Blast Monograph

7/31/2019 Blast Monograph

1/74

b o r d e n i n s t i t u t e m o n o g r a p h s e r i e s

Blast InjuryTranslaTing research inTo

operaTional Medicine

James H. Stuhmiller, PhD

edited by

William R. Santee, PhD

Karl E. Friedl, PhD, Colonel, US Army

Borden InstItute


2/74

F m ha 25 ya, h Miliay opaial Mici rach Pgam

(MoMrP) ha b a wl la i h y bla-la ijy. thi ach

ha pc iigh, aa, a piciv ml ha aa hma

xp, gi h ig pciv ym, a allw qick p h

qi ga i a apily chagig bal vim. th wk MoMrP

ci a h w bla i h 21 cy.

thi vlm wa ppa miliay mical caial . th c h imai i

ici ha may m h bai ci a plicy. th pii ai

cai hi a h piva viw h ah a a b c a icial

a lcig h viw h dpam h Amy h dpam d.

dag slci: th ah a pblih hav ma vy h accacy

ag ci hi. Hwv, i i h pibiliy vy pacii cl apppi-

a imai c acai cc ag ach cliical iai, pcially

w amilia g a pc. th ah, i, pblih, a h dpam

d ca b hl pibl ay i hi bk.

u ta Ba nam: u a ba am i hi pblicai i illaiv

pp ly a imply m by h dpam d.

nal Lagag: ul hi pblicai a hwi, macli a p

xclivly m.

Cai pa hi pblicai pai cpyigh ici.

ALL rIGHts reserVed.

n cpyigh pa hi pblicai may b pc ami i ay m

by ay ma, lcic mchaical (iclig phcpy, cig, ay i-

mai ag a ival ym), wih pmii i wiig m h pblih

cpyigh w.

Pblih by h oic th sg Gal a tMM Pblicai

B Ii

Wal r Amy Mical C

us Amy Mical dpam C & schl

This publication is a reformatted version of the April 2008 preprint of the same title. It is made

available with the understanding that it will not be cited or reproduced without the permissionof the publisher.

All illustrations and photographs courtesy of L-3/Jaycor, San Diego, California.


3/74

cont ent s

Foreword v

introduction 1

Bla Ijy taxmy 3

P-Wl Wa II rach 4occpaial Limi Bla exp 5

Miliay opaial Mici rach Pgam

(Bla Ijy rach) 8

First-generation injury modeling 11

obv Bla Iji 11

explay Ijy Ml 13

Lg Ijy 16InJurY swa, Vi 1.0 4.3 18

simpl Wav 19

th Bla t dvic 20

Bla i ecl 21

Cmpaial Fli dyamic 22

second-generation injury modeling 23

InJurY swa, Vi 5.0 7.1 23

rplacm h Z-li i Miliay saa 1474 27scay Bla Ijy Mlig 29


4/74

tiay Bla Ijy Mlig 30

Cmbi Ijy Mlig 31

Clig h Bla t si31

third-generation injury modeling 33

Fii elm Mlig 33

Fii elm Mlig i Bla Ijy 34

InJurY swa, Vi 8 36

txic Ga Ihalai 38

Bla ec Bhi By Am 42

Fourth-generation injury modeling 43Pmac epi 43

Cal nv sym Ijy 44

Bla tamaic Bai Ijy Mchaim 48

Bimchaical a Phyilgical rp Ml 52

summary 55

reFerences 57

James H. Stuhmiller is Senior Vice President and General Manager, Simulation, Engineering,

and Testing, L-3 Communications, 10770 Wateridge Circle, San Diego, California 92121.


5/74

Fw

Blast Injury: Translating Research into Operational Medicine cib

piig bimical ach ha m h bai c kwl-

g bla ijy mchaim. Mch hi kwlg, la caag, ca b appli icly lvig h bla ijy pblm ay.

F xampl, aig pimay bla lg ijy, la m

aly w ca lag aimal bla ijy ach, wa cclly

appli lvig h c pblm pcig waigh m

vl xpliv wap.

th pimay gal h dpam d (dd) Bla Ijy

rach Pgam i c gi a limi c bimi-

cal ach ha a bla ijy kwlg gap. th ky achiv-ig hi gal i aig wha ha alay b la ab bla

ijy. uaig wha w kw ab bla ijy i j a impa

a aig wha w kw. A h i cmphiv viw

h Amy xiv ivm i vlpig bla ijy ml, hi

bk hlp pvi acc h xiv piy pimay bla

ach p a aa.

michael j. leggieri, jr.

dd Bla Ijy rach Pgam


6/74


7/74

Ici

I 1864, ig h Amica Civil Wa, h 48h Pylvaia gim

wa ma p pimaily m wh ha b cal mi i civilia li. A

h ig Pbg, Vigiia, agg , h ia a ig a l h Ca li. I wa g, ill wih gpw, a h

li Jly 30, 1864. th iiial xpli kill 280 Ca li.

B, iically, h bq Bal h Ca l caali alig

1,500 Ca a 4,000 ui li, cig ay wh w

w miig.1

I 1968, l-ai xpliv w ic i h Viam Wa

cla ly aa, miil, a my li. th m

bla m ip cl k lially ch vyhig blw.th ria h pc h hmbaic wap a hm

i Aghaia a h Chch rpblic.

I 1979, ig vlpmal ig a w M198 hwiz (rck

Ila Aal, rck Ila, Ill), iig h m gic ga

bla p i h cw lcai, which lighly xc h limi

Miliay saa 1474 (ni Limi Miliay Mail). By gla-

i, li cl b xp ch i i, h ig

wa pp. Bca h capabiliy i h gic wa a ky

lm i h mii h hwiz, ilig a ciical wap ym

wa civly blck.

o ocb 23, 1983, h Fi Baali, 8h Mai Haqa

bilig i Bi, Lba, wa y by a i ck la wih


8/74

2 | blast injury: translating researchinto operational medicine

cmp ga-hac xpliv.2 th lig xpli a h cl-

lap h bilig kill 241 mai, ail, a li. u maiv

am lw-ch xpliv pc ma caali ha bcm aicaigly cmm acic i m, aymmic waa a i civilia

im.

A ocb 2005, impvi xpliv vic (Ied) hav acc

hi all Amica ah i Iaq. rai bmb w i

Wl Wa II by Blia gilla ail nazi ai a pa h ail

wa,3 i nh Ila agai h Biih Amy, i Aghaia agai

h ria Amy, i Lba agai h Iali, a w agai h

ui sa hgh h Mil ea. I 2005, h us miliay iv

$3.3 billi i Ied cma, pimaily hgh impv am ah chlgi.4

A h xampl hw, h ya, bla m xpli

hav b a ha h balil, a ha civilia m ac -

im, a a ha li i aiig. F m ha 25 ya, h Miliay

opaial Mici rach Pgam (MoMrP) h us Amy Mical

rach a Mail Cmma (usAMrMC; F dick, M) ha b

a laig wl ach gaizai i h y bla-la ijy. th

MoMrP pgam ha

conductedextensiveanimalteststoestablishinjurypatterns,elucidate

ijy mchaim, a pvi ciical aa ablihig ijy

aa;

developedmathematicalmodelsofphysiologicalresponseinbothanimals

a hma xapla aa iai miliay lvac;

developedinjurycriteriathatareusedthroughoutthemilitaryandcivilian

cmmii ima ijy pial a a limi xp;a

developedinstrumentation to standardize themeasurementofblast

vim ijy am.

thi ach cv h aiial bla-c cagi:

primary effectsh lig m h chig c bla v-

p,

secondary effectsh lig m h impac bi accla

by h bla wav a llwig wi, a

tertiary effectsh lig m impac wih wall a h g

ca by acclaig h by il.


9/74

introduction | 3

I aii, h c hav b i xampl, icapaciai,

ijy, a lhaliy m h ihalai ga ga by xpliv a

c y ym, iclig aiy ijy. rach iig havai i hma pci i aa h ha bla, iclig h vl-

pm b by am, ambil ay ym, a l iji

lhal wap.

May h ky iig h MoMrP bla ach pgam hav

b pblih i p-viw lia. Hawa a wa h

chaacizai a aalyi bla p hav b wily iib.

nhl, h l appa ly i chical p a a l ac-

cibl. th pp hi pblicai i pvi a vviw h

usAMrMC bla ach pgam, hw hw qaiaiv phyilgyha pvi l li paial mici, a iica

ici ach.

