Blast injuries present unique triage, diagnostic, and management challenges as a consequence of the blast wave itself. This is referred to as primary blast injury (PBI). Blasts produce a pressure wave that moves out from the center of the explosion at supersonic speed. Primary blast injury is due solely to the direct effect of the pressure wave on the body. The magnitude of the wave depends on the size of the explosion and the environment in which it occurs: the more powerful the blast, the greater the damage. The effects of the blast wave are increased in a closed space such as a building or bus and underwater. Primary blast injury occurs almost exclusively in gas-containing organs: the ear, the respiratory tract, and the GI tract.

Other blast injuries include Secondary Blast Injuries: those injuries caused by flying debris caused by the blast. In many terrorist bombings, casualties have multiple penetrating wounds caused by shrapnel deliberately put into the bomb to cause extensive injuries. Tertiary Blast Injuries are by propulsion of the body by the shock wave into solid objects. Head, spine and extremity injuries are common.

Finally, Quaternary or Miscellaneous Blast Injuries are other sequelae of the blast, often including crush injury and crush syndrome resulting from the collapse of a building or other structure. Other injuries include burns and inhalation injuries.

TIIDE’S Role in Blast Injury Education

Few civilian health care providers in the United States have experience treating casualties with injuries from blasts. Currently, there is an urgent need to develop, disseminate, and exchange information about injuries caused by terrorism. TIIDE was established through a CDC Cooperative Agreement to meet this demand.

The TIIDE Project is constructed around three interrelated areas that work to minimize the health consequences of terrorism and other public health emergencies:

• Lessons learned from terrorist events—Certain problematic themes are recurrent in mass casualty responses such as controlled dispatch, bystander and mutual aid response and communications. To explore these themes, CDC and TIIDE partners convened meetings in 2005 and 2006 to provide a forum for individuals and organizations with experience in the management of terrorist explosions to share their insight with key acute care and public health organizations in the U.S.

Recent terrorist bombings such as those in Israel, London, and Mumbai may identify new information and provide insight into local, state, regional, and national responses to the event and the mitigation of these foundational, recurrent problems. These experiences will be analyzed in an effort to improve response to events in the U.S.

• Partnerships—Partners enhance CDC’s ability to coordinate with the emergency care community and ensure that critical information is accessible to a broad spectrum of providers and organizations. Partnerships also provide an avenue and a platform to disseminate the information gained through the Lessons Learned project.
• Dissemination—CDC will investigate and identify appropriate technologies for the dissemination and exchange of information delineated through Lessons Learned. TIIDE will promote the use of the appropriate media on issues related to injuries from terrorism for the emergency care community and public health partners.

Additional Blast Injury Resources

Blast Injuries: Information for Health Care Providers and Public Health Professionals

Blast Injuries: What Clinicians Need to Know

Blast Injuries: Finding Out the Facts