From the Guidelines
Explosive injuries should be oriented by determining the direction of the blast wave and the position of the victim relative to the explosion, taking into account the severity of injuries such as penetrating injuries to head, neck, torso, and extremities proximal to elbow or knee, as outlined in the guidelines for field triage of injured patients 1. When assessing explosive injuries, it is crucial to identify the type and severity of injuries, including primary blast injuries caused by pressure waves, secondary injuries from flying debris, tertiary injuries from being thrown by the blast, and quaternary injuries such as burns and inhalation injuries. The following steps can be taken to orient explosive injuries:
- Identify entrance and exit wounds, as blast injuries typically cause more damage on the side facing the explosion
- Look for characteristic patterns of injury, including:
- Primary blast injuries affecting air-filled organs like lungs and ears
- Secondary injuries resulting from flying debris and showing penetrating trauma
- Tertiary injuries occurring when victims are thrown by the blast and showing blunt force trauma
- Quaternary injuries including burns and inhalation injuries
- Document the distribution of wounds, fragmentation patterns, and tissue damage to establish orientation It is also important to consider the guidelines for field triage of injured patients, which include anatomic criteria such as all penetrating injuries to head, neck, torso, and extremities proximal to elbow or knee, chest wall instability or deformity, and amputation proximal to wrist or ankle 1. Additionally, the positioning of the ill or injured person should be done with caution, avoiding movement if possible, especially if a pelvic or spine injury is suspected, and following the guidelines for first aid, which recommend moving the person to a safe location if the area is unsafe, or placing an unresponsive person in a lateral side-lying recovery position if breathing normally 1.
From the Research
Explosive Injury Orientation
- Explosions can cause complex and multiple forms of damage, leading to various types of injuries, including penetrating fragment wounds, blunt injuries, and thermal damage 2, 3.
- The orientation of explosive injuries can be influenced by the type of explosive device, the distance from the blast, and the presence of obstacles or barriers 2.
- Injuries from explosions can be dominated by penetrating fragment wounds, which can be life-threatening and require immediate medical attention 2, 4.
- The management of explosive injuries requires a comprehensive approach, including primary prevention, injury mitigation, and consequence management 2, 5.
- Medical professionals should be prepared to cope with explosion trauma, including complex injury patterns and multiple casualties, and should have the necessary experience and training to handle emergency situations 6, 3, 5.
- The immediate lifesaving management of explosive injuries may involve techniques such as compression tamponade, digital compression, and vessel ligation to control hemorrhage and prevent airway compromise 4, 5.
- In mass-casualty events, treatment may need to be focused on immediately life-threatening complications, and patients with bleeding into body cavities or from the trunk should be given priority in transport 5.