Skip to main content
SpringerLink
Log in

Evaluating evidence supporting the relevancy of 4 psi as a blast overpressure value associated with brain health and performance outcomes following low-level blast overpressure exposure

  • Review
  • Published:
Shock Waves Aims and scope Submit manuscript

Abstract

Evidence suggests that low-level blast (LLB) overpressure exposure from military heavy weapons training is associated with subclinical adverse brain health and performance (H &P) outcomes. Existing DOD safety policies related to blast overpressure exposure are not specific to LLB-related brain health effects. This study sought to synthesize the available literature and analyze the relevancy of a specific blast metric to LLB exposures and the manifestation of adverse brain H &P outcomes. A literature search yielded 311 unique articles, from which 220 were identified as human studies on LLB published from 2010 to 2021. After more exhaustive exclusion criteria were applied, 14 articles met the criteria for inclusion. Findings on brain H &P changes were examined in relation to quantified LLB measurements (e.g., peak overpressure) to identify trends. Overall, the included studies suggested that alterations of reaction time, a metric for neurocognitive performance, as well as symptom reporting can occur following cumulative LLB exposures above 4 psi (27.6 kPa). Biomarkers and neurosensory changes have not demonstrated consistent associations with LLB exposures. These findings suggest that cumulative blast overpressure exposures above 4 psi (27.6 kPa) based on current measurement methodologies for body-worn sensors may be associated with adverse brain H &P outcomes. Current research efforts seek to better quantify LLB exposure, the relationships between LLB (e.g., intensity, duration, dose) and brain health, as well as to assess brain H &P domains more comprehensively. These efforts will serve to promote a better understanding of the interaction between LLB exposures and adverse brain H &P outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Belding, J.N., Egnoto, M., Englert, R.M., Fitzmaurice, S., Thomsen, C.J.: Getting on the same page: consolidating terminology to facilitate cross-disciplinary health-related blast research. Front. Neurol. 12, 695496 (2021). https://doi.org/10.3389/fneur.2021.695496

    Article  Google Scholar 

  2. Lang, M., Kamimori, G.H., Misistia, A., LaValle, C.R., Ramos, A.N., Ghebremedhin, M.Y., Egnoto, M.J.: Shooter-experienced blast overpressure in 50-caliber rifles. J. Spec. Oper. Med. 18(4), 87–91 (2018). https://doi.org/10.55460/9YOK-PEQH

    Article  Google Scholar 

  3. LaValle, C.R., Carr, W.S., Egnoto, M.J., Misistia, A.C., Salib, J.E., Ramos, A.N., Kamimori, G.H.: Neurocognitive performance deficits related to immediate and acute blast overpressure exposure. Front. Neurol. 10, 949 (2019). https://doi.org/10.3389/fneur.2019.00949

    Article  Google Scholar 

  4. Woodall, J.L.A., Sak, J.A., Cowdrick, K.R., Bove Muñoz, B.M., McElrath, J.H., Trimpe, G.R., Mei, Y., Myhre, R.L., Rains, J.K., Hutchinson, C.R.: Repetitive low-level blast exposure and neurocognitive effects in Army Ranger Mortarmen. Mil Med. 188(3/4), e771–e779 (2021). https://doi.org/10.1093/milmed/usab394

  5. Hearing USA. Pressure limits to provide protection from eardrum rupture. Technical Information Paper No. 51-070-0217 (2017)

  6. Carr, W., Yarnell, A.M., Ong, R., Walilko, T., Kamimori, G.H., da Silva, U., McCarron, R.M., LoPresti, M.L.: Ubiquitin carboxy-terminal hydrolase-L1 as a serum neurotrauma biomarker for exposure to occupational low-level blast. Front Neurol. 6, 49 (2015). https://doi.org/10.3389/fneur.2015.00049

    Article  Google Scholar 

  7. Kamimori, G.H., Reilly, L.A., LaValle, C.R., Olaghere da Silva, U.B.: Occupational overpressure exposure of breachers and military personnel. Shock Waves 27, 837–847 (2017). https://doi.org/10.1007/s00193-017-0738-4

    Article  Google Scholar 

  8. Belding, J.N., Englert, R.M., Fitzmaurice, S., Jackson, J.R., Koenig, H.G., Hunter, M.A., Thomsen, C.J., da Silva, U.O.: Potential health and performance effects of high-level and low-level blast: a scoping review of two decades of research. Front. Neurol. 12, 628–782 (2021). https://doi.org/10.3389/fneur.2021.628782

    Article  Google Scholar 

  9. Belanger, H.G., Bowling, F., Yao, E.F.: Low-level blast exposure in humans: a systematic review of acute and chronic effects. J. Spec. Oper. Med. 20(1), 87–93 (2020). https://doi.org/10.55460/3AC6-AX9I

