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Explosions and blast Injuries

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An explosion is a rapid increase in volume and release of energy in an extreme manner, usually with the generation of high temperatures and the release of gases.

  • Supersonic explosions created by high explosives are known as detonations and travel via supersonic shock waves.
  • Subsonic explosions are created by low explosives through a slower burning process known as deflagration.
  • As the risk of terrorist attacks increases in the U.S., disaster response personnel must understand the unique pathophysiology of injuries associated with explosions and must be prepared to assess and treat the people injured by them.
    • See: CDC Injury Prevention - Explosions and Blast Injuries, a Primer for Clinicians
      • Explosions can produce unique patterns of injury seldom seen outside combat. When they do occur, they have the potential to inflict multi-system life-threatening injuries on many persons simultaneously. The injury patterns following such events are a product of the composition and amount of the materials involved, the surrounding environment, delivery method (if a bomb), the distance between the victim and the blast, and any intervening protective barriers or environmental hazards.

A blast injury is a complex type of physical trauma resulting from direct or indirect exposure to an explosion. Blast injuries occur with the detonation of high-order explosives as well as the deflagration of low order explosives. These injuries are compounded when the explosion occurs in a confined space.

Blast injuries are divided into four classes: primary, secondary, tertiary, and quaternary.

  • Primary injuries are caused by blast overpressure waves, or shock waves
    • These are especially likely when a person is close to an exploding munition, such as a land mine.
    • The ears are most often affected by the overpressure, followed by the lungs and the hollow organs of the gastrointestinal tract.
    • In general, primary blast injuries are characterized by the absence of external injuries; thus internal injuries are frequently unrecognized and their severity underestimated.
    • Blast lung refers to severe pulmonary contusion, bleeding or swelling with damage to alveoli and blood vessels, or a combination of these. It is the most common cause of death among people who initially survive an explosion
  • Secondary injuries are caused by fragmentation and other objects propelled by the explosion.
    • These injuries may affect any part of the body and sometimes result in penetrating trauma with visible bleeding
    • At times the propelled object may become embedded in the body, obstructing the loss of blood to the outside. However, there may be extensive blood loss within the body cavities. Fragmentation wounds may be lethal and therefore many anti-personnel bombs are designed to generate fragments.
  • Tertiary injuries: Displacement of air by the explosion creates a blast wind that can throw victims against solid objects.
    • Tertiary injuries may present as some combination of blunt and penetrating trauma, including bone fractures and coup contre-coup injuries. Children are at particularly high risk of tertiary injury due to their relatively smaller body weight.
  • Quaternary injuries, or other miscellaneous named injuries, are all other injuries not included in the first three classes. These include flash burns, crush injuries, and respiratory injuries.
  • *Traumatic amputations quickly result in death, unless there are available skilled medical personnel or others with adequate training nearby who are able to quickly respond, with the ability for rapid ground or air medical evacuation to an appropriate facility in time, and with tourniquets (for compression of bleeding sites) and other needed equipment (standard, or improvised; sterile, or not) also available, to treat the injuries.
    • Whether survivable or not, they are often accompanied by significant other injuries. The rate of eye injury may depend on the type of blast.

Casualty estimates:

Explosions in confined spaces or which cause structural collapse usually produce more deaths and injuries. Confined spaces include mines, buildings and large vehicles.

Resources & Additional Reading: