Karin A. Rafaels

Pulmonary Injury Risk Assessment for Short-Duration Blasts

BACKGROUND Blast injuries are becoming more common in modern war and terrorist action. This increasing threat underscores the importance of understanding and evaluating blast effects. METHODS For this study, data on more than 2,550 large animal experiments were collected from more than 50 experimental studies on blast. From this dataset, over 1,100 large animal experiments were selected with positive phase overpressure durations of 30 milliseconds or less. A two variable nonlinear logistic regression was performed on the experimental data for threshold injury and lethality in terms of pressure and duration. The effects of mass, pressure, and duration scaling were all evaluated. RESULTS New injury risk assessment curves were analyzed for both incident and reflected pressure conditions. Position dependent injury risk curves were also analyzed and were found to be unnecessary, at least for prone and side on conditions. CONCLUSIONS The injury risk assessment showed good correlation to some of the existing injury assessments. It also showed good correspondence to a reported human case of blast exposure. Pressure scaling was analyzed to be unnecessary for these short duration exposures. Recommended injury assessments for various orientations relative to the incoming blast wave are included.

Survival Risk Assessment for Primary Blast Exposures to the Head

Many soldiers returning from the current conflicts in Iraq and Afghanistan have had at least one exposure to an explosive event and a significant number have symptoms consistent with traumatic brain injury. Although blast injury risk functions have been determined and validated for pulmonary injury, there is little information on the blast levels necessary to cause blast brain injury. Anesthetized male New Zealand White rabbits were exposed to varying levels of shock tube blast exposure focused on the head, while their thoraces were protected. The specimens were euthanized and evaluated when the blast resulted in respiratory arrest that was non-responsive to resuscitation or at 4?h post-exposure. Injury was evaluated by gross examination and histological evaluation. The fatality data from brain injury were then analyzed using Fishers exact test to determine a brain fatality risk function. Greater blast intensity was associated with post-blast apnea and the need for mechanical ventilation. Gross examination revealed multifocal subdural hemorrhages, most often near the brainstem, at more intense levels of exposure. Histological evaluation revealed subdural and subarachnoid hemorrhages in the non-responsive respiratory-arrested specimens. A fatality risk function from blast exposure to the head was determined for the rabbit specimens with an LD(50) at a peak overpressure of 750?kPa. Scaling techniques were used to predict injury risk at other blast overpressure/duration combinations. The fatality risk function showed that the blast level needed to cause fatality from an overpressure wave exposure to the head was greater than the peak overpressure needed to cause fatality from pulmonary injury. This risk function can be used to guide future research for blast brain injury by providing a realistic fatality risk to guide the design of protection or to evaluate injury.

Brain Injury Risk from Primary Blast

BACKGROUND Military service members are often exposed to at least one explosive event, and many blast-exposed veterans present with symptoms of traumatic brain injury. However, there is little information on the intensity and duration of blast necessary to cause brain injury. METHODS Varying intensity shock tube blasts were focused on the head of anesthetized ferrets, whose thorax and abdomen were protected. Injury evaluations included physiologic consequences, gross necropsy, and histologic diagnosis. The resulting apnea, meningeal bleeding, and fatality were analyzed using logistic regressions to determine injury risk functions. RESULTS Increasing severity of blast exposure demonstrated increasing apnea immediately after the blast. Gross necropsy revealed hemorrhages, frequently near the brain stem, at the highest blast intensities. Apnea, bleeding, and fatality risk functions from blast exposure to the head were determined for peak overpressure and positive-phase duration. The 50% risk of apnea and moderate hemorrhage were similar, whereas the 50% risk of mild hemorrhage was independent of duration and required lower overpressures (144 kPa). Another fatality risk function was determined with existing data for scaled positive-phase durations from 1 millisecond to 20 milliseconds. CONCLUSION The first primary blast brain injury risk assessments for mild and moderate/severe injuries in a gyrencephalic animal model were determined. The blast level needed to cause a mild/moderate brain injury may be similar to or less than that needed for pulmonary injury. The risk functions can be used in future research for blast brain injury by providing realistic injury risks to guide the design of protection or evaluate injury. (J Trauma Acute Care Surg. 2012;73: 895–901. Copyright

The temperature-dependent viscoelasticity of porcine lumbar spine ligaments.

