FALLS CHURCH, Virginia –
The Department of Defense is committed to focusing on warfighter brain health. Some DOD actions include monitoring service members, instituting injury prevention safety measures, and continuing to provide innovative brain injury treatments.
"A top priority for the DOD is taking care of our people," said Dr. Lester Martinez-Lopez, assistant secretary of defense for health affairs. "This priority includes promoting brain health and countering traumatic brain injury in all its forms.
"As the military community's understanding of brain health has evolved over the years, the department's senior leaders recognized the need to develop a departmentwide comprehensive strategy and plan to address these issues," Martinez-Lopez said. "The Warfighter Brain Health Initiative is a coordinated effort between operational and medical communities and its critical focus is optimizing the brain health of the warfighter and actively leading the way forward."
The DOD is in its first year of implementing the Warfighter Brain Health Initiative, according to Kathy Lee, director, warfighter brain health policy.
"In 2022, we finalized all the strategy and actions to include capturing joint requirements so that we had one master roadmap for the department. Now in 2023, we have moved out with safety information and will continue to share more as we further our understanding of brain threats, injuries, and effects on brain health."
Brain injury is a care and research area DOD has been leading since the start of the Afghanistan and Iraq conflicts. DOD recognized a need to expand its efforts beyond brain injury to better understand and address brain threats, which includes blast overpressure.
According to the DOD, blast overpressure is the sudden onset of a pressure wave from explosions occurring with the use of shoulder-carried artillery and heavy armor in both training and deployment, in breaching buildings and from improvised explosive devices.
"Research has furthered our understanding that blast exposure derives from both enemy action in combat and from training on our own weapons and tactics. Experiences by service members in recent conflicts and training environments illuminated concerns related to repetitive subconcussive blast exposures and effects on brain health," said Lee.
"We needed to address threats in holistic and comprehensive ways and started looking at cognition as the main indicator of brain health."
The Warfighter Brain Health Initiative includes significant efforts to address blast overpressure.
"We have been focusing on identifying threats in our environment and better understanding impacts on brain health so that we can protect troops through their entire careers," said Lee.
Blast Overpressure Study
The DOD launched 26 health and performance studies as part of Section 734, also called the Blast Overpressure Studies.
"Section 734 had three elements that we needed to address," said Lee. "These three areas include: identifying and monitoring blast overpressure, making sure each service member has documentation of these events, and providing safety measures to help avoid unnecessary exposure to blast."
The studies included monitoring, documenting, providing safety protocols, and establishing mitigation actions. The team also investigated weapons that may cause blast overpressure.
"One of the things we did early on was to codify a list of 15 tier-one weapons that the military departments told us were used most often and by those with higher risk occupational specialties," said Lee.
"We categorized 15 weapon systems and found out everything we could about them in terms of blast overpressure and brain effects. We also looked at how the duration and frequency of use affects an individual warfighter. We were able to see what the symptoms reports were, and what type of cognitive or thinking changes occurred. This type of work had been done before but at looking at lung and hearing issues not on brain health effects."
Lee said DOD spent four years working the most recent study.
"We continue to communicate results back to the military departments," said Lee. "After it wrapped in September 2023, we began writing a report to Congress to answer the basic questions based on the elements that were outlined in Section 734."
While that report will be submitted to Congress soon, Lee said the department is next conducting a business case analysis in 2024 with a multi-prong approach to assess a standardized program to monitor blast overpressure.
"To date, various tools and information guidance is available that can help address what to do when you are exposed to blast overpressure. And we are raising awareness on activities that put people at risk," said Lee.
"DOD is investigating how can we better understand the long term and late effects of repetitive exposures to the brain with the goal of protecting our troops."
Resources for Providers and Patients
For the latest on what MHS is doing to optimize the brain health of our service members, visit the Warfighter Brain Health Hub, which contains links to brain injury and brain health resources, comprehensive Q&A, the DHA's Traumatic Brain Injury Center of Excellence, and reference list of more than 40 news articles, videos, and other updates.
The Defense Health Agency's Traumatic Brain Injury Center of Excellence has developed two products: a low-level blast exposure fact sheet for patients and a separate fact sheet for providers. TBICoE also offers a variety of resources to raise awareness of TBI prevention, diagnosis and treatment for patients and families, as well as key TBI resources for providers.