    Article  Google Scholar 

  10. Interim Report to the Committees on Armed Services of the U.S. Senate and House of Representatives Section 717 of the National Defense Authorization Act for Fiscal Year 2020 (Public Law 116-92). Inclusion of Blast Exposure History in Medical Records of Members of the Armed Forces (2020)

  11. Boutte, A.M., Thangavelu, B., LaValle, C.R., Nemes, J., Gilsdorf, J., Shear, D.A., Kamimori, G.H.: Brain-related proteins as serum biomarkers of acute, subconcussive blast overpressure exposure: a cohort study of military personnel. PLoS ONE 14(8), e0221036 (2019). https://doi.org/10.1371/journal.pone.0221036

    Article  Google Scholar 

  12. Gill, J., Cashion, A., Osier, N., Arcurio, L., Motamedi, V., Dell, K.C., Carr, W., Kim, H.-S., Yun, S., Walker, P., Ahlers, S., LoPresti, M., Yarnell, A.: Moderate blast exposure alters gene expression and levels of amyloid precursor protein. Neurol Genet. 3(5), e186 (2017). https://doi.org/10.1212/NXG.0000000000000186

    Article  Google Scholar 

  13. Thangavelu, B., LaValle, C.R., Egnoto, M.J., Nemes, J., Boutte, A.M., Kamimori, G.H.: Overpressure exposure from 50-caliber rifle training is associated with increased amyloid beta peptides in serum. Front. Neurol. 11, 620 (2020). https://doi.org/10.3389/fneur.2020.00620

    Article  Google Scholar 

  14. Wang, Z., Wilson, C.M., Mendelev, N., Ge, Y., Galfalvy, H., Elder, G., Ahlers, S., Yarnell, A.M., LoPresti, M.L., Kamimori, G., Carr, W., Haghighi, F.: Acute and chronic molecular signatures and associated symptoms of blast exposure in military breachers. J. Neurotrauma 37(10), 1221–1232 (2020). https://doi.org/10.1089/neu.2019.6742

    Article  Google Scholar 

  15. Sajja, V., LaValle, C., Salib, J.E., Misistia, A.C., Ghebremedhin, M.Y., Ramos, A.N., Egnoto, M.J., Long, J.B., Kamimori, G.H.: The role of very low level blast overpressure in symptomatology. Front. Neurol. 10, 891 (2019). https://doi.org/10.3389/fneur.2019.00891

    Article  Google Scholar 

  16. Skotak, M., LaValle, C., Misistia, A., Egnoto, M.J., Chandra, N., Kamimori, G.: Occupational blast wave exposure during multiday 0.50 caliber rifle course. Front. Neurol. 10, 797 (2019). https://doi.org/10.3389/fneur.2019.00797

    Article  Google Scholar 

  17. Rhea, C.K., Kuznetsov, N.A., Ross, S.E., Long, B., Jakiela, J.T., Bailie, J.M., Yanagi, M.A., Haran, J., Wright, W.G., Robins, R.K., Sargent, P.D., Duckworth, J.L.: Development of a portable tool for screening neuromotor sequelae from repetitive low-level blast exposure. Mil. Med. 182(S1), 147–154 (2017). https://doi.org/10.7205/MILMED-D-16-00140

    Article  Google Scholar 

  18. Carr, W., Stone, J.R., Walilko, T., Young, L.A., Snook, T.L., Paggi, M.E., Tsao, J.W., Jankosky, C.J., Parish, R.V., Ahlers, S.T.: Repeated low-level blast exposure: a descriptive human subjects study. Mil. Med. 181(5), 28–39 (2016). https://doi.org/10.7205/MILMED-D-15-00137

    Article  Google Scholar 

  19. Tschiffely, A.E., Statz, J.K., Edwards, K.A., Goforth, C., Ahlers, S.T., Carr, W.S., Gill, J.M.: Assessing a blast-related biomarker in an operational community: glial fibrillary acidic protein in experienced breachers. J. Neurotrauma 37(8), 1091–1096 (2020). https://doi.org/10.1089/neu.2019.6512

    Article  Google Scholar 

  20. Gill, J., Motamedi, V., Osier, N., Dell, K., Arcurio, L., Carr, W., Walker, P., Ahlers, S., LoPresti, M., Yarnell, A.: Moderate blast exposure results in increased IL-6 and TNFalpha in peripheral blood. Brain Behav. Immun. 65, 90–94 (2017). https://doi.org/10.1016/j.bbi.2017.02.015

    Article  Google Scholar 

  21. Wiri, S., Needham, C., Ortley, D., Duckworth, J., Gonzales, A., Walilko, T., Bentley, T.B.: Development of a fast-running algorithm to approximate incident blast parameters using body-mounted sensor measurements. Mil. Med. 187(11–12), e1354–e1362 (2021). https://doi.org/10.1093/milmed/usab411

    Article  Google Scholar 

  22. Belding, J.N., Fitzmaurice, S., Englert, R.M., Koenig, H.G., Thomsen, C.J., da Silva, U.O.: Self-reported concussion symptomology during deployment: differences as a function of injury mechanism and low-level blast exposure. J. Neurotrauma 37(20), 2219–26 (2020). https://doi.org/10.1089/neu.2020.6997

