TEMSA’s 2021 Horizon Award
2021 Horizon Award
Natan Menchaca (Camino Real Ambulance)
Natan Menchaca is a supervisor with Camino Real Ambulance. Camino Real has been in operation since 2008 and serves the small communities of Carrizo Springs, Eagle Pass and Del Rio.
Natan rose to prominence during the Covid-19 pandemic. The communities and hospitals that Camino Real serve are located on or near the Mexican border. Three hospitals in the area provide varying level of care. However, they often depend on the larger health systems in San Antonio, which are three hours away.
During the first surge on the border in August 2020, all three of these hospitals were overwhelmed by Covid-19 cases. One hospital, which has 10 ten ICU beds and averages 70 ventilator hour per year (patients on ventilators for a combined for 70 hours a year), found itself with over 20 ICU patients, and 75 percent of them were on ventilators. Although supplemental staffing and both intensivists and telemedicine pulmonologists helped these rural hospitals, patients still needed to be moved to San Antonio, and that often 10 to 15 transports a day.
As more was learned and equipment became available, patients were being placed on high-flow O2 at 40, 50 and 60 lpm. Although this kept several patients off ventilators, when these patients needed to be moved to town, the oxygen demand of these high flow units made it impossible to make a trip to San Antonio, even by air, without running out of oxygen.
Natan was in the middle of this and helped develop a plan of an oxygen chase vehicle that would accompany the ambulance to town and a series of EMS providers who would keep H or M tanks available for Natan’s crews and others who were bringing these critical patients to town.
Natan went to work with his team and transformed one of their ambulances to safely carry and secure enough oxygen for his crew to make it to San Antonio without exhausting the oxygen supply. This allowed them to begin moving these patients on high flow at a much lower risk to the patient and without the patient having to be intubated and placed on a ventilator, which was the only option for air transport.
This unit began to bring patients to town around the clock, and it appeared that the Covid-19 gods were mocking us: Early on a Sunday morning in San Antonio’s medical center, Natan’s ambulance was struck by a drunk driver as they were turning into a hospital to deliver the patient to a hospital. Fortunately, no one in the ambulance was severely injured, but the ambulance was totaled in the collision.
With the reduction in normal ambulance transports and delays in getting paid for these long-range transports, plus not being eligible for CARES Act dollars, Camino Real was facing a challenge as to how they would replace this unit in a way that would allow it to provide the same long-distance oxygen transport.
Again, Natan got to work and began huddling with the RAC and DSHS. Due to their location and the services they were providing to such a remote area, Natan was able to secure Extraordinary Emergency Funds from DSHS to fund the ambulance replacement. Not only was Natan a leader in his communities and his agency during the pandemic, but he also continues to lead today. The new ambulance he secured is capable of carrying two patients on stretchers and to provide high-flow oxygen for their routine three-hour transports.
Natan also jumped into regional pandemic response planning. He was actively involved in the development of both the “Paramedic Initiated Refusal” guidelines and the regional “No Response by EMS” guidelines. Natan was also involved in triaging and working with the EMTF resources that were deployed to Del Rio and Laredo as transfers were coordinated and carried out from these three remote communities.
Natan is a quiet leader who makes a big impact. As a result of his work, many individuals in his communities survived Covid-19 because Natan went the extra mile to ensure that they could make it to higher levels of care that were three hours away.