Blast injuries from Madrid terrorist bombing attacks on March 11, 2004

Abstract

Blast injuries after terrorist attacks are seen with increasing frequency worldwide. Thousands of victims were attended in the hospitals of Madrid, Spain, on March 11, 2004 after the bombing attacks against the commuter trains. Thirty-six patients were attended in our institution. Seventeen of them suffered from severe or life-threatening injuries, and 19 had mild injuries. The most common lesions were thoracic trauma and blast lung injury, acoustic trauma, and orbital and paranasal sinus fractures. Other findings were hepatic and splenic lacerations, and vertebral and limb fractures. Emergency radiology had an important role in the correct management of the victims. Prompt radiological diagnoses of these complex lesions are crucial to efficient treatment. Therefore, radiologists have to become familiar with the injury patterns and specific lesions caused by blast wave.

Evaluation of trauma patterns in blast injuries using multiple correspondence analysis

“…Gunshot and blast related injuries differ in cranial and postcranial element distinction as well as present a focused versus diffuse fracture pattern throughout the body. The results in this study concur with previously published studies that examine various contexts of blast injury [14,[18][19][20]. Variations in the observed patterns, with other literature on blast injuries, may be related to a difference in the context (such as combat versus civilian cases), geographical differences (open air or enclosed) as well the type of explosive material and its construction (such as improvised explosive devices linked with terrorism).…”

“…Fracture patterns varied between the two samples and is consistent with the current literature on both types of trauma [10,14,[18][19][20]27,28]. Gunshot injuries cluster in the cranial regions with blast-related injuries in the postcrania.…”

“…Enclosed blast injuries present with similar diffuse and broad patterns of injuries but with more fragmentation caused from secondary blast trauma, or shock waves. In the Oklahoma City bombing, 75% of the victims had extremity trauma [43]; whereas in the Madrid train bombings, the head and neck area was the most injured followed with the extremities [28,48,49]. The diffuse injury and fragmentation of the extremities in the Bosnian blast-injury cases were associated with a rocket-propelled grenade that had been launched into a closed environment; therefore the fracture patterns are expected to be more similar to an enclosed contexts rather than an open air context [45].…”

“…Other variables, such as whether the person is an open or enclosed environment can also influence the pattern of trauma [14][15][16][17]. For example, terrorist bombing events (occurring in both enclosed and open areas) typically result in a high prevalence of extremity injuries, particularly to the head and lower limbs [18][19][20].…”

Blast injury research models

“…1 -2%) [8], but higher percentages were reported for explosions in confined spaces (e.g. figures ranging from 63% to 94% of critically injured civilian survivors in the Madrid train bombings [9,10]). More recently, authors have quoted a report by Ramasamy et al [11] as evidence that the incidence of primary blast injury is very small (approx.…”