Inside a darkened operations center in San Antonio, six coordinators sit behind workstations lined with monitors. Across six glowing screens, they follow the movements of medical helicopters, the status of hospitals and a steady stream of calls for help across South Texas. 

Each station inside the Southwest Texas Regional Advisory Council’s medical command, or STRAC’s MEDCOM, center has a different job. One coordinates trauma transfers.

Another tracks and dispatches medical helicopters.

Others help law enforcement officers find psychiatric care for people in crisis or coordinate nurses responding to sexual assault and domestic violence cases.  

The public rarely interacts with the operation directly. But for 30 years, MEDCOM has served as the behind-the-scenes hub connecting hospitals, emergency medical services and other first responders across a 22-county region covering roughly 26,000 square miles — an area larger than the size of West Virginia. 

That obscurity means the region’s trauma system is operating exactly as intended, explained Eric Epley, STRAC’s executive director and CEO.

“The regional trauma system is one of those things you don’t really think about till you need it,” Epley said. “if you don’t know our organization’s name, we’re probably doing a good job because the system’s working. If you do know our name, something’s broken, and we’re not fixing it.” 

Solving a problem 

MEDCOM was created in 1996 to solve a relatively straightforward but potentially deadly problem.

At the time, South Texas had three Level I trauma centers: Brooke Army Medical Center, Wilford Hall Medical Center and University Hospital. A smaller hospital trying to transfer a critically injured patient could call one facility and be turned away because it was full, then encounter the same problem at another.  

The hospitals operated under the assumption that another trauma center would be able to take the patient in, but with no communication between the three, patients would end up stranded in rural hospitals without the capacity to treat them, Epley said.

So MEDCOM took on the role. Three decades later, it still serves as a single point of contract for trauma transfers, staying with a request until a receiving hospital is found.

The MEDCOM control room where dispatchers coordinate emergency transfers to trauma centers across the organization’s 22-county service region. Credit: Diego Medel / San Antonio Report

Since its inception the center has coordinated more than 107,000 trauma transfers, including 6,554 last year. 

Sometimes those transfers can take coordinators outside of the 22-county service area, like in 2019 when a man was bitten by his pet cobra and taken to the now defunct Southwest General Hospital in South San Antonio.

While hospitals typically stock a range of antivenoms for snakes commonly encountered in their service area, no one had anticipated a bite from a snake native to Asia to take place on the South Side of San Antonio.  

MEDCOM was unable to locate a hospital with cobra antivenom on hand, so they called the San Antonio Zoo. State law requires zoos to have antivenom for venomous animals in their collections. 

But the zoo’s resident cobra had passed away, so they no longer had cobra antivenom.

That’s when the power of coordination came into play, Epley said. 

A zoo veterinarian in San Antonio reached out to his counterpart at the Houston Zoo, which housed two cobras at the time and had the antivenom on hand. While helicopter transfer would be the normal protocol, a thick blanket of fog that day complicated things.

So MEDCOM contacted leadership at Acadian Ambulance — a private company that provides medical transportation across Texas and other states.

They quickly dispatched an ambulance in Houston to pick up the antivenom and head west toward San Antonio — while another ambulance left San Antonio headed east toward Houston.

The crews met around Columbus, transferred the medication and continued in opposite directions.

About four and a half hours after the incident began, Epley said, the antivenom arrived at the hospital — and the man survived. 

“That’s just a crazy story, but it’s not uncommon,” Epley said. ”We’re like the gateway for everything problematic. If someone’s having a problem in the hospitals or in EMS, they call MEDCOM, and we help connect them to solutions.” 

Part of their work also includes coordinating medical helicopter arrivals at hospitals, acting as traffic controllers so helicopters carrying critically injured patients won’t arrive to find the helipad occupied.

A screen tracks live flights across the San Antonio region inside the Southwest Texas Regional Advisory Council’s Medical Command, or MEDCOM, control room. Credit: Diego Medel / San Antonio Report

And when a mass casualty incident occurs, MEDCOM plays a key role in the region.

During emergencies such as the shootings in Uvalde and Sutherland Springs, MEDCOM worked with responders to distribute the victims among hospitals rather than overwhelming a single emergency department. For a major incident in a smaller community, MEDCOM can also help bring ambulances and other resources in from surrounding jurisdictions.

Epley says that work is only possible through collaboration, while MEDCOM makes things move, STRAC doesn’t actually own or control any ambulances, helicopters or hospitals it coordinates.

“I like to say, it’s big hat, no cattle,” he said. “A lot of responsibility, but no authority to actually make it happen. So we have to work collaboratively with our partners.”

And over the last three decades those responsibilities have expanded far beyond coordinating trauma care. 

“That’s what it was built for in 1996,” he said. “One thing we found out at MEDCOM: if you do really good work, you get rewarded with more work.” 

Expanding horizons 

Since 2018, the center has operated a law enforcement navigation program designed to help officers responding to people experiencing mental health crises.

Instead of automatically taking someone to an emergency room or jail, officers can contact MEDCOM, where coordinators can see psychiatric bed availability and direct them to an appropriate facility.  

The service is now used about 1,400 times per month in Bexar County, Epley said, through partnerships with the San Antonio Police Department’s SA CORE program and the Bexar County Sheriff’s Office’s SMART teams. 

Roughly 80% of those encounters result in an officer taking the person directly to a psychiatric facility, Epley says. Others may require an emergency room or EMS because of an injury, overdose or other medical need. 

MEDCOM handled more than 12,000 such navigations to psychiatric facilities last year and has handled more than 100,000 since the program began, according to STRAC.

As for the next 30 years of MEDCOM, Epley says that its next evolution could involve innovations utilizing technology to streamline processes. 

He envisions drones stationed around the region carrying scarce medical resources — potentially whole blood for transfusions, as an example — directly to responders in remote communities.

Whatever comes next, Epley said MEDCOM’s purpose remains largely the same: solving problems most people will never know existed.