Skip to main content
SpringerLink
Log in

Blast Injuries

  • Chapter
  • First Online:
Essentials of Autopsy Practice

  • 1138 Accesses

Abstract

The pathological investigation of deaths due to explosions presents the pathologist with a unique set of professional challenges as a result of the complex nature of blast-related polytrauma itself and the wider circumstances surrounding such deaths. In contemporary society with its heightened threat of terrorist activity, the well-documented problem of landmines, and ongoing military conflicts in many parts of the world, the chances of involvement in the investigation of such deaths grows year upon year, and no pathologist either conducting such autopsies or involved in any aspect of civil contingency planning can afford to be ignorant of the effects of blast and the investigative approach to such cases. The aim of this chapter is to provide an introduction to the phenomenon of blast, the nature of blast-related injuries to the human body, and to outline the investigation of such deaths from a pathological perspective. It is written on the basis of over 10 years of involvement in blast-related research and the practical experience of dealing with over 300 deceased victims of explosions from over 150 separate incidents in both civilian and military contexts.

An erratum to this chapter can be found at http://dx.doi.org/10.1007/978-0-85729-519-4_8

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    Manuscript in preparation.

References

  1. Breeze J, Allanson-Bailey LS, Hunt NC, et al. Surface wound mapping of battlefield oculo-facial injury. Injury. 2011. (Epub ahead of print).

    Google Scholar 

  2. Cernak I, Noble-Haeusslein LJ. Traumatic brain injury: an overview of pathobiology with emphasis on military populations. J Cerebral Blood Flow Metabol. 2010;30:255–66.

    Article  Google Scholar 

  3. Leibovici D, Gofrit ON, Stein M, et al. Blast injuries: bus versus open-air bombings – a comparative study injuries in survivors of open-air versus confined space explosions. J Trauma. 1996;41:1030–5.

    Article  PubMed  CAS  Google Scholar 

  4. Wade CE, Ritenour AE, Eastridge BJ, et al. Explosion injuries treated at combat support hospitals in the global war on terrorism. In: Elsayed NM, Atkins JL, editors. Explosion and blast-related injuries: effects of explosion and blast from Military operations and acts of terrorism. Burlington: Elsevier Academic Press; 2008.

    Google Scholar 

  5. Hiss J, Takana T. Modern war wounds. In: Mason JK, Pudue BN, editors. The pathology of trauma. 3rd ed. London: Arnold; 2000.

    Google Scholar 

  6. Bilukha OO, Brennan M, Woodruff BA. Death and injury from landmines and unexploded ordnance in Afghanistan. JAMA. 2003;290:650–3.

    Article  PubMed  Google Scholar 

  7. International Committee of the Red Cross. Mines: a perverse use of technology. Geneva: ICRC; 1992.

    Google Scholar 

  8. Kluger Y, Kashuk J, Mayo A. Terror bombing mechanisms, consequences and implications. Scand J Surg. 2004;93:11–4.

    PubMed  CAS  Google Scholar 

  9. Mellor SG, Cooper GJ. Analysis of 828 servicemen killed or injured by explosion in Northern Ireland 1970–1984: the hostile action casualty system. Br J Surg. 1989;76:1006–10.

    Article  PubMed  CAS  Google Scholar 

  10. Kluger Y. Bomb explosions in acts of terrorism – detonation, wound ballistics, triage and medical concerns. IMAJ. 2003;5:235–40.

    PubMed  Google Scholar 

  11. Ramasamy A, Harrison SE, Stewart MPM, Midwinter M. Penetrating missile injuries during the Iraqi insurgency. Ann R Coll Surg Engl. 2009;91:551–8.

    Article  PubMed  CAS  Google Scholar 

  12. Kluger Y, Peleg K, Daniel-Aharonson L, Mayo A. The special injury patterns in terrorist bombings. J Am Coll Surg. 2004;199:875–9.

