Guidelines for conducting epidemiological studies of blast injury.

Blast injuries are often caused by more than one mechanism, do not occur in isolation, and typically elicit a secondary multi-system response. Research efforts often do not separate blast injuries caused by blast waves from those caused by blunt force trauma and other mechanisms. 15 experts from nine different NATO nations developed in the HFM Research Task Group (RTG; HFM-234 (RTG)) 'Environmental Toxicology of Blast Exposures: Injury Metrics, Modelling, Methods and Standards' Guidelines for Conducting Epidemiological Studies of Blast Injury. This paper describes these guidelines, which are intended to provide blast injury researchers and clinicians with a basic set of recommendations for blast injury epidemiological study design and data collection that need to be considered and described when conducting prospective longitudinal studies of blast injury.

Guidelines for using animal models in blast injury research.

Blast injury is a very complex phenomenon and frequently results in multiple injuries. One method to investigate the consequences of blast injuries is with the use of living systems (animal models). The use of animals allows the examination and evaluation of injury mechanisms in a more controlled manner, allowing variables such as primary or secondary blast injury for example, to be isolated and manipulated as required. To ensure a degree of standardisation across the blast research community a set of guidelines which helps researchers navigate challenges of modelling blast injuries in animals is required. This paper describes the guidelines for Using Animal Models in Blast Injury Research developed by the NATO Health Factors and Medicine (HFM) Research Task Group 234.

Contemporary body armor: technical data, injuries, and limits.

The introduction of firearms in the fifteenth century led to the continuous development of bulletproof personal protection. Due to recent industrial progress and the emergence of a new generation of ballistic fibers in the 1960s, the ability of individual ballistic protections to stop projectiles greatly increased. While protective equipment is able to stop increasingly powerful missiles, deformation during the impact can cause potentially lethal nonpenetrating injuries that are grouped under the generic term of behind armor blunt trauma, and the scope and consequences of these are still unclear. This review first summarizes current technical data for modern bulletproof vests, the materials used in them, and the stopping mechanisms they employ. Then it describes recent research into the specific ballistic injury patterns of soldiers wearing body armor, focusing on behind-armor blunt trauma.

Consequences of nonpenetrating projectile impact on a protected head: study of rear effects of protections.

BACKGROUND: Police and armed forces have helmets that can now stop handgun bullets and even a certain category of rifle bullets. The trend is to increase the ballistic limits of helmets, but injuries caused by nonpenetrating impacts are not well understood. The helmet defeats the projectile and creates a local cone of deformation that impacts the head a second time. The term "rear effects" describes the behind-armor blunt trauma caused by the nonpenetrating impact. METHODS: To analyze rear effects on the skull, an experimental study was associated with parametric simulations on a three-dimensional finite element model. Transfer of energy throughout the head was tested on 30 human skulls filled with a silicone gel. The magnitude of contact forces on the skull surface and the pressure levels in the skull were recorded during a reference impact. RESULTS: A biomedical approach by pathologic findings and radiographs showed very localized fractures. The protection brought by the diploe in the multilayered bone was confirmed and characterized by numerical simulations. CONCLUSION: This first step toward a better understanding of the rear effect phenomenon in relation to its consequences on brain tissue will lead to the design of more efficient protections.

Identification of linear viscoelastic constitutive models.

Accelerations induce in the brain mechanical stresses that may explain the loss of consciousness feared by fighter pilots. In this study, the brain is modelled as a multi-domain structure and a finite element method is used to identify the constitutive law parameters of each domain and then to analyse the stress level in the brain. The loading and observed strain rates induced by hypergravity seem to indicate a quasi-static behaviour of the brain structure. A general procedure has been developed to characterise the behaviour of a structure including several domains. Each of them is assumed to be isotropic and homogeneous with a linear viscoelastic behaviour. These constitutive laws were identified using only the displacements of several nodes on the envelope discarding the displacements between domains at the interaction surfaces. These interfaces may be buried inside the structure and not connected with the external surface. Two validation examples are proposed to show the reliability and effectiveness of the method.

Evaluation of cerebral stresses under acceleration taking into account the lateral ventricles.

In certain flight configurations, fighter pilots are exposed to high Gz acceleration that may induce inflight loss of consciousness (LOC). That LOC is usually preceded by visual prodromes as greyout and blackout. The pathophysiological cause of these phenomena is used to be related to the effects of accelerations on the vascular system (Burton, 1988; Whinnery, 1990). However technological advances have created aircraft generating high accelerations with rapid onset rates (1-6 Gs-1). The symptomatology of inflight LOC has changed and prodromes no longer appear. Pilots also reported a lacunar amnesia of the LOC. In order to evaluate the potentially adverse effect of acceleration on the brain tissue, it was important to study its mechanical behavior under hypergravity. An approximation of the cerebral stresses was obtained by coupling an 'ex vivo' experiment (Guillaume et al., 1997) with a numerical simulation. Firstly, the calculations have been realized considering the brain as homogeneous. Secondly, the cerebral ventricles have been individualized. The results of these two approaches were compared.

Effects of perfusion on the mechanical behavior of the brain-exposed to hypergravity.

In certain flight configurations, fighter pilots are exposed to high Gz acceleration which may induce inflight loss of consciousness (G-LOC). In order to study the mechanical effects induced by these accelerations on the cerebral structures, an experimental model has been developed in vitro. Fresh bovine brains were excised and placed in a transparent mold modeling the inside of the skull. Half of these brains were perfused during the experiment. This assembly was placed into the gondola of a centrifuge, in front of a camera lens. Displacements and deformations of the brains were filmed and recorded at different onset rates. Measurements were made after off-line digitalization of images. Experimental data were incorporated into a finite element calculation code whose mesh represented the brain. The applied behavior law was elastic, the structure being considered as homogeneous and isotropic. The first results concerned the elastic properties of the brains under hypergravity. The mean value of the Young's modulus of the nonperfused brain was 46.8 kPa, which corresponded to the values published in reference literature. For the perfused brains, the mean value of the Young's modulus was higher. The mean value of the equivalent Poisson's ratio was 0.35. In fact, contrary to impacts, the mechanical stimulation is long enough to allow fluid displacements. The mean value of the equivalent Poisson's ratio calculated in the present study should probably be increased since this study was performed post mortem.

Experimental model for studying the mechanical effects of +Gz accelerations on the brain.

NASA: Bovine brains were excised and placed into a transparent mold equipped with a pump and perfusion system. This unit was then centrifuged and changes in brain contour were video recorded. Analysis of the resulting images showed that changes occurred in brain structures as a result of crushing. The effects of perfusion on the amount of deformation and other results are discussed.^ieng