2020 Acting Chief Medical Officer, CBP

In 2020, I served as Acting Chief Medical Officer for U.S. Customs and Border Protection. For the first time, I watched the trauma principles we proved on city streets play out across a national mission. It showed me just how far this work can reach—and how many lives it can touch.

When I stepped into the role, CBP was facing intense pressure on every front: large migrant flows, fragile populations, remote terrain, and a spotlight on how we handled health and safety. It was a different battlefield, but the core problem was familiar: people were getting hurt, or arriving already in bad shape, and the system was too slow or too fragmented to respond the way it needed to.

I approached CBP the same way I approached Dallas SWAT. First, understand the ground truth. I spent time listening to frontline agents, medical staff, and leadership. I asked simple questions: Who is getting sick or injured? Where are we failing them? What do you wish you had on hand when things go bad?

The answers were blunt. Long transport times. Limited medical capability in remote areas. Overcrowded facilities. Kids and adults arriving with dehydration, infections, chronic disease, trauma, and mental health crises. The stakes were high, and the margin for error was small.

So we went back to basics: apply trauma medicine principles to a national border mission.

Push care forward

We worked to push medical capability closer to where people were being encountered and held, not just at the big hospitals downstream. That meant supporting forward-deployed medical staff, better triage tools, and clearer protocols for when and how to escalate care. The goal was the same as it had always been in my work: shorten the time between the moment someone is in trouble and the moment someone with the right skills steps in.

Standardize how we look at risk

At CBP’s scale, you can’t rely on instinct alone. You need simple, clear frameworks that anyone can follow under pressure. We leaned on the same mindset that drives tactical medicine and Stop the Bleed: don’t overcomplicate it. Identify the biggest, most preventable causes of harm and build systems around them.

That meant focusing on:

• Rapid recognition of life-threatening conditions
• Early intervention for dehydration, respiratory distress, and sepsis
• Clear criteria for hospital transfer
• Tight coordination with local EMS and hospitals along the border

Train for the worst day, not the average one

In Dallas, we drilled for gunshots and blast injuries. At CBP, the threats looked different, but the principle held: you don’t rise to the occasion; you fall to your level of training.

We emphasized training and guidance that prepared teams for:

• Sudden surges in population at holding facilities
• Infectious disease spread in crowded environments
• Pediatric emergencies involving very young children
• Medical crises in remote, austere locations far from higher-level care

The goal was not to turn every agent into a medic. It was to make sure the right people, with the right training and equipment, were in the right place before the crisis hit.

Build bridges, not silos

Trauma work has taught me that no single agency saves a life alone. In Dallas, that meant law enforcement, EMS, and hospitals working as a team. At CBP, it meant aligning with public health partners, local health systems, NGOs, and other federal agencies.

My job was to help connect those dots, so that when CBP encountered someone in crisis, we weren’t improvising the handoff. We were executing a plan.

Keep the mission clear: protect life

Border security is a charged topic. The politics around it are loud. In the middle of that, it’s easy to lose sight of a simple truth: every person in CBP custody, every agent on the line, every child in a holding facility is a human being whose life has value.

In trauma, clarity comes from stripping away noise and asking one question: what do we need to do right now so this person doesn’t die or suffer needlessly? I carried that same question into every conversation at CBP.

Leadership decisions, resource fights, and policy debates all came back to that core idea: protect life. Agents’ lives. Detainees’ lives. Families’ lives. Everyone.

What 2020 taught me

Serving as Acting Chief Medical Officer for CBP in 2020 reinforced a lesson I first learned in trauma bays and on SWAT calls: if you build simple, disciplined systems around the hardest moments, you can change outcomes at scale.

The work at CBP was not about headlines or politics. It was about:

• Bringing order to chaos in high-risk environments
• Applying proven trauma principles to new, complex settings
• Refusing to accept preventable harm just because the system is big or the problem is hard

Standing on the border, looking at the scope of the mission, I saw the same truth I saw years earlier in Dallas: when you push care forward, train with purpose, and stay focused on protecting life, the impact reaches far beyond the walls of any single hospital or any single city.