    Article  PubMed  Google Scholar 

  13. Department of Defense Directive 6025.21E, Enclosure 2. Taxonomy of injuries from explosive devices, 2006.

    Google Scholar 

  14. Ramasamy A, Hill AM, Hepper AE, Bull AM, Clasper JC. Blast mines: physics, injury mechanisms and vehicle protection. J R Army Med Corps. 2009;155:258–64.

    Article  PubMed  CAS  Google Scholar 

  15. Ramasamy A, Hill AM, Masouros SD, et al. Evaluation of the effect of vehicle modification in reducing injuries from landmine blasts. An analysis of 2212 incidents and its application for humanitarian purposes. Accid Anal Prev. 2011;5:1878–86.

    Article  Google Scholar 

  16. Cooper GJ, Maynard RL, Cross NL, Hill JF. Casualties from terrorist bombings. J Trauma. 1983;23(11):955–67.

    Article  PubMed  CAS  Google Scholar 

  17. Sasser SM, Sattin RW, Hunt RC, Krohmer J. Blast lung injury. Prehosp Emerg Care. 2006;10:165–72.

    Article  PubMed  Google Scholar 

  18. Kirkman E, Watts E. Characterization of the response to primary blast injury. Philos Trans R Soc Lond B Biol Sci. 2011;366:286–90.

    Article  PubMed  CAS  Google Scholar 

  19. Tsokos M, Paulsen F, Petri S, et al. Histologic, immunohistochemical, and ultrastructural findings in human blast lung injury. Am J Respir Crit Care Med. 2003;168:549–55.

    Article  PubMed  Google Scholar 

  20. Kirkman E, Watts S, Sapsford W, Sawdon M. Effects of blast injury on the autonomic nervous system and the response to resuscitation. In: Elsayed NM, Atkins JL, editors. Explosion and blast-related injuries: effects of explosion and blast from Military operations and acts of terrorism. Burlington: Elsevier Academic Press; 2008.

    Google Scholar 

  21. Wolf SJ, Bebarta VS, Bonnett CJ, et al. Blast injuries. Lancet. 2009;9687:405–15.

    Article  Google Scholar 

  22. Owers C, Morgan JL, Garner JP. Abdominal trauma in primary blast injury. Br J Surg. 2011;98:179–80.

    Article  Google Scholar 

  23. Paran H, et al. Perforation of the terminal ileum induced by blast injury: delayed diagnosis or delayed perforation? J Trauma. 1996;40:472–5.

    Article  PubMed  CAS  Google Scholar 

  24. Radford P, Patel HD, Hamilton N, et al. Tympanic membrane rupture in the survivors of the July 7, 2005, London Bombings. Otolaryngol Head Neck Surg. 2011;145:806–12. Epub 2011 Jan 9.

    Article  PubMed  Google Scholar 

  25. Harrison CD, Bebarta VS, Grant GA. Tympanic membrane perforation after combat blast exposure in Iraq: a poor biomarker of primary blast injury. J Trauma. 2009;1:210–1.

    Article  Google Scholar 

  26. Xydakis MS, Bebarta VS, Harrison CD, et al. Tympanic-membrane perforation as a marker of concussive brain injury in Iraq. N Engl J Med. 2007;357:830–1.

    Article  PubMed  CAS  Google Scholar 

  27. Ohnishi M, Kirkman E, Guy RJ, Watkins PE. Reflex nature of the cardiorespiratory response to primary thoracic blast injury in the anaesthetised rat. Exp Phyisiol. 2001;86(3):357–64.

    Article  CAS  Google Scholar 

  28. Weil YA, Petrov K, Liebergall M, et al. Long bone fractures caused by penetrating injuries in terrorists attacks. J Trauma. 2007;4:909–12.

    Article  Google Scholar 

  29. Wong JM, et al. Biological foreign body implantation in victims of the London July 7th suicide bombings. J Trauma. 2006;60:402–4.

    Article  PubMed  Google Scholar 

  30. Greaves I, Porter K, Smith JE, et al. Consensus statement on the early management of crush injury and prevention of crush syndrome. J R Army Med Corps. 2003;149:255–9.

