Association of MOS-Based Blast Exposure With Medical Outcomes

Abstract

The study of effects associated with human exposure to repeated low-level blast during training or operations of select military occupational specialties (MOS) challenges medical science because acute negative effects that might follow such exposures cannot be expected to be clear or prevalent. Any gross effects from such occupational blast exposure on health or performance should be expected to have been already identified and addressed by affected military units through changes to their standard training protocols. Instead, effects, if any, should be expected to be incremental in nature and to vary among individuals of different susceptibilities and exposure histories. Despite the challenge, occupational blast-associated effects in humans are emerging in ongoing research. The purpose of the present study was to examine medical records for evidence of blast-associated effects that may have clinical significance in current standard of care. We hypothesized that populations exposed to blast by virtue of their military occupation would have poorer global medical outcomes than cohorts less likely to have been occupationally exposed. Records from a population of 50,254 service members in MOSs with a high likelihood of occupational blast exposure were compared to records from a matched cohort of 50,254 service members in MOSs with a lower likelihood of occupational blast exposure. These two groups were compared in hospitalizations, outpatient visits, pharmacy, and disability ratings. The clearest finding was higher risk among blast-exposed MOSs for ambulatory encounters for tinnitus, with adjusted risk ratios of 1.19 (CI 1.03-1.37), 1.21 (CI 1.16-1.26), and 1.31 (CI 1.18-1.45) across career time points. Other hypothesized effects (i.e., neurological outcomes) were smaller and were associated with acute exposure. This study documents that service members in occupations that likely include repeated exposure to blast are at some increased risk for neurosensory conditions that present in medical evaluations. Other hypothesized risks from occupational exposure may manifest as symptomology not visible in the medical system or current standard of care. Separate studies, observational and epidemiological, are underway to evaluate further the potential for occupational risk, but the evidence presented here may indicate near-term opportunities to guide efforts to reduce neurosensory risk among exposed service members.

Hearing Loss and Irritability Reporting Without Vestibular Differences in Explosive Breaching Professionals

“…As such, the sample size for this study may limit the power of these results and should be interpreted with some caution. However, these findings are consistent with other recent work ( 18 , 19 ), though it should be noted that breachers did not report headaches at a higher rate. In addition, self-reported responses are subjective and can be influenced by motivation to be perceived by others as ill or injured, or actually being perceived as such.…”

Data_Sheet_1.DOCX

“…As such, the sample size for this study may limit the power of these results and should be interpreted with some caution. However, these findings are consistent with other recent work (18,19), though it should be noted that breachers did not report headaches at a higher rate. In addition, self-reported responses are subjective and can be influenced by motivation to be perceived by others as ill or injured, or actually being perceived as such.…”

Neurotrauma Biomarker Levels and Adverse Symptoms Among Military and Law Enforcement Personnel Exposed to Occupational Overpressure Without Diagnosed Traumatic Brain Injury

“… 6 , 7 Despite this variance, all of these scenarios generate repeated LLOP exposures, 8 and personnel affected report similar symptoms at a greater frequency than their nonexposed counterparts. 9 …”

“…6,7 Despite this variance, all of these scenarios generate repeated LLOP exposures, 8 and personnel affected report similar symptoms at a greater frequency than their nonexposed counterparts. 9 Understanding LLOP effects has become a health care priority, 10 yet injury responses or health status changes remain elusive. Repeated exposures are not known to be associated with clinically defined traumatic brain injury (TBI).…”