Why are blast injuries an important issue right now?

America's armed forces are sustaining attacks from explosions or blast by rocket-propelled grenades, improvised explosive devices, and land mines almost daily in Iraq and Afghanistan. Civilians and military personnel working in the combat zones are at particular risk of TBI caused by blasts. These attacks often result in TBI or concussion which may occur simultaneously with other more obvious life threatening injuries. Sometimes, in the case of mild TBI, there may be no outward sign of injury. Over 90% of combat-related TBI’s are closed brain injuries. For these reasons, individuals exposed to blasts should be screened for TBI immediately following the event to minimize medical complications. Delays in treatment can reduce the chance for optimal recovery or result in significant cognitive, physical and/or psychological impairment.

How many combat injuries are caused by blasts?

These numbers are based on those who have been treated following medical evacuation from theater to DVBIC sites. Screening at Walter Reed Army Medical Center found that 32% of service members evacuated from theater had TBI. Post deployment screening programs of non-injured service members are now underway throughout the military. By doing so, they are identifying TBI which may have previously gone unidentified.

How does a blast cause injury?

Blast injuries are injuries that result from the complex pressure wave generated by an explosion. The explosion causes an instantaneous rise in pressure over atmospheric pressure that creates a blast overpressurization wave. Primary blast injury occurs from an interaction of the overpressurization wave and the body with differences occurring from one organ system to another. Air-filled organs such as the ear, lung, and gastrointestinal tract and organs surrounded by fluid-filled cavities such as the brain and spinal are especially susceptible to primary blast injury (Elsayed, 1997;Mayorga, 1997). The overpressurization wave dissipates quickly, causing the greatest risk of injury to those closest to the explosion.

In a blast, brain injuries can also occur by other means such as impact from blast-energized debris, the individual being physically thrown, burns and/or inhalation of gases and vapors. Blast injuries can be multiple and complex and can often not be assessed in the same manner that other brain injuries might be examined. A better approach to take in evaluating a brain injury caused by a blast may, therefore, be to conduct the evaluation based on the mechanism (cause) of the injury.

What symptoms may indicate a closed brain injury?

Difficulties experienced as a result of a closed brain blast injury may include post concussion complaints such as decreased memory and attention/concentration, headaches, slower thinking, irritability, depression, and/or sleep disturbances.

What is DVBIC doing to care for those with blast injuries?

The Defense and Veterans Brain Injury Center (DVBIC) works to identify all service members who have sustained a closed brain injury during combat operations and to ensure that they receive the best care available. For example, at Walter Reed Army Medical Center, the DVBIC team reviews all incoming casualty reports and screens all patients injured in blasts, motor vehicle crashes, falls, and gunshot wounds to the head. Brain injury specialists evaluate patients who are identified with a brain injury. Recommendations are then made for treatment and duty status. TBI educational materials are given to patients and families.

Blast Injury References

(A partial list follows. This is not a comprehensive list.)

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