Bt ijuy Txmy

th vil cqc big a a xpli ca pc a wi

ag iji ha ca b gaiz i a axmy (tabl 1). th highp h bla ca ch h by a ca ial ijy. th

iji a call pimay bla iji. sg wi bhi h bla

ca hl agm a bi agai h by a ca h am

bl ama pai iji ha wl cc i h maial w

ppll by h ma. thi cla iji i call cay iji.

th g wi bhi h bla a h p gai i h

wav ca x igiica c ha ca accla h by a ca h

am bl ama ha wl cc i a all a ca cah. thi cla iji i call iay iji. th xm ha a ligh la by h

xpli ca ca big a bli, wha ihalig h xic i

ga ca la immia icapaciai lay lhaliy. thi cla

iji i call qaay iji. Fially, ay h ama ca la

bq c ca by ipi h by bichmical -

lgical ym. thi cla iji i call cllaal iji. Alhgh

bla pvi a iq pc by which pjcil a ppll, bi

a accla, a ama i ca, h lig iji a qla ca

al l m h amaic v.

Iji ha l m chig vp, hwv, a ly iq

bla. th pimay bla iji cc bca h by i a li,

icmpibl ma; i ha ai-caiig ga ha will ch h


10/74


xal la. Chig allw h hll h by i h gi

mv apily iwa, h iig h ai-caiig i a pcig

lcal, lag . Iji h lg, gaiial (GI) ac, a p-p piay ac (urt) a cmm maiai hi c. rapi

ii h ai-caiig ga ca ami ighbig

li ga a wll. Ci h ha, xampl, ai i pa m

h g wav ha vlp i h lg. Lag mai h

by ca al la i li ga ha l i amag (g, liv

a pl lacai). Fially, api vlmic chag i h mal

phyilgical ag ca ip ymic pc. Cai ai mbli

by cig ga ac h aibl bai h lg a cai lag

p ai i h vacla ym may b pibl bai ijya cll ah.

th y bla ijy ca b ghly ivi i w bjciv: (1)

chaaciz pimay bla iji, pc ha a iviga i h

ama ach; a (2) la bla pjcil impac chaaciic,

whl-by mi, a xm ha, ligh, amphic vimal

cii ha, i , la pimay iji. th i bjciv ha

qi w ach, wha h c bjciv ha qi aapa-

i pvi ach. tgh, a cmpl, qaiaiv phyilgicalaig bla ijy ha mg.

pt-W W ii rh

Fllwig vlpm cla wap, ach i bla ijy c

h c xmly lag blai paicla, ablihm lhal-

iy ciia a wi ag cii. Bilgical iji m bla wcagiz a pimay, cay, a iay, b h wa lil amp

a h mchaim h iji. dig hi pi, mpiical

ml lhaliy w .

I h ui sa, h majiy bla bilgy ach wa cc

a h Bla t si a Kila Ai Fc Ba (Albqq, nM). th

Lvlac Fai Mical ecai a rach (Albqq,

nM) pa hi i m h 1950 il 1980, h phip

vai agci cc wih cla wap c , i h

1970, wih l-ai xpli. Aimal agig m mic , a wll

a mmi, w ima lhaliy m bla i h p, i

bilig, i xhl, a wih cmbiai bla a hmal c.

(s h cmphiv hiy h Bla t si.5)


11/74


12/74


table 1. Taxonomy of Blast Injury

ctt

Uqu to -oxov, ut omt vomt o tboy t ov-uzto wv.

Boy u t- o ytot bu tboy ot yomb tu

(-ot o)tt uo voum .

imt o t boy

om y b bomb mt.

.

ctoy

pmy

soy

Boy pt at

g-f tutu mot utb buty u t tttotou wy,u, tott tt, m .

it toto o -ot o utoto o boo ot, v,

, ky.

dt o wtt boy, y tvu ytm, u ut tt btmtt to ot to t boy.

ay boy t my b

t.

d o t ,m, o tmt objt.

Ty o iju

Bt u (umoy

botum).

Tym mmb utu

m m.

abom mo

oto; ob (y)

utu.

couo (tumt bjuy wtout y o

juy).

lto o t v, ,

ky.

cotuo to t t.

dtoto utu o t

t v.

a mbo tou o

t boo bouy o

t u.

su boo ow

u tt my to tu

juy t b.

ay juy ot wt

mt o - objt.T mo ot uqu to

bt; owv, bt ov

t wy o o

t objt.

ptt bt (mt-

to) o but ju.

ey tto ( b out),

ku tu, t.


13/74

introduction | 7

table 1. Taxonomy of Blast Injury (continued)

ctt

Wo-boy -to u by t btw.

Uv o ot boy u byt bt w.

a xoo-mtju ot otwt u o wt.

h tmtu.

Tox .

soyoqu otum.

exbto oomto oxt oto.

ctoy

Tty

Quty

cot

Boy pt at

ay boy t my bt.

d o t uoto tt t boymt.

pmy /k xtmt tt bt tv tot too.

ay boy t my bt.

Boy u, y.

rtoy ytm.

sytm o ommv tum.

Ty o iju

ay juy ot wt

wo-boy moto

mt. T mo ot

uqu to bt; owv,

bt ov t

wy o t t

boy.

Ty ju tt wou

ou o .

Ftu, otuo,

o- o-

ju, t.

Tumt mutto;

mu t.

Bu (, t,

u tk).

ayx.

ijuy o tto om

tox f .

not uqu to bt.

a, yym,

yto.

atm, o obtutv

umoy , o otbt obm om

ut, mok, o tox um.


14/74


Mty ot M rh pm(Bt ijuy rh)

Fm h bgiig, h MoMrP bla ach pgam wa ml-ba.

th cii a ml-ba ym cam m a balac am

h immia a lg-m bi aimal, phyical ga, a

mahmaical ml appach. o xm, a h acal ha

agai a hma h xac cii i i h la ambig-

way mi a c a ha qi aig

h ial mchaim. thi i hically pibl cii ha

pc ijy a i impacical i h ag cii. o h

h xm, a mahmaical ml ha cap vy mchaical, chmi-cal, a bilgical apc h hma by ca pvi a imlai bai

yig ay iai wih ik a iivial. Giv h a

kwlg a cmpig, hi gal xc ay aabl av. I

bw h xm a cmbiai aimal, phyical ga,

a mahmaical ml ha cib m pa cal h iaci

(Fig 1). th gal h MoMrP i h apppia mix

l iv h b pibl immia aw, whil ciig vlp

icmally b mahmaical ml ha will xpa h galiy aig.

th i pblm a wa h ipai h p igal.

ulik h ializ wavm ha ha b c a chaac-

iz i lag-cal xpli, h hwiz wavm cai w pak.

thi m c h impl mpiical cla ha xi a,

bca hy vai i magi a im paai m plac plac

a h hwiz, w pc b aiac h gmy

h imai. Jayc, Ic (sa dig, Cali), vlp a mahmai-cal ml h ppagai h bla m h mzzl h wap,

accig h lia lci m h g. th ml pv

cclivly ha h wavm w m h iaci. Fhm,

h ml wa abl pvi a cmpl map h haza aa a

h g, all g lvai a chag yp, wih qiig xiv

phyical mam. Wih hi ml, aalyi h wap ym

cl al b ma wih aa m ly a w mam lcai

calibai.13

uig h l h ml a a gi, aimal i w mla

a cc a h Bla t si. Fm 1980 il i cl i 1998, h

c h ach wa ijy, lhaliy. si pa bla cii

ha pc bvabl c i, li-haig ijy a


15/74

introduction | 9

ah. Ga ca wa ak cm pahlgi bv i all ga.

Pimaily hp w a bjc pvi cicy ac all

i. thi 18-ya pc aly 2,000 aimal xp hap h m xiv cllci bla-la ijy aa i h

wl. sbqly, a cmphiv pahlgy cig ym bla

iji wa vlp.

th ali ijy w c ablihig a hhl lvl

bla vp, blw which ijy wl cc. ualy, ch a

lvl cl b mi iiivly, bca mall pbabilii ijy

qi a lag mb aimal ima hhl wih cic.

th lw-lvl i hw, hwv, ha h ai-caiig ga (i,lg, GI ac, a acha/layx) w h i ga b ij.14

nx, w ig mi i urt ijy cc b lg

a GI iji, wih h hgh ha a haml pc ijy cl b

a a iica impig, m i, ial ijy. thi hyph-

i wa ba aiy xpic i which a mpay hhl hi (a

mi, ai haig l) alway pc pma haig l a,

h, allw hma bjc b ablih a bai.

ualy, bla-ca urt ijy cc a ially h am lvl

ha ca lg a GI iji.

