WRAIR participates with NATO on guidelines for blast overpressure

Walter Reed Army Institute of Research:

"The Blast-Induced Neurotrauma branch, commonly called BINT, at the Walter Reed Army Institute of Research participated in a North Atlantic Treaty Organization working group in support of the new report “Guidelines to Mitigate Military Occupational Brain Health Risks from Repetitive Blast Exposure."

These guidelines, which are the result of an international effort involving 8 nations, identified practices and knowledge to minimize and mitigate the risk of brain health problems due to repeated blast exposure.

“The working group was formed because service members across the world experience similar issues from occupational exposure to blast,” said Dr. Walter Carr, research psychologist at BINT. “WRAIR has been researching the effects of blast exposure for more than 20 years, so we have lots of observations and data to contribute.”

BINT recently developed initial blast overpressure dose-response curves, models that describe the relationship between blast exposure during training and the potential health consequences that exposure could have. This work is the culmination of many years of rigorous research. In just the last 5 years, BINT has published more than 25 research papers and given more than 50 posters and presentations at conferences around the world.

“The dose-response curve was a key part of the new NATO guidelines,” explained Lt. Col. Matthew LoPresti, Director of the Blast Induced Neurotrauma branch. “WRAIR is a center of excellence for blast overpressure research. We were glad to participate in the working group and contribute our data and experience in developing the report.”

The report is broken into three main sections: Interim Exposure Guidelines, Operational Guidelines, and Research & Development Guidelines.

The first major component of the report is the interim exposure guidelines, which provide safety thresholds: numerical limits for the amount of pressure that an individual may be exposed to before certain brain health consequences are expected to occur. These thresholds are established for multiple types of measurements to make them useful across fields and training circumstances.

“The evidence supports the idea that help is needed,” said Dr. Carr. “It shouldn’t be the case that soldiers conduct routine training and experience disturbed sleep, hearing damage, or increased proteomic biomarkers of neurotrauma.”

The operational guidelines within the report provide flexible recommendations for any given country to develop a program that mitigates brain health risks from repetitive blast exposure. These recommendations are divided among four capabilities, each of which has multiple sub-capabilities, and are designed to be useful for any nation.

“The report is not intended for any one specific country or resource level,” said Dr. Carr. “The guidelines are highly flexible so that the effort can be adjusted based on a nation’s resources and availability.”

Further, the report also includes research and development guidelines, which identify important research areas and gaps that still exist in scientific understanding of effects from blast exposure.

“Blast injury is often misunderstood,” said Lt. Col. LoPresti. “It is frequently conflated with concussions more typically caused by head impacts, however recent results from our research indicate that the two injuries are distinct. We are excited to contribute our most recent findings to the new working group that continues the work of the original group.”

The new NATO working group, which WRAIR is also a collaborator on, began in June 2026. The group’s goal is to develop a research program that addresses the identified gaps in our knowledge of the brain health consequences of blast overpressure and implementation of mitigation practices that can be adopted by our allies and partners.

For more information on WRAIR’s blast dose-response curve, read this article: [https://www.dvidshub.net/news/553849/wrair-creates-dose-response-curve-predict-effects-blast-overpressure](https://www.dvidshub.net/news/553849/wrair-creates-dose-response-curve-predict-effects-blast-overpressure)

For more information on WRAIR’s Brain Induced Neurotrauma branch, visit the website: [https://wrair.health.mil/Biomedical-Research/Center-for-Military-Psychiatry-and-Neuroscience/Blast-Induced-Neurotrauma/](https://wrair.health.mil/Biomedical-Research/Center-for-Military-Psychiatry-and-Neuroscience/Blast-Induced-Neurotrauma/)"