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COVID-19
PANDEMIC

STRAC, THE RMOC, AND DISASTER AND

PANDEMIC PREPAREDNESS AND RESPONSE

By Ronald M. Stewart, MD; Joe Palfini, BSN; D. Eric Epley, CEM; Brian J. Eastridge, MD

History of Texas Regional Advisory Councils 1) be maximally inclusive with engagement of all stakeholders,
In May of 1989, the 71st Texas Legislature passed an Omnibus 2) encourage dialogue and consensus decision making centered on
Rural Health Care Rescue Act (HB-18). This bill provided the foun- what is the right thing to do for the patient or population being
dation of the modern Texas EMS and Trauma System. Following served,
this legislation, the Texas Department of Health approved rules 3) establish systems that ensure timely and structured cooperation
which divided the state into 22 geographic trauma service areas and communication,
(TSAs). These geographic areas were based off of natural referral 4) develop data systems with strong support for research and quality
patterns and were sized to include at least three counties in a region improvement, and
that could support at least one Level III trauma center. In turn, each 5) cultivate a bias for action.
of these areas were directed to establish a Regional Advisory Coun-
cil (RAC) as a 501 C3, non-profit corporation. The original purpose This approach naturally fosters civility, professionalism, humility,
of the RACs was to administer the regional EMS and trauma sys- mutual respect and timely, evidenced based action. We believe these
tems in Texas. Over these three decades, regional EMS and trauma processes and values resonate with the culture and values of South
systems first developed then flourished and subsequently grew to Texas health professionals.
encompass the full spectrum of emergency health care, including Managing South Texas emergency health care and disaster re-
regional disaster response. sponse is multifaceted and complex, but for clarity we will focus on
things we believe are relevant to physicians and patients related to
Southwest Texas Regional Advisory Council the COVID-19 pandemic in South Texas.
The Southwest Texas Regional Advisory Council (STRAC) leads
and administers an integrated military and civilian trauma and EMS STRAC Disaster and Pandemic Response
system encompassing a 22 county, 27,000 square mile region. The Following the attacks of 9-11 and the anthrax incidents of Octo-
STRAC held its initial meeting in 1993 at the UT Health Science ber 2001, the Joint Emergency Preparedness Committee of the
Center’s Library. In 1998, the STRAC was established as a 501c3 Bexar County Medical Society (BCMS) and the Greater San Antonio
non-profit, tax-exempt organization chartered in the State of Texas. Hospital Council (GSAHC) formed the Regional Emergency Med-
The first Chair of the STRAC was Charles Bauer, MD, past presi- ical Preparedness Steering Committee (REMPSC) to organize local
dent of the Bexar County Medical Society (BCMS) and chair of the hospitals, physicians, pharmacists and other stakeholders for the best
BCMS Emergency and Disaster Preparedness Committee from response the area could provide with existing resources. This effort
1985–2006. From 1993 forward, the principal goal of the STRAC led to the realization that we, similar to almost every other region in
was to establish a regional trauma and EMS system designed to the United States, had some key vulnerabilities. Many of our existing
maximally reduce trauma related death and disability. plans were untested and unworkable in real-world conditions. Com-
Trauma system development is inherently multidisciplinary, and munication and data sharing capability across the health care and
the principal goal of a trauma system naturally extends to encom- public health systems were virtually non-existent, and ultimately there
pass all emergency health care and disaster response. The STRAC was no mechanism to rapidly coordinate a complex health related
has benefitted from an incredible regional team of physicians, disaster, especially one that required the integration of acute health
nurses, paramedics, first responders, educators, public health, emer- care, public health and emergency management. This situation con-
gency management and IT professionals. Through the development trasted starkly with the public safety (police, fire and EMS) and mil-
of STRAC systems, important lessons have been learned that are itary communities which had far more robust communications and
relevant to addressing all complex health problems. Implementation coordination systems. This led to the development of the STRAC
of STRAC systems is based on the following five key principles: Regional Medical Operations Center (RMOC) concept.

38 San Antonio Medicine • June 2020