Fially, w cc ablih a ival bla xp

ha cl pic ijy m h bla p igal al, limiaig h

cc aimal hma . th lgical caia, ba h

InjuryResponse

Human Target

Animal Model

Compliant Physical Target

Rigid Physical Target

Rigid Mathematical Model

Mathematical Model

Complete Mathematical Simulation

Reproducible Operational Biofidelic Validated Statistical

BiomechanicalCorrelate

FACTORS

FAVORING

BIOLOGICALT

ESTING

FA

CT

OR

S

FAV

ORIN

G

SIM

ULATION

Fid

elity

UnderstandingRequired

Gen

erality

,Kn

owle

dgeGain

ed

Risk

,Cost

Compliant Mathematical Model

Impact

Figure 1. Animals, physical surrogates, and mathematical models.


16/74


i cal amag m bla, wa implh im igal

h p igal. Impl, hwv, i pvi a ival cla

wih bla ijy.Fail h amp iiy impl pa mak i bla

ijy wa amplii wh bla i cl w i. rl h

i c h a acal aamical yamic a

ca pimay bla ijy. Mahmaical mlig hlp gi

ach a ablih ciia.


17/74

Fi-gai IjyMlig

Fi-gai ml cla ijy mchaical p hby, ah ha h chaaciic h bla p il. thi bi-

mchaically ba ciia wa iv by ail p-ba cla

pic ijy impl wav i h il cmplx wav i

cl.

th mchaim ijy wa hyphiz ci h caal

p: (1) bla wav ca mpal a paial laig iibi

h xal by ac; (2) h by m h laig a ca

ial a ai i h i; a (3) wh h i xc maial limi, ijy cc. Cmpaial pw, bh i m

cmp p a imlai wa, wa i i iacy i h aly 1980;

hwv, mahmaical mlig ma igiica cibi. F ga

ym w ci i i-gai ijy mlig: (1) h ympaic

mmba, (2) h acha, (3) h GI ac, a (4) h lg.

obv Bt iju

Bla ca ca a wi ag iji. A h xpliv lvl gw, h

magi h c acig h by gw, a h x h

by p ica. occpaial aa, hwv, c i-


18/74


19/74

First-generation injury modeling | 13

gp, wha h kiy, paca, a gallbla m h hi gp.

Claly, h ai-caiig ga a h m vlabl a, h,

qi h ga ciai ccpaial xp. All ga a

ily ij a imila bla iiy. Lhaliy, which i pimaily

a mlipl ga ail, i a hi am lvl.

exty ijuy M

Mahmaical mlig bilgical ym i paiclaly iicl, bca

vy apc h ym (gmy, maial ppi, a gh) i

cmplx a mi by v mall c, all h way w h

Figure 3. Liver injury resulting from blast.


20/74


cll hmlv. th, ach apc h ml m b gi a

valia by xpimal aa.

Tym Mmb ijuy M

tympaic mmba p i a cmm bla ijy a ha c-

c a bla lvl ally wll blw ay h ial iji. Alhgh

ci a li-haig ijy, am p ca b xmly

pail a may may b acia wih haig l. I h mi-

1980, am p wa a cc bla xp i aiig a

i cmba. th, a

vlp a mahmaical

ml h pc waak. Fii lm

mlig (FeM) wa

ml h ap a h

mmba. th a

which h mmba

w ba ip

i ppi ma-

m. th ml wa b-qly valia agai

i vi aa ablih

bimchaically ba i-

jy cii.15

Th-ly ijuy

M

th i i ablih-ig urt ijy a a pc-

m i ial

ijy pmp h

a ml ha cl b

xapla urt iji

m aimal hma.

Bla-ic achal ijy

i ia i appa-

ac, cpig h

cailag bw h by

ig. I xm cii,

i ca p a a clcFigure 4.Trachial injury resulting from blast.


21/74


22/74


h wall. th c vai wih bbbl iz, vp, a ac c-

. F lag vp, h bcam ga ha p h

wall cc. oc h mchaim wa ablih, ga GI mlw vlp ha allw hi bbblwall iaci phma b

h i.1720

Wih h ga bvai a a gi, a mahmaical ml

h bbbl yamic a wall p wa vlp.21 th ml pc

h am yamic p a, wh cpl wih maial ppi a

h gh h ac wall, ca pvi a piciv ml GI ijy

m bla.

Bca lg ijy wa vally lc a h pimay ijy

bla xp limi, h GI ml wa p. th ml gg,hwv, ha GI ijy may b ga i hp ha i hma bca h

hp i a mia wih mch m ga i h ii. A mmay h

aly bla aa aalyi a ml vlpm i i h pblicai

Modeling of the Non-Auditory Response to Blast Overpressure: Characteriza-

tion and Modeling of Thoraco-Abdominal Response to Blast Waves.22

lu ijuy

ev hgh all h ai-caiig ga a ij, Wal r Amy

Ii rach (WrAIr) phyicia mi ha ijy h lg i

ga cc a hl b xp aa. A a l,

mlig ach c aig lg ijy mchaim

a vlpig piciv lg ml.

M ga h by a liqi-ill, m a ai-ill, b h lg

i a cmplx maix m ha 500 milli mall ai ac ( alvli), wih milli ccig aiway.23 u mal phyilgical mi,

hi c ac a a impl ball ha ill a mpi, wih a p

p m ii i ha i m a lc h iac h

may mall aiway. u h api mi ca by bla, hwv, ai

ca lw a gh hgh h aiway, a h lg ac a a cllci

ila ai bbbla am. Fam hav h iig phyical ppy

ha hi p (h p a which a vlmic ibac i

pa h maial ca b pa h pa) i ly 30 40 m/

h ha ai a iih ha wa.24,25 thi lw p

ca h lg pachyma icly bhi h mvig ch wall b

ch a vly ij, i h ch wall vlciy i ga gh. th

ijy pc a chaaciic ac hmhag pa pmialy


23/74


h bla i i h il, b ca ivlv h i lg wh h

bla i cl (Fig 6).

I h aly 1980, Jayc bga wkig wih P Y C Fg a

h Bigiig dpam a h uiviy Caliia, sa dig,

cllc aa ha wl pp h vlpm a lg ijy ml.

P Fg ha alay b yig h maial ppi lg i-

.26 ov h bq val ya, h a hi cllag ablih h

ky yamic ppi lg i h api mi acia wihbla.27 thy cim h lw p a mi i vaiai

wih aplmay p. thi gp al ablih h clai

ial lg p wih mah bakw h alvla wall.28

thy ma h ppi h whl lg a lg i bh

mall aimal a hma, a hy hw ha h maial ppi

w imila. expim w cc lcia h ijy pc,

a mchaim ijy a h i lvl w pp.28,29Jayc, i

h i applicai ii lm aalyi bilgical ym,

vlp a w-imial ml h hax bla laig

qaiy h i ijy pc.30,31 tha ml pc h lw

p h ial p wav i h lg, hwig ha h high

val h p w lca h plal ac h bla i,

Figure 6. Lung injury resulting from blast. (left) Complex waves. (right) Freefield waves.


24/74


25/74


h -call il i- p mam, which i cv

la wih mla wav lci. ec by iai

a acc by h agl h ch h bla ici. th mical

a a WrAIr h vi InJurY wa mak ca-by-cahalh haza am wap ym.

sm Wv

u a bimchaical ml cib bla ijy qi kwlg

laig. Laig iibi ca b qi cmplx, v impl,

-il bla wav. A bla wav i h il ha a laivly implcipi. th xpli pc a high-p gi ha vlv i

a hck ha mv a a p ga ha h p . th

p ca bhi h hck a ca v p blw h ambi

p. tabl xpimally mi val a lga hi

a clai cap h aa.35 Wh a bla wav ik h g,

i ca a lc wav wih a c hck . th ici a -

lc wav ca iac wih ah a, i h bla i g gh,

pc a hi hck wav, h -call Mach wav, ha mv paalll

h g. Abv a cai high, call h ipl pi, wh h h

hck ic, bv h ici a lc wav; blw h

ipl pi, bv ly h Mach wav (Fig 8). A ca b ,

v -il xpli pc cmplica bla pa.

