James Stone, MD, PhD, Helps NATO Develop Brain Health Guidelines

Adapted from an article by Eric Swensen.

James Stone, MD, PhD, professor of radiology and medical imaging, served on an international team to write NATO guidelines for protecting soldiers’ brains from blast exposures common in military combat and training.

Dr. Stone was one of two UVA faculty members who contributed to this work, joined by fellow UVA faculty member Matthew Panzer, PhD, a professor of mechanical and aerospace engineering at the UVA School of Engineering & Applied Science.

Research from Dr. Stone and colleagues over approximately 20 years has shown that frequent, low-level blast exposures from weapons or breaching – using explosives to enter buildings or other structures – can cause brain injuries and harmful changes in brain function over time.

“Our understanding of blast-related brain injury has changed dramatically over the past decade. We now recognize that it’s important to consider not only single blasts that cause immediate injuries, but also the cumulative effects of repeated low-level blast exposures,” Dr. Stone said. “These guidelines translate the best available evidence into practical recommendations that can help protect service members while helping to lay the foundation for a roadmap for the research that’s needed to mitigate the brain health effects of repeated blast exposure across NATO forces.”

The report blends guidelines that can be put in place now with a roadmap for where additional research is needed, all with the goal of reducing soldiers’ risk of suffering blast-related brain injuries.

• Blast interim exposure guidelines: These guidelines can be implemented immediately by NATO forces. They include limiting the maximum amount of blast “overpressure” – an air pressure shock wave – a soldier should experience in a single exposure.
• Operational guidelines: These recommendations focus on developing four key capabilities:
  • Monitoring blast exposures
  • Collecting health and performance data from soldiers
  • Analyzing the effects of blast exposures
  • Implementing strategies to manage soldiers’ brain health and mitigate risk
• Research and development guidelines: These guidelines highlight areas for future research, including identifying better ways to monitor blast exposures and determining the individual risk factors that shape how soldiers’ brains respond to – and are injured by – blasts.

“Our job as engineers is to understand how a blast wave interacts with the human body and use information to build better protective equipment, smarter training procedures, and define clear exposure limits,” Dr. Panzer said. “This report gives U.S. forces and our allies guidelines they can act on today, plus a roadmap for what is still needed to keep soldiers safer in the future.”

UVA is among the leading research organizations studying blast injury from both a medical and engineering perspective. The institution recently received a new blast simulator, a gift from United States military partners, which Drs. Stone and Panzer say will expand UVA’s capabilities to address several of the research gaps identified in the NATO report.