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A blast injury is an injury caused by being in close proximity to an explosion. These types of injuries are most commonly seen by military physicians, although they can also occur in civilian settings as a result of industrial accidents and acts of terrorism. Treatment of blast injuries can be complicated by a number of factors, not least of which is that there are often multiple victims, and trauma facilities can become overwhelmed by people seeking medical attention.
Blast injuries are caused by the pressure wave that occurs in the immediate aftermath of an explosion, as well as by shrapnel from the explosive device. People in confined spaces are more likely to be severely injured, and the bigger the explosion, the more severe the injuries. In massive explosions like nuclear detonations, instant death may occur for many victims in the immediate proximity of the bomb.
There are four different categories of blast injury. A primary blast injury is characterized by internal trauma such as pulmonary barotrauma or “blast lung,” neurological injuries caused by the slamming of the brain against the skull, ruptures of the intestines and other internal organs, ruptured ear drums, and damage to the globe of the eye. One serious concern with primary blast injuries is that externally, patients may look fine, leading first responders to think that a patient is not a major concern. Delayed treatment can lead to secondary injuries like brain damage as a result of oxygen deprivation, as well as death from internal bleeding.
Secondary blast injuries include external trauma caused by being struck with shrapnel. People with secondary blast injuries can also have internal injuries and it is important to avoid focusing exclusively on gruesome external trauma while ignoring the potential for internal injuries. Tertiary blast injuries occur when people are thrown by the explosion. People can be severely injured by being slammed against walls and pavements. Finally, miscellaneous or quaternary injuries include things like burns and crush injuries.
Treatment of blast injuries usually involves large teams of first responders at the site of the explosion who examine and triage patients before packaging them for transport to hospitals. Patients may require surgery as well as other medical interventions to treat a blast injury. Blast injury survivors are commonly in need of rehabilitation as they recover, and they must be monitored carefully for signs of brain injuries. Some traumatic brain injuries are not immediately apparent and may go unrecognized for hours or days.