Charge of Weight,W

Incident Wave

Mach Stem

Range,R

Path ofTriplePoint

HOB

Ground Reflection

Figure 8. Mach stem and triple point. HOB: height of burst.


26/74


Wh a hck wav hi a by, ah cmplica iaci cc.

th ac h by acig h bla c ac a a lc, pcig

i w lc wav; b, bca i i gally cv, la, h cab may lc hck wav. A h wav pa a h by, h

agl h ici wav h ac chag, alig h gh h

lc wav; a h i, h i lc wav. na hi lcai,

h lw m h bla paa m h by a ca a gi bhi

h by ha ha a p lw ha h ici wav, b high ha

ambi. Cqly, h laig pa a aig hma i a impl

bla wav i qi cmplx: (a) h ch, amig acig h bla, civ

a laig ha ca b 2 8 im ga ha h ici wav; (b) h

i civ a laig cmpaabl wih h ici wav; a (c) h backl a laig ha i a aci h ici wav. th iaci ca

b calcla wih cmpaial li yamic (CFd) imlai.3638 I

h i abv h ipl pi, h h iibi i v m cmpli-

ca bca h by i hi by w wav: (1) h ici cmp a

(2) h lc cmp.

F a aimal aig all , h i v m cmplicai.

o pa h wav pa v h back h aimal i h ma -

cib pvily, b h h pa h wav pa h aimala ca aiial lci h g. th ch, which i mally

acig wwa, ca civ a bla laig ha ci mlipl hck

iaci.

Claly, v i h impl gmy h il, h bla laig

h by qi mi bla ijy ca b qi cmplx. Chaac-

izig h laig i m a igl, -il p mam

wa aqa.

Th Bt Tt dv

Bca h bla laig i h il wa aily i m a -

il p gag, a w im wa vlp. evally kw a

h Bla t dvic (Btd), i ci a mal cyli, pp m

h , wih h appxima iam h hp ch a wih

ac-m p gag vly pac a h cyli. th la

Btd ha a ahpmphic hap a pvi a h aachm

a i cmplx ig vim (Fig 9). o p gag i

i acig h cmig bla wav, wih h h gag cpig

h i a back. th Btd i i i h am ici a h


27/74


Figure 9.Blast Test Device.

bjc, vically a aig hma

hizally a aig aimal.39

sic i icpi, h Btd ha bh p im pviig

laig aa bla ijy aalyi.

Bca i ma h laig i-

cly, h i ip h

im p, cc gag

iai, acc big i

h Mach wav, h ac ha

a qi wh -il gag a

. ov h ya, h Btd ha b

plac icly h g imla

a li iig m a p pii,

ppp p i a a imlaig a pa-

g i a vhicl, a hg m vical

pp imla p aimal

i a cl.

Bt eu

I h la 1980, ica impac Miliay opai uba t-

ai (Mout) mphaiz h ai wap i m bilig

cl. Iiial aimal i hw ha h iai a a m

ag ha hi -il cpa a hw wha appa b

iiiv (g, ha aimal ah away m h xpliv, b i

a c, a mch m vly ij ha aimal cl h bla, balg a wall). th iig ma ha h xpliv chag wigh a h

iac, which ha b maiay chaacizig -il bla, w

lg ici ac ci.

Bla i cl, call cmplx xp, l amp

x pvi ijy a lhaliy clai. ev hgh h Bw

cv pvi a clai lhaliy i h il, i cl b ap-

pli cmplx wav. Alhgh h pak p w ab h am a

wl cc a h am iac m h am chag i h il, h

ai w mch lg bca h wav lci m h wall.

I h Bw cv w , hy wl pic lhaliy i big

cii. A hc chag w pp h iii ai i

a amp xplai h aa, b w aiacy.


28/74


29/74

sc-gai IjyMlig

th c gai ijy mlig x h igl-g--m ml pimay bla ijy h aa icly m h

Btd a aaiz h halh haza am pc. Al, ml

cay a iay iji w vlp. th cllabaiv wk

bw MoMrP a h Ji n-Lhal Wap Pgam (JnLWP)

pjcil impac ijy lhal wap l h vlpm

ml cap m impac ijy all pa h by ha

cl b a cay bla ijy. th cllabaiv wk b-

w MoMrP a h naial Highway taic say Amiiai(nHtsA) l ml ijy m whl-by impac ha cl b

vala iay bla ijy. Fially, a cpaiv pjc bw

MoMrP a h d ncla Agcy xpl h cmbi v-

p a hmal iji a h cllaal c cmpmi

imm ym.

inJUrY sftw, V 5.0 t 7.1

Pvi vi InJurY wa ha ci h laig m a

igl i h by cclly pic -il bla ijy. I h

il, h ijy i pimaily i h lb h bla i. Cmplx wav


30/74


xp, hwv, hw h impac laig m all i h

by a, cqly, h pahlgy hw ijy all lg gi. th

im h InJurY wa bi m h gwig mb aimal aa cllc wih Btd a h Bla t si.40

Tt Wk th lu

th i chag i InJurY wa wa cmp h maliz

wk m calclai wih h plal ac ml, ach

h Btd mam. th wk wa mm a cla wih vall

bv pahlgy. thi impl appach xplai h ijy , p-

cially h ica haza i c cl.

Wh-By l

th impac imla laig m all i h by l

ach ci m cmpl bimchaical cipi hacic

mi. th Lbll ml, vlp a Gal M Cpai

(di, Mich), i i h amiv iy chaaciz ch im-

pac a ha b caliba by caav i.41 th ml acc

h i ma ah, ca b ima whl-by

acclai m blaplica h yamic ciac laihip lag ch mai wih a cmbiai pig a amp. th

Lbll ml, hwv, i aamically ba; i chaaciz h ch

wih a qival ma, b a qival aa. F li-by impac,

ly h ch ma i ; b, bla wav ha a cib by a

p (c/aa), a ch aa m b aig.

t mi h civ aa h ch ac by a bla wav, a

ii lm ml h hax ba h naial Libay Mi-

ci (Bha, M) Viibl Hma Pjc aa wa vlp.42

thial ga w lv a paa aamical gi a maial.

Maial ppi h lg w ba ali, ablih ma-

m; h ha a a a liqi-ill ac; a h ib a ch wall

mcl cmbi i a igl maial wh laic ppi w lc

m aa i h lia. th ml wa valia h am impac

cii ha ha b caliba h Lbll ml, iclig bh

al a i impac.

th valia ii lm ml wa xami ig a i

which bla laig a lg pahlgy w kw i ail. th l-

ig pici ial p iibi clly mach h bv

pahlgy pa. th al maliz wk wa mi m h

calcla ch wall mi, which al ag wih h impl InJurY


31/74

second-generation injury modeling | 25

wa ima. Fially, h lly valia ml wa mi

h civ aa ha hl b acia wih h Lbll ml. th alaa p h bla cl b ivi i h pa ha i m by

h bla a h pa ha mv wih h i . th lig mii

Lbll ml (Fig 10) ag wih h m ail ii lm ml

wih pc ch cmpi, al maliz wk, a whl-by

mi. th plal ac ml wa plac by h mii Lbll

ml i h x gai InJurY wa.43

efft f Mut exuBa aimal aa availabl a h vlpm h i vi

InJurY wa, i wa bliv ha h wa cmlaiv ijy

h lg m bla (i, h lg wa ij i xp, i wa v

ij, ma hw may im h bla wa appli). A m aa w

cllc, i bcam cla ha h wa a cmlaiv c i lg ijy a

ha hi c wa ciical miig h ccpaial xp.

th aimal aa wa aalyz ig a ml i aig ac-

c cmlaiv amag. Mlipl lgiic gi, icpaig

h aig ac, w pc clai lvl lg

ci: (1) ivial (mall pchia), (2) ligh (l ha 5% h lg

ac aa c), (3) ma (l ha 30% aa c), a

(4) v (m ha 50% aa c).

Ae + Af= Ab

Af

Af

Ae M3

M1

K12

C12

M2

K23i

K23

C23

Kve23 Cve23

Figure 10. Modified Lobdell model.


32/74


33/74


34/74


h xpim vii gp 64 bjc pgig hgh h

xp maix. tha mb bjc wl allw a ima hpbabiliy ail a h 95% cic lvl. Ivaiably, m bjc

pp ach gp, caig h igiicac h l a pa-

icla xp cii p blw h ag cic lvl.52

Figure 12. Volunteers being exposed to simulated mortar blasts.


