San Antonio MMC, TX: Local DVBIC Activities
Brooke Army Medical Center (BAMC) and Wilford Hall Medical Center (WHMC)
The Neurology staff and residents at Wilford Hall Medical Center (WHMC) have been involved with the TBI initiative since its inception by Congressional act in 1991 when it was known as the Defense and Veterans Head Injury Program. When the DoD decided in 1992 to ensure that the three services with large medical missions were involved, WHMC was designated as the Air Force lead site. When the mission grew and expanded with the OEF and OIF campaigns, the cadre of dedicated personnel grew from one part-time military officer principal investigator and three full-time contract personnel, to its current two part-time military officers (one Army/one Air Force) and twelve contract personnel.
The current San Antonio Team supports TBI patients and their families from both WHMC and Brooke Army Medical Center (BAMC) across town about 15 miles away. The team’s presence at BAMC was cemented when the influx of service member patients increased notably in the summer of 2007. About the same time, leadership at BAMC created the TBI Treatment Team; a premier team that would focus on the varied yet unique aspects of TBI patient care. DVBIC and the TBI Team work together to ensure that all TBI injured service members are identified and receive treatment.
Members of DVBIC review post-deployment questionnaires, airevac manifests (lists), and screen service members at Troop Clinics to ensure each returning, injured service member is screened for a TBI injury. They also pre-screen inpatients at BAMC. DVBIC providers at WHMC and in the TBI clinic at BAMC conduct evaluations and follow-up treatment. Neurological and neuropsychological evaluations and cognitive rehabilitation are completed by DVBIC staff and TBI clinic providers at BAMC and WHMC. Referrals are also made to other appropriate specialty services.
We are lucky to have two Regional Care Coordinators (RCC). The RCCs are tasked with developing a working knowledge of preexisting systems of care within their local military and VA medical communities. They are responsible for compiling a regional resource bank for patients with TBI and providers to facilitate access to these services. The RCC at BAMC also reviews the airevac manifest and meets service members at the Warrior in Transition Unit’s “morning formation” to interview them and enter their information into the RCC database. He follows their treatment from arrival until they are discharged from BAMC’s care. The other RCC works from WHMC and is responsible for tracking the care of patients in Arkansas, Kansas, Louisiana, Missouri, Oklahoma, and Texas. Thousands, to include providers, service members, and their families located near the twenty nine military installations, twenty two VA facilities, and an untold number of civilian institutions within our six state catchment area benefit from this program.
Another function of our RCCs, in conjunction with our Education Coordinators, is to provide lectures on TBI symptoms, treatment, and resources for providers within the catchment area. The Education Coordinators also provide briefings to military unit supervisors on identifying and managing service members with TBI. Once a week, a briefing is offered in BAMC for family members to help them understand their loved-one’s injury and recovery process. If you are interested in setting up or attending one of these classes, please call (210) 292-7665 or (210) 292-7228.
The final item accomplished at our facilities is research. A protocol we have been conducting since 2005 is “Defense and Veterans Brain Injury Center (DVBIC) Prospective Traumatic Brain Injury Tracking Protocol.” When a service member is identified as being injured with a TBI, he or she is asked if they agree to allow their medical and injury information to be placed within our database of patients for research purposes. All identifying information is removed prior to analysis. There are several other research protocols being conducted, such as “Cognitive Deficits in Military Service Members Exposed to Blast Injuries” and “Measurement of Executive Dysfunction in Concussive BI Patients.” These research initiatives will help medical personnel better diagnose, treat, and educate military leadership about brain injuries to help reduce their effects in the future.
WHMC and BAMC are combining to become San Antonio Military Medical Center (SAMMC) by 2011 due to BRAC initiatives. WHMC’s neurology staff, residency program and most of the DVBIC team will move into facilities at the present BAMC site.