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Jarvis, Pickett and Vithalani: After-action report – The Texas blizzard of 2021

5 Texas EMS medical directors recount the operational and 911 triage challenges recent weather posed as power outages afflicted the region


Drs. Jeff Jarvis, Jason R. Pickett and Veer D. Vithalani join MCHD medical directors to discuss 911 triage, operational challenges faced in the recent blizzard.


After a large response, especially one with unique challenges, it’s always good to look back from an after-action perspective to identify what we did right, what we did wrong, and what direction the unexpected came from.

In this special episode of the MCHD Paramedic Podcast, MCHD Medical Directors Dr. Robert Dickson and Dr. Casey Patrick are joined by three EMS leaders to discuss the biggest challenges they faced during the recent icy weather event in Texas.

Our guests include:

  • Jeff Jarvis, MD, MS, EMT-P, FACEP, FAEMS, EMS director for Williamson County EMS and Marble Falls Area EMS, in suburban Austin
  • Jason R. Pickett, MD, FACEP, FAEMS, acting medical director for Austin Travis County
  • Veer D. Vithalani, MD, system medical director and chief medical officer, MedStar Mobile Healthcare, Fort Worth and surrounding region

Together, they discuss the challenges they saw coming, as well as those that came as a surprise, as ice, then widespread power outages, and then water challenges made it operationally difficult to respond as call volumes tripled.

This cascade of events included diminished hospital capacity, and required 911 triage from high-risk populations, including:

  • Oxygen-dependent patients
  • Dialysis patients
  • Hospice patients

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The MCHD Paramedic Podcast was launched in early 2018 in an effort to provide easily consumable core-content EMS education and insights from prehospital care thought leaders. The Clinical Services Department of The Montgomery County Hospital District EMS service developed the podcast as a tool to better engage and disseminate continuing education to our MCHD medics as well as first responders and EMS professionals nationwide.

Dr. Casey Patrick is the assistant medical director for Montgomery County Hospital District EMS and is a practicing emergency physician in multiple community emergency departments across Greater Houston. His EMS educational focus is on innovative paramedic teaching via the MCHD Paramedic Podcast. Dr. Patrick’s prehospital clinical research involves the investigation of paramedic use of bolus dose intravenous nitroglycerin for acute pulmonary edema and the implementation of lung protective ventilation strategies for intubated EMS patients. Casey and his wife, Alyssa, work and live in Conroe, Texas, and Spokane, Washington. Together they have five children: Mia, Ainsley, Brock, Dean and Will.

Dr. Dickson graduated with honors from the University of Texas Health Science Center San Antonio in 2001 and completed emergency medicine training at Indiana University in 2004. He serves as the EMS medical director at Montgomery County Hospital District EMS and an assistant professor of emergency medicine at Baylor College of Medicine in Houston, Texas. His academic interests include systems of care in stroke and other time-sensitive emergencies, neurologic emergencies and education. He is board certified in emergency medicine in both the U.S. and Australasia, and has subspecialty board certification in EMS medicine. He has authored multiple professional articles and presented at regional, national and international conferences on emergency medicine and EMS topics.