![]() Other IEDs consist of an artillery round, homemade explosives (HME) concealed underground and initiated remotely by one of a number of commercial available electronic transmitting devices 3. As this penetrating device is created post detonation it is referred to as an explosively formed projectile or penetrator (EFP) 18. The IED can be aimed horizontally at specific crew members of a vehicle with devastating accuracy. On detonation the concave faces of the discs are forced inside out to form a molten hot projectile capable of penetrating armoured vehicles. The IED is remotely armed by mobile phone, and initiated when a vehicle breaks an infrared beam. A focused blast occurs when all of the kinetic energy is channelled along the path of least resistance, in the same way a bullet is propelled directly through a rifle barrel.Ī characteristic concealed IED employed by insurgents in Iraq consists of a camouflaged bank of 155mm artillery rounds (up to seven) 25 packed behind rows of conical copper discs. After an underwater detonation, the blast wave and sound are transmitted faster and further than a surface detonation 4, 12. Fifty were killed and seven hundred injured by improvised explosive devices (IEDs) placed on three trains and one bus 11. The world witnessed a diabolical example of multiple confined blasts in the July 2005 London bombings. The walls of a room, bus or train confine and reflect the blast wave, increasing the extent of injuries experienced by casualties trapped inside 4. ![]() The result is that casualties situated three metres from the blast are subjected to nine times more blast effect than casualties situated six metres from the blast 4.īlast waves are enhanced by environmental factors such as confined spaces, underwater detonation and focused detonation 4 18. as time and distance increase from detonation, blast wave energy decreases 4. The blast energy to time and distance relationship is inversely proportional, i.e. ![]() Casualties are likely to experience multiple blast effects and multi system injuries 17, 29 depending on: proximity to the epicentre of the explosion, protective equipment employed 6, whether the explosion occurred in a confined space and the size and shape of missiles energized by the blast 4, 18, 23. To summarize these effects primary is movement of air pressure, secondary is movement of projectiles, tertiary is movement of humans, and quaternary are miscellaneous injuries. Quaternary injuries are an assortment of miscellaneous insults encompassing respiratory compromise, thermal burns, and crush injuries 18, 23. Tertiary injuries are a consequence of blunt trauma, as humans are propelled into stationary objects, or along the ground 18 23. The velocity and irregular profile of blast missiles cause haemorrhage and localized crush injuries which are more extensive than gunshot wounds (GSWs) 16. Other missiles can be energized by the blast wind including rocks, dirt, bone fragments of other casualties, and clothing 17, 29. Projectiles can be incorporated into the design of the device such as: metal casing (classically termed ‘shrapnel’ after its 1784 inventor Major-General Henry Shrapnel 19), nails, nuts, bolts, or glass coated in faeces designed to maximize secondary infection 17, 29. Projectiles are driven indiscriminately from the detonation site into humans at up to 1800 metres per second 1, 2, 16, 17, 18, 23. Secondary injuries involve penetrating trauma. The peak physiological effect is experienced by air filled organs the middle ear, lungs and colon 10, 16, 18, 22, 23. Consequently it is referred to as barotrauma (literally ‘pressure injury’) 21. The abrupt pressure change stretches then contracts human tissue beyond normal limits. The blast wave quickly exerts blast overpressure (BOP) outwardly from the centre of the blast 4. Primary injuries are the consequence of the rapidly expanding blast wave which follows a detonation 2, 3, 10, 16, 17, 18, 23. The purpose of this paper is to outline emerging blast mechanisms of injury (MOI) directed against coalition troops in Iraq and Afghanistan, resultant patterns of injury (POI), and prehospital challenges which first responders encounter with this unique group of casualties.īlast injuries are categorized by mechanism into primary, secondary, tertiary and quaternary injuries 1-10, 17, 18, 23. Injury patterns have evolved as a direct result of developments in personal protective equipment and insurgent tactics techniques and procedures (TTPs) 8, 15, 17, 18. Explosions cause more military casualties (65.5%1), than any other combat mechanism of injury 1-9, 14, 16, 18. ![]()
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