Blast injuries--and the pivotal role of trauma surgeons.

An explosion is the sudden release of energy and its radial propagation through air, solid structures and living tissue. Treatment of blast injuries is complex and combines the principles of penetrating and blunt trauma, chemical or thermal burns and disaster and mass casualty management. Primary blast injuries are a direct result of the explosion itself. The sudden release of energy is translated into a shock wave that travels at supersonic speed (5000 metres/second). There is a sudden and short-lived rise in pressure, followed by a prolonged negative pressure, or vacuum, responsible for additional injury. The organs most at risk for primary blast injuries are the lungs, the ears and the gastrointestinal tract. The explosion also sets solid objects in motion; these act as projectiles, and can travel over far greater distances (secondary blast injuries), and their management is no different from penetrating or blunt trauma from other causes. The explosion may cause not only "projectiles," but the body itself to be displaced: These tertiary blast injuries include traumatic amputations and crush injuries following land mine explosions. Finally, quaternary blast injuries comprise other forms of associated trauma, such as burns, asphyxia or poisoning from release of noxious substances by the blast. These injuries can be particularly taxing for rescue teams because of their tendency to affect large amounts of patients and the risk they pose to the rescuers themselves. Individual management of the blast injury victim requires a multidisciplinary team; terrorist or wartime bombings also require expertise in disaster management and triage.