Blast Injuries

Coffs Harbour Divisional Training Blast injuries A Blast can result from: an explosion in the workplace (explosives or chemicals) at home (a gas heater) from fireworks a result of terrorist attack. 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training London terrorist attacks 19 November 2018 Coffs Harbour Divisional Training

London terrorist attacks Royal London Hospital admitted 194 patients to its accident and emergency (A&E) department Patients presented with embedded foreign bodies, blast lung injury, mangled lower limbs and multiple severely contaminated fragment wounds – forcing surgeons to recommend amputation. 19 November 2018 Coffs Harbour Divisional Training

London terrorist attacks surgeons performed 11 primary limb amputations in seven patients, nine limb fasciotomies, five laparotomies and one sternotomy. Thirty-eight of the walking wounded patients (20%) presented with tympanic membrane ruptures, a primary marker for blast lung injury 19 November 2018 Coffs Harbour Divisional Training

London terrorist attacks Removal of foreign material Those patients who underwent removal of foreign or dead material returned to the operating theatre every 48 hours The 48-hour [observation] usually revealed the wounds were still heavily contaminated, A number of the patients had to go back to the theatre about five times before the wounds were deemed clean enough 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Mechanism of Injury The principle mechanism behind the injuries is the creation of tremendous kinetic energy over a short time. There are four general types of injuries caused by an explosion: 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Mechanism of Injury direct blast injuries—primary injuries injuries caused by flying objects accelerated by the explosion—secondary injuries injuries sustained by the victim's movement—tertiary injuries miscellaneous injuries caused by the explosion or the explosives 19 November 2018 Coffs Harbour Divisional Training

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Coffs Harbour Divisional Training Types of explosives There are two general types of explosives: High-order Low-order Each type of explosive will create slightly different injury patterns 19 November 2018 Coffs Harbour Divisional Training

High-order explosives High-order explosives are chemicals with a very high rate of reaction. These chemicals include nitroglycerin, dynamite, C-4, and a mixture of ammonium nitrate and fuel oil. + 19 November 2018 Coffs Harbour Divisional Training

High-order explosives On detonation, the chemical is converted into a gas at a very high temperature and pressure. + 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Overpressure The intense rise in pressure or blast wave is often called "overpressure." Typically, the pressure wave increases instantly and then quickly decays. The amount of damage from the pressure wave depends on a number of variables 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Overpressure The increase in pressure can be so intense and abrupt that it shatters surrounding materials and structures. With time and distance, the wave deteriorates until it becomes a mere sound wave. 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Overpressure Damage or injuries to a person from a blast wave that engulfs the entire body will depend on the magnitude of the pressure spike and the duration of the pressure or force 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Low-order explosives Low-order explosives are designed to burn, then relatively slowly release energy. Often, these explosives are called "propellants" because they propel an object such as a bullet through a barrel. Low-order explosives include pipe bombs, gunpowder, and Molotov cocktails 19 November 2018 Coffs Harbour Divisional Training

Primary blast injuries Primary blast injuries result from the blast wave created by high-order explosions and have an overall incidence of 20 percent Primary blast injuries commonly affect the ear, respiratory system, and gastrointestinal system. The brain and cardiovascular system may also be affected 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training The ear In the ear, the eardrum typically ruptures, especially when the overpressure exceeds 5 psi. With extremely high overpressures, the eardrum may be destroyed and the ossicles (bony structures) can be dislocated or fractured. At lower pressures, the eardrum may bleed without rupture 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training The ear 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training The ear 19 November 2018 Coffs Harbour Divisional Training

Secondary blast injuries Secondary blast injuries are caused by debris propelled by the blast wind of the explosion, resulting in both penetrating and blunt trauma. Individuals far from the scene of an explosion can be struck and injured by this debris. For example, after the 1998 terrorist bombing of the U.S. Embassy in Nairobi, flying glass wounded victims up to 2 kilometers away 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Secondary injuries produced by nuts and bolts packed with explosive. 19 November 2018 Coffs Harbour Divisional Training

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Coffs Harbour Divisional Training Signs & Symptoms Coughing up frothy blood Chest pain Possible bleeding from ears Possible fractures Multiple soft tissue injuries Shock 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Management Follow DRSABCD Call 000 for an ambulance Place casualty in comfortable position Control bleeding Care for wounds and burns Immobilise fractures Monitor breathing and other signs 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Embedded objects Glass or debris from a blast may penetrate through a casualty’s skin and embed in the tissues 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Embedded objects DO NOT try to remove it as it may be plugging the wound and restricting bleeding DO NOT exert any pressure over the object DO NOT try to cut the end of the object unless its size makes it unmanageable 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Management Control bleeding by applying pressure to the surrounding areas but not on the object Place padding around the object or place a ring pad over the object and a bandage 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Amputated parts With any amputation the aim is to: Minimise blood loss and shock Preserve the amputated part because it may be possible to re-attach a finger, or limb by microsurgery. 19 November 2018 Coffs Harbour Divisional Training

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Coffs Harbour Divisional Training Management Follow DRSABCD Call 000 for an ambulance Apply direct pressure to the wound and raise the limb to control blood loss Apply sterile dressing 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Management The amputated part DO NOT wash or soak the amputated part Wrap in gauze or material and place in a watertight container (plastic bag) Place sealed container in cold water with ice added Send to hospital with casualty 19 November 2018 Coffs Harbour Divisional Training

Coffs Harbour Divisional Training Questions 19 November 2018 Coffs Harbour Divisional Training