the start,” said U.S. Army Lt. Col. Robert Cybulski, Jr., director, microbiology, DPALS, noting collaborative efforts with the BAMC screening and testing operation, Infectious Disease Service and Preventive Medicine.
Additionally, technicians from Wilford Hall Ambulatory Surgical Center and the Department of Defense Food Analysis and Diagnostics Laboratory have volunteered their time and resources to assist the ongoing COVID-19 mission at BAMC, he added.
“Their support ensures we can support the COVID-19 mission as well as our routine laboratory mission for our patients,” Cybulski said.
Each day, the total list of positives generated during a 24-hour period is sent to Infectious Disease, Public Health personnel on Joint Base San Antonio, and select physicians within BAMC Family Medicine to ensure patient follow-up is completed and documented appropriately, and to facilitate additional reporting to community Public Health officials.
“The laboratory has not only shown amazing resiliency as it has adapted to the evolutionary changes that have come from the CDC, DoD, and other agencies regarding the understanding of COVID-19, but the staff has shown a level of teamwork and camaraderie that I’ve only experienced under the most high-stress environments,” said Army Master Sgt. Jeffrey Thomas, DPALS noncommissioned officer in charge.
Pharmacy steps up to reduce footprint
The Pharmacy Department has also stepped to the forefront to assist COVID response efforts. To ensure staff and patient safety and reduce the footprint within the hospital, BAMC implemented a curbside pharmacy service across the organization starting in late March.
Over the course of just over two months, BAMC serviced more than 89,500 vehicles and dispensed over 162,000 prescriptions. Since June 1, BAMC has processed more than 97,500 prescriptions through its drop-off and pick-up in-house services.
“Due to the COVID crisis, the BAMC Pharmacy team quickly came together on very short notice and successfully made the new curbside pharmacy service a reality in less than 48 hours,” said Army Col. Stacey Causey, chief, Department of Pharmacy. “The process has been a big success for the pharmacy and organization.”
While the curbside service was well received by customers, BAMC is working to ensure the utmost convenience and safety with its in-house prescription drop-off and pick-up service, eliminating waiting times and waiting area crowds.
“My team stepped up to do what was needed to ensure the safety of our patients,” Causey said. “I am incredibly proud of their efforts.”
Dialing in to healthcare
BAMC also has been leveraging every virtual asset to its fullest extent in recent months in an effort to keep patients safe at home.
In response to the COVID-19 pandemic, the Virtual Medical Center at BAMC increased virtual health appointments from 16 percent of overall appointments in January 2020 to 52 percent in May 2020, said Army Lt. Col. Sean Hipp, director of the Virtual Medical Center, noting that Primary Care and Behavioral Health have been active users of virtual services.
Virtual appointments can be used for medication refill requests, lab and radiology results, cold and allergy symptoms, urinary tract infections and routine follow-up appointments in which a physical exam isn’t required.
The Virtual Medical Center is also exploring the expansion of tele-critical care support, or TCC, Hipp said. This involves a network of providers and other specialists monitoring smaller wards, providing overwatch and support for patients in intensive care units. With COVID-19, there’s a feasible tele-critical application at BAMC, he noted.
“We are looking into the possibility of installing cameras and central monitoring equipment for wards in which COVID patients are being cared for,” Hipp said. “Critical care providers are a finite resource and having this capability would enable them to provide invaluable care to a greater number of patients.
“TCC would expand staff capability and will reduce PPE use and the medical staff’s exposure risk,” he added.
Hipp is hoping the current virtual trend will lead to lasting benefits.
“On the readiness side, we already have a robust readiness clinic and the ability to see patients all over the world rapidly. Now, we are gaining a better understanding of what can be done over the phone or on video, which will lead to better access to care throughout the San Antonio Military Health System,” he said.
“BAMC will continue to assess and explore ways to support our beneficiaries and community during this ongoing national emergency,” the commanding general said.
“We are honored to serve our active duty, retirees, their family members and this tremendous community,” he said, “and we are proud to serve our nation as a premier readiness platform for our military medical personnel.”