Defense Support to Civil Activities - City of Austin-Travis County

Group of military and front line workers

During 2020, I was in the combined Emergency Medical Services (EMS) and Disaster Medicine Fellowship program at Brooke Army Medical Center, Fort Sam Houston, TX. As part of this two-year program, Emergency Medicine specialist physicians are first trained to become medical directors for prehospital care systems. The Disaster Medicine year is focused more on large-population emergencies and operational medicine, with both years including Public Health through a Master’s degree in that field. Much of the program necessarily takes place with civilian partner agencies like City of San Antonio Fire Department and Cypress Creek EMS.

In January 2020, SARS-CoV-2 seemed to be a distant concern for Central Texas.

I went to 911 calls in support of San Antonio paramedics and didn’t suspect

SARS-CoV-2 to be present. In February and March 2020, Lackland Air Force Base had received evacuees from China, and later from cruise ships. Potential cases in the community resulted in a specially equipped ambulance response, with a field supervisor required to have a mandatory call with a physician to determine the transport destination. As cases began to build in the Northeast, I was scheduled to rotate at the Austin-Travis County Office of the Medical Director, which oversees the emergency response agencies of the City of Austin and Travis County in the heart of the state. The rotation was intended to focus on prehospital medicine in the structure of a separate “third service” municipal agency and quickly became far more about disaster medicine and public health.

In the State of Texas, County Health Departments have an administrative Director – but the physician Health Authority is the legal source for public health orders. In a rather unique circumstance, the Health Authority for City of Austin-Travis County was its EMS Medical Directors. This allowed for a unique integration between paramedics, firefighters, law enforcement, and public health – as the physician leadership was shared amongst all. A colleague helped build the initial “Drive Through” testing site for Austin; which was primarily supported by the Austin Fire Department. My role was primarily with the development of an Alternate Care Site (ACS) – an improvised medical facility many would call a “field hospital.”

Such facilities were typically employed in the recent past for localized disasters like tornados and hurricanes. Generally, ACS facilities would provide low acuity care that one might typically see at a nursing home – and we posited it would be useful for accepting stable patients from hospitals. This was made more complicated by the infection control measures and oxygen requirements that would not be seen in other disasters. The Austin-Travis County EMS Department took lead on development with me as the physician advisor for April and May. We looked at former hospital facilities, which were not adequate. Eventually, it was determined to utilize the Austin Convention Center as one large facility. Not long after I left Austin for Cypress Creek EMS, the ACS was opened in order to relieve pressure from area hospitals The ACS remains in operation almost a year later.