Resident Eagle: In Memory of Craig Manifold

Resident Eagle is a monthly column profiling the work of top EMS physicians and medical directors from the Metropolitan EMS Medical Directors Global Alliance (the "Eagles"), who represent America’s largest and key international cities. Tentative dates for Gathering of Eagles 2021: June 14–18, Hollywood, Fla. For more See useagles.org.

On Sunday, Sept. 20, 2020, the EMS, military medicine, and medical communities lost a true friend and extraordinary mentor, Craig A. Manifold, DO.

Taken by an unanticipated sudden cardiac event, Manifold is survived by a remarkable legacy and an extended family of outstanding medical practitioners whom he educated and inspired, including nurses, soldiers, doctors, and EMS personnel. At the same time he left behind thousands who relied upon him for his leadership, guidance, and sage counsel and role-modeling. 

He is survived by his wife of 31 years, Denise L. Moore, and the children he passionately loved, Hanna Manifold-Cappadonna, Della Manifold-Stolle, and Caleb Manifold. Both Hanna and Della are practicing RNs.

Nationally renowned for always asking, “Is there anything I can do for you today?” Manifold always answered the phone when called upon, day and night. He was a true giant in the EM community, both literally and figuratively—a man who exuded the gentle spirit of a servant leader who endlessly assisted others with sincere caring, integrity, and soundly grounded knowledge. 

Master of Many Responsibilities

Beginning at age 14, Manifold served as a volunteer EMT and later as a military medic, aeromedical technician, EM physician, EMS physician, EMS medical director, flight surgeon, EM educator, researcher, and product developer. He was also a medicolegal consultant, chief medical officer, disaster leader, tactical medicine leader, editor, and surgeon general for the Texas Air National Guard. He was an exemplary role model for character, integrity, and public service. He constantly juggled multiple responsibilities but managed to master them all.

Manifold began his EMS-related occupations as a volunteer firefighter/EMT in Stewartstown, Pa. After enlisting in the Air Force as a medic at 18, he soon became an aeromedical evacuation technician/flight instructor. Completing his undergraduate degree and ROTC commissioning with a BA in physiology and a minor in chemistry, he graduated four years later from the Philadelphia College of Osteopathic Medicine and went on to complete his EM residency training at San Antonio’s USAF Wilford Hall Ambulatory Surgical Center.

Over the next several years, Manifold was consistently appointed to increasingly significant responsibilities. He served as the USAF associate EM residency director at Wilford Hall and the initial EMS education director. He was soon named chief of professional services, then medical group commander and eventually chief of service for numerous emergency departments. Manifold transitioned his military career to joint surgeon (senior physician) for the Texas Air National Guard, later achieving the rank of brigadier general (BVT). 

During his years of military medical service, Manifold deployed in numerous combat operations, including Afghanistan during Operation Enduring Freedom. He deployed and supported multiple special operations missions and conventional deployments, including Southern Watch, Noble Eagle, and Urgent Fury. 

He was the first EM physician appointed team leader for the USAF mobile field surgical team and an integral member of development groups serving military critical air transport teams. Additionally, he authored the USAF’s first official concept-of-operations manual for the mobile field surgical team. 

Boots on the Ground

When Manifold transitioned to the Texas Air National Guard in 2003, his affinity for EM and its subspecialty of EMS evolved further as he acquired significant boots-on-the-ground expertise in disaster response. For example, he served as the senior Texas Air National Guard physician on numerous deployments, including the post-landfall response for Hurricane Katrina in 2005. Among a number of critical actions, as the chief of flight medicine and deputy commander of deployed medical teams, he led the evacuation of 5,000 civilians from the Ernest N. Morial Convention Center in New Orleans. In like manner, he responded to hurricanes Gustav, Rita, and Ike. 

In the flooding aftermath of Hurricane Harvey, he led the National Guard medical response in its entirety as joint surgeon for the Texas military deployment. This massive response supported the evacuation and recovery of the Texas coast. 