That year confirmed something for me: the principles of tactical and trauma medicine don’t just belong on a battlefield or a city street. They belong anywhere people face high risk, limited resources, and no room for error. And if we’re willing to meet reality where it is, we can build systems that honor every life that passes through them.

Dr. Alexander Eastman and the Medicine That Starts Before the Hospital

Many assume emergency care begins when an ambulance arrives at the hospital, as hospitals are often seen as the center of medicine. Dr. Alexander Eastman challenges this view through his practical and optimistic approach. As a trauma specialist who collaborates closely with first responders, he emphasizes that the first few minutes are critical and that care can begin well before a patient reaches the operating room.

This is not a dramatic philosophy. It is a realistic one.

In serious injuries, time is critical. Bleeding can become fatal quickly, and breathing issues may escalate within moments. Confusion and panic can further delay response. Dr. Eastman focuses on early interventions that improve outcomes, whether on the street, at home, or at a crash scene, as well as in the trauma bay. He bridges these environments, recognizing that real emergencies are rarely straightforward.

A doctor who thinks like a first responder

Dr. Eastman’s background includes deep exposure to emergency response work, and that matters. People who have worked in the field tend to speak differently. They value steps that work under stress. They value simple plans that people can follow with shaky hands. They respect limited time, noise, poor lighting, and chaotic scenes.

This experience shapes his approach to trauma care.

Some medical advice may appear ideal in theory but is impractical in real situations. Dr. Eastman prioritizes actions that both first responders and bystanders can perform, focusing on interventions that buy time until advanced care is available. He views these early steps as integral to the chain of survival.

The contrarian point that feels true

Here is a positive contrarian idea that fits his work.

The medical world often celebrates the final rescue. The surgery. The ICU miracle. The heroic save.

Dr. Eastman’s approach emphasizes that the most effective interventions often occur before the headline moment. The best outcomes result from quickly stopping severe bleeding, clear team communication, and prompt action.

This perspective does not diminish the role of trauma surgeons; rather, it provides them with a stronger foundation. Early intervention increases the likelihood of successful hospital care.

The critical importance of bleeding control

Many people underestimate the danger of bleeding, assuming it remains manageable until professionals arrive. In reality, severe bleeding can be fatal within minutes. Dr. Eastman therefore emphasizes bleeding control as an essential skill for both first responders and bystanders.

The concept is straightforward.

Slowing or stopping bleeding buys critical time, increasing the chance of survival until advanced care is available. The necessary tools and steps should be simple, rapid, and effective.

This focus also builds community confidence. Training empowers individuals, replacing helplessness with the ability to act effectively during emergencies.

Collaboration with law enforcement and high-risk teams

Dr. Eastman has collaborated with law enforcement and specialized response teams, operating at the intersection of medicine and public safety. This work involves preparing for injuries in unstable, high-risk environments and training those who must respond before traditional medical support is available.

This role demands trust and clear communication.

First responders seek guidance that acknowledges their real-world challenges, with steps tailored to their equipment, responsibilities, and time constraints. They value training that enhances their capabilities while respecting their roles.

Dr. Eastman’s work is guided by a consistent principle: preparedness must be practical, repeatable, and easy to recall under stress.

Instruction that addresses real-world constraints

Some instruction addresses only ideal conditions, while effective teaching prepares individuals for less-than-ideal situations.

Dr. Eastman’s educational efforts highlight this distinction. He favors straightforward steps and routines that teams can practice until they become automatic. He encourages training that simulates real pressure, reflecting the realities of emergency situations.

This approach fosters confidence without arrogance. Individuals do not need to feel like heroes; they need to feel capable, and capability is built through repetition.

