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Updated: Aug 7, 2026
A Test Bed to Examine Helmet Fit and Retention and Biomechanical Measures of Head and Neck Injury in Simulated Impact
Published on: September 21, 2017
A Hybrid Paradigm to Develop Head Injury Criteria for Behind Helmet Blunt Trauma
Narayan Yoganandan1, Tyler F Rooks1, Wade Mueller1
1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
Introduction:
The widely used head injury criterion (HIC) has improved human safety and vehicle design in automotive environments. Because of its application to civilians, tests that led to HIC were conducted without helmets. Studies focusing on military environments are sparse. Behind helmet blunt trauma (BHBT)-specific head injury criteria do not exist to the best knoweldge of the authors. The objective of this study is to present a focused literature review of military studies and a novel paradigm for developing enhanced BHBT medical injury criteria (EMIC) for assessing helmet performance and advancing combat and medical readiness of the Warfighter.
Materials And Methods:
The widely used PubMed database was accessed to identify articles for a systematic literature review ranging from its inception to August 30, 2025. The review focused on experimental head injury articles with a focus on tests pertinent to the replication of the injury and developing injury criteria.
Results:
The review identified literature involving different surrogates: The PubMed database query identified 390,032 and 102,390 articles for the key words "impact system" and "injury criteria". Using the key words "injury risk curve" and "blunt impact," the database returned 11,517 and 5,619 articles. "Blunt impact" and "injury risk curve" identified 31 articles, while "blunt impact" and "injury criteria" had 313 articles. BHBT-specific articles with biological surrogates were limited and discussed in the body of the paper. A reanalysis of post-mortem human subject surrogate (PMHS) test data was done to develop force and deflection injury risk curves. One paper in the database used a live animal model; however, brain injury and skull fracture outcomes were not presented.
Conclusions:
The literature review identified limited studies for BHBT-specific scenarios. Available PMHS test data are inadequate to develop robust region-specific injury criteria for skull fractures. A novel hybrid paradigm combining cadaveric human and animal, and live animal experimentation, and computational modeling is needed to develop human BHBT injury risk curves from which injury criteria can be specified for EMIC for Warfighter protection from skull fractures and brain injuries. The academic consortium from the present study authors is pursuing studies along these lines.
