Bomb Blast: Pattern and Nature of Injuries

Abstract

Bomb blast cause injury on large groups of people by multiple mechanisms. Bomb blast injuries differ from the conventional description of trauma complexity. Primary injuries are caused by blast wave and over pressure. Secondary injuries are caused by flying debris and cause shrapnel wounds. Tertiary injuries are caused by blast wind due to forceful impact and quaternary injuries are caused by other vectors like heat, radiation etc. Combined injuries, especially blast and burn injury or blast and crush injury, are common during an explosive event. Knowledge about nature of injuries is essential for medicolegal and postmortem reports. INTRODUCTION: Explosions and blasts occur accidently or deliberately. Accidently explosion and blasts arise out of negligence, poor maintenance of factory units or faulty operations. In recent times, bomb explosions and blasts are a casual daily event. No day passes by without reports of terrorist attacks and bomb blasts. The act of bombing is intentionally carried out act for political gains, aimed at civilians and executed by sub-national militant groups. The casualties arising out of blasts are large and victims face serious physical and psychologically repercussions. Minor blasts are deliberately set-off to create a state of fear among the public. Since, the art of making ammunition and executing attacks have become sophisticated and precise, the extent of injury is overwhelming. Explosives used for making explosives may be of high-order explosives or low-order explosives. The pattern of injury that occurs with bombs and explosions are unique and is never seen beyond the combat. 1 The nature of the injury may be blunt or penetrating and often affects multiorgan systems. 2 In addition, high-pressure air expanding from the detonation center also inflicts injuries. 3 A blast or explosion produces numerous casualties and injuries that present with unique triage, diagnostic, and management challenges to the emergency staff. SEVERITY OF BLAST INJURIES: The type of explosives used determines the severity of blast injuries and fatalness of the case. 4 Severity of injury is dependent on number of factors, which include: 1  Composition and amount of the explosive materials used.  The surrounding location of explosion.  The method of detonation and delivery of bomb.  The distance between the victim and the blast.  Any intervening protective barriers or environmental hazards. EXPLOSIVE MATERIALS AND DEVICES: Explosives may be of high-order explosives or loworder explosives. The former produce a supersonic over-pressurization shock wave and the latter produces subsonic explosion without the production of over-pressurization wave. Manufactured or improvised explosive weapons (explosive and incendiary bombs) are usually high-order explosives