Chapter 30. Blast and gunshot injuries
Injuries to blast and gunshot are becoming increasingly common in modern Western society.
Basic rules for blast and bomb incidents
• Do not become a casualty yourself. Do not approach the scene until it has been declared safe – risks of secondary explosions, fire and building collapse are high
• Do not disturb or remove objects found in the environment – they may have forensic or other non-medical implications
• Do not disturb obviously dead victims or move body parts
• If there are multiple victims, triage will be necessary so that those most in need are identified, assessed and resuscitated first. This will normally be coordinated by an ambulance incident officer (in liaison with a medical incident officer)
• Care for multiple victims involves teamwork and it may be necessary to summon medical teams to the site – particularly if entrapment of victims is a feature.
Basic rules for gunshot incidents
• Do not become a casualty yourself. Do not approach the scene until it has been declared safe by the police, preferably by a firearms unit
• The management of the gunshot victim follows exactly the same <C>ABC system as any other trauma patient.
Physical effects of an explosion
A front of high pressure or shock wave is formed which travels through the surrounding environment with a velocity greater than the speed of sound in air.
Behind the shock front is an area of turbulence defined as the dynamic pressure or blast wind.
The magnitude of an explosion is determined to a large degree by the type and quantity of explosive used as well as the environment – whether the explosion occurs in an open space or is confined inside a building.
Other features are the flash from the explosion, the risk of fires developing and the collapse of buildings.
Mechanisms of bomb injury
• Blast shock wave
• Blast wind
• Fragmentation
• Crush
• Burn
• Psychological.
Biological effects of blast
Primary effects
Primary effects result from exposure of the body to the overpressure associated with the shock wave. The most notable effects are in areas of the body where there are air-fluid interfaces:
Ear
The tympanic membrane or eardrum is very susceptible and injury is common but unpredictable. The ear must be correctly aligned to the shock wave for injury to occur.
Abdomen
Injuries range from mild contusion of bowel wall to areas of perforation with faecal spillage and subsequent peritonitis.
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