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Mechanisms of Blast Injury

The four basic mechanisms of blast injury are termed as: primary, secondary, tertiary, and quaternary.

The primary blast wave refers to the intense over-pressurization impulse created by a detonated high-order explosive. Blast injuries are characterized by anatomical and physiological changes from the direct or reflective over-pressurization force impacting the body's surface. The high-order explosive blast wave (over-pressure component) should be distinguished from “blast wind” which is the forced super-heated air flow. The latter may be encountered with both high-order explosive and low-order explosive. The following table is found on the CDC's website concerning mass trauma - http://www.cdc.gov/masstrauma/preparedness/primer.htm

Injury Category	Characteristics	Body Part Affected	Detailed Types of Injuries
Primary	Unique to HE, results from the impact of the over-pressurization wave with body surfaces.	Gas filled structures are most susceptible - lungs, GI tract, and middle ear.	Blast lung (pulmonary barotraumas) TM rupture and middle ear damage Abdominal hemorrhage and perforation Globe (eye) rupture Concussion (TBI without physical signs of head injury)
Secondary	Results from flying debris and bomb fragments.	Any body part may be affected.	Penetrating ballistic (fragmentation) or blunt injuries Eye penetration (can be occult)
Tertiary	Results from individuals being thrown by the blast wind.	Any body part may be affected.	Fracture and traumatic amputation Closed and open brain injury
Quaternary	All explosion-related injuries, illnesses, or diseases not due to primary, secondary, or tertiary mechanisms. Includes exacerbation or complications of existing conditions.	Any body part may be affected.	Burns (flash, partial, and full thickness) Crush injuries Closed and open brain injury Asthma, COPD, or other breathing problems from dust, smoke, or toxic fumes Angina Hyperglycemia, hypertension

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Overview of explosive-related injuries

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