Blast overpressure is the sudden onset of a pressure wave from explosions. The bigger the explosion, the more damaging the pressure wave. Experiences by Department of Defense personnel in training and operational environments demonstrate possible adverse effects on brain health and cognitive performance resulting from exposure to BOP. During military training and deployment, Service members can be exposed to BOP using:
- Shoulder-fired weapons.
- Heavy armor.
- Breaching buildings.
- Improvised explosive devices.
- Rocket propelled grenades.
Over time, exposure to BOP can lead to adverse brain health effects. Symptoms of BOP include:
- Headaches.
- Dizziness.
- Slowed thinking.
- Concentration or memory problems.
- Tinnitus.
- Sleep disturbances.
Low level blast exposure is not the same as traumatic brain injury. LLBE are generated from firing weapon systems or explosives in training or deployed environments. LLBE can occur from a single training event or exercise as well as from repetitive exposures throughout one’s military career. LLBE during training and combat could affect brain health and produce symptoms that are similar to those seen in mild traumatic brain injury. Regardless of the source of BOP, its effects on brain health have challenged health care providers for more than a century.
History
In World War I, symptoms of BOP were referred to as “shell shock.” Service members who were exposed to heavy artillery on the front lines of Europe reported symptomsgoes the NIH of tremor, poor concentration, dizziness, sensitivity to noise, memory loss, headache, and ringing in the ears. With no visible signs of head injury, their symptoms went undiagnosed and mostly untreated.
By World War II, the term post-concussion neurosis described those same “invisible wounds of war” reported in World War I. The symptoms remained difficult to treat and hard to prevent.
During combat missions in support of the Global War on Terrorism, enemy use of IEDs exposed an injury landscape different from prior U.S. conflicts. During the Iraq conflict, nearly half of the service membersgoes to NIH who were injured experienced high-level blast. High level blast is defined as the blast generated from incoming munitions. TBI became the “signature and invisible wound” of both of those conflicts. The DOD expanded its clinical care capacities and investments in research to better understand the effects from high level blast events.
Warfighter brain health is a top priority of the DOD. Knowledge, prevention, and treatment of BOP is evolving, but well underway.
To manage brain health risks of BOP exposures, we’re taking aggressive measures to minimize the risk of adverse brain health effects. All new Active and Reserve Component accessions will undergo cognitive assessments as part of the entry process by Dec. 31, 2024. In addition, mitigation strategies to prevent or reduce BOP will be implemented. Protocols for identification, tracking, record keeping, and data collection processes of all personnel who are potentially exposed to BOP will be established. Training and education of personnel potentially exposed to BOP hazards is also a critical component of these new measures.
Resources
The Traumatic Brain Injury Center of Excellence has developed a low-level blast exposure fact sheet for patients and a separate fact sheet for providers. TBICoE also offers resources about TBI prevention, diagnosis, and treatment for patients and families.