Such roles include indirect fires (artillery, mortar), explosive breaching, and antiarmor weapon operation.
The term “occupational blast exposure” is intended to denote repeated exposures to low-level explosive blast events that occur as part of training and operational activities experienced by personnel in designated roles in the military and law enforcement. Separate studies, observational and epidemiological, are underway to evaluate further the potential for occupational risk, but the evidence presented here may indicate near-term opportunities to guide efforts to reduce neurosensory risk among exposed service members. Other hypothesized risks from occupational exposure may manifest as symptomology not visible in the medical system or current standard of care. This study documents that service members in occupations that likely include repeated exposure to blast are at some increased risk for neurosensory conditions that present in medical evaluations. Other hypothesized effects (i.e., neurological outcomes) were smaller and were associated with acute exposure. The clearest finding was higher risk among blast-exposed MOSs for ambulatory encounters for tinnitus, with adjusted risk ratios of 1.19 (CI 1.03–1.37), 1.21 (CI 1.16–1.26), and 1.31 (CI 1.18–1.45) across career time points.
These two groups were compared in hospitalizations, outpatient visits, pharmacy, and disability ratings. Records from a population of 50,254 service members in MOSs with a high likelihood of occupational blast exposure were compared to records from a matched cohort of 50,254 service members in MOSs with a lower likelihood of occupational blast exposure. We hypothesized that populations exposed to blast by virtue of their military occupation would have poorer global medical outcomes than cohorts less likely to have been occupationally exposed. The purpose of the present study was to examine medical records for evidence of blast-associated effects that may have clinical significance in current standard of care. Despite the challenge, occupational blast-associated effects in humans are emerging in ongoing research. Instead, effects, if any, should be expected to be incremental in nature and to vary among individuals of different susceptibilities and exposure histories. Any gross effects from such occupational blast exposure on health or performance should be expected to have been already identified and addressed by affected military units through changes to their standard training protocols. The study of effects associated with human exposure to repeated low-level blast during training or operations of select military occupational specialties (MOS) challenges medical science because acute negative effects that might follow such exposures cannot be expected to be clear or prevalent.
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