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Explosives

  • John M. Wightman
  • Barry A. Wayne
Chapter

Abstract

Intentional bombings occur throughout the world on an almost daily basis. Many are simple acts of vandalism, such as pipe bombs in mailboxes. Others are targeted to destroy specific structures or kill specific individuals. Although these crimes could be considered acts of terror, this chapter focuses on injuries seen in victims of explosions intended to affect as many people as possible. Conventional explosives remain the most common form of terrorist attack, because they are easy to buy or steal, do not require sophisticated equipment or operator training to employ, can be transported and concealed easily, and are capable of causing widespread damage with a single attack. Moreover, bombs can be activated remotely in either distance or time, thus allowing the perpetrators to be removed from the incident scene for safety, escape, or alibi purposes. They can also turn individuals into human weapons, as the epidemic of suicide bombers in Israel demonstrated in 2002.

Keywords

Continuous Positive Airway Pressure Blast Injury Tension Pneumothorax Pulmonary Contusion Crush Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Caro D, Irving M. The Old Bailey bomb explosion. Lancet 1973;1:1433–1435.PubMedCrossRefGoogle Scholar
  2. 2.
    Waterworth TA, Carr MJT. An analysis of the post-mortem findings in the 21 victims of the Birmingham pub bombings. Injury 1975;7:89–95.PubMedCrossRefGoogle Scholar
  3. 3.
    Waterworth TA, Can MJT. Surgery of violence: report on injuries sustained by patients treated at the Birmingham General Hospital following the recent bomb explosions. BMJ 1975;2:25–27.PubMedCrossRefGoogle Scholar
  4. 4.
    Brismar B, Bergenwald L. The terrorist bomb explosion in Bologna, Italy, 1980: an analysis of the effects and injuries sustained. J Trauma 1982;22:216–220.PubMedCrossRefGoogle Scholar
  5. 5.
    Adler J, Golan E, Golan J, et al. Terrorist bombing experience during 1975–79: casualties admitted to the Shaare Zedek Medical Center. Isr J Med Sci 1983;19:189–193.PubMedGoogle Scholar
  6. 6.
    Frykberg ER, Tepas JJ, Alexander RH. The 1983 Beirut Airport terrorist bombing: injury patterns and implications for disaster management. Am Surg 1989;55:134–141.Google Scholar
  7. 7.
    Katz E, Ofek B, Adler J, et al. Primary blast injury after a bomb explosion in a civilian bus. Ann Surg 1989;209:484–488.PubMedCrossRefGoogle Scholar
  8. 8.
    Rignault DP, Deligny MC. The 1986 terrorist bombing experience in Paris. Ann Surg 1989;209:368–373.PubMedCrossRefGoogle Scholar
  9. 9.
    Gomez Morell PA, Escudero Naif F, Palao Domenech R, et al. Burns caused by the terrorist bombing of the denartment store Hinercor in Barcelona: part 1. Burns 1990;16:423–425.CrossRefGoogle Scholar
  10. 10.
    Hodgetts TJ. Lessons from the Musgrave Park Hospital bombing. Injury 1993;24:219–221.PubMedCrossRefGoogle Scholar
  11. 11.
    Mallonee S, Shariat S, Stennies G, et al. Physical injuries and fatalities resulting from the Oklahoma City bombing. JAMA 1996;276:382–387.PubMedCrossRefGoogle Scholar
  12. 12.
    Hadden WA, Rutherford WH, Merrett JD. The injuries of terrorist bombing: a study of 1532 consecutive patients. Br J Surg 1978;65:525–531.PubMedCrossRefGoogle Scholar
  13. 13.
    Hill JF. Blast injury with particular reference to recent terrorist bombing incidents. Ann R Coll Surg (Engl) 1979;61:4–11.Google Scholar
  14. 14.
    Pyper PC, Graham WJH. Analysis of terrorist injuries treated at Craigavon Area Hospital, Northern Ireland, 1972–1980. Injury 1983;14:332–338.PubMedCrossRefGoogle Scholar
  15. 15.
