1. Blast Injuries

2. Coffs Harbour Divisional Training
Blast injuries
A Blast can result from:
an explosion in the workplace (explosives or chemicals)
at home (a gas heater)
from fireworks
a result of terrorist attack.
19 November 2018
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3. Coffs Harbour Divisional Training
London terrorist attacks
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4. London terrorist attacks
Royal London Hospital admitted 194 patients to its accident and emergency (A&E) department
Patients presented with embedded foreign bodies, blast lung injury, mangled lower limbs and multiple severely contaminated fragment wounds – forcing surgeons to recommend amputation.
19 November 2018
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5. London terrorist attacks
surgeons performed 11 primary limb amputations in seven patients, nine limb fasciotomies, five laparotomies and one sternotomy.
Thirty-eight of the walking wounded patients (20%) presented with tympanic membrane ruptures, a primary marker for blast lung injury
19 November 2018
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6. London terrorist attacks
Removal of foreign material
Those patients who underwent removal of foreign or dead material returned to the operating theatre every 48 hours
The 48-hour [observation] usually revealed the wounds were still heavily contaminated,
A number of the patients had to go back to the theatre about five times before the wounds were deemed clean enough
19 November 2018
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Mechanism of Injury
The principle mechanism behind the injuries is the creation of tremendous kinetic energy over a short time.
There are four general types of injuries caused by an explosion:
19 November 2018
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Mechanism of Injury
direct blast injuries—primary injuries
injuries caused by flying objects accelerated by the explosion—secondary injuries
injuries sustained by the victim's movement—tertiary injuries
miscellaneous injuries caused by the explosion or the explosives
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10. Coffs Harbour Divisional Training
Types of explosives
There are two general types of explosives:
High-order
Low-order
Each type of explosive will create slightly different injury patterns
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11. High-order explosives
High-order explosives are chemicals with a very high rate of reaction.
These chemicals include nitroglycerin, dynamite, C-4, and a mixture of ammonium nitrate and fuel oil. +
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12. High-order explosives
On detonation, the chemical is converted into a gas at a very high temperature and pressure. +
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Overpressure
The intense rise in pressure or blast wave is often called "overpressure."
Typically, the pressure wave increases instantly and then quickly decays.
The amount of damage from the pressure wave depends on a number of variables
19 November 2018
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Overpressure
The increase in pressure can be so intense and abrupt that it shatters surrounding materials and structures.
With time and distance, the wave deteriorates until it becomes a mere sound wave.
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Overpressure
Damage or injuries to a person from a blast wave that engulfs the entire body will depend on the magnitude of the pressure spike and the duration of the pressure or force
19 November 2018
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16. Coffs Harbour Divisional Training
Low-order explosives
Low-order explosives are designed to burn, then relatively slowly release energy.
Often, these explosives are called "propellants" because they propel an object such as a bullet through a barrel.
Low-order explosives include pipe bombs, gunpowder, and Molotov cocktails
19 November 2018
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17. Primary blast injuries
Primary blast injuries result from the blast wave created by high-order explosions and have an overall incidence of 20 percent
Primary blast injuries commonly affect the ear, respiratory system, and gastrointestinal system.
The brain and cardiovascular system may also be affected
19 November 2018
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18. Coffs Harbour Divisional Training
The ear
In the ear, the eardrum typically ruptures, especially when the overpressure exceeds 5 psi.
With extremely high overpressures, the eardrum may be destroyed and the ossicles (bony structures) can be dislocated or fractured.
At lower pressures, the eardrum may bleed without rupture
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The ear
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20. Coffs Harbour Divisional Training
The ear
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Coffs Harbour Divisional Training

21. Secondary blast injuries
Secondary blast injuries are caused by debris propelled by the blast wind of the explosion, resulting in both penetrating and blunt trauma.
Individuals far from the scene of an explosion can be struck and injured by this debris.
For example, after the 1998 terrorist bombing of the U.S. Embassy in Nairobi, flying glass wounded victims up to 2 kilometers away
19 November 2018
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Secondary injuries produced by nuts and bolts packed with explosive.
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Signs & Symptoms
Coughing up frothy blood
Chest pain
Possible bleeding from ears
Possible fractures
Multiple soft tissue injuries
Shock
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25. Coffs Harbour Divisional Training
Management
Follow DRSABCD
Call 000 for an ambulance
Place casualty in comfortable position
Control bleeding
Care for wounds and burns
Immobilise fractures
Monitor breathing and other signs
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26. Coffs Harbour Divisional Training
Embedded objects
Glass or debris from a blast may penetrate through a casualty’s skin and embed in the tissues
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27. Coffs Harbour Divisional Training
Embedded objects
DO NOT try to remove it as it may be plugging the wound and restricting bleeding
DO NOT exert any pressure over the object
DO NOT try to cut the end of the object unless its size makes it unmanageable
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Management
Control bleeding by applying pressure to the surrounding areas but not on the object
Place padding around the object or place a ring pad over the object and a bandage
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Amputated parts
With any amputation the aim is to:
Minimise blood loss and shock
Preserve the amputated part because it may be possible to re-attach a finger, or limb by microsurgery.
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31. Coffs Harbour Divisional Training
Management
Follow DRSABCD
Call 000 for an ambulance
Apply direct pressure to the wound and raise the limb to control blood loss
Apply sterile dressing
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32. Coffs Harbour Divisional Training
Management
The amputated part
DO NOT wash or soak the amputated part
Wrap in gauze or material and place in a watertight container (plastic bag)
Place sealed container in cold water with ice added
Send to hospital with casualty
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33. Coffs Harbour Divisional Training
Questions
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