What Do We Know About Blast Injuries: Speculating About the Boston Marathon Bombing
Posted Apr 15 2013 9:42pm
Remains of a low order device
The Disease Management Care Blog's thoughts and prayers go out to the Boston Marathon bombing victims and their families. Like all Americans, it hopes the death rate remains low and is confident that the survivors' recovery will be a credit to the world-class skill of the physicians and nurses staffing Boston's ERs, operating rooms and ICUs.
While it was digesting the horrific details, the DMCB was struck by the likelihood that the Afghan and Iraq wars as well as multiple terrorist attacks have enhanced our ability to deal with blast injuries.
What have we learned?
As outlined in this abstract , the initial explosion results in "primary" injury, fragment or shrapnel injuries are "secondary," being bodily thrown results in "tertiary" blunt injury while the burns and other trauma are "quaternary." It's difficult to survive a primary injury because the supersonic compressive air wave travels though the human body and "shears" any organ with an air/water interface, such the lung and intestines; that's also why ear drums rupture.
Unfortunately, the stress wave can also cause bone fractures and, if severe enough, "transosseous" amputation. The DMCB was dismayed by reports of some of the victims losing their limbs, which suggests the devices were large if "low-order" bombs. Amputations were common in the '05 London terror bombings because the victims were in close proximity to the devices and the blast waves were at ground level . Initial reports from Boston suggest the devices were placed in trash receptacles, which, if it turns out to be true, would fit the pattern.
Given the standard emergency triaging , the DMCB suspects the secondary, tertiary and quaternary victim counts are still being compiled. In addition, it will be some time before we understand the incidence of traumatic brain injuries and their associated symptoms of unbalance, hampered motor function, disordered vision, decreased communication and depression. The etiology and our ability to predict it remains a topic of research .