Dec. 9, 2020
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BY Elaine Sanchez
, Brooke Army Medical Center
With COVID-19 cases on the rise across the nation,
Brooke Army Medical Center is bracing for the impact of the coming
winter months as colder weather drives people indoors where the virus is
more likely to spread.
Equipped with lessons learned, BAMC is preparing to shift resources
and personnel to ensure hospital readiness in the event of a patient
increase. On the preventive front, leaders continue to underscore the
importance of safety measures such as hand washing, face coverings,
personal protective equipment and physical distancing.
"The ability to remain flexible and agile, while ensuring the
delivery of safe, high quality care, has been vital since the start of
the pandemic," Army Brig. Gen. Shan K. Bagby, BAMC commanding general,
noted. "Nearly a year ago, the San Antonio Military Health System moved
out quickly to ensure the safety of our patients and staff, and we
continue, as a system, to do everything possible to preserve their
health and wellbeing."
Decision Points
Key leaders at BAMC continually assess current conditions, both
within the San Antonio Military Health System, Joint Base San Antonio
and across the community to ensure "we are all in step with each other
and working effectively as a team," Air Force Col. Heather Yun, deputy
commander for medical services, explained. Leaders across the
organization also evaluate personnel and resources, to include personal
protective equipment, on a daily, sometimes hourly, basis to ensure they
are tracking trigger points for every contingency.
"These assessments help shape our posture and ensure we are ready to
respond quickly and appropriately, whether it's scaling back elective
surgeries to increase bed capacity or leaning more heavily on virtual
care to protect patients and preserve PPE," Bagby said.
Health care personnel are a trickier resource to manage for a
military hospital. Unlike their civilian counterparts, military
personnel are called on to deploy in support of overseas operations, as
well as humanitarian missions and stateside efforts. In recent days,
numerous BAMC health care professionals have been assisting in the
hard-hit areas of North Dakota as well as in El Paso, Texas, about eight
hours west of San Antonio.
BAMC has also offered to accept non-COVID-19 beneficiaries from
William Beaumont Army Medical Center in El Paso, freeing up their
capacity to admit additional TRICARE patients with COVID-19 as needed.
"BAMC is proud to support our El Paso neighbors and colleagues,"
Bagby said. "We will continue to work alongside our Military Health
System partner to help relieve the stress on their local health care
system as needed."
In the event of a patient increase and to avoid shortages to critical
care areas, BAMC is prepared to draw nurses and technicians from
outpatient clinics as well as lean on its partner, the Institute of
Surgical Research Burn Center, which is housed in the hospital.
These combined efforts have helped to ensure BAMC stands ready to support both military and community-based missions.
"The keys to our success so far have been in communication, deference
to expertise, and collaboration, and we are relying on those in our
current response as well to keep us agile and on the right track," Yun
said. "We are in constant communication with our staff from all across
the organization to ensure that concerns are addressed as early and
effectively as possible, before they become safety issues. And we are
relying on our subject matter experts who are keeping up with the
science and advances in their field to provide counsel and refine our
responses."
Community Support
As with all military hospitals, BAMC primarily provides care to
active duty, military retirees and family members. However, as the only
Level I trauma center in the Defense Department, BAMC has a unique
community role within the local trauma network. Alongside its Level I
partner, 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% 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, many
of which bear striking similarities to combat wounds. As a trauma
center, service members from a vast array of specialties are able to
hone valuable medical skills while aiding the community they call home.
"Our close partnership with Southwest Texas Regional Advisory
Council, University Health System and the other local health care
systems allows BAMC to seamlessly integrate into community crisis
responses, Air Force Col. Patrick Osborn, deputy commander for surgical
services, 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.
Critical Care
This has been evident in recent months. This past summer, BAMC took
on additional trauma patients to ease capacity at local hospitals.
Additionally, BAMC continues to care for the area's most critically ill
COVID-19 patients, to include beneficiaries, veterans and civilian
patients, through the 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. 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 health care
resources by admitting civilian ECMO patients and seeking out military
beneficiaries that can be transferred from community hospitals," Osborn
said.
The mutual support of BAMC's military and community partners is key to mission success, the commander noted.
"Due to their support and the expertise of this team, the San Antonio
Military Health is able to continue to ensure safe, quality care for
our 250,000 active duty and military beneficiaries while preserving its
readiness role as a worldwide response platform and sustaining the Level
I trauma support of our region," Bagby said.