JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas (April 11, 2023) — Brooke Army Medical Center participated in a large-scale, city-wide mass casualty exercise April 6.

The San Antonio Mass Casualty Exercise and Evaluation, or SAMCEE, is an annual exercise designed to assess the surge capabilities of hospitals in the 26,000-square-mile region covered by the Southwest Texas Regional Advisory Council, which manages the regional trauma and emergency healthcare system for Southwest Texas.

“The SAMCEE allows BAMC to enhance our readiness as one of only two Level I Trauma Centers supporting San Antonio,” said Steve Burton, BAMC emergency manager.

This year’s complex scenario involved a man intentionally crashing a truck into a crowd of people attending a festival in downtown San Antonio. He then exited his truck carrying handguns and a rifle and began firing indiscriminately before running into a building and firing at the people inside. The gunman also fired from upstairs windows down at the crowd. Stray bullets hit propane tank on a food truck, resulting in an explosion. Numerous people were injured or killed.

In a separate simulated incident, a local “meth” house exploded causing burns to eight people. Additionally, some were contaminated and needed to be decontaminated at BAMC, explained Burton.

Nearly 600 volunteers and role players acting as victims, friends and family members participated in the annual exercise.

In total, BAMC received 50 simulated patients with mock injuries to depict a wide range of injuries.
SAMCEE specifically tests the region’s capabilities to respond to a mass casualty incident by assessing patient reception procedures, treatment processes, and the ability to track patients within the system.

“Unfortunately, natural and other types of disasters can happen anytime, and emergency personnel are the first line of defense,” said Army Col. Jason Bothwell, chief of emergency medicine at BAMC. “Mass casualty exercises allow us to hardwire best practices when the stakes are lower, so we can best respond in the event of a real-world scenario. This training also prepares our military teammates to save lives on the battlefield.”

The BAMC trauma mission is unique as the Department of Defense’s primary readiness platform for more than 9,000 personnel who work together to hone their ability to care for patients and sustain wartime trauma care skills. Alongside University Health, BAMC provides lifesaving care to more than 6,000 trauma patients each year, including 750 burn patients, from an area that stretches across 22 counties in Southwest Texas and encompasses 2.2 million people. About 85% of those are civilian trauma patients from the local community.

“We were able to successfully activate our emergency operations personnel and hospital command center, recall our hospital incident management team, and work on staff synchronization efforts,” Burton said. “The exercise also enables BAMC to comply with several Joint Commission Standards/Elements of Performance and to identify opportunities for improvement.”

SAMCEE also tested BAMC’s decontamination team and, this year, the hospital activated a supplemental labor pool in the Carolyn D. Putnam Auditorium.

“Overall, we achieved our training objectives,” Burton said. “I believe the most important success we achieved was in demonstrating our ability to work effectively as a team during a disaster.”

Bothwell agrees. “The spirit of ‘how can I help?’ was on full display – both in the ED and across Team BAMC,” Bothwell said. “It takes a lot of collaboration to care for 50 trauma patients in just a few hours, and there was great teamwork across multiple services. We also saw the impact of excellent preparation and great leadership.”

“A sincere thank you to all of the volunteer patients who participated – they were awesome!” he added.

Army Col. Matthew Geiman, BAMC’s deputy commander for patient support and the exercise’s incident commander, said the exercise was a “tremendous success.”

“The MASCAL tested our capability to meet the needs of the community during a crisis scenario,” he said. “Our approach was to stress every component of our Emergency Operations Plan to ensure our multidisciplinary teams were prepared while providing realistic training that our Army and Air Force personnel could use during deployments. I am super proud of the team’s response.”