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DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries
UNCLASSIFIED
UNCLASSIFIED
17-20 Nov 2008 1 of 8
DoD Medical Research Program for the Prevention, Mitigation and
Treatment of Blast Injuries
DoD Medical Research Program for the Prevention, Mitigation and
Treatment of Blast InjuriesBlast-Related Traumatic Brain
Injury Research Gaps
Biomedical Science and Engineering Conference
Oak Ridge National Laboratory18-19 March 2009
Blast-Related Traumatic BrainInjury Research Gaps
Biomedical Science and Engineering Conference
Oak Ridge National Laboratory18-19 March 2009
Michael J. Leggieri, Jr.Director
DoD Blast Injury Research Program Coordinating OfficeU.S. Army Medical Research and Materiel Command
The views expressed in this presentation are those of the author(s) and do not reflect official policy or position of the Department of the Army, Department of
Defense or the U.S. Government.
Michael J. Leggieri, Jr.Director
DoD Blast Injury Research Program Coordinating OfficeU.S. Army Medical Research and Materiel Command
The views expressed in this presentation are those of the author(s) and do not reflect official policy or position of the Department of the Army, Department of
Defense or the U.S. Government.
UNCLASSIFIED
UNCLASSIFIED
DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries
UNCLASSIFIED
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18 March 2009 2 of 11
FY06 NDAA, Section 256, 6 Jan 06—directed SECDEF to establish a coordinated Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries
DoDD 6025.21E—Medical Research for Prevention, Mitigation, and Treatment of Blast Injuries, 5 Jul 06
Designated SECARMY as Executive Agent (EA)
Assigns the Assistant Secretary of Defense for Health Affairs (ASD(HA)) as the approving authority for Military Health System prevention and treatment standards developed and proposed by the DoD EA.
SECARMY delegated authority and assigned responsibility to execute EA responsibilities to ASA(ALT), 4 Jan 2007
ASA(ALT) delegated authority and assigned program responsibility to Cdr, USAMEDCOM, 16 Jan 2007
Cdr, USAMEDCOM approved charter for Blast Program Coordinating Office at USAMRMC on 5 Jun 2007
Program HistoryProgram History
DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries
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Defining “Blast Injuries”
(DoDD 6025.21E)
Defining “Blast Injuries”
(DoDD 6025.21E)
PRIMARY
SECONDARY
TERTIARY
QUATERNARY
QUINARY
• Blast lung • Eardrum rupture and middle ear damage • Abdominal hemorrhage and perforation • Eye rupture• Concussion (TBI without physical signs of head injury)?
• Penetrating ballistic (fragmentation) or blunt injuries • Eye penetration
• Fracture and traumatic amputation • Closed and open brain injury• Blunt injuries• Crush injuries
• Burns• Injury or incapacitation from inhaled toxic fire gases
• Illnesses, injuries, or diseases caused by chemical, biological, or radiological substances (e.g., "dirty bombs")
*Psychological trauma (including PTSD)
Unique Unique to to
BlastBlast
*Added based on latest research suggesting a high risk of developing PTSD following a concussion
DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries
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18 March 2009 4 of 11
Key Blast Injury Research TopicsKey Blast Injury Research Topics
Injury PreventionInjury Prevention
Blast Loading
CFD Simulation
Observed Pathology
FEM Simulation
Test ConditionsBlast Loading
CFD Simulation
Observed Pathology
FEM Simulation
Test Conditions
•Link between primary blast and mTBI?
