In mass-casualty incidents involving explosions, 3 concentric zones are identified:
Blast epicenter
Secondary perimeter
Blast periphery
In a blast epicenter (kill zone), most people are dead or mortally injured. In the secondary perimeter (critical casualty zone), there are more survivors, but many of them likely have multiple injuries. In the blast periphery (walking-wounded zone), most casualties have non–life-threatening injuries and psychological trauma.
An explosion creates a blast wave. An intense blast wave can tear tissue. A less intense blast can damage the eardrums, lungs, and abdomen. Blast waves also throw debris at very high speed that can injure any part of the body.
Symptoms of Blast Injuries
People who have sustained blast injury to the lungs may have shortness of breath, cough (including coughing up blood), chest pain, rapid breathing, and wheezing. People with an abdominal blast injury may have abdominal pain, nausea, vomiting, blood in their vomit, rectal pain, and testicular pain. Other blast injuries include blindness, deafness, spinal cord injury, or pain while walking. Some people may appear to have suffered a stroke or heart attack.
Diagnosis of Blast Injuries
Evaluation for multiple trauma (using imaging studies and electrocardiography)
People who have sustained a blast injury are evaluated for multiple trauma, including injury to the lungs and ears. Doctors try to identify any penetrating or crush injury. They do imaging studies and monitor people with electrocardiography.
Treatment of Blast Injuries
Oxygen and IV fluids
Treatment of specific injuries
People are given oxygen and fluids and are monitored for complications, such as air embolism, acute crush syndrome, and compartment syndrome (a limb-threatening condition caused by excessive swelling of injured muscles). Hyperbaric oxygen therapy may be given to people who develop deep tissue infections.
