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Blast Injuries EMS Providers Need To Understand

The use of explosive devices against civilian targets is one of the most common terrorist tactics. It is a severe terrorism threat that we face worldwide, and all EMS providers need to be aware of it. The kind of injures they may have to face and what emergencies may come up in such a case are vital to be mindful of.

There are four basic types of blast injuries that EMS providers need to understand.

Primary Blast Injuries

These injuries are caused by the supersonic over-pressurization blast wave. This wave is unique to HE explosives (High-order). Even when there is no prominent head or any other physical injury, there is always a chance of internal injuries.

When this over-pressurized wave strikes the body’s surface, a number of things can happen that an EMS provider should check for. The eardrum can be ruptured. There are chances of ocular rupture and concussion. It can cause pulmonary barotrauma, perforation of gas-filled structures like the gallbladder intestines can also happen.

This blast basically turns solid or liquid into gas instantly. It is not difficult to imagine the destruction it can cause. The human body is very strong, yet it is delicate, and that is its beauty. It is not made to bear such traumas and remain unscathed. EMS providers need to be well prepared for situations like this.

Secondary Blast Injuries

These injuries are often caused by Low-order blasts. The exothermic waves of these blasts are subsonic are not as powerful as the HE explosives. They may be unable to cause primary injuries, but they can cause injuries nonetheless.

Most of the injuries in such blasts are caused by flying debris, projectiles, and bomb fragments. They can cause penetrating and blunt traumas. When EMS providers document the damages caused by the pieces of an explosive device itself, they use the term ‘fragmentation’. It is also imperative to know about these documentation details since it can be used for investigation purposes.

Tertiary Blast Injuries

This type of injury results when a human body is thrown by the blast wind: many manifest fractures, brain injuries, and traumatic amputations.

These injuries can be severe in some cases and require quick decisions from the EMS providers. Honestly, no type of damage is easy to deal with when there is a blast because it becomes difficult to estimate the loss, and quick actions are required.

Quaternary Blast Injuries

Everything else not caused by primary, secondary, or tertiary injuries is a quaternary injury. It can be anything, including asthma, COPD exacerbations caused by the smoke, toxic fumes, or dust, crush wounds, burns, and angina.


There can be multi-dimensional injuries, and EMS responders need to be mindful of them when treating the blast victims. The challenging but vital task is to recognize the injuries even when the victim doesn’t appear severely injured. There can be potentially lethal internal injuries hidden. Internal damage is dangerous, and the victims need to be transported to the trauma centers.

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