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BAMC, Argentine Army medical providers share COVID-19 best practices

Image of Video teleconference image. Click to open a larger version of the image. Argentine Army Col. Oscar Zarich, Argentine Partner Nation Liaison Officer, U.S. Army South, left, moderates a COVID-19 subject matter expert exchange between doctors from the Argentine Army and Brooke Army Medical Center, Oct. 21, 2020. The video teleconference consisted of a panel of medical professionals discussing lessons learned to provide a compilation of best practices in response to the COVID-19 pandemic and other health-related topics. (Photo by Robert A. Whetstone, Brooke Army Medical Center.)

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Medical professionals from around the world are using technology to discuss COVID-19 best practices and share lessons learned. The Brooke Army Medical Center (BAMC) in San Antonio, Texas and Argentine Army’s Central Military Medical Hospital did not let 5,600 miles of separation keep them from discussing best practices against COVID-19.

U.S. Army South facilitated the virtual subject matter expert (SME) exchange between BAMC and CMMH, located in Buenos Aires, which touched on numerous topics and provided lessons learned for the participants. The exchange opened an avenue allowing doctors from both countries to discuss critical aspects of combating the disease to help protect the force and enhance readiness, while strengthening and building partnerships.

The exchange of best practices focused not only on readiness, but how to treat both COVID-19 and non-COVID-19 patients, staff protection, research and development, and testing protocols. A total of 17 medical practitioners participated in the virtual SME exchange.

Although they practice their craft in different countries, both teams understood the importance of reducing risk to staff as paramount to providing safe, quality care to service members and the local communities they serve.

At the beginning of the pandemic, BAMC started with a deliberate operations order to assess staff, logistics and bed expansion capacity. “We have many simultaneous missions to conduct,” said U.S. Army Col. Michael Wirt, BAMC deputy commanding officer. “Not just the mission to provide health care within our hospital; we also deploy some of our staff to respond to local, regional, and national requirements to support the COVID-19 crisis.”

In response to the pandemic, BAMC reduced its inpatient census, tightly managed personal protective equipment until the supply line became more predictable, limited the number of entrances to the hospital, conducted screening of everyone coming into the building, and began drive-through testing, in order to reduce the chance of infection in the hospital.

Both BAMC and CMMH treat COVID-19 and non-COVID-19 patients in separate areas. The CMMH team stated that COVID-19 areas follow strict protocols, requiring PPE in all entrance points. These specific wards are routinely disinfected and CMMH employs a security committee that ensures the non-COVID-19 area stays COVID-19-free.

Supply and demand, particularly with PPE and COVID-19 testing material, was a concern for both BAMC and CMMH. BAMC continues its partnership with University Health System and the Southwest Texas Regional Advisory Council to provide Level I Trauma care for 22 counties, encompassing 2.2 million people, even in the face of unprecedented healthcare system stress across the region. There are over 14 million people in the metropolitan area of Buenos Aires, and CMMH provides care to the military and general population. Even with PPE being such a prime commodity, CMMH manages to test their hospital staff of over 2,400 every 15 days, while still administering about 5,000 COVID-19 tests a day.

U.S. Air Force Col. Patrick Osborn, BAMC deputy commander for surgical services remarked on the trauma and emergency platform used to coordinate pandemic response with the local area and non-military medical healthcare systems. “That allowed for discussions on resources, testing, and policies on managing the pandemic, from a regional standpoint.”

The U.S. Air Force Secretarial Designee program allows BAMC to transport and accept extracorporeal membrane oxygenation (ECMO) patients for complex critical care when hospital capacity allows. The ECMO program provides significant community support for the sickest COVID-19 patients while furthering the readiness of numerous critical care personnel. 

“Through the infectious disease and public health communities, we have been working with public health in the state,” said U.S. Air Force Col. Heather Yun, BAMC deputy commander for medical services. “We’re one of many military health system hospitals in the United States, and all of our subject matter experts have been passing best practices back and forth and actually developing clinical practice guidelines. We’re on the sixth version [of the COVID-19 guidelines].”

Because of the fluid nature and constant learning surrounding COVID-19, protocols have been continuously changing for healthcare professionals. “We’ve had to write a lot of things in pencil, and rewrite them in pencil again two weeks later,” Yun explained. “We certainly follow CDC guidelines when it comes to things like infection prevention and control. When it comes to treatment protocols, we follow the science. Current protocols involve Dexamethasone and Remdesivir for hospitalized patients on oxygen.”

Practices and procedures that require high exposure is an obstacle that medical treatment facilities have to negotiate in order to maintain a safe environment during the pandemic.

When community transmission has been high, many non-emergency procedures are postponed until conditions are favorable. “We haven’t been doing a lot of elective surgeries or aerosol-generating procedures when we have a lot of community transmission,” said Yun. All patients are treated as a potential COVID-19 patient, guarding against the risk of transmission, she stated.

Communicating as a staff during the pandemic also offered challenges. CMMH and BAMC have had to rely on off-the-shelf technology to conduct meetings that would have otherwise been face-to-face.

BAMC is one of the participating sites of the clinical trials for Remdesivir as a treatment for COVID-19 infected patients. BAMC is also involved in trials with convalescent antibodies/convalescent plasma.

As part of the Operation Warp Speed goal to deliver safe and effective vaccines and therapeutics by January 2021, five DOD locations, to include BAMC, have been identified to participate in AstraZeneca’s the Phase III trial evaluating the vaccine candidate.  

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