Issue In Depth

Experience, Insight and Wisdom: A Blueprint for Handling COVID-19

Vital Signs » Winter 2021
James Augustine, M.D., ’83

James Augustine, M.D., ’83, Emergency Medicine, is quite experienced at handling disasters. From train derailments to pandemics, the emergency medicine physician, who also completed his emergency medicine residency at Wright State University Boonshoft School of Medicine (BSOM), has assisted with disaster planning and creating best practices for many crisis care situations. He is now using this experience to assist with, and try to stay one step ahead of, COVID-19. 

Augustine has been involved in helping emergency physicians, firefighters and emergency medical service (EMS) agencies across the nation plan, prepare and execute processes related to COVID-19 since before the first case in the United States was confirmed.

When the Centers for Disease Control and Prevention (CDC) first began to hear about the virus, preparations began. Part of that preparation included reaching out to colleagues, including Augustine, to discuss how to plan for the disease, manage care and curtail the spread. Eventually this group would become the CDC COVID Health Systems and Worker Safety Task Force, which has been crucial to the CDC’s efforts in battling the pandemic.

Augustine’s working relationship with the CDC began in 2001 while he was living and working in Atlanta. During this time, he was assistant professor and vice chair of emergency medicine with Emory University and medical director for both the city of Atlanta Fire Rescue Department and Atlanta’s Hartsfield Jackson International Airport. 

As medical director for one of the busiest airports in the nation, Augustine worked with the CDC to establish guidelines for international flights and travelers, especially during the SARS crisis in 2003 and Ebola in 2014. He also worked with the CDC in 2009 during the H1N1 flu outbreak. Augustine was able to build upon these past experiences with viral outbreaks and working with the CDC and use them as a blueprint for COVID-19.

Throughout Augustine’s career, he has served as medical director for fire and EMS with nearly 20 agencies between Ohio and Florida. These roles facilitated Augustine’s membership in 2009 with the International Association of Fire Chiefs (IAFC) and “the Eagles.” 

IAFC members are experts regarding policy for disaster response and public safety, and represent the leadership of firefighters and emergency responders worldwide. As the IAFC began planning for the virus, Augustine was asked to join their COVID-19 Task Force.

The Eagles, a de-facto coalition of the Metropolitan Municipalities EMS Medical Directors Alliance, is composed of most of the jurisdictional EMS medical directors for the 60 to 70 largest cities’ 911 systems in the United States. This group also includes the chief medical officers for several pivotal federal agencies such as the FBI, United States Secret Service and the White House Medical Unit, as well as numerous global counterparts, from Paris to Auckland, and Berlin to Manila. This cohesive cadre of EMS specialists is responsible for stewarding the medical protocols and respective training for all aspects of day-to-day 911, 999, 112 and 000 type emergency responses within their respective jurisdictions, encompassing well over one-third of the population of the United States and more than 130 million citizens worldwide.  

Augustine’s primary role is to take COVID-19 information and share it. “The CDC supplies the science, and I work with the IAFC, Eagles and fire and EMS agencies across the country to formulate best practices for patient care,”
said Augustine.

Augustine also shares the CDC’s science he receives with the emergency physicians who are part of US Acute Care Solutions. US Acute Care Solutions is a national physician group based in Canton, Ohio. Augustine is the immediate past chair of the group’s National Clinical Governance Board.

Equally important in this process is sharing with the CDC what is going on in the field. Augustine communicates what IAFC and Eagles members, emergency providers and the community are experiencing day-to-day, what processes are or are not working, and what needs to be addressed. For example, since the beginning of the outbreak, more emergency care has been happening in the home. People fear COVID-19 exposure and do not want to be transported to the hospital. Guidelines are needed for this change in emergency care. “Sharing of information is definitely a two-way street, and necessary,” Augustine added.

This past fall, as COVID-19 cases began to ramp up, Augustine coordinated fire and EMS providers to assist with testing at public health clinics and high-risk sites, such as nursing homes. Now, with the rollout of the vaccines, he is organizing fire and EMS personnel to assist with administering vaccines at many community sites. 

The IAFC and Eagles have been instrumental in providing insight and helping Augustine stay one step ahead of the virus in his planning. Before it was national news, the Seattle Fire Department medical director, also an Eagles member, shared the early experience of dealing with the first COVID-19 case in the country. Another Eagles member from Minneapolis, infectious disease expert Mike Osterholm, Ph.D., M.P.H., who would later appear with some regularity on the news broadcasts, provided early insight on how COVID-19 would affect people, and how systems would have to respond. Eagles members from Italy, Germany and France shared what was happening in their countries, enlightening him as to what to expect in the United States, so that preparations could be initiated in hard-hit areas like New York City.