    Article  PubMed  CAS  Google Scholar 

  31. Reis ND, Better OS. Mechanical muscle-crush injury and acute muscle-crush compartment syndrome: with special reference to earthquake casualties. J Bone J Surg Br. 2005;87:450–3.

    Article  CAS  Google Scholar 

  32. Frykberg ER. Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 2002;53:201–12.

    Article  PubMed  Google Scholar 

  33. Kauvar DS, Dubick MA, Blackbourne LH, Wolf SE. Quaternary blast injury: Burns. In: Elsayed NM, Atkins JL, editors. Explosion and blast-related injuries: effects of explosion and blast from Military operations and acts of terrorism. Burlington: Elsevier Academic Press; 2008.

    Google Scholar 

  34. Sorkin P, Nimrod A, Biderman P, Myo A, Kluger Y. The quinary (Vth) injury pattern of blast. In: Proceedings of the annual meeting of the Eastern Association for the surgery of trauma, Amelia Island; 2004.

    Google Scholar 

  35. Kluger Y, Nimrod A, Niderman P, et al. The quinary pattern of blast injury. Am J Disaster Med. 2007;1:21–5.

    Google Scholar 

  36. Bell RS, Vo AH, Neal CJ, et al. Military traumatic brain and spinal column injury: a 5-year study of the impact blast and other military grade weaponry on the central nervous system. J Trauma. 2009;66(4 suppl):S104–11.

    Article  PubMed  Google Scholar 

  37. Murray CK, Reynolds JC, Schroeder JM, et al. Spectrum of care provided at an echelon II medical unit during operation Iraqi freedom. Mil Med. 2005;170:516–20.

    PubMed  Google Scholar 

  38. Ling G, Bandak F, Grant G, Armonda R, Ecklund J. Neurotrauma from explosive blast. In: Elsayed NM, Atkins JL, editors. Explosion and blast-related injuries: effects of explosion and blast from Military operations and acts of terrorism. Burlington: Elsevier Academic Press; 2008.

    Google Scholar 

  39. Agoston DV, Gyorgy A, Eidelman O, Pollard HB. Proteomic biomarkers for blast neurotrauma: targeting cerebral oedema, inflammation and neuronal death cascades. J Neurotrauma. 2009;26:901–11.

    Article  PubMed  Google Scholar 

  40. Kocsis JD, Tessler MD. Pathology of blast-related brain injury. J Rehabil Res Dev. 2009;46:667–72.

    Article  PubMed  Google Scholar 

  41. Alley MD, Schimizze BR, Son SF. Experimental modelling of explosive blast-related traumatic brain injuries. Neuroimage. 2011;54 Suppl 1:S45–54.

    Article  PubMed  Google Scholar 

  42. Elder GA, Christian A. Blast-related mild traumatic brain injury: mechanisms of injury and impact on clinical care. Mt Sinai J Med. 2009;76:111–8.

    Article  PubMed  Google Scholar 

  43. Knudsen SK, Oen EO. Blast-induced neurotrauma in whales. Neurosci Res. 2003;46:377–86.

    Article  PubMed  Google Scholar 

  44. MacDonald CL, Johnson AM, Cooper D, et al. Detection of blast-related traumatic brain injury in US military personnel. NEJM. 2011;364:2091–100.

    Article  CAS  Google Scholar 

  45. DeWitt DS, Prough DS. Blast-induced brain injury and posttraumatic hypotension and hypoxaemia. J Neurotrauma. 2009;26:877–87.

    Article  PubMed  Google Scholar 

  46. Hull JB. An investigation into the mechanism of traumatic amputation by explosive blast. Doctor of Medicine, University of Birmingham, Birmingham; 1995.

    Google Scholar 

  47. Ramasamy A, Hill AM, Masouros S, et al. Blast-related fracture patterns: a forensic biomechanical approach. J R Soc Interface. 2011;8:689–98. Epub 2010 Dec 1.