Study Design. A uniaxial tensile loading study of 13 lumbar porcine ligaments under varying environmental temperature conditions. Objectives. To investigate a possible temperature dependence of the material behavior of porcine lumbar anterior longitudinal ligaments. Summary of Background Data. Temperature dependence of the mechanical material properties of ligament has not been conclusively established. Methods. The anterior longitudinal ligaments (ALLs) from domestic pigs (n = 5) were loaded in tension to 20% strain using a protocol that included fast ramp/hold and sinusoidal tests. These ligaments were tested at temperatures of 37.8°C, 29.4°C, 21.1°C, 12.8°C, and 4.4°C. The temperatures were controlled to within 0.6°C, and ligament hydration was maintained with a humidifier inside the test chamber and by spraying 0.9% saline onto the ligament. A viscoelastic model was used to characterize the force response of the ligaments. Results. The testing indicated that the ALL has strong temperature dependence. As temperature decreased, the peak forces increased for similar input peak strains and strain rates. The relaxation of the ligaments was similar at each temperature and showed only weak temperature dependence. Predicted behavior using the viscoelastic model compared well with the actual data (R2 values ranging from 0.89 to 0.99). A regression analysis performed on the viscoelastic model coefficients confirmed that relaxation coefficients were only weakly temperature dependent while the instantaneous elastic function coefficients were strongly temperature dependent. Conclusions. The experiment demonstrated that the viscoelastic mechanical response of the porcine ligament is dependent on the temperature at which it is tested; the force response of the ligament increased as the temperature decreased. This conclusion also applies to human ligaments owing to material and structural similarity. This result settles a controversy on the temperature dependence of ligament in the available literature. The ligament viscoelastic model shows a significant temperature dependence on the material properties; instantaneous elastic force was clearly temperature dependent while the relaxation response was only weakly temperature dependent. This result suggests that temperature dependence should be considered when testing ligaments and developing material models for in vivo force response, and further suggests that previously published material property values derived from room temperature testing may not adequately represent in vivo response. These findings have clinical relevance in the increased susceptibility of ligamentous injury in the cold and in assessing the mechanical behavior of cold extremities and extremities with limited vascular perfusion such as those of the elderly.

Primary Blast Survival and Injury Risk Assessment for Repeated Blast Exposures

Background: The widespread use of explosives by modern insurgents and terrorists has increased the potential frequency of blast exposure in soldiers and civilians. This growing threat highlights the importance of understanding and evaluating blast injury risk and the increase of injury risk from exposure to repeated blast effects. Methods: Data from more than 3,250 large animal experiments were collected from studies focusing on the effects of blast exposure. The current study uses 2,349 experiments from the data collection for analysis of the primary blast injury and survival risk for both long- and short-duration blasts, including the effects from repeated exposures. A piecewise linear logistic regression was performed on the data to develop survival and injury risk assessment curves. Results: New injury risk assessment curves uniting long- and short-duration blasts were developed for incident and reflected pressure measures and were used to evaluate the risk of injury based on blast overpressure, positive-phase duration, and the number of repeated exposures. The risk assessments were derived for three levels of injury severity: nonauditory, pulmonary, and fatality. The analysis showed a marked initial decrease in injury tolerance with each subsequent blast exposure. This effect decreases with increasing number of blast exposures. Conclusions: The new injury risk functions showed good agreement with the existing experimental data and provided a simplified model for primary blast injury risk. This model can be used to predict blast injury or fatality risk for single exposure and repeated exposure cases and has application in modern combat scenarios or in setting occupational health limits.

Pulmonary injury risk assessment for long-duration blasts: a meta-analysis

BACKGROUND Long-duration blasts are an increasing threat with the expanded use of thermobaric and other novel explosives. Other potential long-duration threats include large explosions from improvised explosive devices, weapons caches, and other explosives including nuclear explosives. However, there are very few long-duration pulmonary blast injury assessments, and use of short-duration exposure injury metrics is inappropriate as the injury mechanism for long-duration exposures is likely different from that of short-duration exposures. METHODS This study develops an injury model for long-duration (>10 milliseconds positive overpressure phase) blasts with sharp rising overpressures. For this study, data on more than 2,730 large animal experiments were collected from more than 55 experimental studies on blast. From this dataset, nearly 850 large animal experiments were selected with positive phase overpressure durations of 10 milliseconds or more. Various models were evaluated to determine the best fit of injury risk as a function of pressure and duration. A linear logistic regression was performed on the experimental data for threshold injury and lethality in terms of pressure and duration. The effects of mass, pressure, and duration scaling were all evaluated, and two goodness-of-fit indicators were used to assess the different models. RESULTS AND CONCLUSIONS New injury risk assessment curves were determined for both incident and reflected pressure conditions for reflecting surface and free-field exposures. Position dependent injury risk curves were also determined. The resulting curves are an improvement to existing assessments, because they use actual data to demonstrate theoretical assumptions on the injury risk.

