DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries UNCLASSIFIED 17-20 Nov 2008 1 of 8 DoD Medical Research Program

DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries

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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.

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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


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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


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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


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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)


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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


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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


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Proposed Injury Mechanisms

Head acceleration

Micro-flexure of skull

Vascular surge

Air emboli

Biochemical

Electromagnetic pulse (EMP)


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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


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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


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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]

Documents

DoD Medical Research Program for the Prevention, Mitigation and Treatment of Blast Injuries UNCLASSIFIED 17-20 Nov 2008 1 of 8 DoD Medical Research Program