35/74


A ip aiical aalyi h vl aa wa cc

ig lgiic gi aaly.53 th bjc-xp w pl

i a pa-ail cm wih bla iiy, ai, a mb xp- a ip vaiabl. th lag mb aa gav h aalyi

ciabl aiical pw a l i a ima h ail ciia

wih a aw cic ba. rl hw ha h bv hhl

ail, a 25-B mpay hhl hi, i aly 10 B high ha

h c Miliay saa limi. I aii, h aalyi hw ha

h b clai bla ijy decreases wih ai, b i ci

wih aa h ik h ai xp, ch a il i.

tak gh, h ima hma hhl lac bh ai-

y a aiy bla iji a ga ha ha pvily iicai Miliay saa 1474. Fmal vii h Miliay saa

icpa ml-ba ciia bh aiy a aiy iji

a gig ciai api by h HHA Pgam.

sy Bt ijuy M

I ccpaial ig, pimay bla ijy i h ly cc. I cmba,wh bla a mch lag, bi ca b ppll a h li by h

bla a la impac ama cay bla ijy. MoMrP ha

vlp a bimchaical ml h impac ama ha ca b

vala hi haza.

I 1996, a iagcy cllabai wa mivlvig usAMrMC;

h Amam, rach, dvlpm, a egiig C (ArdeC);

h naial Ii Jic (Wahig, dC); a h us dpam

tapai (Wahig, dC) qaiy pjcil impac ijii m h chaaciic h pjcil (ma, vlciy, hap, a

cmpii) a h gi h by impac. th ach cllc

a viw all pvi i a mahmaical ml impac ijy

a lc h m cibl ha wl cib h wi ag

bl ama a paig iji. A wa pgam, h Iim

tal By Ml (ItBM; Jayc, Ic), wa vlp a iib

h pig gaizai.54

th ItBM wa p h chaacizai h impac

la m h pjcil. spcializ imai maig h

magi, ai, a x h c liv by h pjcil

wa vlp.55,56 A pcializ appaa wa vlp accla

vai pjcil a cll p h imai -


36/74


miai yamic ppi a h pcl aic ppi.

th cmbiai h ig appaa, pcl, a ml imai

bcam h aa lhal wap am.WrAIr cc wi mi ial iji m -

lhal pjcil impac. t cii cv a ijy pcm m

mil ki biig hgh-a-hgh hax pai.

sbq hi iiial wk, h Ji n-Lhal Wap dic-

a (JnLWd; Qaic, Va) wa m, a i 2005, a Mmam

Agm bw usAMrMC a JnLWP wa maliz ha

chlgy a c. u hi agm, ji ach ci

bl ama m pjcil ha icl ml vlpm, a

aimal a pmm hma bjc ig. thi ach bi bhgaizai by pviig amal bl ama ijy aa pp

usAMrMC li pci ach pgam a JnLWd lhal

wap am pgam.

thi pahip ha pc w bimchaically ba ml

a wi ag cay bla (impac) iji. A ii lm ml

ki p impac ha pc a ml pai ijy

ha ak i acc h ail aamical c a clhig.57 thi

ml ha b valia agai aimal i a h Ai Fc rachLabay (Bk Ciy Ba, tx) a hiical aa cllc m h

lia. similaly, a bimchaically ba cla ib ac ha b

vlp ha acc h ail aamical c a maial

ppi b.58 simila c-applicai ha ijy, kll ac,

a abmial ijy a big p. th ItBM, h Avac tal By

Ml (AtBM), a ivaiv applicai pvi h b imai

ijy m cay bla c.

Tty Bt ijuy M

th hi m ijy l m whl-by alai ca by h

bla p iial a bla wi. th c ca hl h by

il i ig bjc a ca bq iay iji. Alhgh

h iji ca l m bla, hy a iq bla a hav b

i i may h cicmac. I 1993, MoMrP bga a cllaba-

iv wih nHtsA (Wahig, dC) ha a ck ijih

m igiica iji ha cc m by impac. thi cllabai

ha pc ml cl-ha ijy a ha-ck ijy ha ca b

appli iay bla iji.


37/74


cmb ijuy M

Cmplicai xp cla xpli icl h llwig:

physicaltraumafromtheblastwave,

burntraumafromthermalradiation,and

disturbancetotheimmunesystemfromtheionizingradiation.

Bca h pibiliy pi a cay ici, c

imm ci i pcially ag wh i cc alg wih ijy

h g. I 1990, h d ncla Agcy, w h d tha

rci Agcy (F Blvi, Va), appach MoMrP ai-ac i iig a laihip bw bla a GI ijy ha cl b

a balil cqc. A pa h ji wk, Jayc

vlp mahmaical ml a a vial am h cla

balil hwig wh cmbi ijy c cl cc. I aii,

a cllla-ba ml h p h imm ym iizig

aiai wa vlp.59 thi ml icpa m cll yamic

a h iaci whi cll wih ppiic ici. th l

galiz h aa, mpiical p cv pvily i am ha cl y a wi ag xp a ivi.

c f th Bt Tt st

nw iial cmmii a Kila Ai Fc Ba bjc

h i m h bla, makig i icaigly iicl chl a

h Bla t si. Fhm, h cc bimchaical mlig iaig a picig bla ijy galy c h w

aimal i. Cqly, i 1998, h Bla t si i Albqq,

nw Mxic, wa cl.

Alhgh h igial qi ab bla ijy ha b aw,

aa ha ha b cllc m ha ca ach cl

v b pc. Wih hi alizai, Cll Kal Fil iii

maial iplacabl hiical val (g, h igial iviga

m i cc a Hihima) a hm aial libai.

oh maiig maial w hipp Jayc akpig.

u MoMrP pp, h bla aa a gig ig, caalg-

ig, a lcic pvai. Fig 13 pvi a xampl h aa

ha ca b iv m h aaba wih IIsYs wa (Jayc, Ic).


38/74


thi pc cially pp MoMrP gig bla ijy pgam,

iclig h im a xi InJurY wa, h im

HHA wa ccpaial xp, a i ijy m

hmbaic xpliv.

Figure 13. Example of blast injury data retrieved and displayed using IISYS software.


39/74

thi-gai IjyMlig

th hi gai ijy mlig xpa h aamical a phyi-lgical ilii h ijy pc. th ml ii lm aaly

cap h mchaical p h by bla ama, a high-

iliy, ymic imlai cap h phyilgical p ihal

xic ga. Fii lm ml allw pici gial ijy pa

a h c pciv clhig. Phyilgical ml x h c

bla icl ihalai ijy, icapaciai, a lay lhaliy.

Ft emt M

FeM i a mahmaical l vlp aalyzig giig c

ha i iig icaig applicai i bimchaic a ama am.

th appach bak h bjc b ii hi ca h hma by

i mall vlm lm. th lm cp pa i

i ga, a hy ca b igla i hap ha h aamy i

accaly p. Bca ach lm p pa a igl i-

, i mchaical ppi a ci im. each h lm

iac wih i ighbig lm hgh h cmm bai. A

lm mv a chag hap, h c a mi ( a

ai) a ami ighbig lm.


40/74


A imlai bgi wih applicai a xal laig, m h

bla vp a pjcil impac, a h calclai avac i

im h mi a ii h whl by a all i iallm. evy pa ach i xpic a ai a h

by p h xal la; wh h qaii xc h

maial gh h i h ga, amag cc. th pw

h FeM appach i ha, i picipl, i h aamy i aqaly

lv by gh lm, i h maial ppi ach i a

aqaly kw, a i h limiig /ai i kw, h ijy

m ay ama ca b pic.

each h apc (gmic a, maial ppi, a

ail limi) a ly impcly kw, hwv, FeM i ill vymch a a. Fi, h hma by i xmly cmplica, wih c-

vy cal w h cll; cqly, i i pibl

ga a cmpl aamical pai. Jgm m b

lv h aamical a ha a m impa h pc

big i. sc, alm bilgical i i ly hmg;

ah, i i ma p i cal lm ha mak h appa

maial ppi p h cal lm big . Agai,

jgm i lc maial ciiv lai a hipaam ha will cap h m lva p a h cal

i. Fially, m i, bca hi cmplx cmpi a,

hav impl ail a ai. th mchaim amag

ca b paial, cmlaiv, a mim l-ccig. Fhm,

h m impa amag i cial, ah ha cal,

ha impl mchaical ail i h ciical pi. F xampl,

p a bl vl ca ih la a mall bl l ha i l-

ccig i ca la a aal hmhag, wih ly a ligh ici h x h maial ail.

dpi h ciabl challg acig h applicai h gi-

ig ccp bilgical ym, pwl l hav b achiv

a, i im, may h iicli pvily will b vcm by

h ll ica i cmpaial pw.

