Table 1

Taxonomy of injuries from explosive devices adapted with permission from DoD Directive (DoDD) 6025.21E3

Taxonomy of blast injuries
PrimaryBlast overpressure (BOP) injury resulting in direct tissue damage from the shock wave coupling into the body
SecondaryInjury produced by primary fragments originating from the exploding device (preformed and natural (unformed) casing fragments and other projectiles deliberately introduced into the device to enhance the fragment threat); and secondary fragments, which are projectiles from the environment (debris, vehicular metal, etc.)
TertiaryDisplacement of the body or part of body by the BOP causing acceleration/deceleration to the body or its parts, which may subsequently strike hard objects causing typical blunt injury (translational injury), avulsion (separation) of limbs, stripping of soft tissues, skin speckling with explosive product residue and building structural collapse with crush and blunt injuries, and crush syndrome development
QuaternaryOther ‘explosive products’ effects—heat (radiant and convective), and toxic, toxidromes from fuel, metals etc.—causing burn and inhalation injury
QuinaryClinical consequences of ‘post detonation environmental contaminants’ including bacteria (deliberate and commensal, with or without sepsis), radiation (dirty bombs), tissue reactions to fuel, metals, etc.