Blast injury

(Redirected from Blast injuries)


  • Primary blast wave increased in closed space - detonation in corner has potential to increase blast yield to 8x
  • Recent enhanced-blast weapons (EBW) disperses gas before explosion - larger blast wave with lower pressure amplitude that diffuses around corners

Spalling Effect

Due to blast pressure forces, injuries are to organs with air-fluid interfaces (spalling effect)

  • TMs
  • Alveoli
  • GI tract

Situational Examples

  • Military - young healthy soldiers with body armor reducing thoracic/abdominal injuries but significant groin and lower extremity injuries
  • Civilian - children to elderly, higher rates of penetrating thoracic/abdominal injury

Injury Classifications

Blast Type Injury Cause Injuries Example
Primary Direct effect from shockwave Sheer and stress forces TM rupture, Ocular Injury, concussion, blast lung
Secondary Impact of fragments Penetrating trauma, amps, lacs
Tertiary Blast propels body or large object into body Crush injury and blunt trauma Similar to MVC: Fractures, Pneumothorax, Hemopneumothorax
Quaternary Environmental Burns, Toxins, Weather
Quinary Bodily absorption of contaminates Hypermetabolic state

Effects based on blast pressure[1]

Potential Injury Pressure (PSI) Structural Effects
Loss of balance/temporary ear damage 0.5-3 psi Glass shatters; facade fails
Slight chance of eardrum rupture 5-6 psi Cinderblock shatters; steel structures fail; containers collapse; utility poles fail
50% chance of eardrum rupture 15 psi Structural failure of typical construction
Lung collapse/damage 30 psi Reinforced construction failure
Fatal injuries 100 + psi* Structural failure

Clinical Features




Infectious Disease

  • Transmission of disease due to penetrating trauma is rare but possible with HIV, HCV, HBV


Markers of severe blast injury

  • > 10% TBSA burn
  • Skull, facial fracture
  • Penetrating injury to head or thorax
  • Traumatic amputations

Differential Diagnosis

Mass casualty incident


CXR with large right sided hemothorax (and widened mediastinum).


  • Chest tube for significant hemothorax and/or pneumothorax
  • pRBCs and FFP in 1:1 ratio with platelets for hemodynamically unstable patients
  • TM rupture - initial treatment supportive and enough for 75% with spontaneous healing; operative repair may be necessary for others
  • Operative exploration for peritonitis
  • Air embolus (rare) - isolate air in apex of LV by placing patient in left decubitus, head down, feet up position


  • Ambulatory patient with normal TM evaluation at low risk for occult blast injury - discharge with precautions
  • All others require admission

See Also


  1. Terrorism Handbook for Operational Responders by Armando Bevalacqua and Richard Stilp (1998) and the Department of the Navy EODB 60 A-1-1-4 (2001) “Table A-1