MEDICAL YEAR IN REVIEW
Street Medicine San Antonio Inaugural Review By Amy Moore, PA-C, DScPAS; Patrick Muehlberger, MD; Hans Bruntmyer, DO, MPH
Background Dr. Hans Bruntmyer, a retired military emergency medicine physician, had a career that largely revolved around being comfortable with the uncomfortable and was no stranger to practicing medicine in austere environments. When he and his family relocated to San Antonio following his military retirement, he was moved by the obvious need for improved access to medical care for the most vulnerable in our society — those who lack shelter, transportation, basic safety and support. He was already familiar with the Street Medicine movement, originally founded by Dr. Jim Withers of Pittsburgh, and began networking with Dr. Withers and other Street Medicine program directors in 2015. During the next few years, Dr. Bruntmyer began to see the reality of creating a Street Medicine — San Antonio program (SMSA) and, in January of 2019, Dr. Bruntmyer began leading “backpack medicine” teams onto the streets of San Antonio to care for unsheltered individuals. Since those first “Street Rounds,” the organization has grown in size and scope, beginning with a single physician and student volunteers to now including three emergency medicine physicians, advanced practice clinician-led teams, nursing teams and a behavioral health component – Street Smart, in addition to countless volunteers of varying levels of training and across a range of professions. Despite his experience to that point, Dr. Bruntmyer could not have imagined the relationships formed or personal and professional growth that would be experienced by himself and all of the volunteers. Over two years have elapsed since the first backpack medicine mission by SMSA. The organization intends to publish regular research to support the development of future Street Medicine programs, educate the medical community on care for the homeless, and to help this program evolve in order to
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make a greater impact on its patients, San Antonio street sleepers, present and future. The authors believe that the first step in that process should be a 100% indepth patient chart review to systematically understand patient and organizational needs over SMSA’s first two years of service. Protocol approval was obtained from the University of the Incarnate Word Institutional Review Board on February 15, 2021 (FWA00009201). This study is an outcome evaluation design of Street Medicine — San Antonio from January 1, 2019 to December 31, 2020. In preparation for the review, a Google Scholar search was conducted between December 1, 2020 and December 31, 2020 to identify Street Medicine program evaluations. Key terms included Street Medicine, Street Medicine review, Street Medicine program evaluation, Street Healthcare and Street Healthcare program. The literature review resulted in three distinct Street Medicine program capstone projects and/or publications1-3 and one case series obtained from the annual Street Medicine Symposium.4 Additionally, eight articles obtained provided additional research related to Street Medicine Programs, such as resident and patient experiences, and in-depth looks at current data and issues that are unique to providing health care for the homeless, both locally and nationwide.5-12 The authors are grateful to contribute to the limited existing field of Street Medicine literature. Results Paper charts were pulled for each patient seen during this timeframe and a single investigator scrubbed each chart for basic demographics (Figure 1), major ailments treated (Figure 2) and supplies utilized (Figure 3). Referrals to SMSA from local social work organizations including Centro San Antonio, Chris-
