Blast Injuries

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Why is this chapter important and what is the chance that an EMS provider will see injuries from a blast or explosion?

The frequency of blast injuries due to military conflict and terrorist activities has increased dramatically in the last 15 years. Injury patterns that used to be seen only in military conflicts are now being seen outside of these areas of conflict due to terrorist activities. Industrial accidents also frequently produce blast injuries that are indistinguishable from those caused by military ordnance. Transportation accidents involving trucks and railcars carrying flammable liquids are also a source of potential blasts that may be seen on any roadway and set of railroad tracks running through EMS service areas.

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How can an EMS service prepare to handle these kinds of injuries should an explosion happen?

We tend to act in emergency situations in the manner that we have trained for them, and preparing for disasters such as an explosion in the communities we serve is something for which we should all train. Boston EMS was able to respond very effectively to the events of April 2013 due to timely training covering very similar scenarios. All prehospital providers should be familiar with their departmental triage scheme for use in mass casualty events. Providers should also be aware of the capabilities of local hospitals and if hospitals have specialized capabilities for adult/pediatric trauma and/or burns. In a bombing or explosion, basic triage principles apply as they would in any mass casualty situation. Every provider should be familiar with the role or roles that may be expected of them to fill in the triage process.

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How do explosions cause injury to people and do all explosions cause the same types of injuries?

Explosives are broadly categorized into high order (HE) and low order (LE) types. HEs can be thought of as being detonated. Examples of HE include military explosives and dynamites. HEs need not be large. A military hand grenade is an HE. HEs are unique in that they cause an overpressurization wave, which results in unique types of injuries that the rescuer will encounter. These waves travel faster than the speed of sound.

In contrast, LEs are best thought of as deflagration or burning. Gunpowder and gasoline-based devices are LEs. LEs need not be small. Technically the 9/11 airplane attacks were LEs. These explosions are subsonic and generally cause burns, blunt trauma, and shrapnel/penetrating-type injuries.

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