UT Health San Antonio answers the call for COVID backup

Seven people standing in front of hospital
Seven health care providers, including five from UT Health San Antonio, participated on a Texas Emergency Medical Task Force deployed by the Southwest Texas Regional Advisory Council. The team worked in a mobile medical unit to provide care for COVID-19 patients at Fort Duncan Regional Hospital in Eagle Pass. They include (from left) Bradley Goettl, DNP, RN; David Wampler, PhD; Romeo Fairley, MD; C.J. Winckler, MD; Julia Bouldin, RN, from John Peter Smith Hospital in Fort Worth; Tatiana Emanuel, PA-C, DMSc; and Keaton Mattick, EMT-P, leader of the Emergency Medical Task Force, with Bexar County Emergency Services District 2.

When medical crises arise, the call goes out for backup. It could be for a natural disaster, such as Hurricane Harvey, manmade disasters, like the ammonium nitrate explosion in West, Texas, or health emergencies, such as the COVID-19 pandemic.

UT Health San Antonio faculty members are serving on interprofessional teams throughout the state through the Texas Emergency Medical Task Force (TxEMTF), part of the Texas Disaster Medical System. The deployments are coordinated statewide by the Southwest Texas Regional Advisory Council (STRAC).

“The purpose of the Texas EMTF program is to provide extra capacity to respond to medical emergencies. Work could include providing emergency medical transport, hospital surge staffing or mobile medical units that can be deployed,” explained Eric Epley, STRAC executive director and CEO.

Right now, medical teams are deploying to COVID-19 hotspots in El Paso, Eagle Pass and the Texas Panhandle.

Tatiana Emanuel, PA-C, DMSc, and C.J. Winckler, MD, as well as others from UT Health San Antonio, served in both El Paso and Eagle Pass.

Providing relief in El Paso

One of the first team members deployed to El Paso was C.J. Winckler, MD. He normally serves as deputy medical director of the San Antonio Fire Department (SAFD) through his faculty position in the Department of Emergency Health Sciences in the School of Health Professions. He also is an assistant professor in the Department of Emergency Medicine.

“My role was administrative and as a hospitalist. In addition to working long hours as a physician, I acted as the medical director and administrator to develop the clinical plan regarding which patients to admit to our mobile medical unit and how to treat and discharge them,” he said. Earlier in Eagle Pass, Dr. Winckler served in these roles but also as an ICU physician.

Katherine Raczek, MD, assistant professor of emergency medicine, and Bryan Everitt, MD, an emergency medicine fellow, worked in the MMU parked at El Paso’s University Medical Center. “The MMU is a mini-hospital with pharmacy services, doctors, nurses, lab and cots,” Dr. Raczek said. “We can do the whole range of medical procedures and interventions there. It is like a field hospital you might see in a military deployment setting,” Dr. Raczek said.

She and Dr. Everitt provided care for patients whose conditions were considered severe and required oxygen support and antiviral medications. Dr. Everitt said that during their two-week deployment to El Paso, they cared for more than 85 patients in the 14-bed mobile facility.

Six Texas Medial Task Force
(From left) Bradley Goettl, DNP, RN; Julia Bouldin, RN, from John Peter Smith Hospital in Fort Worth; David Wampler, PhD; C.J. Winckler, MD; Romeo Fairley, MD, and Tatiana Emanuel, PA-C, DMSc., served on an early COVID-19 Emergency Medical Task Force team in Eagle Pass.

Lending a hand in Eagle Pass

Back in July, five faculty members from UT Health served on a team at the Fort Duncan Regional Medical Center in Eagle Pass.

“The hospital was full of extremely sick patients. They were holding ICU-admitted patients in the emergency department and on normal medical floors. All of the staff were under extreme stress,” described Romeo Fairley, MD, MPH, FACEP, assistant professor of emergency medicine, director of disaster preparedness and response, and director of the disaster medicine fellowship.

This was the first deployment for physician assistant Tatiana Emanuel, PA-C, DMsc, lead advance practice provider in the Department of Emergency Medicine. “We responded to codes, stabilized patients, and performed critical care and emergent procedures such as intubations and inserting central, arterial and dialysis access lines,” she said.

However, what stuck with her the most is that families could not be present to receive information or to support their loved one. “Emotionally, it is very hard for the patients and their families. Family members were waiting for updates, but providers and nurses were extremely busy taking care of critically ill patients, so the waiting time for news probably felt like forever to them. Sparing the moment and giving them an update about their loved one helped alleviate a lot of stress and anxiety,” said Dr. Emanuel, also an assistant professor in the Department of Physician Assistant Studies, part of the School of Health Professions.

Even faculty members who have been deployed many times learn from these experiences. David Wampler, PhD, LP, FAEMS, associate professor of emergency health sciences, said he was amazed by an unusual observation of some COVID patients. “We were dealing with some very sick patients that were in or near respiratory failure, but they did not realize it. They were still somewhat functional. Previously, I would have immediately moved to induction, intubation and artificial ventilation, but these patients did surprisingly well with noninvasive breathing therapy. This experience is forcing me to take a more objective and evidence-based approach to prehospital critical care patients,” he said.

Man looking at chest X-ray
Bradley Goettl, DNP, RN, looks at a chest X-ray while deployed to Eagle Pass to provide care for COVID-19 patients.

The importance of teamwork was an important take-away for Bradley Goettl, DNP, RN, a triple-certified nurse practitioner in family practice, emergency and adult acute care. “We collaborated with an amazing staff. I hope that we were able to take one task off their plates to make their day more manageable. For me, there will always be a bond with the staff from Fort Duncan. Teamwork is the only way to get through this kind of situation,” added Goettl, who is an assistant professor of emergency medicine and also serves in the School of Nursing.

Other UT Health faculty who have served to date include Mark Foster, MD, assistant professor of emergency medicine, and EMS fellow Joshua Tsau, MD. As COVID continues, these and other faculty members will likely be deployed numerous times to save lives throughout Texas.



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