    Article  Google Scholar 

  23. Modica, C.M., Egnoto, M.J., Statz, J.K., Carr, W., Ahlers, S.T.: Development of a blast exposure estimator from a Department of Defense-wide survey study on military service members. J. Neurotrauma 38(12), 1654–61 (2021). https://doi.org/10.1089/neu.2020.7405

    Article  Google Scholar 

  24. Vartanian, O., Coady, L., Blackler, K., Fraser, B., Cheung, B.: Neuropsychological, neurocognitive, vestibular, and neuroimaging correlates of exposure to repetitive low-level blast waves: evidence from four nonoverlapping samples of Canadian breachers. Mil. Med. 186(3–4), e393–e400 (2021). https://doi.org/10.1093/milmed/usaa332

    Article  Google Scholar 

  25. Vartanian, O., Tenn, C., Rhind, S.G., Nakashima, A., Di Battista, A.P., Sergio, L.E., Gorbet, D.J., Fraser, D.D., Colantonio, A., King, K., Lam, Q., Saunders, D., Jetly, R.: Blast in context: the neuropsychological and neurocognitive effects of long-term occupational exposure to repeated low-level explosives on Canadian armed forces’ breaching instructors and range staff. Front. Neurol. 11, 588531 (2020). https://doi.org/10.3389/fneur.2020.588531

    Article  Google Scholar 

  26. Belding, J.N., Jackson, J.R., Englert, R.M., Fitzmaurice, S., Koenig, H., Thomsen, C.J., da Silva, U.O.: Blast exposure, traumatic brain injury, and self-reported symptomology among active duty enlisted marines: An examination of post-deployment health assessment records, 2005–2012. Naval Health Research Center, Defense Technical Information Center (2020)

  27. Carr, W., Kelley, A.L., Toolin, C.F., Weber, N.S.: Association of MOS-based blast exposure with medical outcomes. Front. Neurol. 11, 619 (2020). https://doi.org/10.3389/fneur.2020.00619

    Article  Google Scholar 

  28. Haran, F., Handy, J.D., Servatius, R.J., Rhea, C.K., Tsao, J.W.: Acute neurocognitive deficits in active duty service members following subconcussive blast exposure. Appl. Neuropsychol. Adult 28(3), 297–309 (2021). https://doi.org/10.1080/23279095.2019.1630627

    Article  Google Scholar 

  29. Amrein, B.E., Letowski, T.R.: High Level Impulse Sounds and Human Hearing: Standards, Physiology, Quantification. Report prepared for Human Research and Engineering Directorate, US Army Research Laboratory, Aberdeen Proving Ground, MD (2012)

  30. Carr, W., Dell, K.C., Yanagi, M.A., Hassan, D.M., LoPresti, M.L.: Perspectives on repeated low-level blast and the measurement of neurotrauma in humans as an occupational exposure risk. Shock Waves 27, 829–836 (2017). https://doi.org/10.1007/s00193-017-0766-0

Download references

Acknowledgements

SSS and SMT would like to acknowledge Jason Bailie, Ida Babakhanyan, and Emma Gregory for their feedback on the study design and content of this manuscript. The authors would also like to acknowledge the efforts of the Co-Chairs, Program Coordinators, Line of Inquiry Coordinators and Performers, and all other personnel involved in the NDAA FY18 Section 734 Program for their contributions toward understanding the effects of low-level blast exposure. This work was prepared under a contract funded by the Traumatic Brain Injury Center of Excellence (TBICoE), Defense Health Agency, Department of Defense.

Author information

Authors and Affiliations

  1. Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring Metro Center I, Suite 6-100 1335 E W Highway, Silver Spring, MD, 20910, USA

    S. S. Sloley & S. M. Turner

  2. General Dynamics Information Technology, Silver Spring, MD, USA

    S. S. Sloley & S. M. Turner

Authors
  1. S. S. Sloley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. M. Turner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. S. Sloley.

Ethics declarations

Disclaimer

The views expressed in this manuscript are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. This work was prepared under Contract HT0014-21-C-0012 with DHA Contracting Office (CO-NCR) HT0014 and, therefore, is defined as U.S. Government work under Title 17 U.S.C.§101. Per Title 17 U.S.C.§105, copyright protection is not available for any work of the U.S. Government. For more information, please contact dha.TBICOEinfo@health.mil. UNCLASSIFIED

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Communicated by R. Banton, T. Piehler, R. Shoge.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sloley, S.S., Turner, S.M. Evaluating evidence supporting the relevancy of 4 psi as a blast overpressure value associated with brain health and performance outcomes following low-level blast overpressure exposure. Shock Waves (2024). https://doi.org/10.1007/s00193-024-01170-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00193-024-01170-9

Keywords

Search

Navigation