Collective reviewThe Surgeon and Acts of Civilian Terrorism: Blast Injuries
Section snippets
Weapons of mass destructions
The Defense Against Weapons of Mass Destruction Act of 1996 defines a weapon of mass destruction (WMD) as any weapon or device that is intended or has the capability to cause death or serious bodily injury to a large number of people through the release, dissemination, or impact of toxic or poisonous chemicals or their precursors, disease-causing organisms or their biologic toxins, or radiation orWe love death. The US loves life. That is the big difference between us.
Osama bin Laden, 1998
Surgeon preparedness
A survey assessment of preparedness of surgeons for disaster management that was conducted by the Eastern Association for the Surgery of Trauma before the terrorist attacks on the World Trade Center and Pentagon on September 11, 2001, demonstrated that its membership of leading US trauma surgeons was not well prepared to respond to the health-care needs of mass casualties from biologic, chemical, nuclear, or blast disasters.7 These trauma surgeons were best prepared to manage blast injury, but
Weapons of opportunity
The attractiveness of explosives and incendiary devices is related to the ready and inexpensive availability of precursors for making bombs, the relative ease of learning how to make a destructive explosive device, and the potential opportunities for using preexisting commercial resources as explosive devices. This was exemplified by the events of September 11, with the use of airplanes as guided missiles operated by suicide bombers. Similar opportunities present themselves in the form of
Physics and biodynamics of blast injury
Blast injury is the physiologic and anatomic insult to the human body caused by the physical properties of an explosion. Molecules in air are constantly in a state of motion and impart intrinsic properties of pressure, temperature, and density, which are referred to as the state of the gas.9 When this state of the gas is disturbed from normal conditions, it can result in an escalation of molecular speed and an increase in the number of molecules occupying a defined space, causing the density,
Blast pathophysiology
Blast injury has been classified into four specific and distinct categories that reflect the mechanism of tissue injury and physical tissue damage that occur as a result of the blast phenomena: primary, secondary, tertiary, and quaternary blast injury.10, 17
Primary blast injury
This form of blast injury results from the deleterious effects of the blast wave passing through the body. A blast wave has two damaging components: the stress wave, which causes damage in relation to the wave’s peak of intensity, and the sheer wave, which is related to the peak velocity strain force of the initiating explosion.18 These waves have little or no effect on solid or fluid-filled organs, but have their major destructive potential in air-containing organs, most specifically at
Secondary and tertiary blast injury
This is by far the most common injury mechanism among blast survivors, so it is the most important to anticipate and to be prepared to treat. In general, management of secondary blast injury is typical of the contemporary management of trauma, although the complex multidimensional nature of these injuries, as described previously, makes them more challenging to treat. Secondary blast injury refers to the impact on a patient’s body of projectiles that are propelled forward from the pressure
Quaternary blast injury
Quaternary blast injury refers to the miscellaneous forms of injury resulting from byproducts of explosions, such as burns from the fireball and resulting fires that may accompany explosions, inhalation of dust particles by both casualties and first responders, chemical and radiologic exposure and contamination from “dirty bombs,” crush injury from falling or entrapping debris, and the effects of building collapse. It also refers to the special needs of the patient as a result of preexisting
Obstetric considerations
The fetus does not possess gas-filled structures, protecting it from this component of the primary blast wave. But recognizing that the primary blast wave is amplified threefold in an aqueous environment should prompt concern about potential maternal-fetal primary blast injury as a result of the amniotic fluid, which surrounds the fetus. In evaluation of the obstetric patient after blast injury, attention should be directed to sonographic examination of the gravid uterus to rule out uterine
Dirty bombs
By definition, “dirty bomb” can refer to any contaminant dispersed as a result of an explosion and falls under the category of quaternary forms of blast injury. Perhaps the most widely publicized dirty bombs are radiologic dispersal devices, which will release radiation without nuclear explosion. The blast effect of the radiologic dispersal device is limited to the explosive potential of the material being used to disperse the radionuclides. Their greatest impact is the fear and social
Acknowledgment
Members of the Ad Hoc Subcommittee on Disaster and Mass Casualty Management of the Committee on Trauma of the American College of Surgeons are:
Dennis Ashley, MD, FACS, John A Armstrong, MD, FACS, Palmer Q Bessey, MD, FACS, Christopher T Born, MD, FACS, Susan M Briggs, MD, FACS, Eileen Bulger, MD, FACS, Patty Byers, MD, FACS, Quirico Canario, MD, FACS, Philip Caropreso, MD, FACS, William Cioffi, MD, FACS, Gerald Demarest, MD, FACS, Jay Doucet, MD, FACS, David Evans, MD, FACS, Richard Fantus, MD,
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Cited by (27)
Imaging in paediatric blast injuries: musculoskeletal injuries in the Syrian Civil War
2022, Clinical RadiologyCitation Excerpt :Blast injuries are injuries caused by the combined effects of excessive pressure created by explosive weapons and accompanying secondary effects. The force of the excessive pressure itself is sufficient to cause injury, but blasts injuries can also occur due to shrapnel fragments, impact injuries after being thrown, or injuries after the collapse of buildings.1–4 Bomb blasts have the potential to cause life-threatening injuries to many people at the same time by affecting different organ systems.
Blast-Induced Traumatic Brain Injuries: Experience from the Deadliest Double Suicide Bombing Attack in Iraq
2021, World NeurosurgeryCitation Excerpt :Historically, injuries caused by blast, shrapnel, and explosives were the domain of military surgeons. However, these injuries have become increasingly common in civilian practice.3,4 Blast bombings are often directed at a large group of unsuspecting civilians, leading to mass-casualty events that overwhelm even the most sophisticated health care systems.
3D reconstructions of a controlled bus bombing
2018, Journal of Forensic Radiology and ImagingCitation Excerpt :In the recent years, the introduction of 3D technologies is changing the manner of documenting both the crime scene and victims. Surface scanners and photogrammetry have been proven very useful tools for 3D documentation of the scene and any other relevant evidence (building, vehicles, large and small objects) [24,25]. 3D technologies are very accurate and allow a permanent documentation of the scene that can be used during the investigations as well as in court to better visualize all the evidences in one single environment [37,38].
Blast injury prevalence in skeletal remains: Are there differences between Bosnian war samples and documented combat-related deaths?
2017, Science and JusticeCitation Excerpt :The injuries resemble ballistic injuries, with blunt or ballistic penetration injuries [13–15]. Tertiary injuries are characterised by the movement of the body and its subsequent impact on structures, resulting in blunt injuries [12,16–18], resembling falls from height or the impact of an object on a bone [19]. Quaternary blast injuries are those which do not fall into the previous categories, such as burns.
Evaluation of trauma patterns in blast injuries using multiple correspondence analysis
2016, Forensic Science InternationalSecuring the Emergency Department during Terrorism Incidents: Lessons Learned from the Boston Marathon Bombings
2019, Disaster Medicine and Public Health Preparedness
This review is a project of the Ad Hoc Subcommittee on Disaster and Mass Casualty Management of the Committee on Trauma of the American College of Surgeons. Members of this subcommittee are listed in the Acknowledgment.