Connecting street-level response and hospital care

A key aspect of Dr. Eastman’s perspective is his ability to connect the initial response with the final stages of trauma care.

First responders witness the initial confusion, danger, and urgency, while hospital trauma teams observe the outcomes of those critical first minutes, recognizing which early actions were beneficial and which delays were harmful.

Collaboration and shared learning between these groups lead to improved patient care.

An effective system relies on shared language, seamless transitions, and clear understanding of each step in the care process. Dr. Eastman supports this systems-based approach, viewing the entire timeline from injury to recovery as a continuous process.

A human-centered approach to preparedness

Preparedness is often perceived as cold or fear-based, but Dr. Eastman’s approach centers on empowerment. He focuses on equipping individuals with essential skills that can make a significant difference during emergencies.

This perspective is hopeful, not grim.

Preparedness also strengthens community. When individuals know how to respond, they feel more connected, less isolated, and develop greater trust. A trained bystander can be pivotal in an emergency.

Key takeaways from Dr. Eastman’s work

Dr. Eastman’s lessons are accessible to everyone, not just medical professionals.

Outcomes improve with early intervention. Teams perform best when they practice simple steps until they become second nature. Communities are safer when individuals are prepared to act rather than wait for others.

This message is not flashy, but it is practical and valuable.

Dr. Alexander Eastman’s career exemplifies practical leadership. He views trauma care as a continuum where early moments are crucial and considers training a vital form of care, as it empowers individuals to act when needed.

While emergency medicine includes dramatic moments, it is the consistent, quiet work of preparation that saves the most lives. This perspective is both practical and worth adopting.

Staying Calm When Seconds Count

Much of my career has been spent in fast paced environments. In emergency medicine, decisions come quickly in noisy, chaotic rooms. My heart races like anyone else’s. The hard part isn’t just knowing what to do; it’s staying steady enough to do it well when everything feels urgent.

Stress isn’t abstract it shows up in your body. Your heart speeds up, your breathing gets shallow, your muscles tense, and your senses narrow. I’ve felt all of this myself, and you probably have too before a hard conversation, a deadline, or a conflict. These reactions are normal. They help in short bursts of danger, but they can get in the way when you need to think clearly or talk calmly at work, at home, or during everyday arguments.

When your heart is pounding and your vision narrows, it’s harder to do simple things and easier to miss details. Time can feel strange too slow or too fast. I’ve watched capable people, including myself, struggle in these moments. This isn’t a sign of weakness or lack of preparation. It’s a normal nervous system response that needs managing, not judging.

Over time, I’ve learned that calm doesn’t mean feeling no stress. It means being able to function inside it: your heart can race and your thoughts can speed up, and you can still choose your next steady step.

One of the most practical tools I use is controlled breathing. Slow, steady breaths help lower my heart rate and bring my body back into balance. I don’t try to eliminate adrenaline; I try to guide it. I use this same approach before tough conversations, big presentations, or important decisions. Taking 3–5 slow breaths in through the nose, out through the mouth often clears my mind faster than anything else.

Another useful technique is mental framing. I focus on the single task right in front of me—not the whole situation, not all the possible outcomes. Just the next step. This keeps me grounded and stops my mind from spiraling. Breaking big problems into small actions makes them workable. In everyday life, that might mean: pay the next bill, send the next email, make one honest phone call instead of trying to solve your whole life at once.

Preparation also helps more than most people realize. Repetition builds familiarity, so under stress your skills require less effort and leave you more room to think. Training doesn’t remove fear; it gives you a plan to follow when fear shows up. Whether you’re rehearsing a medical procedure, practicing a presentation, or planning what you’ll say in a hard meeting, preparation makes stressful situations feel more manageable.

Situational awareness is another key habit. I make a point of scanning what’s happening around me, even when things are hectic. A simple mental check helps: what’s changing, what’s stable, and what needs my attention right now? This reduces tunnel vision and helps me see the whole picture. Outside of emergencies, this can look like noticing the tone of a room, watching how a conversation is going, or spotting your own early signs of stress before they build into burnout.