Ft emt M Bt ijuy

o h i applicai FeM bla ijy wa h y

wav ppagai i h lg bla laig.30,60 thi wk wa

cc wh FeM wa wa i i iacy, b wa abl m-


41/74

third-generation injury modeling | 35

a h ciical a play by h lg iq maial pp-

i ccaig a iibig laig. th lg, bca i ha

h cmpibiliy ai b a iy 100 im ga ha ai, ha avy lw p ly ab 30 40 m/. Wh h ch wall

mv a a aci ha p (g, 10 m/), ciabl p

ca bil p a h i ac h hax wall. Wh h vlci-

i bcm ga ha 20 m/, h qival hck wav ca b

pc ha a vy civ. th iigh hlp gi h aly

InJurY wa ml.

th x applicai wa p h ympaic mmba.61 I hi

ca, h gmy h ac ga i a impl ha h pa

h by. th mchaical c h a ci h ympaicmmba, a i wll-kw gmy a maial ppi; h

icla chai, agai wih wll-kw gmy a ppi; a h

cchla ha, alhgh i ha cmplx ial c, ac ly a a lx-

ibl ba pp miig h la h a m. thi ml

wa abl pvi a bimchaical xplaai a a piciv ml

ympaic mmba p. I v xplai m h iq aig

pa i hi ki ijy.

th i applicai FeM h whl hax wa calibah Lbll ml ha wa cib pvily. th Lbll ml i a -

phyilgical ml hax p impliv laig. th ml

pcii a ma h m gi, b a aa. Bca bla wav

apply a p (c/aa) h by, i i cay mi h aa

ha cp h Lbll ml ma ha h ml ca b

cmp h ch mi. F hi pp, a FeM h hma hax

wa cc m h Viibl Hma Pjc aa . th aamical

ail wa qi limi, wih h ml ly lvig h ch wall, lg,ha, a iaphagm. Bca h a cmpi i, maial pp-

i w ima m cmpi h lyig i maial. th

ml wa caliba agai hma caav i ig impac ma.

Fm h imlai, h Lbll ml cl b ip i m

h phyilgical lm a, i paicla, h qival aa

laig mi. thi ml wa h y bla laig, a a

clai wa vlp ala p laig i c ha cl

b appli h ma i h Lbll ml. thi ky clai m h

bai h InJurY wa, vi 5.0 7.1.

th ji ach pgam bw MoMrP a nHtsA bla

a ca cah ijy pc a i ii lm ml h hma

kll ha w kll ac ijy ciia. H, h gmy


42/74


i laivly impl a ca b accaly mi by mical imagig.

Jayc vlp mahmaical amai pc FeM ml

h kll icly m imagig, iclig h li h cmpic h i a abl a h ipl.6264 th i p-

c bimchaically ba ha-ijy ciia ha cl b i h

amiv il ha impac agai ii vhicl c a

iay bla ijy. th am bimchaical ml a pic

cal kll ac ha ai m h ha hiig vy mall pi

h cay bla pjcil.65 th ml a al big y

h c ha pci66 a h cai a igl kll ac

cii all il. th ml a i h ItBM.

th xampl FeM applicai w vlp impv valia h impl ijy ml a clai. Bgiig i 2000,

MoMrP bga a pgam wih Jayc ml h bl ama ha

cc bhi by am wh h am p a high-p bll wih

FeM a h ial pc. th ml pc h aamy i a ga

ail ha pvily, a qi w mical imagy a w

mahmaical am aalyz, gm, a bil b lm. th

ml vlp hav b valia wih aimal i which mical

imagig i pc bjc-pciic ml ha a valia agaiim aimal .

saig i 2003, MoMrP a JnLWd mla a cllabaiv

ach pgam apply h high-iliy hacic p ml

h impac pjcil. th l i AtBM, which ii lm

imlai mi ib ac a lg ci ba pjcil-

pciic, bjc-pciic, a lcai-pciic cii. JnLWP AtBM

pvi h m acca ima lhal wap c. th am

ml ica h iliy imai cay bla ijy.I aii b bimchaical p, AtBM cmp h

ajcy a impac lcai pjcil, iclig h miai

impac lcai iivial i a cw. thi capabiliy, wh appli

cay bla ijy, allw cmpig h aiic bh ijy

lcai a iji aliic cmba cii.

inJUrY sftw, V 8

th la vi InJurY wa, la i 2005 m h MoMrP

Wb i, ic h aamical im (Fig 14). Acc

i ak h amal aamical ic bw hp (aw


43/74

third-generation injury modeling | 37

ch, wi i which h majiy h ijy aa hav b

mi) a hma (ba ch, aw i which h ml

i appli). I aii, by iai i acc by iigihig

h a back i h Lbll ml. thi gai h ml ha

b valia agai Bla t si aa ha hav b cally qaliy

chck, a h c a -yllw-g chaacizai h

laiv haza h bla xp.

Figure 14. INJURY software, version 8.2, used to estimate lung injury from blast exposure.


44/74


Tx g iht

I aii h mchaical bla iji, xpliv pc xic ga

ha, wh ihal, ca la iiai, icapaciai, ah. Bh

halh haza a vivabiliy am qi a ma ima h

pbabiliy h pi m xp ga ga by bla

h lig i.

th Liv Fi t Pgam (LFtP; dic opaial t a

evalai) i a us dpam d gaizai pibl

vig a valaig h vivabiliy us ym a vhicl m

my wap ym. I 1994, h LFtP ivi MoMrP paicipa

i h mlai hma c m my wap i i h aa bla a xic ga. MoMrP i a i pjc wih Jayc

vala xiig xic ga xp aa, iiy hcmig,

a ma impvm ha cl b ma i h a m

ai h LFtP. small aimal w cc ha highligh h

hcmig xiig aa.67 th pjc l i h aiway

bl chmiy ml ha wa xpa xic ga vivabiliy a-

m. thi wk iii ha h hcmig xiig aa

a m hi lack a phyilgical bai, bh cal l maimal hma a acc ciical phyilgical p.

Fllwig hi iiial valai, a vlp a ail phyi-

lgical ml h by p xic ga ihalai wa ak.

thi pc a i c bk ha viw a mmaiz

xiig ml a xpimal aa m which h ach ha

b pla. th i bk hi i viw all pvi ml,

mchaim, a am bilgical c ca by xic ga

ihalai.68

th all-xiig aam bk, p, a papw cllc i a c bk.69 th aa w igiiz a aalyz

vala c aa a iiy miig aa ha wl b

cc a phyilgically ba ml. th hi bk hi

i viw all cl--bahig ml, bca vilai wa h

mia phyilgical ac miig m pvi ml.70

th viw claly iii h lack kwlg vilai

chag ha cc ig xic ga ihalai; h, a xiv i

mall aimal hav b cc a WrAIr a a h Lvlac r-

piay rach Ii (Albqq, nM). th i vilai

c, cpl wih a cmpilai ha pvi aimal

icapaciai a lhaliy, pvi h bai vlpig phyilgically

ba ml.


45/74


46/74


Fhm, h chmical a phyilgical paam by h ml

m b ima m i vi i mam limi aimal ig.

th qaii gally hav lag vaiai i hi val a qi aymaic ma cm a igl, accp val. th mahmaical bai

PBPK ml, hi vaiai i applicai, h chiq ablih-

ig paam val, a h mh ipig a ig h l

a mmaiz i a cmphiv c bk.73 Alhgh PBPK ml

a i may apc phyilgy, ciabl lia xi j

halcab. n ly a h bac impa i-xigihig

applicai, b al may a z plig a a big limia

m glbal vimal a. th h mb pibl

cmp ha vay i impacpig hi vimalimpac, chmical cmpii, a/ pylyic c mak hi aa

xmly cmplx. th cmp a h PBPK ml ha hav b

vlp a hi bilgical c a ic i a c

c bk.74 Fially, ly a h chmical a bilgical impac

h bac cmplx, b al i h glai ha cl hi

a placm. Bca viig apppia i pci chm i a

cmp bla miigai, h glay lacap hi cmplx aa

i aalyz a mmaiz i a hi c bk.75PBPK ml icl a piay cmp ha mi h

am chmical ihal ig h xp. Bca h ml hav

b vlp a i im a by i ach, h i lil

cicy i h lci mal phyilgical paam, pcially

vilai. Fhm, all h ml am ha vilai i a-

c by h ga ihal a ig ay iaci i vilai ca by

ga mix. A PBPK ml (which cmm phyilgical paam)

ha b vlp ha ha b caliba agai all halcab aaavailabl i h lia. Fhm, hi ml ha b cpl h

tGAs vi 2.0 ml cibig vilai chag m chmical

a xci c. th cmbi ml ca aalyz m ha 30 ga

i cmbiai a i iga tGAs vi 2.0P.76

tGAs vi 1.0 2.0P acc vilai chag wih ac

ha vay wih h xal ccai h ga. th aimal i,

hwv, hw ha h vilai chag vay wih im i a cmplx

way. May h chag cc val mi i mall aimal,

cpig h im qi ciical bl chmiy chag

cc. Bca lag ic i h vilai--by ma ai b-

w mall aimal a hma, h c migh ak lg cc.

