Unveiling the spectrum: Understanding directed energy weapon injuries and military health care implications

Directed energy weapons (DEWs) are emerging technologies that are transforming the modern battlespace. Despite their increasing presence, the associated injury patterns and health outcomes remain poorly understood. This review aims to consolidate existing knowledge on DEW-related injuries to assist military medical professionals in improving clinical care.

A scoping review was conducted in accordance with PRISMA-ScR guidelines and included peer-reviewed and grey literature from 1980 to Nov. 30, 2024. Databases searched included PubMed, MEDLINE, AccessMedicine (textbooks), the Cochrane Library, EMBASE, Google Scholar, and Military Legal Resources (U.S. Army JAG School). Studies that focused on chemical, acoustic, and electrical/electromagnetic weapons were excluded because of differing pathophysiology. Two independent reviewers performed screening and data extraction. Results were synthesized narratively.

Out of 200 identified studies, 33 met inclusion criteria. Most documented injuries involved thermal damage to skin, internal organs, and eyes. Notably, data were sparse on reproductive effects and the management of DEW injuries in polytrauma. Evidence suggests that DEWs may inflict central nervous system or deep tissue damage without external signs, potentially delaying diagnosis and treatment. Injury severity varied by energy type, anatomical target, and exposure duration.

DEWs introduce novel clinical challenges for military health care providers, with injury profiles that may not align with traditional trauma paradigms. Standard physical assessments may fail to detect certain injuries. Long-term health outcomes following DEW exposure are largely unknown. There is an urgent need to develop and validate clinical guidelines and treatment protocols as DEWs become increasingly integrated into military operations.