A little over a year ago, in June 2022, the Department of Defense launched the Warfighter Brain Health Initiative to bring together the operational and medical communities in a more unified approach toward optimizing service member brain health and countering traumatic brain injuries. The WBHI specifically focuses on assessing cognitive capabilities, monitoring brain threats, to include blast overpressure, and minimizing the effects and risk from exposures and TBIs to improve a warfighter’s overall performance.
One of the goals of the initiative was to track a service member’s brain health from initial entry into the military all the way to retirement.
“We want you in for the long haul, and we want you to have a highly functional and productive life when you leave the military,” said Kathy Lee, lead for the WBHI and director of Casualty Management for the Office of the Assistant Secretary of Defense for Health Affairs.
One of the early areas of focus for the initiative was to conduct a longitudinal medical study to improve the DOD’s understanding of the impact of blast overpressure, also referred to as BOP. Blast overpressure is caused by the shock wave results firing weapons systems or explosive detonations (e.g., breaching charges). Some of the main symptoms caused by excessive BOP exposure to the brain are headaches, slowed cognitive processing or slowed reaction time.
As part of this process, OSD(HA) asked each service to identify their top 3–5 high overpressure weapon systems generating blast pressure exposure effects for service members. Then OSD(HA) used the service input, which Lee said was critical in creating a list of these “Tier 1” Weapon Systems, to place them into distinct categories:
Shoulder Mounted Weapons
- M3 Multi-Role Anti-Armor Anti-Personnel Weapon System (MAAWS)
- M135 AT4 light anti-tank weapon system
- M72 light anti-armor weapon
.50 Caliber Weapons
- MK15 Sniper Rifle
- M107 Sniper Rifle
- M2A1 Machine Gun
- GAU-21 Machine Gun
Indirect Fire Systems (Howitzers)
- M119 Towed 105mm
- M777 Towed 155mm
- M109 Paladin SP 155mm
Indirect Fire Systems (Mortars)
- M224 60mm
- M252 81mm
- M120/M121 120mm
Demolition (Breaching Charges)
- Door: Net Explosive Weight – 0.23 – 0.30 pounds
- Wall: New Explosive Weight – 10 – 14 pounds
The purpose of identifying these initial Tier 1 systems for review is to improve service member health assessments and outcomes, said Lee.
“We’re offering a mitigation strategy to try to keep service members safe and then the recognition that if they have these symptoms, go get checked out, go and get a medical person to do some eyes on, to do a quick assessment, and check those things that we talked about,” said Lee.
Included in the longitudinal medical study, the Defense Centers for Public Health–Aberdeen, formerly the U.S. Army Public Health Center, is in the process of developing Blast-related Brain Injury Interim Health Protection Criteria and associated risk assessment process. DCPH-A is the Office of Primary Responsibility, or OPR, for FY18 National Defense Authorization Act, Section 734 Line of Inquiry, LOI, 3: Exposure Environment. The LOI 3 has seven objectives, one of which is to conduct Joint Service Member Occupational Health Assessments for each of the Tier 1 Weapons Systems and Breaching Charges. The Health Hazard Assessment Division, along with Industrial Hygiene and Noise subject matter experts, at DCPH-A is supporting this effort by collecting data and measuring exposures from different weapons systems and breaching charges to make recommendations on how to help mitigate risk.
“The DCPH-A team is investigating blast waves in terms of what they call incident peak and incident impulse data,” said Dr. Timothy “AJ” Kluchinsky, chief of the DCPH-A Health Hazard Assessment Division, and OPR Lead for LOI 3. “The incident peak is the highest pressure level, and the incident impulse is the highest pressure level AND the time that it is high.”
One of the main goals of the team, in addition to creating the criteria to assess BOP exposures to the brain, was to review the safety precautions that existed for BOP and determine if they are sufficient or if they needed to be updated, said Olivia Webster, a biomedical engineer with HHA and the lead investigator for LOI 3.
“We’re also reviewing features of the environment to determine what was having the most impact on the exposure to the service member, and then one of the other big things that we did was have data fields developed in the Defense Occupational and Environmental Health Readiness System–Industrial Hygiene, or DOEHRS-IH, to capture BOP and Impulse Noise exposure data.” “DOEHRS-IH provides a mechanism that allows the DOD to manage occupational and environmental health risk data and actively track biological, chemical and physical health hazards to individual service members,” said Webster.
One of the challenges for the team is collecting data from multiple weapons systems in extreme environmental conditions to help determine the effects of temperature, altitude and humidity on BOP exposure. To date, the team has completed occupational health assessments of the above Tier 1 Weapon Systems and Breaching Charges. These data are included as part of Joint Service member Occupational Health Assessments, or JSOHA. The JSOHA Program provides commanders and other risk managers with a comprehensive assessment of service member exposures to potential occupational hazards inherent to using various weapon systems during training and combat.
“We’re striving to get involved in the very early stages of weapon system development to establish these criteria,” said Kluchinsky. “We’re establishing an equation for weapon developers, testers, and assessors to facilitate identification of the effects of a weapon on a warfighter’s brain health. The ultimate goal is coming up with ways to reduce the exposure to a crew or service member, while still allowing the weapon design to meet the other key performance parameters. For example, being able to fire munitions far with so much accuracy and with so many repetitions is the goal while taking into account brain health factors. So, ultimately there’s a minimum threshold and an objective associated with each key performance parameter.”
Webster says one of the HHA team’s goals is to associate their recommendations with the risk levels outlined in the Military Standard 882E, Department of Defense Standard Practice System Safety, which delineates the DOD approach for identifying hazards and assessing and mitigating associated risks encountered in developing, testing, production, using and disposing of defense systems.
Kluchinsky says when it comes to BOP, the HHA team is writing the BOP assessment protocol for the WBHI. As part of the effort, the team uses approximately 60 blast gauges issued to service members who wear 3 at each firing position. Then they collect data and download that data to a laptop for processing.
Lee says one of the goals of the WBHI is to act rapidly.
“We need to get the information collected by this team out to the warfighters,” said Lee. “This increases the credibility that medical folks have with the operational folks to demonstrate that we are taking care of them, and we are sharing what we know as quickly as possible.”
The goal is to provide this information to service members who may be experiencing symptoms.
“We want to get this out to the field with the understanding that if you do have these symptoms afterwards, and you do think your thinking skills have been affected, and you do have ringing in your ears and eye movement changes, difficulty reading, things like that, that you need to go get checked out,” said Lee. “Go get checked out and see, especially if they're not transient, and see what we can do to make that better.”
Here are some government resource and information links on TBI and the WBHI:
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