he article Preparation for Terrorist Threats: Explosive Devices
provides an overview of what health professionals should know about blast terrorism.
Both blast trauma and conventional trauma have aspects of blunt, penetrating, burn, crush, and inhalational injuries. However, victims of a blast may suffer all of these injuries simultaneously, with additional injury caused by the blast wave itself. Tertiary injuries can also cause traumatic amputation. Although the vast majority of blast injury victims suffer from conventional injuries, lack of knowledge about primary blast injuries and failure to recognize a blast's effect on certain organs can result in additional morbidity and mortality.
Many mechanisms of injury are involved in blast injuries:
- Primary blast injury – Refers to tissue damage from the blast wave itself, specifically in areas with tissue-gas interfaces, such as the lungs, intestines, and tympanic membrane.
- Secondary injury – Refers to penetrating or blunt injury that results from the acceleration of shrapnel or debris. This is the most common type of injury because it does not require the victim to be near the point of detonation.
- Tertiary injury – Results from acceleration-deceleration forces imposed as the blast wind propels the victim. As the body is tumbled on a rigid surface, it suffers from blunt injury, in particular closed head injury, as well as penetrating injuries as it is accelerated over sharp debris.
- Flash and flame burn and inhalational and crush injuries – These injuries are incurred from fires and structural collapse.
Secondary and tertiary injury overlap significantly, and both are more common than primary blast injury. However, primary blast injuries are the most severe. The effects of the blast wave on structural elements and on human tissues cause complex combinations of injuries in blast victims. The principal factor that determines severity of injury is distance of the victim from the site of detonation. Injuries may also vary due to the victim's position with respect to incident waves and the degree of reflected shock waves to which the victim is exposed.
Treatment of blast trauma involves full integration of the regional emergency medical services (EMS) system and the regional trauma system, in accordance with plans developed in collaboration with regional public safety and emergency management agencies. Although most blast trauma is caused by explosive or incendiary agents, the possibility of other weapons of mass destruction (WMD), such as biological
, or nuclear weapons
, should always be considered.Text adapted from the Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians manual