As temperatures reached 100 degrees, Dr. Bryan Everitt arrived at the scene of the most deadly human smuggling event in U.S. history on the city’s South Side.
On that day, more than two years ago, he was tasked with a second triage and canvassed the area near Quintana Road searching to see if anyone could possibly still be alive.
Paramedics screened dozens of unconscious people for cardiac activity. Forty-eight people were dead, and five people made it to hospitals alive but later died.
They had been suffocated by heat inside a locked tractor-trailer, which was reportedly “hot to the touch.”
“It’s tough to talk about,” Everitt said in his office at UT Health San Antonio, where he teaches emergency medicine. His tone was somber, and he looked at the floor.
“What I witnessed was patients that had suffered from the worst parts of heatstroke. … We had to pick people up off the top of each other,” he recalled.
What followed from that experience was the realization that the way San Antonio responds to these kinds of emergencies needed to change in order to save lives.
People suffering from heatstroke in Southwest Texas, and even children left in cars, now have a better chance of recovery thanks to this doctor’s improved emergency protocol.
He took a page from sports medicine journals, in which doctors were already using cool water immersion to treat athletes, and suggested the use of Thermal Emergency Management Patient bags — TEMP for short —to quickly cool down a person at the scene. Before, getting to the nearest hospital took several minutes. Time these victims don’t have.
“It was working really well for patients who had heatstroke in marathon [running] or in the military,” he said. “That’s hard to do in the back of an ambulance. Is there something better?’ Then someone said, ‘Why don’t we use a body bag?’”
The TEMP bags look like zip-up body bags and are filled with ice and water to cool patients down. It’s for people with a body temperature of 103.9 degrees or higher, who have been exposed to intense heat and who are in an altered mental status.
The mission is to cool the person down to a body temperature of at least 101 degrees as fast as possible; since heat-related illnesses can cause stroke, heart attacks, irreversible brain and organ damage, said Dr. C.J. Winckler, medical director for the Southwest Texas Regional Advisory Council (STRAC) EMS Region 8.
“We are all speaking the same language now. We, all the STRAC, all the EMS agencies, all the fire departments, we are all speaking the same language now. This has been really a monumental shift in the way we think about MCI’s (mass casualty incidents),” he said.
EMS responding to heat-related illnesses across STRAC’s 22-county region can have 50 TEMP bags and up to 10 pounds of ice and 60 pounds of cold water at a scene within 15 minutes.
Since March, there have been 490 cases of heat-related illness in San Antonio. Since TEMP bags were implemented in June 2023, they’ve been used 23 times in Bexar and Comal counties, according to STRAC.
As the city implements campaigns and opens cooling centers, sometimes going door-to-door, it’s still difficult to get some into cooler spaces in rural and urban areas.
“Every day, vulnerable populations are at risk for heatstroke, heat exhaustion, being dehydrated, sunburns,” Winckler said. “San Antonio is a heat dome. This is a heat island. … Tall buildings, lack of trees, … so people that are unhoused in San Antonio are at the greatest risk.”
Earlier this summer, Bexar County Sheriff’s Office deputies rescued 26 migrants smuggled under a trailer in South Bexar County.
How TEMP bags work
After checking the heart, temperatures and administering IV fluid if needed, responders place the patient inside the cooling bag. EMS will gently move the patient back and forth inside, and after some minutes, the ice begins to melt.
The new measure is especially essential because every second counts, Winckler said. When a person’s body temperature rises above 104 degrees, an inflammatory reaction occurs and cells start overheating and don’t regenerate.
It can take up to 30 minutes for the patient to reach at least a 101-degree body temperature, as the body starts to cool at least .1-to-.15 degrees Celsius per minute. Then responders will drain the water out as the patient gains consciousness.
“We were never really doing a very good job of” responding to heat-related illnesses before, said Nikki Hardwick, paramedic for Wilson County EMS 3 and clinic operations manager.
“We’ve seen it work,” she said. She recalled responding to a patient before the protocol was put into place, where all the best efforts to cool the person “did nothing,” she said.
Hardwick, who represents her county in STRAC’s pre-hospital committee, responded to a patient who had an intellectual disability, which made it difficult for his elderly mother to recognize symptoms of a heatstroke.
“Unfortunately that call did not end well as an end result. He suffered a massive heatstroke, and he was young, too,” she said.
The TEMP bags, had they been available, “would’ve made a difference in being able to protect some perfusion of the brain,” she said.
The strategy is also being used to respond to the worst type of calls, Winckler said — children left in hot cars.
“We have the ability to cool them down now, right where we find them,” he said. “The quicker we can fix these patients, we can get their cells functioning normally again… I’m talking minutes. We need them cooled off within minutes.”
He said he’s seen the use of TEMP bags in rural counties, too; people living in trailers without air conditioning units in South Texas plains have nowhere to go to cool off. More patients who need the new measures are people experiencing homelessness, or with substance abuse issues, and elderly people, he said.
“[They’re in] their homes, having to make tough decisions regarding what they’re going to spend their limited income on: ‘Are we going to be able to afford that electricity bill for the AC, versus eating this week?’
With higher temperatures we’re seeing each summer, we expect to see more of these patients,” Winckler said.
STRAC will continue working with UT Health San Antonio’s Department of Emergency Medicine, UTSA’s bioengineering department and the University of Arkansas’ Department of Health, Human Performance and Recreation Health to improve research and treatment modalities for heatstroke in South Texas, he added.
They died in the worst way possible
June 27, 2022, wasn’t the first time Everitt had seen such horror.
Everitt was an ER intern at University Hospital in 2017 when he first encountered mass casualty heat deaths.
More than 100 migrants were stuffed in a tractor-trailer at a Walmart on the South Side. Nine people died and 30 were transported to the ER where he was working.
He remembers a critical patient in the resuscitation bay began seizing, and marked down a 104-degree body temperature. That was after EMS tried cooling the patient down with water and Gatorade and by placing ice bags on the groin, neck and axilla, a traditional technique for responding to heat-related illnesses.
It took three hours to get that patient to a safe body temperature, Everitt said.
The patient suffered a cardiac arrest as well as massive organ damage and spent three months in the hospital before going to rehab.
The TEMP bags — which can prevent such outcomes — cost $25 each, much less than the costs of a patient recovering from such injuries, he said.
Additional suspects were recently arrested in the deaths of the 53 migrants who died of heat-related illnesses in 2022. In his office, Everitt put his hands together and looked up as he said, “Thank God,” with a sigh.
“A lot of times no one gets punished or there’s no justice for some of these people, so it’s nice to hear that someone is hopefully going to pay for this atrocity,” he said. “As long as criminals are going to take advantage of people, we’re going to have to be prepared to respond.”
He often thinks about changing the outcome of that day more than two years ago, when so many migrants died in pursuit of a better life in the U.S. — and especially about the five people they transported to the hospital who later died.
If workers in the field had access to TEMP bags then, “we wouldn’t have lost all five,” he said.