Texas, excluding the Fort Hood area
Lt. Col. Jeffrey Lewis, U.S. Air Force
DVBIC Site Director
San Antonio Military Medical Center (SAMMC) and Wilford Hall Ambulatory Surgical Center (WHASC)
DVBIC San Antonio is a proud component of SAMMC, one of the nation’s premier medical facilities, offering highly sophisticated medical care for service members, family members, civilians and veterans. SAMMC is a 425-bed, state-of-the-art medical facility, playing a critical role in patient care, as well as taking care of wounded warriors in transition from the Global War on Terrorism. The medical center is also the Defense Department’s (DoD) only stateside Level I Trauma Center and receives more than 5,700 emergency room visits each month.
When DVBIC was created by a Congressional act in 1991, the DoD designated a lead site for each service; Walter Reed Army Medical Center for Army, San Antonio’s WHASC (then known as Wilford Hall Medical Center) for Air Force, and Naval Medical Center San Diego for Navy. San Antonio DVBIC started with one part-time military neurologist site director and three full-time contract personnel at Wilford Hall. With the onset of the OEF and OIF campaigns, the cadre of dedicated DVBIC personnel grew to its current two part-time military officer directors and 17 contract personnel.
The team’s mission expanded into SAMMC and was cemented when the influx of wounded service members increased there notably in the summer of 2007. About the same time, leadership at SAMMC formed the TBI Services Clinic within the Department of Orthopedics and Rehabilitation; a premier team that would focus on the varied yet unique aspects of TBI patient care. DVBIC and the TBI clinic staff (now known as the Brain Injury Rehabilitation Services; BIRS) work together to ensure that all TBI injured service members are identified and receive treatment.
In 2011, WHASC’s U.S. Air Force neurology staff, residency program and the rest of the DVBIC team moved into facilities at the present SAMMC site on Fort Sam Houston.
Members of DVBIC review post-deployment questionnaires, airevac manifests (lists), and screen service members at Troop Clinics to ensure each returning, injured service member are screened for TBI. Neurological and neuropsychological evaluations and cognitive rehabilitation are completed by DVBIC staff and BIRS providers at SAMMC. Referrals are also made to other appropriate specialty services.
DVBIC SAMMC also provides TBI education services to service members, veterans, their families, health care professionals and supporters throughout Texas. The Regional Education Coordinator, Toni McCall, supports TBI educational initiatives by facilitating military medical training programs, conducting TBI awareness and prevention presentations, and disseminating TBI awareness education. She collaborates with local military institutions, such as Army Medical Department Center and School and Defense Medical Readiness Training Institute. She provides TBI clinical tools and arranges for subject matter experts to teach pre-deploying providers the essentials of TBI diagnosis and treatment, including the latest DoD instructions and clinical care standards for TBI management in deployed and non-deployed settings. The events supported are Joint Forces Combat Trauma Management Course, Combat Casualty Care Course, Expeditionary Medical Emergency Support provider course, Brigade Surgeon Course and Combat Operational Stress Control Training Course. McCall also presents monthly concussion awareness presentations to service members and SAMMC hospital staff in support of the Army’s mandated Warrior Concussion/Mild TBI Awareness Campaign.
Education outreach is conducted by hosting information booths at military medical conferences, Yellow Ribbon Reintegration events and community events, such as school resource fairs. These outreach efforts foster strong partnerships across military bases, veteran hospital systems and brain injury organizations across Texas.
The SAMMC DVBIC site is actively involved in several TBI research studies including surveillance of TBI in active-duty service members, treatment trials to address cognitive complaints following TBI, state of the art neuroimaging studies to examine possible biomarkers of TBI, and social, emotional and cognitive outcomes following TBI.
A descriptive TBI tracking study was conducted at SAMMC DVBIC from 2005-2012. Service members participated by agreeing to allow their medical and injury information to be placed within a de-identified research database. Over 1,500 cases in this database were combined with similar databases from the Walter Reed and San Diego DVBIC sites to conduct large multivariate analyses. Research questions recently explored with this large combined military database included predictors of outcome, blast versus non-blast concussions, effects of psychiatric conditions and long-term effects of multiple concussions and multiple deployments. A new tracking repository that will form the basis for additional analyses and allow recruitment and referral to additional site projects is currently being conducted.
SAMMC DVBIC recently completed data collection of the congressionally mandated TBI treatment trial entitled the Study of Cognitive Rehabilitation Effectiveness (SCORE!). SCORE! is a prospective, randomized treatment study for OEF/OIF service members with a history of mild TBI and persistent cognitive complaints 3-24 months post-injury. Participants were recruited from consecutive patient referrals to the TBI service at SAMMC and randomly assigned to one of four treatment arms. This study is a first-of-its-kind clinical trial of cognitive rehabilitation in U.S. service members, and rigorously designed to address many of the common methodological problems in prior similar research. Additionally, a complementary functional neuroimaging study is examining neuropathological predictors of treatment response in the SCORE! trial, using state-of-the-art MRI technologies.
SAMMC DVBIC will participate in the new DoD and VA funded Chronic Effects of Neurotrauma Consortium. This multicenter collaboration brings together several VA and DoD sites across the United States and combines the skill of national and international experts in TBI to identify and characterize the anatomic, molecular, physiological and functional mechanisms of chronic brain injury.