    Frykberg ER, Tepas JJ. Terrorist bombings: lessons learned from Belfast to Beirut. Ann Surg 1988;208:569–576.PubMedCrossRefGoogle Scholar
  16. 16.
    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;76:1006–1010.PubMedCrossRefGoogle Scholar
  17. 17.
    Abenhaim L, Dab W, Salmi LR. Study of civilian victims of terrorist attacks (France 1982–1987). J Clin Epidemiol 1992;45:103–109.PubMedCrossRefGoogle Scholar
  18. 18.
    Coupland RM, Meddings DR. Mortality associated with use of weapons in armed conflicts, wartime atrocities, and civilian mass shootings: literature review. BMJ 1999;319:407–410.PubMedCrossRefGoogle Scholar
  19. 19.
    Cooper GJ, Maynard RL, Cross NL, Hill JF. Casualties from terrorist bombings. J Trauma 1983;23:955–967.PubMedCrossRefGoogle Scholar
  20. 20.
    Scott BA, Fletcher JR, Pulliam MW, Harris RD. The Beirut terrorist bombing. Neurosurgery 1986:18:107–110.PubMedCrossRefGoogle Scholar
  21. 21.
    Hull JB, Bowyer GW, Cooper GJ, Crane J. Pattern of injury in those dying from traumatic amputation caused by bomb blast. Br J Sure 1994;81:1132–1135.CrossRefGoogle Scholar
  22. 22.
    Hull JB. Traumatic amputation by explosive blast: pattern of injury in survivors. Br J Surg 1992;79: 1303–1306.PubMedCrossRefGoogle Scholar
  23. 23.
    Quintana DA, Parker JR, Jordan FB, Tuggle DW, Mantor PC, Tunell WP. The spectrum of pediatric injuries after a bomb blast. J Pediatr Surg 1997;32:307–310; discussion, 310–311; errata, 932.PubMedCrossRefGoogle Scholar
  24. 24.
    Jimenez-Hernandez FH, Lliro Blasco E, Leiva Oliva R, et al. Burns caused by the terrorist bombing of the department store Hipercor in Barcelona: part 2. Burns 1990;16:426–431.PubMedCrossRefGoogle Scholar
  25. 25.
    Frykberg ER, Hutton PM, Balzer RH. Disaster in Beirut: an application of mass casualty principles. Mil Med 1987:152:563–566.PubMedGoogle Scholar
  26. 26.
    Hogan DE, Waeckerle JF, Dire DJ, Lillibridge SR. Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med 1999;34:160–167.PubMedCrossRefGoogle Scholar
  27. 27.
    Stuhmiller JH, Phillips YY, Richmond DR. The physics and mechanisms of primary blast injury. In: Bellamy RF, Zajtchuk R, eds. Conventional Warfare: Ballistic, Blast, and Burn Injuries. Office of the Surgeon General of the United States Army, Washington DC, 1991, pp. 241–270.Google Scholar
  28. 28.
    Iremonger MJ. Physics of detonations and blast-waves. In: Cooper GJ, Dudley HAF, Gann DS, Little RA, Maynard RL, eds. Scientific Foundations of Trauma. Butterworth-Heineman, Oxford, 1997, pp. 189–199.Google Scholar
  29. 29.
    Wightman JM, Wayne BA. Blast and crushing injuries. In: Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency Medicine: A Comprehensive Study Guide, 6th ed. McGraw-Hill, New York, in press.Google Scholar
  30. 30.
    Wightman JM, Gladish SL. Explosions and blast injuries. Ann Emerg Med 2001;37:664–678.PubMedCrossRefGoogle Scholar
  31. 31.
    Benson M, Koenig KL, Schultz CH. Disaster triage: START, then SAVE-a new method of dynamic triage for victims of a catastrophic earthquake. Prehosp Disast Med 1996;11:117–124.Google Scholar
  32. 32.
    Garner A, Lee A, Harrison K, Schulz CH. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med 2001;38:541–548.PubMedCrossRefGoogle Scholar
  33. 33.
    Singh D, Ahluwalia KJS. Blast injuries of the ear. J Laryngol Otol 1968:82;1017–1028.PubMedCrossRefGoogle Scholar
  34. 34.
    Sudderth ME. Tympanoplasty in blast-induced perforation. Arch Otolaryngol 1974;99:157–159.PubMedCrossRefGoogle Scholar
  35. 35.
    Roberto M, Hamernik RP, Turrentibe GA. Damage to the auditory sytem associated with acute blast trauma. Ann Otol Rhinol Laryngol 1989;98(suppl 140):23–34.Google Scholar
  36. 36.
