Improvised Explosive Devices: Pathophysiology, Injury Profiles and Current Medical Management

Abstract

The improvised explosive device (IED), in all its forms, has become the most significant threat to troops operating in Afghanistan and Iraq. These devices range from rudimentary home made explosives to sophisticated weapon systems containing high-grade explosives. Within this broad definition they may be classified as roadside explosives and blast mines, explosive formed pojectile (EFP) devices and suicide bombings. Each of these groups causeinjury through a number of different mechanisms and can result in vastly different injury profiles. The "Global War on Terror" has meant that incidents which were previously exclusively seen in conflict areas, can occur anywhere, and clinicians who are involved in emergency trauma care may be required to manage casualties from similar terrorist attacks. An understanding of the types of devices and their pathophysiological effects is necessary to allow proper planning of mass casualty events and to allow appropriate management of the complex poly-trauma casualties they invariably cause. The aim of this review article is to firstly describe the physics and injury profile from these different devices and secondly to present the current clinical evidence that underpins their medical management.

In-vehicle extremity injuries from improvised explosive devices: current and future foci

“…Critically, injuries from IEDs are very different from those of gunshot wounds (figure 1). The soft tissue injury combined with considerable foreign debris often requires aggressive surgery [10]. In a single incident, an IED can cause multiple casualties, with devastating injuries requiring multidisciplinary intervention, subsequently placing a significant burden on field hospital surgical facilities.…”

“…Ambush of patrols and convoys with direct fire from small arms and rocket-propelled grenades, and indirect mortar fire of fixed positions have been characteristic of previous insurgency operations [4][5][6]. In contrast, the signature weapon of the conflicts in Iraq and Afghanistan has been the roadside bomb or improvised explosive device (IED) [7][8][9][10]. Critically, injuries from IEDs are very different from those of gunshot wounds (figure 1).…”

Shaping the military wound: issues surrounding the reconstruction of injured servicemen at the Royal Centre for Defence Medicine

“…Blast injuries are heterogeneous complex events and personnel sustain injuries that differ from civilian injuries by virtue of their distribution, the mechanism and the degree of contamination. Blast injuries are characterized as primary (caused by the effect of peak overpressure on tissues), secondary (caused by flying objects or fragments), tertiary (caused by bodily displacement) or quaternary (caused by explosion) [3]. This produces a heterogeneous mixture of sharp, blunt and penetrating trauma, which may affect the entire body and is of discontinuous distribution.…”

Lessons learned from the casualties of war: battlefield medicine and its implication for global trauma care

“…7 The burden of morbidity in conflict is, however, increasing. 8 The reason for this is two-fold; first, due to medical and logistical developments the lives of many more seriously injured soldiers are being saved, even those who have experienced injuries previously deemed 'unsurvivable'. 8 Second, there has been a shift in tactics used in most low-intensity modern conflicts, with greater emphasis on maiming soldiers rather than killing them, as this has a greater impact on enemy resources (Gawande, 2004).…”

“…8 The reason for this is two-fold; first, due to medical and logistical developments the lives of many more seriously injured soldiers are being saved, even those who have experienced injuries previously deemed 'unsurvivable'. 8 Second, there has been a shift in tactics used in most low-intensity modern conflicts, with greater emphasis on maiming soldiers rather than killing them, as this has a greater impact on enemy resources (Gawande, 2004). 40 In low-middle-income countries the rapidly evolving infrastructure and construction sector, as well as more roads, has meant trauma has become a leading cause of death in young people (0-24 years old).…”