Blast injuries

Injuries that were rarely seen beyond the battlefield are slowly starting to show up in the civilian arena. With the ever increasing risks of terrorist attacks worldwide the potential for casualties related to explosions are also at risk of increasing. Yet in the UK few EMS providers have had experience in dealing with these types of injury

A blast injury occurs from the result of a direct or indirect exposure to an explosion. Blast injuries occur due to overpressure occurring as a result of the detonation of high explosives. These injuries are compounded when the explosion occurs in a confined space.

Classification

Blast injuries are divided into four classes: primary, secondary, tertiary, and quaternary.

Blast Lung Injury (BLI)

BLI is a major cause of morbidity and mortality for blast victims both at the scene and among initial survivors. The 'Blast' from an explosive device sends out a shock wave which impacts on the lungs and results in tearing, haemorrhage, contusion, and oedema which results in a ventilation/perfusion disassociation.

Possible Signs and Symptoms in the Absence of any Visible Injury

Note: Tympanic rupture was an indicator of Blast Lung Injury and this should be suspected, although the absence of tympanic injury DOES NOT exclude lung injury.

Injuries associated with early mortality are:
General Management Techniques

Recognition of specific hazards associated with a suspected terrorist bombing, such as secondary devices and structural instability.

A METHANE radio call to your dispatcher in the event of an explosion in a highly populated area

Consider HART/HEMs deployment

TRIAGE

TRIAGE

GO DR SHAVPU ‹C› ACBC

Administer high concentration of O2 (As per O2 Guidelines),  Assisted ventilations if needed (Positive pressure ventilation may increase the risk of alveolar rupture and air embolism in presence of Blast Lung Injury, BLI), Patient positioning. as much history as possible should be obtained. *Important historical information includes distance from the explosion; whether open, closed, or semiconfined space*  

Secondary survey  

Continually monitor patient condition 

Priority  ASHICE  

Smooth and rapid Time Critical journey to appropriate hospital facility (Major Trauma Unit or Trauma unit - Use local trauma decision trees to help your decision)

Professional handover to hospital staff

Other Reading

http://www.bt.cdc.gov/masscasualties/blastlunginjury_prehospital.asp

http://en.wikipedia.org/wiki/Blast_injury

http://en.wikipedia.org/wiki/Triage

http://www.sempermax.com/ied_injuries_145.html

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Question

  • Can Entonox be administered for chest injuries?