    Article  PubMed  Google Scholar 

  48. Shuker ST. The effect of blast on the mandible and teeth: transverse fractures and their management. Br J Oral Maxillofac Surg. 2008;46:547–51.

    Article  PubMed  Google Scholar 

  49. Breeze J, Gibbons AJ, Hunt NC, et al. Mandibular fractures in British military personnel secondary to blast trauma sustained in Iraq and Afghanistan. Br J Oral Maxillofac Surg. 2011;49:607–11.

    Article  PubMed  CAS  Google Scholar 

  50. Shuker ST. Maxillofacial air-containing cavities, blast implosion injuries, and management. J Oral Maxillofac Surg. 2010;68:93–100.

    Article  PubMed  Google Scholar 

  51. Kirkman E, Watts S, Cooper G. Blast injury research models. Philos Trans R Soc Lond B Biol Sci. 2011;1562:144–59.

    Google Scholar 

  52. Morrison JJ, Hunt N, Midwinter M, Jansen J. Associated injuries in casualties with traumatic lower extremity amputations caused by improvised explosive devices. Br J Surg. 2012;99:362–6.

    Article  PubMed  CAS  Google Scholar 

  53. Ritenour AE, Blackbourne LH, Kelly JF, et al. Incidence of primary blast injury in US military overseas contingency operations: a retrospective study. Ann Surg. 2010;251:1140–4.

    Article  PubMed  Google Scholar 

  54. Necmioglu S, Subasi M, Kayikci C, Young D. Lower limb landmine injuries. Prosthet Orthot Int. 2004;28(1):37–43.

    PubMed  CAS  Google Scholar 

  55. Ramasamy A, Hill AM, Philip R, et al. The modern ‘deck-slap’ injury – calcaneal blast fractures from vehicle explosions. J Trauma. 2011;71:1694–8.

    Article  PubMed  Google Scholar 

  56. Ruwanpura R, Kumara KS, Jayawardane H, de Alwis LB. Suicidal bomb explosions in Sri Lanka. Am J Disaster Med. 2008;3:47–51.

    PubMed  Google Scholar 

  57. Shields LB, Hunsaker DM, Hunsaker JC, Humbert KA. Non-terrorist suicidal death involving explosives. Am J Forensic Med Pathol. 2003;24:107–13.

    PubMed  Google Scholar 

  58. Tsokos M, Turk EE, Madea B, et al. Pathologic features of suicidal deaths caused by explosives. Am J Forensic Med Pathol. 2003;24:55–63.

    PubMed  CAS  Google Scholar 

  59. Crane J. Violence associated with civil disturbance. In: Mason JK, Purdue BN, editors. The pathology of trauma. 3rd ed. London: Arnold; 2000.

    Google Scholar 

  60. Petersen K, Riddle MS, Danko JR, et al. Trauma-related infections in battlefield casualties from Iraq. Ann Surg. 2007;245:803–11.

    Article  PubMed  Google Scholar 

  61. Sudoyo H, Widodo PT, Suryadi H, et al. DNA analysis in perpetrator identification of terrorism-related disaster: suicide bombing of the Australian Embassy in Jakarta 2004. Forensic Sci Int Genet. 2008;2:231–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Forensic Pathology Services, Culham Science Centre (F5), Abingdon, Oxfordshire, OX14 3DB, UK

    Nicholas C. A. Hunt MBBS FRCPath DipRCPath(Foren)

Authors
  1. Nicholas C. A. Hunt MBBS FRCPath DipRCPath(Foren)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicholas C. A. Hunt MBBS FRCPath DipRCPath(Foren) .

Editor information

Editors and Affiliations

  1. , Forensic Pathology Unit, Leicester Royal Infirmary, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, United Kingdom

    Guy N. Rutty

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Hunt, N.C.A. (2013). Blast Injuries. In: Rutty, G. (eds) Essentials of Autopsy Practice. Springer, London. https://doi.org/10.1007/978-0-85729-519-4_5

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-519-4_5

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-518-7

  • Online ISBN: 978-0-85729-519-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation