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Building bombed by a fertilizer bomb
Blast injuries present unique triage, diagnostic, and management challenges as a consequence of the blast wave itself. This is referred to as primary blast injury (PBI). Blasts produce a pressure wave that moves out from the center of the explosion at supersonic speed. Primary blast injury is due solely to the direct effect of the pressure wave on the body. The magnitude of the wave depends on the size of the explosion and the environment in which it occurs: the more powerful the blast, the greater the damage. The effects of the blast wave are increased in a closed space such as a building or bus and underwater. Primary blast injury occurs almost exclusively in gas-containing organs: the ear, the respiratory tract, and the GI tract.
Other blast injuries include Secondary Blast Injuries: those injuries caused by flying debris caused by the blast. In many terrorist bombings, casualties have multiple penetrating wounds caused by shrapnel deliberately put into the bomb to cause extensive injuries. Tertiary Blast Injuries are by propulsion of the body by the shock wave into solid objects. Head, spine and extremity injuries are common.
Finally, Quaternary or Miscellaneous Blast Injuries are other sequelae of the blast, often including crush injury and crush syndrome resulting from the collapse of a building or other structure. Other injuries include burns and inhalation injuries.
ATS has served as the Lead TIIDE agency for the development of a Blast Injuries Monograph and 17 Blast Fact Sheets that provide just-in-time teaching for clinicians dealing with the sequelae of blasts and bombings.