Beneficial to Augustine in developing national COVID-19 guidelines is his experience in managing hospital operations and seeing the big picture. He served from 2004 to 2011 with The Joint Commission as a member and then chair of the Hospital Professional Technical Advisory Committee. The Joint Commission is the accreditation group for hospitals and is responsible for improving hospital disaster plans and regulating care standards. He also served for six years on the Board of Directors of the American College of Emergency Physicians (ACEP), a group involved with establishing clinical care standards within emergency medicine. He continues to serve with ACEP’s epidemic expert panel. 

Creating COVID-19 best practices, keeping providers safe and avoiding risk are also of the upmost importance. Augustine knows all too well how devastating this disease can be. In November of 2020, his son’s father-in-law, a 52-year-old firefighter in Ohio, died from COVID-19. That same month, Augustine’s son, a paramedic and battalion chief, also in Ohio, contracted COVID-19. Fortunately, his son recovered and is doing well.

Augustine shared the initial focus of CDC communication, including disseminating information to the public, caring for the infected, limiting the spread and improving the effectiveness of diagnostic testing, has now shifted into the next steps. He is now working with the CDC on COVID-19 vaccine distribution and vaccine confidence. He recently presented via a webinar on the vaccines to fire chiefs and EMS medical directors across the nation. “There are many firefighters and EMS personnel who are unsure about the vaccines. It’s important they understand that the vaccines are safe and that their families, co-workers and the community need them to be vaccinated,” Augustine added.

The technical issues around COVID-19 vaccines themselves are a challenge. “Never before in the pandemic playbook have there been multiple vaccine options, or those that must be given in two doses,” said Augustine. These have resulted in major logistics challenges, such as coordinating where people go for the second shot and making a particular vaccine brand available upon request. It’s also about addressing issues after vaccinations, such as when will it be safe to stop wearing a mask. 

Augustine sees vaccine confidence growing and vaccine availability improving. “This pandemic has been different than any other, and different from what we planned and prepared for,” Augustine added.

Augustine credits his success in dealing with crisis care to experiences from his early years in Dayton. Working as an emergency physician at Miami Valley Hospital, Augustine was able to learn emergency preparedness procedures from physicians who, just a few years earlier, cared for victims of the 1974 tornado in Xenia, Ohio. “Dayton has great emergency preparedness and provides great emergency care because of this tragic event. I am so fortunate to have had an opportunity to learn emergency care in a Dayton area hospital.”

An event which further expanded Augustine’s early learning in disaster responsiveness was the train derailment in Miamisburg, Ohio, in 1986. The train, carrying phosphorus and sulfur, ignited and released a toxic plume over the community, creating what was the largest evacuation in the nation’s history. Augustine was serving as medical director with the fire department in the Dayton suburb West Carrollton, in addition to working in the emergency department at Miami Valley Hospital. He worked around the clock for two days and nights at the fire station, functioning as command central, for emergency medical personnel. He assisted with triage and coordinated medics from nearly 30 jurisdictions to assist police with evacuations and care for victims.

Augustine does not forget where it all began. “I credit everything I know about health care to Wright State,” said Augustine. He acknowledges the community hospital experience at BSOM provides instruction in a variety of clinical settings and allows first-hand learning about different approaches to care. He believes the diverse clinical settings allow students to gain maturity by learning agility and how to think on their feet. “I’m proud of my Wright State heritage. Lessons learned there have allowed me to help so many.”

When Augustine isn’t wearing his “national hat,” as he calls it, he is teaching students at BSOM as a clinical professor in emergency medicine. Additionally, he serves as medical director for the Washington Township Fire Department near Dayton, Ohio, and with Forest Park Fire EMS, City of Morrow EMS, Hapeville Fire Department, South Fulton Fire Department and Riverdale Fire and Emergency Services all near Atlanta, Georgia. Augustine is also associate medical director with North Collier Fire EMS in Naples, Florida. 

Throughout his career, Augustine has contributed his wisdom and crisis care experience to more than 250 publications and articles, including “Emergency Considerations in COVID-19 Vaccine Administration” and “Physician at the Scene of an Emergency.” He also has held editorial positions with a half dozen medical publications. Augustine has received many awards and honors, including most recently the Street Medicine Society and the John P. Pryor Award for exemplary service. He has received multiple service awards with Atlanta Fire and Rescue.

Augustine shared, “This past year has truly been overwhelming,” but emphasized that he is blessed to have the opportunity to help other people. He stated, “We will learn from this pandemic and the world will be better for it!”

Augustine lives in Naples, Florida, and Dayton, Ohio. His wife Linda is a 1981 Wright State University graduate with a degree in nursing. They have three grown children and four grandchildren.

—Lisa Coffey

Last edited on 04/29/2021.