Bombings and Blast Injuries: A Primer for Physicians

Conventional weapons and explosives continue to be the most commonly employed instruments of destruction by terrorists worldwide. Such attacks are occurring with increasing frequency and ferocity. The effects of bombings and blast injuries are both physically and psychologically devastating. Explosions combine four mechanisms of injury. In addition to these causes of injury and death, crush injury, entrapment, and compartment syndrome magnify the devastation of blast trauma. By recognizing the unique features of blast injuries and by prioritizing mass casualties to provide maximal benefit for the greatest number of patients, the physician will be better equipped to triage and stabilize these victims. Bombings and Blast Injuries: A Primer for Physicians Bombings and blasts have the potential to inflict multiple and devastating injuries to a large number of victims simultaneously and without warning. Because of the variety of circumstances involved in such an event (e.g., indoor vs. outdoor, size of the explosive charge, distance of victims from the explosion, presence of secondary debris and of biological or radiological contaminants, structural collapse), each bombing event is unique. Also unique to blasts is the range of potential physiological consequences to different human organs and organ systems, ranging from tympanic membrane rupture to impalement, and from burns to traumatic amputations. Worldwide, bombings are an increasingly effective and frequent terrorism tool. Explosions are the most common cause of casualties associated with terrorism.1-5 The 1995 Oklahoma City bombing, the 2004 Madrid train bombing, and the explosions of September 11, 2001, in New York City and Washington, DC, and the 2005 London subway bombings have demonstrated the capacity of bombings and blast injuries to kill and to terrify. According to Dennis C. Blair, Director of National Intelligence, “Conventional weapons and explosives will continue to be the most often used instruments of destruction in terrorist attacks.”6 While biological and chemical weapons are often mentioned and are much feared as terror tools, it is bombs that have actually produced the majority of injuries, deaths, and societal disruptions in the modern era.1 In addition to deliberately detonated explosions, there are also industrial accidental explosions that occur with regularity at factory and mining operations, in fuel transportation and storage, and in grain elevators. Because of the constant risk of civilian incidents and the increasing risk of terrorist attacks, health care providers must become familiar with the characteristics of explosives and of explosions and of the nature of the injuries they may inflict.