During this era Manifold remained based in the San Antonio area, where he entered academic life as an assistant professor in the Department of Emergency Health Sciences in the School of Health Professions at the University of Texas Health Science Center at San Antonio. In this position he soon assumed a key role not only in educating top-notch medics, EMTs, and first responders but also future EMS physicians. 

He became a noted EM researcher with many peer-reviewed publications and served as the medical director of record or faculty member for several education programs across the nation. He possessed an outstanding breadth of knowledge of EM, prehospital care, military medicine, disaster medicine, tactical medicine, and air-medical support, with a unique presentation style. He became a sought-after speaker for conferences.

Beyond educational talents, his longstanding experience in far-forward conditions and prehospital medicine made him an unusual and talented expert in EMS operations as well. He served as the medical director for several EMS agencies in the San Antonio area, including several years for the city of San Antonio, and worked to bring several of those agencies together to form united EMS goals for the region.

For the past decade he was instrumental in changing the provision of care at the San Antonio Police Department, serving as medical director for the SAPD and its special-operations team. The tactical medicine program he created thrives today. Most recently he was integral to the development of the Bexar County Sheriff’s Office “Calm Approach SM” training, a program that focuses on officers working together safely and humanely to secure suspects. 

Manifold additionally worked with the regional aeromedical rescue program, San Antonio AirLife, and with U.S. Customs and Border Protection in the San Antonio region, and recently became part of a team of EM physicians providing health security and mass-gathering support for major entertainment tours and sports enterprises. 

As a highly experienced tactical medical officer and director, he remained a perennial figure of knowledge within the Special Operations Medical Association community and also served on the South Texas Regional Advisory Council (STRAC) for EMS and Trauma Care along with the Texas Governor’s EMS and Trauma Advisory Committee. 

Impact and Influence

Nationally Manifold served in several different leadership capacities. At the time of his death, he was the national medical director for the National Association of Emergency Medical Technicians (NAEMT). Not only a member of the NAEMT’s board of directors and chair of its Military Relations Committee, he was also editor in chief of the most current edition of the Advanced Medical Life Support (AMLS) textbook. 

Manifold was a board member of the National Registry of EMTs, concomitantly serving as chair of its International and Research committees. At the same time, he had significant impact in evolving leadership roles for the Metropolitan EMS Medical Directors (“Eagles”) Global Alliance—one of the most influential and respected coalitions in the world of EM. Helping to reinvent the Eagles’ acclaimed conferences over the past year, he led several new partnerships for the coalition while maintaining the Eagles’ unique relationship-based and cross-supportive organizational philosophy. 

Moreover, he was instrumental in establishing and hosting twice-weekly educational and data-packed conference calls with high-impact information to keep participants on the cutting edge of COVID-19. 

In recent years Manifold served as chair of the American College of Emergency Physicians’ EMS Committee, testifying before congress on strengthening our nation’s trauma system. Always on the forefront of advocacy, he dealt with the U.S. Drug Enforcement Agency to eliminate evolving regulations that impaired the use of important controlled substances in the out-of-hospital setting. The list could go on. Whenever there was a cause to champion, Manifold could be found on the frontlines.

Most recently he was unanimously nominated for the National Association of EMS Physicians’ Ronald D. Stewart Award for lifetime achievements and contributions to the discipline of emergency medical services. Among those joining in this nomination was Dr. Stewart himself.

Conclusion

The death of Dr. Craig Manifold left an irreparable loss for those of us in the medical community who admired and counted on him. At the same time, we in the EM and EMS fields remain extremely grateful that so many of his achievements will be sustained and that his lasting imprint will remain around the globe for years to come. Simply put, his innumerable contributions to the specialty of EM will live on.   

Paul E. Pepe, MD, MPH, FAEMS, MCCM, is coordinator of the Metropolitan EMS Medical Directors (aka “Eagles”) Global Alliance and medical director for special operations and tactical medicine for the the Broward County (Fla.) Sheriff’s Office.