Bca m xic ga pp vilai, wha h hac i,


47/74


48/74


Bt efft Bh By am

A h us miliay i gag i ba a aymmic waa, li a

icaigly xp bla m miliay xpliv. I h Aghai-

a a Iaq clic, aly 65% all caali a m bla ijy.

Bca h cc ha balliic by am may hav m xpc

ampliyig c bla ijy, h naick sli C (naick, Ma)

ha am wih MoMrP mak a ciiic miai h c

by am bla ijy.

MoMrP i aiig hi i w ky aa. Fi, h ciabl

xpic WrAIr i aimal ha b appli aiig h naick

sli C cc aimal ha will pvi ha vic hc bla am a h lig ijy. th xpic Jayc

i big aalyz aa, iliz mahmaical ml ip

aimal l, a xapla h iig i hma. thi i pvi-

ig h valiai h InJurY wa ml, pcially i xm

vim wh lhaliy cc.

t pp am valai, a pcializ Btd ma h c

clhig a am i big vlp. thi w vic, cpl wih

a w i InJurY wa ml, will pvi h am mi h vlabiliy c pci ym.


49/74

Fh-gai IjyMlig

th h gai ijy mlig integrates mahmaical ml h mchaical p h by wih h cibig h phyilgical

a ymic p. th iga ml will pic phyical a

cgiiv pmac cqc, j pahlgical cm, a will

a cgiiv ijy ha cc hgh cay pc. th

ml a impa p wa a cmpl, qaiaiv aig

bilgical p all ama.

pfm et

Pvi mlig bla c ha c picig ijy a

lhaliy. Alhgh h a impa pi, hy chaaciz

h cmpl haza ca by bla h ll paial impac. A xp-

a l ha qi pc immia icapaciai a ah,

bla ca ga h phyical a mal pmac h waigh,

wih h cqc ha h may b abl accmplih h mii

pc a himl agai h lhal ha.

th gal h Phyical a Cgiiv Pmac Mlig Pjc

i vlp a valia mahmaical ml ha pic h p-

mac pi. th wk will cmbi h ii lm ml


50/74


chaaciz h phyical

amag bla ama wih

h dPM chaac-

iz h phyilgical c-

qc. th iga

ii lm ml ci ml ha cib h

ha, ck, hax, a

abmial gi (Fig

16). th dPM i

ima xyg livy a

icapaciai i hypxic

a xic ga xp7882

(Fig 17). Igai h w mlig ym

will pc a cmpl

cipi h phyical

a phyilgical p

bla ama.

ct nvu sytm ijuy

th pibiliy ha bla i pibl h amaic bai ijy (tBI)

bv i ig wa-igh ha bcm a i aial imp-

ac. simila cc xi i p a amiv ay. Bla-ic

tBI ivlv a cmplx a lly mchaical pahway ha

i i m ha c i civilia ig. th abiliy a h

magi hi ik, pv i ccc, a c a iag i may

b hac by a piciv mhlgy ha ca lik amaic v

maigl cgiiv ma a cliical cm. th Piciv

Ml h tBI pjc will c labay a cliical

gh h lik i h caal pah a mahmaical mlig i h

lik gh i a abl piciv mhlgy.

Figure 16. Integrated finite

element model of the head, neck,

thorax, and abdominal regions.


51/74

Fourth-generation injury modeling | 45

epimilgical aa m opai eig Fm/opaiIaqi Fm (oeF/oIF) a claig mil tBI bla. A c y

iica ha 59% bla-ij pai m oeF/oIF ami Wal

r Amy Mical C ha a la mil tBI.83 I ha y, aa w

pvi by d dbah Wa, dic h d a Va Bai

Ijy C, ba pai a Wal r Amy Mical C.

o h 450 pai wih bai iji a bw Jaay 2003 a

Fbay 2005, m bai iji w ca by Ied, a cl-bai

iji mb paig . I i bliv ha ca a likly -

p bca lack pmp iagi. Mil tBI a a igiica,

lg-m challg pai cvy a habiliai, pcially wh

h pma iabilii a ivlv, ch a l xmii ha

qi h pai la w kill. I ha al b bv ha mil

External TempClothing

Wind Velocity

ExternalO2, CO2

Altitude Activity

BodyTemp

BloodChemistry

O2, CO2 Conservation

Heat Conservation

Stroke VolHeart Rate

ArterialResistance

Cardiac Control

ArterialResistance Control

FrequencyDrive

Breathing Control

ShiveringSweating

Thermal Control

Blood FlowDistribution

Circulation

Air FlowDistribution

Ventilation

Figure 17. Schematic diagram of circulatory and respiratory systems in the Dynamic

Physiology Model. Temp: temperature; Vol: volume.


52/74


tBI m h c clic acc a lag ppi caali

ha i h c us wa.

exm ha ama m bl impac la maiv amag ahmhagig ha hav b i xivly. thhl high-ma,

lw-p impac ha ijy hav b ba i pahlgical bva-

i i pima a pmm hma bjc. Alhgh h hhl

a ba bimchaic a lgical mlig, hy hav v

h amiv ay . Mil tBI i w big i ig li,

a wll a i p, a ha a a m bl ijy mchaim, a m

bl cliical cm, a a mch lw hhl. thhl h

lw lvl iji will b vlp aily m pimilgical aa

al a a aily i i aimal ml. A ga aig h lyig mchaical pc will b qi. Fhm, bla

p aiial challg bca h pimay mchaim aci i

bl impac h ha, may ivlv h mchaical pahway, a

i a m api ha alm all pvi ha ijy ca.

cu lk f Tum-cu B ijuy

I i gally accp ha tBI i ca by lcal mchaical i

h bai ha ip al cll a i (pimay ijy), which, i ,la cial ipi hgh mablic a bichmical pc

(cay caca), lig i h cliically bv pychlgical

cqc. Alhgh h phyical, chmical, a lgical pc

a igly qaii, h i ampl vic ha h pimay iji

la h lgical cqc ha a i pai wih tBI.

Mchaically ca pimay ijy ha b bv i aimal m-

l bh impac a bla ama. I bla aimal ml, acy a

mic- glial p hav b ,84,85

a wll a chag i appicmchaim.86 Hilgical i hav c gaig i

h cbal cx a hippcamp a 1 a 5 ay a bla

xp.87,88 evic lacal a cial chag llwig

bla ama ha al b bv.88,89 Chmical alai laig

m a cgiiv yci llw i tBI i a.90,91 I ila

i , ijy cll lig m h applicai api mchaical

c ha b bv i hlial cll,92 i ax,9396 a i cical

acy a .97 evic i a a gla axal aciviy

ha al b bv.98 I aii i a ha-ic cllla

ijy, h i al vic cllla amag m ic p c.

