Gulf War and Health Volume 9: Long-Term Effects of Blast Exposures (2014) / Chapter Skim
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5 Recommendations
5 Recommendations
Pages 185-200
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From page 185... ...
RESEARCH RECOMMENDATIONS Because of the inadequacy of evidence on long-term consequences of blast, the committee relied heavily on the literature to assess the evidence on acute effects and on its own collective medical expertise to draw conclusions regarding the plausibility of long-term consequences. Some long-term effects are obvious and well-documented consequences of acute injuries, but others will require additional study.
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From page 186... ...
VA can begin to improve the diagnosis of and treatment for blast injuries, particularly health outcomes for which there is sufficient evidence of an association with exposure to blast, namely: • Sufficient evidence of a causal relationship between penetrating eye injuries resulting from exposure to blast and permanent blindness and visual impairment (visual acuity of 20/40 or worse)
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From page 187... ...
Because exposure to blast is likely to lead to polytrauma that may affect many organ systems both acutely and in the long term, VA should assess its ability to coordinate care of blast survivors who have several health conditions. VA should assess the adequacy of current approaches to management of multiple chronic conditions, such as rehabilitation, and of its long-term followup care in treating blast survivors.
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From page 188... ...
After completion of the military task, the information in the individual storage units would be downloaded onto computers on a military base and stored in a large database. Much of the technology for the sensors and data-storage system has been developed (for example, helmet cameras are commonly worn by service members in the field)
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From page 189... ...
Biomarkers of Blast Injury Identification of blast injuries in service members, particularly injuries that are not acutely severe and may go undetected for long periods, presents a major challenge in both clinical and research settings. The ability to define biomarkers of blast injury that could serve as surrogates for exposure
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From page 190... ...
The committee believes that biomarker research has the potential to advance the understanding of the biology of a wide range of complex diseases, including blast injury. Many of the available studies in this field focus on potential biomarkers associated with TBI.
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From page 191... ...
For prospective definition of biomarkers of the signature blast injury that could be applied in future assessments, the committee recommends two complementary prospective studies. In the first study, a small number of service members enrolled in the Breacher Training Course, which includes exposure to blast, would be studied in detail to measure and control for blast exposure objectively.
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From page 192... ...
Recommendation 5-5. The Department of Veterans Affairs should conduct research on acute and long-term consequences of blast injury involving all service members and veterans, not just users of the Veter ans Health Administration.
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From page 193... ...
The Department of Veterans Affairs should cre ate a database linking Department of Defense records (particularly records that identify blast-injured service members) to records in the Veterans Health Administration, active-duty military treatment facili ties, and TRICARE (the Department of Defense health care program)
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From page 194... ...
The Department of Defense should determine whether existing screening tests administered during the physical exam ination conducted on enlistment can be used to measure susceptibility to blast injury, and if additional screening tests might be helpful in determining whether a service member has an increased susceptibility to blast injury. In making the determination, the following questions should be considered: • Do some biologic markers predict an increased risk of long-term effects of blast injury?
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From page 195... ...
and other documents related to blast injuries. The Blasts and Explosions VA DOD General Guidance Pocket Guide (2004)
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From page 196... ...
Field Work Group, the Polytrauma Rehabilitation Center Family Care Collaborative, the DOD–VA Family Transition Task Force, the National Center for PTSD, the DOD Amputation Patient Care Program, and the Defense and Veterans Brain Injury Center. VA's Simulation Learning, Education and Research Network (SimLEARN)
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From page 197... ...
• Expand the focus of the Polytrauma and Blast-Related Injuries Quality Enhancement Research Initiative to include injuries other than TBI and PTSD. Blast injuries and rehabilitation after them should be viewed through a wide clinical lens.
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From page 198... ...
2011. Cerebrocerebellar hypometabo lism associated with repetitive blast exposure mild traumatic brain injury in 12 Iraq War veterans with persistent post-concussive symptoms.
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From page 199... ...
2009. Clinical Practice Guideline: Management of Concussion/Mild Traumatic Brain Injury.
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