A Methodology for Assessing Blast Protection in Explosive Ordnance Disposal Bomb Suits

To reduce human casualties associated with explosive ordnance disposal, a wide range of protective wear has been designed to shield against the blast effects of improvised explosive devices and munitions. In this study, 4 commercially available bomb suits, representing a range of materials and armor masses, were evaluated against 0.227 and 0.567 kg of spherical C-4 explosives to determine the level of protection offered to the head, neck, and thorax. A Hybrid III dummy, an instrumented human surrogate [1], was tested with and without protection from the 4 commercially available bomb suits. 20 tests with the dummy torso mounted to simulate a kneeling position were performed to confirm repeatability and robustness of the dummies, as well as to evaluate the 4 suits. Correlations between injury risk assessments based on past human or animal injury model data and various parameters such as bomb suit mass, projected area, and dummy coverage area were drawn.

Injuries of the head from backface deformation of ballistic protective helmets under ballistic impact.

Modern ballistic helmets defeat penetrating bullets by energy transfer from the projectile to the helmet, producing helmet deformation. This deformation may cause severe injuries without completely perforating the helmet, termed “behind armor blunt trauma” (BABT). As helmets become lighter, the likelihood of larger helmet backface deformation under ballistic impact increases. To characterize the potential for BABT, seven postmortem human head/neck specimens wearing a ballistic protective helmet were exposed to nonperforating impact, using a 9 mm, full metal jacket, 124 grain bullet with velocities of 400–460 m/s. An increasing trend of injury severity was observed, ranging from simple linear fractures to combinations of linear and depressed fractures. Overall, the ability to identify skull fractures resulting from BABT can be used in forensic investigations. Our results demonstrate a high risk of skull fracture due to BABT and necessitate the prevention of BABT as a design factor in future generations of protective gear.

Thoracic and lumbar spinal impact tolerance

INTRODUCTION Thoracolumbar injuries resulting from motor vehicle accidents, falls, and assaults have a high risk of morbidity and mortality. However, there are no biomechanically based standards that address this problem. METHODS This study used four cadaveric porcine specimens as a model for direct spinal impact injuries to humans to determine an appropriate injury tolerance value. The anthropometric parameters of these specimens are compared with values found in a large human cadaveric dataset. Each specimen was subjected to five impacts on the dorsal surface of the lower thorax and abdomen. RESULTS The injuries ranged from mild spinous process fractures to endplate fractures with anterior longitudinal ligament (ALL) transactions with a maximum AIS=3. The average peak reaction force for the thoracic failure tests was 4720+/-1340 N, and the average peak reaction force for the lumbar failure tests was 4650+/-1590 N. DISCUSSION When scaled to human values using anthropometric parameters determined in this study, the force at which there is a 50% risk of injury is 10,200+/-3900 N. This value favorably compares to that found in the existing literature on isolated vertebral segments. SUMMARY After demonstrating that the porcine model can be used as a spinal impact model for the human, the resulting injury risk value can be used in determining new standards for human injury risk or in guiding the design of safety equipment for the back.

Re-evaluating the Neck Injury Index (NII) Using Experimental PMHS Tests

Objective: The neck injury index, NII, developed in ISO 13232 (2005) as a testing and evaluation procedure for assessing the risk of injury to the AO/C1/C2 region of the cervical spine in motorcycle riders is reevaluated using an existing postmortem human subjects (PMHS) data set and resulting in a reformulated NII criterion applicable to PMHS tests. Methods: A recent series of 36 PMHS head/neck component tests was used to examine the risk of neck injury in frontal impacts and to assess the predictive capability of NII for impacts of various orientations. Using force and moment load cell PMHS experimental data, injury risk was assessed using NII evaluated with the ISO 13232-5 algorithms. Results: The injury risk predictions are compared with the injury outcomes from the head/neck PMHS. The NII criterion underestimated the injury incidence of the PMHS experimental group. The average predicted risk of injuries for the experimental injury tests based on NII across the MAIS levels was 0.7 percent, though there were 11 AIS 3+ injuries observed in the actual testing (30.6%). Using the experimental injury outcomes and the experimental force and moment time histories, the normalizing coefficients from NII are reevaluated to minimize the difference between NII risk assessment and the experimental injury outcome in the least squares (L2) basis. This reanalysis is compared with existing human and PMHS neck injury criteria. Conclusions: By reanalyzing the NII formulation using an existing PMHS injury data set with known forces and moments and known injury outcomes, a new NII PMHS is developed that uses PMHS loads to predict injury. This reformulation removes the dependency of the original NII formulation on the forces and moments from motorcyclist anthropomorphic test device (MATD) experiments and simulations yet retains the advantages of the multi-axial neck injury criterion.