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Blast Injury – Mechanisms and Casualty Considerations

Blast Injuries

Think blast injuries, and unfortunately in today’s political climate we’re most likely to think of terrorist bomb attacks.  However, blast injuries are sustained by many causes including industrial incidents and residential gas explosions.  Just this week there were reports of five injured in a Manchester gas explosion.

So what forces are involved in such explosions and what injury patterns should a responder expect to see in the casualties involved?



Mechanisms and Patterns of Injury

Primary Blast Injuries are caused by the blast itself.  Any pressure wave associated with the blast could cause damage to the body.  The pressure wave will produce injuries to air filled organs such as the ears and lungs, from a rapid compression of the air in the organ.  This can cause lung contusions and heamatomas or perforation of the bowel.  Primary blast injuries are more prevalent with higher mortality rates if the detonation occurs in a confined space.

Projectile debris created by a blast has the potential to cause Secondary Blast Injuries.  In a bombing situation, these projectiles may be components of the bomb itself.  Otherwise materials such as glass, shrapnel and wood splinters may cause penetrating or blunt injury as they are carried in very fast winds created by the blast (800 mph plus).

Tertiary Blast Injuries are caused by the blast wind throwing the casualty with force.  Various injuries can be sustained in this mechanism, including multiple fractures, amputations and impalement.

Finally, burns from associated fires or exploding hot gases are categorised as Quaternary Blast Injuries.  Building collapse may also cause crush injuries.  Environmental contamination, biological components or leaked chemicals may create further suffering immediately and potentially for some time following an explosion.


Special ConsiderationsFire Tape

Due to the nature of the mechanisms and forces involved in blasts, the responder may need to employ triaging skills to deal with multiple casualties.  A major incident may be declared and a local system protocol to deal with such an incident may be implemented.  Often such an incident will involve a multidisciplinary team including the Fire and Rescue Service, Hazardous Area Response Teams and Urban Search and Rescue Teams to name a few.

As with responding to any incident the responder’s welfare and safety comes above the treatment of any casualties.  This may mean standing off from the scene, awaiting the police, fire service or special medical and rescue teams to enter the scene and make it safe.

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