Recovery is easy to ignore, but it matters. Working through stress drains you, even if you handle it well. Sleep, hydration, food, and basic movement all affect how you cope with the next wave of stress. I’ve learned sometimes the hard way that skipping these basics eventually wears down your patience, your mood, and your ability to think clearly, both at work and at home.

My work has shown me that calm is a skill, not a personality trait. Anyone can improve it. You start by noticing how your body reacts to stress and learning to work with it instead of fighting it. This is just as true for a parent running late on a school morning as it is for a clinician responding to an alarm.

When every second counts, the goal isn’t perfection it’s functioning. Clear thinking, steady hands, and a few simple decisions done well are what calm looks like in real life. Most people will never work in an emergency room, but everyone will face urgent, overwhelming moments. In those times, the same principles help: notice what your body is doing, use your breath to steady yourself, narrow your focus to the next step, and aim to be effective, not perfect.

Why Dallas Changed How Tactical Trauma Care Works

 For years, trauma systems were built on a single assumption: medical care begins after danger has passed. In real life, that delay often costs lives.

The Dallas Police Department Tactical Medic Program was designed to challenge that assumption.

Created during Dr. Alexander Eastman’s work at Parkland Memorial Hospital and UT Southwestern Medical Center, the program integrates advanced medical providers directly into law enforcement operations. These clinicians are trained to function inside unstable environments and provide care during active threats, not after them.

This approach replaces distance with proximity. Instead of waiting for scenes to be secured, bleeding is controlled immediately. Critical decisions are made on-site. Time, not tradition, becomes the priority.

The program has been tested in high-risk operations and mass casualty incidents, demonstrating how early intervention can change outcomes when seconds matter most. Its structure helped influence modern thinking around tactical emergency casualty care and public safety medical planning.

The program’s significance is not in its novelty, but in its realism. Injuries happen before safety is guaranteed. Effective systems are built for that reality, not against it.

Alex Eastman Reflects on His Experience with the NAEMT Spring 2018 Project

 I will never forget when I found out I would be highlighted in the Spring 2018 edition of the NAEMT Newsletter. This was a significant moment in my career, and I was fulfilling multiple roles as a provider of care in prehospital medicine, trauma care, and public safety. I have been a firefighter, EMT, Paramedic, Trauma Surgeon, and Police Lieutenant throughout my career. All of these roles have impacted how I provide patient care and the responsibilities that come with providing care in emergency medicine. I appreciated the opportunity to take some time and reflect on the journey and the experiences that have helped shape me into the provider that I am today.

Reflecting on the experience of preparing for the feature allowed me to think back to my early days in the field. I remember the first time I rode in an ambulance and the lessons that were learned with each call. These early experiences taught me the value of staying calm, thinking clearly, and the importance of teamwork. These lessons also taught me that the best care begins before a patient arrives at the hospital. These principles have continued to follow me through medical school, surgical residency, and every other role that has followed. I was able to share this perspective with a larger audience by participating in this project.

As a result of the interview, there was a specific focus on the need for high-quality education in prehospital trauma care. Education programs available to first responders help build a solid foundation of knowledge before they arrive at the bedside. My involvement in national trauma education stemmed from my desire to enhance educational opportunities and create materials that reflect the true nature of field medicine. By contributing to this effort, I felt as though I could give back to the profession that has shaped my life in a meaningful way.

To read the full article, visit my blog.

Dr. Alexander Eastman: Pioneering Crisis Leadership in Emergency Medicine

Dr. Alexander Eastman has emerged as a national leader in crisis readiness. 

Known professionally as Alexander Eastman MD and widely recognized as Dr. Alex Eastman trauma surgeon Dallas, he has dedicated his career to strengthening how communities respond to violent incidents and large scale emergencies. 