•Drugs to prevent and treat blast-related hearing loss
•Analysis of combat injuries and PPE performance (JTAPIC)
•Multi-effect blast injury models to improve protective equipment
•Resilience enhancement and prevention of PTSD
Hair CellAntioxidant Defenses
•Tissue engineering and prosthetics
•Return-to-duty Standards•Recovery of function
ResetReset
Before After
•Diagnostics and neuroprotectant drugs for TBI
•Hemorrhage control & blood products•Treatment of psychological trauma•Damage control orthopedics•Pain management
Acute TreatmentAcute Treatment
DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries
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Current DoD InvestmentCurrent DoD Investmentin TBI Researchin TBI Research
Field Epidemiology (TBI and Psychological Health)
Diagnostics (biomarkers and imaging)
Treatment (neuroprotectant drugs, tissue engineering, & other)
Rehabilitation/Reintegration Strategies (return-to-duty standards, telemedicine, & other technologies)
“Physics of Blast” (tissue-level injury mechanisms and computational modeling)
Effects of Repeated Blast Exposures
Treatment of Related Illnesses (e.g., heterotopic ossification)
DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries
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TBI Research GapsTBI Research Gaps
mTBI Biomarkers
Effects of Repeated Occupational BOP Exposures
Epidemiology of mTBI and PTSD
Advanced Neuroimaging to
Detect mTBI
Existence and Mechanism of BOP-Induced TBI
TBI Therapeutics—Clinical Trials
Novel Approaches to Facilitate TBI Rehab
Field-Portable mTBI Diagnostic Devices
TBI Rehab/Augmentation Programs or Devices
DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries
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Non-Impact, Blast-Induced Mild Non-Impact, Blast-Induced Mild Traumatic Brain Injury (mTBI)Traumatic Brain Injury (mTBI)
The Problem
Warfighters are exposed to blast events
Major research gap is whether blast exposure causes a unique non-impact (primary) mTBI (concussion)
Two critical questions:Does non-impact, blast-
induced mTBI exist? If so, what is the mechanism
of injury?
Oleg Nikishin/Getty Images
DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries
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18 March 2009 8 of 11
Non-Impact, Blast-Induced Mild Non-Impact, Blast-Induced Mild Traumatic Brain Injury (mTBI)Traumatic Brain Injury (mTBI)
Proposed Injury Mechanisms
Head acceleration
Micro-flexure of skull
Vascular surge
Air emboli
Biochemical
Electromagnetic pulse (EMP)
DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries
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18 March 2009 9 of 11
Non-Impact, Blast-Induced Mild Non-Impact, Blast-Induced Mild Traumatic Brain Injury (mTBI)Traumatic Brain Injury (mTBI)
Current Research Investment
More than 40 research projects at military and federal laboratories, universities, industry partners
Ongoing research in Sweden & Singapore
Research topics include:Computational modeling of
brain injuryEffects of blast loading on brain
tissuesBlast wave transmission
through brainEffects of repeated blast
exposure
DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries
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18 March 2009 10 of 11
Non-Impact, Blast-Induced Mild Non-Impact, Blast-Induced Mild Traumatic Brain Injury (mTBI)Traumatic Brain Injury (mTBI)
Way Ahead
Organize and host International State of-Science Conference in May 2009, Nat’l Capital Region
International, military, industry, and academic researchers & clinicians
Examine research about relationship between blast exposure and non-impact mTBI
Review mechanisms of non-impact, blast-induced mTBI
Document outcome in peer-reviewed publication
DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries
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18 March 2009 11 of 11
Points of ContactPoints of Contact
Mr. Michael LeggieriMr. Michael LeggieriDirectorDirectorDoD Blast Injury Research Program Coordinating OfficeDoD Blast Injury Research Program Coordinating OfficeU.S. Army Medical Research and Materiel CommandU.S. Army Medical Research and Materiel CommandFort Detrick, MD 21702Fort Detrick, MD 21702301-619-7376301-619-7376michael.leggieri@[email protected]
LTC Kelly HalversonLTC Kelly HalversonArmy Program CoordinatorArmy Program CoordinatorJTAPIC Program ManagerJTAPIC Program ManagerDoD Blast Injury Research Program Coordinating OfficeDoD Blast Injury Research Program Coordinating OfficeU.S. Army Medical Research and Materiel CommandU.S. Army Medical Research and Materiel CommandFort Detrick, MD 21702Fort Detrick, MD 21702301-619-9838301-619-9838kelly.halverson@[email protected]
Col (sel) Marla De JongCol (sel) Marla De JongAir Force Program CoordinatorAir Force Program CoordinatorDoD Blast Injury Research Program Coordinating OfficeDoD Blast Injury Research Program Coordinating OfficeU.S. Army Medical Research and Materiel CommandU.S. Army Medical Research and Materiel CommandFort Detrick, MD 21702Fort Detrick, MD 21702301-619-9830301-619-9830marla.dejong@[email protected]