Caviai, which ha b hw cc a ma ha acclai,

la lag lcal p (ha amph) p vap bbbl


53/74


cllap.99 thi mchaim ha b cim i lihipy i.100 d-

plymizai pil micbl ha b bv a vy high aic

p (680 am) a i la xp (lw-p ampli,b api lcai).

th bla-ic pimay mchaical amag cllla c a

a cay caca c, iclig i chal ipi, appi,

a ci. th cay pc la cial a mablic

yci ha a bvabl i avac magic ac imagig

(MrI). Qaiicai h lik bw bvabl miccpic amag

a MrI paam i h h lik i h piciv chai. obvai

cay bai ijy, i h m bichmical alai, ha b

bv i bla ijy.101104 M impaly, hwv, i i wll kwha cay ijy i a cmplx caca phyilgical v ca by

h ial mablic, bichmical, cilgical, a immlgical

alai iiia by pimay iji.105,106

th cay c a aily bvabl wih magic ac

pccpy (Mrs). Mrs i a pwl i viv mh c chmi-

cal wihi h bai ha a lva bai pc. th m wily

mh a 1H-Mrs a 31P-Mrs ha c cmp wih hyg

a phph. rc i hav hw ha h abl ccai ai ccai, paiclaly N-acyl apaa (nAA), cla

wih pychlgical , cgiiv yci, a aly ci a

lgiial chag.107 Mrs ha pvi cla wih h llwig:

cognitivedeclineintheagingbrain;108

cognitiveoutcomesinchildren;109

theWechslerMemoryScale;110,111

geneticallybasedWilliamssyndrome;112,113

a diseasessuchasbipolardisorder,114,115 Alzhim,116,117 a

chizphia.118

Mrs ha cla wih pamaic i (Ptsd) i cm-

ba va,119121 cmba va wih vic bichmical chag,122

pi wa,123 a pi wa.124 I m i, hwv,

pai wih Ptsd i c ily ai, mmy, la-

ig ,125 i hy hw lw lvl nAA.126 P Mrs al

ha m i.127133 Mrs imagig ha cla wih cial

ipc ma,134 Glagw ocm scal, a pychlgical

pmac.135


54/74


Bt Tumt B ijuy Mhm

oc mchaical hav ca pimay cllla ijy i h bai

i, bq bichmical, mablic, a lgical pc will

la cgiiv yci a av cliical cm. th iq

challg bla tBI i mi hw h xal (mchaical,

chmical, a lcical) ca by xp xpli ca a ampliy

h pimay cllla ijy. th Piciv Ml h tBI pjc will

bil h 25 ya bla ml xpic a l mi a qa-

iaiv cci. th llwig ci am h a a magi

h bla ha a likly b ivlv i bla tBI.

chtzt f Bt exu

Bla ijy i iiia by h mchaical laig h bla wav

h by, wih cay c h xic ga a lcmagic pl

la by h xpliv. th g bla wav which h i a high

pbabiliy vival hav a pak p ~20 am a a ai a

w millic. uig CFd a aa cmpil i h Bla ovp

daaba, h i aqa imai chaaciz bla ha ac by

Probability

ofLethality

1.0

0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0.0

Logistic regression for lethality

95% confidence bands

BOP data with 10 sample bin size

0.001 0.010 0.100 1.000

Figure 18. INJURY correlation of lethality. BOP: blast overpressure; Wtot: Wsum corrected

for the number of exposures.


55/74


us waigh a lc cii ha will b maigl labay

ivigai. Chaacizig h bla c i h i p i vlpig a

-- piciv ml.Ied ca pa a xpliv gy ag m h qival a w

p tnt (iil) i pip bmb ha p i

ck bmb. diac m h xpli h waigh ca al vay,

a h bla laig ca b amplii by lci ii cl. th

ag i yig tBI, hwv, a h xp ha will

hwi pc v ijy ah. th bimchaically ba

InJurY wa, hgh h miliay ima bla ijy

all lvl m ccpaial xp limi vivabiliy ima,136138 i

lc xp cii ha a i a maigl ag (Fig 18).Ba InJurY aaly a cim by h xiv bla vp

aa piy, i i ccl ha h g bla wav which h

i a high pbabiliy vival hav a pak p ab 20 am a a

ai a w millic.

pthwy f it dtub

Acclai h bai m ic bla laig h ha a g

bl i h bai m bla la h ca pc pxci, w pl, a mchaical a i h mal phyi-

lgical ag ha ca ca i a cllla amag. Fhm, m-

pay ipi xyg livy m immia lgical p

a lcical ipi cllla pc m h xpli-ga

lcmagic pl may h cmp h pimay iji. M-

lig h pahway i a ciical pa bilig a Piciv Ml a

igig pciv li.

Acceleration Effects. A bla wav avl a ~300 m/, i h ha/by i ac a aci a millic b h h. thi

iial p ca accla h ha, a imlai hw ha, a

h maximm vivabl pak val, h ha ca b accla p 300

g. Jayc ha mi ha h hhl mil tBI, ba p

ijy cci,139 i 50 g, ha ha acclai m bla i

caily a pial ijy pahway. Acclai al ic a hy-

aic p gai i h bai, wih a p ic qal h

acclai iy h bai hal h wih h bai. F a 300 g

acclai, h bai cl xpic gi cmpi a ga a 3

am h impac (cp) i. Acclai ga ha 80 g a capabl

lwig p i h bai a pi whi caviai cc h

ppi (ccp) i. Cllap h vap bbbl ca la lag


56/74


p i xc 1,000 am,116 which ca ca ciabl lcal am-

ag. thi phm ha b ma i ga ml a i

mahmaical imlai,140,141

a i h pimay ijy mchaimcaia i ha impac.140146 simlai h hw ha mall x

h kll ca x h caviai lag aa h bai.141 th bi-

mchaical FeM h ha pvi a way alaig xal laig

i i h bai i (Fig 19).

Vascular Surge. dii h hax a abm i bv

bla laig, aiig m h pc ai-caiig ga i h .

I h hax, h iwa mvig ch wall pc a cmpi wav i

h lg ha ly amag h lg i, b ca al x a cm-

piv c h ha. th applicai bla laig h abm

pc a ic cplig, hgh h abmial c, h iaphagm,

laig a pwa mi ha al x a c h haa bla

pch h g. Bh h pc ca la a g i bl lw.

Figure 19. Deformations of the skull coupled with head acceleration can

create regions of high stress concentration within the brain.


57/74


Bai ijy m bla

aimal ml, wh

ha w pcm h ic bla,100

migh b xplai by

hi mchaim. Fii

lm aalyi hw

ha a 20-am bla la-

ig agai h p-

c a mall, vlm-

ic g bl m

h ha ab 0.2mL a a l h la

ami h ha

hgh h lg; b i

al pc a 10-mL

g a a l la-

ig liv hgh h

abm (Fig 20).

Amig h maliibi bl

lw, ab 2 mL h

g will b liv

h bai. Wh hi

vlmic g ach

h bai, h

ica bl vlm

pc a bqp ica. sim-

lai ig h L-3/

Jayc ha ml ima ha a iacaial p aly 10 am

ca l. Cmbi wih h ica chig c pal by

am, hi mchaical pahway i big i i h pjc.

Mchaical ama ca by h bla wav, bla wi, c-

ay impac i m likly h pimay ca tBI. nhl, h a

axiliay c ha a acia wih xpliv ha cl agm

aggava h mchaical ijy.

Hypoxic Effects. I i cmmly bv ha aimal xp bla

ipi i vilai a caiac p 10 llwig bla

xp a ci h p ha pi may mi. I

Figure 20. Schematic diagram of mechanical response modelfor binding structures in neurological cells.


58/74


59/74


th ach pahip bw usAMrMC a nHtsA ha a-

vac ii lm ml h ha ha cmbi aamical gmy

wih h mchaical ppi h i giv a pwl calclail. thi pahip ha p a mb i i yamic h

i bai,155 i ppi,156161 a iivial cll.94,162 Bca

h availabiliy high-li aamy a yamic i ppi,

h abiliy mi lcal mchaical wihi h bai i wll

avac.

A i ca pa, h usAMrMC/MoMrP igh vlpig

amal mahmaical l a bla/ama ijy may allw

a i aial impac b a qickly, wih h pial

vlpig bh a ciiic aig a a agy pvia miigai.


60/74


61/74

smmay

F m ha 25 ya, MoMrP ha b a wl la i h y

bla-la ijy. thi ach ha pc iigh, aa, a piciv

ml ha aa hma xp, gi h ig pcivym, a allw qick p h qi ga i a apily

chagig bal vim.

th wk MoMrP ci a h w bla i h

21 cy. tgh wih i pa, MoMrP i achig ijy

h cal v ym; pci c by am m mg-

ig hmbaic wap; a pici pmac cm, bh

phyical a cgiiv, h bla a h ama.

th cii (ma ca b) mahmaical mlig a al c h aig aa; gi xpim; a

pjc aig cmplx, al-li cai h balil ha

l i a capabiliy ha i piv w challg. Fhm,

h abiliy imla bimchaical a phyilgical apc h by

amaic cicmac ca b appli i halh, ay,

a pmac li.


62/74


63/74

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