San Antonio MMC, TX

Contact Information

San Antonio Military Medical Center (SAMMC), Fort Sam Houston, TX

Catchment Area

Arkansas, Kansas, Louisiana, Missouri, Oklaholma and Texas

Leadership

Col. Roberto J. Sartori, U.S. Army
DVBIC Site Director

Col. Roberto J. Sartori obtained his Bachelor of Science degree from the U.S. Military Academy at West Point, N.Y. After serving six years as an intelligence officer, he was granted the Army Health Professionals Scholarship and returned to his hometown of San Juan, Puerto Rico, for medical school. He graduated magna cum laude from the University of Puerto Rico School of Medicine and was assigned to the former Walter Reed Army Medical Center in Washington, D.C., where he completed an Internship and residency in neurology. Duty assignments have included chief of Neurology Section, Martin Army Community Hospital, Fort Benning, Ga.; assistant chief, Neurology Clinic, Brooke Army Medical Center, Fort Sam Houston, Texas. He also served as the first chief of the Traumatic Brain Injury (TBI) Clinic for the 3rd Medical Group Hospital at Elmendorf Air Force Base in Anchorage, Alaska. Sartori is board-certified in neurology and sleep medicine, with additional specialization in medical acupuncture.

Lt. Col. Gerry York, U.S. Army
DVBIC Site Co-Director

Lt. Col. Gerry York is a radiologist who was trained in neuroradiology and has experience in diffusion tensor imaging (DTI) and fMRI research. He is the associate program director for research for San Antonio Uniformed Services Health Education Consortium Radiology and is chief of MRI at Brooke Army Medical Center. He has been instrumental in helping DVBIC establish a research consortium with University of Texas Health Science Center and Baylor Medical College.

Jan E. Kennedy, Ph.D.
Principal Investigator/Senior Scientific Director

Jan E. Kennedy is a neuropsychologist and the senior scientific director for DVBIC at the San Antonio Military Medical Center.

Kennedy was born and raised in northwest Illinois and received her bachelor’s degree in psychology from Western Illinois University. She moved to Texas to complete her master’s degree in experimental psychology from the University of Texas at Arlington. Subsequently, she worked as a research and psychological associate in the mood disorders clinic at the University of Texas Southwestern Medical Center in Dallas, Texas. Kennedy received a Ph.D. in clinical psychology from the University of North Texas while working part time as a human factors evaluator in the Usability Laboratory at IBM. She moved to San Antonio and completed an internship in clinical psychology at the South Texas Veterans Health Care System and a post-doctoral fellowship in neuropsychology at Brooke Army Medical Center. She also completed post-doctoral fellowship work at the Research Imaging Institute, University of Texas Health Science Center at San Antonio, coordinating a PET imaging study in Vietnam Veterans with post-traumatic stress disorder. Kennedy has been employed as a Henry M. Jackson Foundation contractor with DVBIC since October 1997.

Program Overview

San Antonio Military Medical Center (SAMMC) and
Wilford Hall Ambulatory Surgical Center (WHASC)

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 military service branches with large medical missions were involved, WHMC was designated as the Air Force lead site. When the mission 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 and 19 contract personnel. In 2011 WHMC and Brooke Army Medical Center (BAMC) combined to become San Antonio Military Medical Center (SAMMC) because of BRAC initiatives. WHMC’s neurology staff, residency program and the DVBIC team moved into facilities at the present SAMMC (BAMC) site on Fort Sam Houston.

The team’s presence at SAMMC was cemented when there was a notable influx of service members in the summer of 2007. About the same time, leadership at SAMMC created the TBI Services Clinic, a premier team that would focus on the varied, yet unique aspects of TBI patient care. DVBIC and the TBI clinic staff work together to ensure that all service members who have sustained TBIs 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 TBI. Neurological and neuropsychological evaluations and cognitive rehabilitation are completed by DVBIC staff and TBI clinic providers at SAMMC. Referrals are also made to other appropriate specialty services.

We have a regional care coordinator who has an extensive working knowledge of TBI systems of care within military, VA and civilian medical communities. He is responsible for maintaining a regional resource bank for patients with TBI and providers to ease access to these services. The regional care coordinator is responsible for tracking the care of patients in Arkansas, Kansas, Louisiana, Missouri, Oklahoma, and Texas. This program benefits thousands -- including providers, service members, their families, and an untold number of civilian institutions within our six state catchment area.

As a result of neighboring military medical training programs, most of our education focus is directed at pre-deployment provider training. Our site provides TBI clinical tools and subject matter experts to teach essentials of TBI diagnosis and treatment in various pre-deploying provider courses, such as Joint Forces Combat Trauma Management Course, Combat Casualty Care Course, and Expeditionary Medical Emergency Support provider course. The Brigade Surgeon course and Combat Operational Stress Control Training were recently added to the site’s involvement. Our local DVBIC education staff also provides TBI training and clinical tools for deploying provider courses under the AMEDD Center & School, the Defense Medical Readiness Training Institute, and Air Education and Training Command. Since the Army mandated the Warrior Concussion/Mild TBI Awareness Campaign in June 2011, DVBIC education staff has been diligently working alongside the SAMMC Hospital Education department to ensure all SAMMC providers are familiar with concussions. DVBIC education coordinators also provide briefings to military unit supervisors on identifying and managing service members with TBI.

The SAMMC DVBIC site is actively involved in TBI research. We have been conducting the "Defense and Veterans Brain Injury Center (DVBIC) Prospective Traumatic Brain Injury Tracking Protocol” since 2005. Service members with TBI participate in this descriptive study by agreeing to allow their medical and injury information, collected on our Clinical Tracking Form, to be placed within a de-identified research database. We have approximately 1,500 cases in this database, which is being combined with a similar database from Walter Reed, to conduct large-n multivariate analyses. Research questions to be explored include predictors of outcome, blast versus non-blast concussions, effects of psychiatric conditions and long-term effects of multiple concussions and multiple deployments. We are currently developing a new Clinical Tracking Form protocol that will form the basis for recruitment and referral to the Walter Reed 15-year study and provide a platform for additional site projects.

SAMMC DVBIC is also participating in an NIH funded, multi-site, prospective, randomized control trial evaluating acute progesterone treatment for moderate-to-severe TBI (ProTECT-III). This treatment trial is sponsored by Emory University with the clinical coordinating center at the Neurological Emergencies Treatment Trials Network. It is a nationwide study involving 33 centers. (SAMMC is the only DoD site involved.) Patients enrolled in this trial at SAMMC are adult trauma patients with a moderate to severe (GCS 4-12) TBI who are available for administration of the drug within four hours after injury. Participants receive continuous infusion of progesterone (or placebo) for four days with outcomes evaluated after six months.

SAMMC DVBIC is conducting a congressionally mandated TBI treatment trial, the Study of Cognitive Rehabilitation Effectiveness (S.C.O.R.E.!). S.C.O.R.E.! is a prospective, randomized treatment study for OEF/OIF service members with a history of mild TBI and persistent cognitive complaints three to 24 months post-injury. Participants are recruited from consecutive patient referrals to the TBI Service at SAMMC. Those who meet eligibility criteria and consent to participate are randomly assigned to one of four, six-week treatment arms.

A complementary functional neuroimaging study is examining neuropathological predictors of treatment response in the SCORE! trial. Several other local research protocols focus on neuroimaging (fMRI, DTI and PET), cognitive and personality changes following TBI and outcome/recovery.