Innovations in Blast Injury Treatment Spotlighted at BIRCO Conference

Story by Paul Lagasse

Medical Research and Development Command

FORT DETRICK, Md. – Debilitating injuries to the nervous system caused by high-pressure shock waves emitted by explosions and heavy weapons fire are among the most complex and challenging wounds that medical practitioners face. Recent advances in trauma prevention and point-of-injury care have significantly increased the survival rates of injured Service Members. At the same time, this progress has also spurred a growing demand for skilled practitioners trained in the latest prevention, treatment and rehabilitation strategies to help Service Members return to duty or to transition successfully to civilian life.

The latest developments in the prevention and treatment of neurosensory injuries resulting from shock waves, formally called blast overpressure, were the focus of a panel discussion at the 8th International Forum on Blast Injury Countermeasures, which took place May 1-3 at the MITRE Corporation in McLean, Virginia. The annual forum, which was co-sponsored by the U.S. Army Medical Research and Development Command’s DOD Blast Injury Research Coordinating Office, brought together experts from around the world to share the latest information and evidence-based approaches for preventing and treating blast injuries.

Dr. Mei Sun, neurosensory portfolio manager at MRDC’s Military Operational Medicine Research Program, provided an overview of his organization’s research focused on identifying the extent and types of injury caused by blast overpressure, as well as by other external forces such as blunt and penetrating trauma, and how it uses those results to identify better ways to prevent and mitigate such injuries. MOMRP’s research also focuses on developing strategies and interventions that build psychological resilience and emotional fitness, which are crucial for recovery from physical injury such as blast overpressure-induced trauma.

Dr. Sun explained that the top three science and technology priorities for MOMRP’s neurosensory research are injury repair and restoration of health, protecting and maintaining neurological functions and improving our understanding of how the body’s neurosensory system works. She said MOMRP’s research focus is intended to complement the work being done by researchers elsewhere by identifying promising new avenues of research in preserving vision and hearing, developing treatments and portable devices and reducing exposure risks in the field.

“The intention is not to compete with industry,” said Sun. “We want to encourage high-reward, high-risk research.”

Sun noted that the neurosensory portfolio is in the process of broadening its scope of research focus areas to encompass more priorities, which should be complete by next year’s IFBIC conference, which will take place in Japan.

“Next year in Tokyo, I think I will have good progress to report back to everyone,” she said.

A team of 14 researchers from MRDC’s Walter Reed Army Institute of Research led by Dr. Alexander Bobrov, chief of trauma infection research chief in WRAIR’s Bacterial Diseases Branch, discussed recent improvements in the use of animal models to develop therapeutic medicines to treat wound infections associated with blast overpressure-induced trauma. He noted that approximately three-quarters of all combat injuries are the result of explosive blasts, most of which cause a wide range of injuries in addition to those of the brain and nervous system, including fractures. Bobrov explained that open fractures, particularly those involving implants, are particularly susceptible to infections such as sepsis and invasive fungal infections if the injury was incurred by a blast, because the shock waves can impede the body’s natural immune response.

That’s because blasts affect the production of proteins in the immune system called cytokines. Research has shown that blast overpressure actually stimulates the production of cytokines that promote inflammation and suppresses the cytokines that arrest it. This imbalance reduces the body’s ability to withstand infections and can even lead to premature death.

“I don’t need to convince you that in modern warfare, the majority of injuries are due to blasts, reaching 75% during the conflicts in Iraq and Afghanistan while in Ukraine, it’s probably close to 95%,” said Bobrov, who also pointed out the increased use of explosive-firing drones in warfare. “Right now there are something like 10 drones for every soldier, so this is a critical issue.”

Injuries to Warfighters caused by drone-launched missiles, improvised explosive devices, artillery and other high-intensity blasts require large-volume blood transfusions and amputations, which increase the risk of fungal infections.

Bobrov and his team found that certain drugs are effective at reducing wound infections, essentially taking over for the cytokines in the immediate aftermath of a blast-related fracture injury. For example, the antibiotic ertapenem significantly impeded the spread of Staphylococcus aureus wound infections, and the antifungal medication liposomal amphotericin B decreases the risk of fungal infections. This promises to lead to new therapeutic regimens for use in far-forward combat environments.

In addition to the presentations by Sun and the WRAIR team, the panel session featured two presentations by researchers at Japan’s National Defense Medical College discussing the promising results of recent studies into treating blast overpressure-related trauma. One study showed that a respiration-stimulating drug, dimorpholamine, improved survival rates in cases of life-threatening respiratory arrest caused by exposure to blast shock waves. The other showed that prompt intravenous administration of water infused with hydrogen gas helps reduce cerebral edema, or swelling of the brain, caused by traumatic brain injury.

Established in 2006 by an act of Congress, BIRCO coordinates DOD-sponsored biomedical research programs aimed at preventing, mitigating and treating blast-related injuries. Its researchers identify knowledge gaps, share information with colleagues across the military support collaborative research among laboratories in the federal government, industry and academia. MRDC was selected to manage BIRCO’s day-to-day coordination and management activities, and because of its unique position and expertise as the Army’s total life cycle medical research, development, acquisition, procurement and logistical support command.