Public health, safety, and industrial hygiene experts from across the Department of Defense gathered in July to review the latest DOD and service research and approaches focused on understanding the full lifecycle of service member exposure to blast overpressure, or BOP, and injury.

This fourth annual Department of Defense Blast Summit, hosted by Defense Health Agency-Public Health July 16-18 in Hampton Roads, Virginia, is part ongoing efforts under the DOD Warfighter Brain Health initiative, which aims to help America’s warfighters maximize their cognitive and physical performance. The initiative is intended to give commanders the tools to maximize force readiness and protect service members from unnecessary and avoidable harm.

The summit also comes on the heels of the Navy Blast Overpressure Summit held on July 15, 2024.

“We understand that blast overpressure is something that affects our sailors and Marines and we want to figure out what this exposure is and get everybody together, all the experts, and figure out what all the variables are so that we can collectively work together, build synergy, and ensure we're all taking care of the force in the same manner,” said U.S. Navy Capt. Chuck Wilhite, deputy commander of Navy and Marine Corps Force Health Protection Command. “We're all different, but we use many of the same weapon systems. I think we can still learn from each other the standoff distances, the personal protective equipment, or PPE, shielding, isolation, and maybe substituting the different weapons systems for better ones.”

Kathy Lee, WBHI director, highlighted the importance of working with front line operators from across the services to help shape and inform the discussion.

“We are looking for command line operator leaders to be champions of this and to really focus on things we can do right now, like safety mitigation,” said Lee. “We will keep those connection points when this blast summit is over. We know if it’s not helping the boots on the ground troops then it really doesn’t make a difference.”

The DOD continues to advance policy to minimize the effects of exposure to blast overpressure, or BOP. For instance, it is broadening its pre-deployment neurocognitive assessment to a department-wide cognitive monitoring program for all service members. A Warfighter Brain Health hub, launched in December, serves as a central location for current information on brain health, including risks, diagnosis, treatment, support resources, and research. This public website includes specific information for service members, families, and health care providers.

The latest initiative is updated policy issued by Deputy Secretary of Defense Kathleen Hicks and aims to reduce injury from blast overpressure. This new policy memorandum “Department of Defense Requirements for Managing Brain Health Risks from Blast Overpressure”, issued on Aug. 8, 2024, rescinds the Assistant Secretary of Defense for Readiness Memorandum, “Interim Guidance for Managing Brain Health Risk from Blast Overpressure,” issued on Nov. 4, 2022, and “establishes DOD requirements and direction for the management of health risks to DOD personnel from exposures to BOP.”

“Blast overpressure is one of many factors that can negatively affect warfighter brain health,” Hicks wrote in a statement Aug. 9, 2024, announcing the updated directive. “This policy memo builds on existing efforts across the military departments to mitigate the impacts of blast overpressure now and positions the Joint Force to advance and leverage research to protect Service members from exposure in the future.”

A top priority for the Department of Defense is to take care of its people, which includes promoting, protecting, and sustaining brain health and reducing traumatic brain injury in all its forms, said Lee.

“While military service can entail exposure to concussive forces and exposure to blast waves, the DOD acknowledges its responsibility to minimize the impacts so that service members and their loved ones can continue to serve with a singular focus on the mission. We owe it to our service members to do everything we can to keep them safe from avoidable harm.”

U.S. Marine Corps Chief Warrant Officer 3 Jacob Campbell, an explosive ordnance disposal officer at Marine Corps Air Station Cherry Point, North Carolina, attended both the DOD and U.S. Navy summits.

“I’m here as a representative for the air station and trying to get some insights during these summits,” said Campbell. “I think this is solidifying what’s been known or discussed at the lower levels. I think these events get the discussion forefront, the problem forefront, and the discussions needed to fix it.”

This new policy memo directs all DOD service leaders to increase monitoring of service member BOP exposure through 12 mitigation actions:

• Ensure all new active and reserve recruits undergo cognitive assessments as part of the entry process by Dec. 31, 2024, and accelerate already mandated requirements for baseline cognitive assessments for currently serving high-risk active duty service members by the end of fiscal year 2025.
• Implement procedures and standards for training and operations that incorporate BOP risk management to minimize the risk of brain injury. This includes PPE, as well as stand-off distances for personnel involved in training, like range and safety officers, as well as stand-off distances for non-training audiences and observers.
• Minimize the number of personnel in the vicinity of BOP generating events.
• Integrate BOP risk management within the weapons system acquisition lifecycle.
• Enforce safety warnings and restrictions in weapons systems technical and operators’ manuals.
• Integrate simulations into training strategies to reduce BOP exposure, when appropriate, and not expend excess rounds once training standards are achieved.
• Identify and track personnel who are potentially exposed to BOP in a centralized system, prioritizing high-risk occupations.
• Until the centralized BOP database is established, implement internal recordkeeping processes and procedures for managing BOP exposure sensor data.
• Prioritize efforts to collect BOP exposure data consistent with applicable DOD guidance.
• Train and educate personnel, report exposures to their command, and seek an evaluation from their medical provider if experiencing symptoms.
• Establish procedures to ensure personnel recognize BOP symptoms, report exposures to their command, and seek an evaluation from their medical provider if experiencing symptoms.
• Establish procedures to track and maintain oversight of BOP exposure risk-management actions, including processes and justification for exceptions to policy.

Campbell hopes to see more participation from people like him, who represent the population most affected.

“I think a lot of the safety and mitigation strategies being discussed are inherently already done at the lower level, too, and that includes range safety officers,” said Campbell. “Most people generally know and will execute according to natural and instinctive safety behaviors. I think there's an education campaign that can go out to ensure that those mitigation strategies are accurate and based on data and not just what is assumed to best practice. It probably just needs to be a top-down information campaign, but it needs to have bottom-up input and refinement.”

Participating in the summit for the first time was U.S. Army Col. Jama VanHorne-Sealy, director of occupational health for the Army Medical Command.

“I think the key thing is, is that we need to continue to synchronize across DOD,” said VanHorne-Sealy. “There's so much good work that's already going on out there that we can learn from each other, take from each other, and we can create a better program holistically. If we're talking to each other, we're learning from the research that's out there between the different services. And we can create an effective program by working together.”

U.S. Army Lt. Col. Patricia H. Passman, director of the occupational and environmental health office of force safety and occupational health for the Assistant Secretary of Defense for Personnel and Readiness, was attending the summit for the first time and provided an overview and update of DOD BOP policy.

“I wanted to understand current state and better be able to articulate to my leadership and through the strategic communication task force—what are those tangible actions that the services are doing now,” said Passman. “We really need to start sharing our good news story because there's so much goodness happening, and I don't think we're quite getting it out there.”

Passman says her office hopes to use the weapons systems assessments and research conducted by her office and other DOD experts to better understand what blast exposure looks like from the weapons systems being studied and then connect how that exposure can correlate to a potential adverse health effect. Her goal is to ensure service members are educated on how they can protect themselves and get help if they need it.

“Take advantage of the opportunities for the education so that you can self-identity when you're experiencing symptoms. If there's any doubt in your mind that you are experiencing symptoms that may be a result of exposures to blast overpressure, seek help, get medical care, and start that treatment pathway,” said Passman. “We are committed to taking action to protect them now. We are acting on what we know right now, and we are identifying what areas we need to focus on that will inform not just the now but certainly into the future so that we can protect our people because that is absolutely our number one priority.”

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