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EXPLOSION AND BLAST INJURIES Mechanisms of Injury

EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

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Page 1: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

EXPLOSION AND BLAST INJURIESMechanisms of Injury

Page 2: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Outline

• Injury definitions• Bomb‐Injury threat model• Agent• Host• Environment• Specific examples• Review

Page 3: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

• Video clip TNT

Page 4: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Injury definitions

• Primary:  blast wave

• Secondary:  projectile fragments

• Tertiary:  contact with objects (blunt)

• Quaternary: burns and toxins

Page 5: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE
Page 6: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Bomb Size & weight

Explosive choicePurpose & SourceDelivery system

AdulterantsTactic

Human Age, sex, & weight

Fitness, PPENutrition, health

Access to care

Open Space, Confined Space,Structural Collapse

Reflecting or Shielding surfacesBuilding and non-structural debris

Air and liquid hazards

Bomb‐Injury Threat Model

Lee-Davis

Page 7: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Agent

500lbs bomb rigged as IED

Page 8: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Anti‐Tank Mine encased in concrete and command detonated via remote control

Artillery shells rigged as IEDs

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Page 10: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Explosives

• Chemical compound that is able to release stored energy in the form of rapidly expanding gases– High Order Explosives (HE)

• TNT, ammonium nitrate fuel oil, C‐4• Blast wave• Primary blast injury

– Low Order Explosive (LE)• Propellants (black powder, pyrotechnics)• No blast wave• Rare primary blast injury

Page 11: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

High explosives

• Stored energy is released rapidly• Detonation• Examples: TNT and dynamite

Page 12: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

PRESSURE

TIME(microseconds)

PEAK OVERPRESSURE

POSITIVE PHASE OVERPRESSURE DURATION

0 ATMZeroAtmosphere Pressure

Horrocks, CL. Blast Injuries: Biophysics, Pathophysiology and Mnaagement Principles.

Idealized blast overpressure waveformseen only in high‐order explosives (HE)

NEGATIVE PHASE

VACUUMZero ATM

Detonation

Page 13: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE
Page 14: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE
Page 15: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

• Nuclear video

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Low explosives

• Stored energy is released slowly• Combustion or deflagration• Examples: gun powder, fuel• No blast wave or overpressurization• Injury results from:

– Thermal burns, – Ballistic (shrapnel)– Suffocation (fumes and toxins)

Page 17: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Host

• Age• Sex• Height• Medical history• Access to care

Page 18: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Environment 

• Open space• Enclosed or confined space• Structural collapse• Underwater

Page 19: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Open space

• Potential for shrapnel to travel a large distance (>100 m)

• Less primary blast injuries

Page 20: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Enclosed space

• Increased mortality• Increased blast pressure• Complicated rescue 

Page 21: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Structural collapse

• Increased mortality from primary blast wave as well as from tertiary and quaternary injuries

• Crush syndrome 

Page 22: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Who is this?

Page 23: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Where is this?

Page 24: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE
Page 25: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

High explosives

• Stored energy is released rapidly• Detonation• Examples: TNT and dynamite, and ANFO!

Page 26: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE
Page 27: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE
Page 28: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE
Page 29: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE
Page 30: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE
Page 31: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Review

• Blasts occur from various causes, including intentional causes

• High explosives detonate• Low explosives combust or deflagrate

Page 32: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Review

• High explosive blasts cause a supersonic blast wave, which is a pressure wave that travels ahead of the other effects (heat and fragments) and causes PRIMARY blast injury.

Page 33: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Review

• Both High and low order explosions cause fragmentation and penetrating injury, known as SECONDARY injury

Page 34: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Review

• Both high and low order explosions can throw people into objects, throw objects into people, or cause structural collapse, causing TERTIARY injury 

Page 35: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Review

• Explosions cause heat injury (burns) and create toxic products (carbon monoxide, cyanide, etc) that cause QUATERNARY injury

Page 36: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Review

• The pattern of injury is predictable given knowledge of:– Agent– Host– Environment

Page 37: EXPLOSION AND BLAST INJURIES - Georgia Poison Center · Bomb Size & weight Explosive choice Purpose & Source Delivery system Adulterants Tactic Human Age, sex, & weight Fitness, PPE

Questions or comments?