Working in the trauma center at Parkland Hospital in Dallas and supporting national response plans in Washington, he has built a reputation for transforming life threatening chaos into coordination and survival.

His work as an Alexander Eastman trauma surgeon goes well beyond hospital walls. As Senior Medical Officer for Operations at the United States Department of Homeland Security, Dr. Alexander Eastman crisis leadership helps guide public safety policy and informs how responders save lives during mass violence and disaster. His experience in Alexander Eastman emergency medicine brings clinical realism into national strategy.

Insights from a Groundbreaking Mass Shooting Publication

One of the most impactful examples of his leadership is his co authorship of the peer reviewed article titled Prehospital Considerations for Mass Shooting Incidents. The publication emphasizes the importance of early, informed action during mass casualty events. It outlines practical steps that first responders and communities can take to shorten the time between injury and lifesaving care.

Key insights from the article include:

• Stopping severe bleeding as soon as possible.

• Organizing efficient triage when many victims are involved.

• Ensuring EMS and law enforcement operate as a unified team.

• Prioritizing rapid movement away from threat zones to definitive care.

These recommendations reflect Alexander Eastman mass shooting prehospital expertise. The article encourages planning before crisis strikes, so that responders know exactly how to act when lives depend on seconds.

From Theory to Real World Application

These lessons are grounded in years of hands on experience. As an Alexander Eastman Parkland Hospital trauma surgeon, Dr. Eastman has seen firsthand how rapid hemorrhage control and coordinated response can turn potential fatalities into survivors. His guidance for mass casualty response focuses on empowering communities, medics, and police to act quickly and confidently before patients reach the operating room.

Why This Article Matters

The full publication offers a deeper look at how response systems must evolve as threats continue to change. It provides step by step guidance for improving preparedness on the ground. Readers can review the article directly through the Journal of the American College of Surgeons to understand how Dr. Alex Eastman surgeon and fellow authors are shaping lifesaving tactics.

The message is clear. Preparation saves lives long before a patient arrives at a hospital. Sharing and applying the principles from the article can improve survival in mass casualty incidents anywhere in the country.

A Continuing Mission of Leadership

Today, Dr. Alexander Eastman continues to train emergency responders; serve as an advisor to federal agencies; and mentor physicians to be the next generation of leaders in trauma care. His work shows us that being ready is not just a response to emergencies but a commitment. Dr. Eastman’s expertise can provide direction during uncertain times and create a pathway for improved public safety and enhanced trauma survival as communities seek clarity. Readers are encouraged to read the entire article to gain practical insights into how Dr. Alexander Eastman and his co-authors can help create a better prepared emergency system throughout all cities, schools and public venues in America.

Nation’s Premier Tactical Physician

By 2014 Dr. Alexander Eastman had been named by a law enforcement publication as "The Nation's Premier Tactical Physician" to recognize his contributions as a trauma medicine, pre-hospital care, & tactical emergency response provider.

Dr. Eastman was an active-duty trauma and acute-care surgeon; however, in addition to providing clinical care within hospitals, Dr. Eastman remained actively involved in supporting emergency medical services (EMS), as well as providing tactical medical support for police and SWAT units. Thus, Dr. Eastman brought together his clinical knowledge base with the real-world experience of being on-scene with first responders who are operating in high-risk environments.

Since early in his career as an EMT/paramedic and having participated in pre-hospital trauma care, Dr. Eastman has developed a vast amount of experience, which would allow him to coordinate the efforts of medical teams, EMS providers, law enforcement agencies, etc., during critical incidents.

The 2014 Recognition of Dr. Alexander Eastman as the "Nation's Premier Tactical Physician" recognizes his continued dedication to bridging clinical trauma care with EMS readiness and public safety operations; it formally acknowledges the unique role Dr. Eastman continues to play in the development of medical preparedness in both hospital and tactical environments.