The victim is ultimately propelled and encounters a stationary object such as a wall, which leads to direct, blunt trauma. Energy from the explosive wave is transferred into the objects that then act as either high-energy or low-energy missiles.Ī tertiary blast injury occurs when the victim becomes displaced due to the pressure wave. Some IEDs can be specifically enhanced with objects such as nails, metal ball bearings, or screws with the specific goal to cause a secondary blast injury and inflict as much trauma as possible. Secondary blast injury results in penetrating trauma by bomb fragments and other projectiles. Blast lung injury (BLI) will be discussed below. Hollow viscous organs such as tympanic membranes, the lungs, and the gastrointestinal organs are at particular risk in this specific type of blast injury. Ī primary blast injury is a type of barotrauma, which results from the interaction of a blast wave with the body. Upon contact with a target, a significant amount of kinetic energy is dispersed which ultimately leads to the injury patterns described below. Examples of high-energy explosives include material such as TNT, C4, Semtex, nitroglycerin, dynamite, and ammonia nitrate fuel oil, while materials like gunpowder and petroleum are examples of substances that cause low-energy explosions. The explosion created by an IED can be classified into high-energy, which creates a supersonic high-pressure blast wave or low-energy explosion which creates a subsonic explosion without a blast wave. This ultimately causes the solid or liquid explosive material to be converted to a gas, which rapidly expands, releasing a large amount of energy. Explosions occur due to an exothermic reaction that is generated when chemical bonds are disrupted. Issues of Concernīlast injuries are the classification of injuries that can be sustained by explosives, and to fully comprehend these injuries, practitioners must first understand the physics behind an explosion. In fact, Kluger states that “ombing and explosions directed against innocent civilians have become the primary instrument of global terror…” It is of great importance that medical personnel be aware of the threat of terrorist-related IED attacks so that the appropriate steps can be taken if such an event were to occur. While the IED is considered one of the greatest threats to troops operating in Afghanistan during the War on Terror, they are not exclusively confined to the battlefield as civilian-targeted terrorist attacks like those mentioned above are becoming more commonplace. The United States Department of Defense defines IEDs as “devices placed or fabricated in an improvised manner incorporating destructive, lethal, noxious, pyrotechnic or incendiary chemicals, designed to destroy, disfigure, distract or harass…” Explosive-related injuries were once thought to be related solely to combat medicine. The focus of this paper will be improvised explosive devices (IEDs). The various types of weapons of mass destruction (WMDs) can be remembered by the acronym CBRNE which stands for chemical, biological, radiological, nuclear, and explosive weapons. Events such as the Boston Marathon bombing and the Manchester attack are reminders that terrorist attacks are of great concern to the general public.
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