Mechanisms of Blast Injury
Type | Mechanism | Typical Injuries |
|---|---|---|
Primary* | Impact of supersonic blast wave on body Preferentially affects hollow or gas-filled structures | Pulmonary barotrauma (blast lung) Tympanic membrane rupture and middle ear damage Abdominal hemorrhage and intestinal perforation Eyeball rupture Mild traumatic brain injury (concussion) |
Secondary | Impact of debris from blast onto body | Penetrating or blunt injuries Eye penetration (evident or occult) |
Tertiary | Impact of body thrown by blast onto environmental surfaces or debris | Fractures and traumatic amputations Closed and open brain injury |
Quaternary | Processes independent of primary, secondary, or tertiary blast injury (eg, burns, toxic inhalation, crush injury from entrapment under debris, aggravation of medical disorders) | Crush injuries with rhabdomyolysis and compartment syndrome Respiratory tract injury from inhaled toxicants Asthma, angina, or myocardial infarction triggered by the event |
Quinary† | Injuries resulting from toxic materials absorbed by the body from the blast and post detonation environment (eg, radiological, biological substances) | Radiation burns or acute radiation sickness (see also Biological Agents as Weapons and Toxins as Mass Casualty Weapons for specific symptoms) |
* Mayorga MA. The pathology of primary blast overpressure injury. Toxicology. 1997;121(1):17-28. doi:10.1016/s0300-483x(97)03652-4 † Kluger Y, Nimrod A, Biderman P, Mayo A, Sorkin P. The quinary pattern of blast injury. J Emergency Management. 2006;4(1):51-55. | ||