US Department of Defense
Advancing Blast Injury Research to Protect and Heal Those Who Serve

Nine-nation NATO Collaboration (HFM-234) Chaired by the PCO Director Releases Full Report on the Environmental Toxicology of Blast Exposures

Injuries secondary to explosive blast are a significant source of casualties in North Atlantic Treaty Organization (NATO) operational environments. Tremendous resources, therefore, have been invested in researching the spectrum of these injuries (see What is Blast Injury?). However, this spectrum is broad and as a result, knowledge gaps have arisen, particularly in a research atmosphere that too often fosters isolated achievements rather than comprehensive solutions. The nine nations comprising the NATO Human Factors and Medicine (HFM) Research Task Group (RTG) HFM-234 cooperatively framed the problem as one of "environmental toxicology," that is, understanding the consequences of any individual blast injury requires knowledge of the dose, mechanism of delivery, and dose-response endpoints.

Initiated in July of 2013, and chaired by the PCO director, Mr. Leggieri, NATO HFM-234 included members from the United States, Germany, Canada, United Kingdom, France, Estonia, the Netherlands, Sweden, and Norway, all of whom have various academic, military, and/or research affiliations. In December 2018, after several years, six international meetings, and long-distance collaboration, the full HFM-234 Report was released to the public according to schedule. This comprehensive report includes the four predetermined deliverables:

  1. A comprehensive Dictionary of Blast Injury Terms to foster harmonization of language across the various blast injury research organizations. This dictionary includes 170 terms, from "acoustic barotrauma" through "Yelverton Pathology Scoring System," complete with figures, detailed explanations, and references.
  2. Guidelines for Conducting Epidemiological Studies of Blast Injury outlined recommendations regarding study design, research planning, and bias minimization strategies, along with data collection forms created to capture demographic, health, medical, and injury experience data.
  3. Guidelines for Reproducing Blast Exposure in the Laboratory described commonly used blast-wave generation platforms and called for researchers to control and record various experimental parameters such as the blast method, blast source, ambient conditions, position/orientation of the specimen, and the relevance of chosen parameters to real-world environments.
  4. Guidelines for using Animal Models in Blast Injury Research recommended steps that all researchers should take when using animals in blast injury research. That is, researchers should attempt, as much as possible, to mimic components of human injuries, record and report mechanical and physiological parameters of their experiments, and use standard methods of blast induction unless special exceptions are necessary.

The HFM-234 RTG was a call for researchers to reconcile and optimize their experimental approaches to blast injury research such that questions regarding the mitigation, treatment and/or prevention of blast injuries can be answered collectively. It is to the credit of the nine NATO nations' collaborative efforts that all of the deliverables were completed, per the charter, and three were published as original articles in the Journal of the Royal Army Medical Corps.1-3

Indeed, this Report will guide future research to ensure that it is applicable and can be built upon by the larger blast injury research community. Ultimately, contributions made by the HFM-234 and others will improve the process of obtaining optimal solutions to address the needs of Service members and civilians.


1 Bieler D, Cernak I, Martineau L, et al. Guidelines for conducting epidemiological studies of blast injury. Journal of the Royal Army Medical Corps. 2018.

2 Watts S, Kirkman E, Bieler D, et al. Guidelines for using animal models in blast injury research. Journal of the Royal Army Medical Corps. 2018.

3 Josey T, Ouellet S, Bieler D, et al. Guidelines for reproducing blast exposures in the laboratory. Journal of the Royal Army Medical Corps. 2018.

Last modified: 03-Jan-2019