    Pahor AL. The ENT problems following the Birmingham bombings. J LarYngol Otol 1981;95:399–406.PubMedCrossRefGoogle Scholar
  37. 37.
    Walby AP, Kerr Ad. Hearing in patients with blast lung. J Laryngol Otol 1986;100:411–415.PubMedCrossRefGoogle Scholar
  38. 38.
    Garth RJN. Blast injury of the auditory system: a review of the mechanisms and pathology. J Laryngol Otol 1994;108:925–929.PubMedGoogle Scholar
  39. 39.
    Leibovici D, Gofrit ON, Shapira SC. Eardrum perforation in explosion survivors: is it a marker of pulmonary blast injury? Ann Emerg Med 1999;34:168–172.PubMedCrossRefGoogle Scholar
  40. 40.
    Rössle R. Pathology of blast effects. In: German Aviation Medicine: World War II. Office of the Surgeon General of the United States Air Force, Washington DC, 1950, pp. 1260–1273.Google Scholar
  41. 41.
    Sharpnack DD, Johnson AJ, Phillips YY. The pathology of primary blast injury. In: Bellamy RF, Zajtchuk R, eds. Conventional Warfare: Ballistic, Blast, and Bum Injuries. Office of the Surgeon General of the United States Army, Washington DC, 1991, pp. 271–294.Google Scholar
  42. 42.
    Mayorga MA. The pathology of primary blast overpressure injury. Toxicology 1997;121:17–28.PubMedCrossRefGoogle Scholar
  43. 43.
    Pizov R, Oppenheim-Eden A, Matot I, et al. Blast lung injury from an explosion on a civilian bus. Chest 1999;115:165–172.CrossRefGoogle Scholar
  44. 44.
    Paran H, Neufeld D, Shwartz I, et al. Perforation of the terminal ileum induced by blast injury: delayed diagnosis or delayed perforation? J Trauma 1996;40:472–475.PubMedCrossRefGoogle Scholar
  45. 45.
    Cripps NPJ, Cooper GJ. Risk of late perforation in intestinal contusions caused by explosive blast. Br J Surg 1997;84:1298–1303.PubMedCrossRefGoogle Scholar
  46. 46.
    Hull JB, Cooper GJ. Pattern and mechanism of traumatic amputation by explosive blast. J Trauma 1996;40(suppl 3):S198-S205.CrossRefGoogle Scholar
  47. 47.
    Hull JB. traumatic amputation by explosive blast: pattern of injury in survivors. Br J Surg 1992;79: 1303–1306.PubMedCrossRefGoogle Scholar
  48. 48.
    Stack LB. Compartment syndrome evaluation. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine, 3rd ed. WB Saunders, Philadelphia, 1998, pp. 932–946.Google Scholar
  49. 49.
    Complications of Trauma, WorldOrtho Inc, 1997, p. 1 (accessed via www.worldortho.com on 18 August 2002).Google Scholar
  50. 50.
    Ost D, Corbridge T. Independent lung ventilation. C in Chest Med 1996;17:591–601CrossRefGoogle Scholar
  51. 51.
    Kubota H, Kubota Y, Toyoda Y, et al. Selective blind endotracheal intubation in children and adults. Anesthesiology 1987;67:587–589.PubMedCrossRefGoogle Scholar
  52. 52.
    Ho AM-H, Ling E. Systemic air embolism after lung trauma. Anesthesiology 1999;90:564–575.PubMedCrossRefGoogle Scholar
  53. 53.
    Oppenheim A, Pizov R, Pikarsky A, et al. Tension pneumoperitoneum after blast injury: dramatic improvement in ventilatory and hemodynamic parameters after surgical decompression. J Trauma 1998;44:915–917.PubMedCrossRefGoogle Scholar
  54. 54.
    Mellor SG. The pathogenesis of blast injury and its management. Br J Hosp Med 1988;39:536–539.PubMedGoogle Scholar
  55. 55.
    Huller T, Bazini Y. Blast injuries of the chest and abdomen. Arch Surg 1970;100:24–30.PubMedCrossRefGoogle Scholar
  56. 56.
    Richardson JD, Franz JL, Grover FL, et al. Pulmonary contusion and hemorrhage: crystalloid versus colloid replacement. J Surg Res 1974;16:330–336.PubMedCrossRefGoogle Scholar
  57. 57.
    Fulton RL, Peter ET. Physiosologic effects of fluid therapy after pulmonary contusion. Am J Surg 1984;148:145–151.CrossRefGoogle Scholar
  58. 58.
    Barbera JA, Macintyre A. Urban search and rescue. Emerg Med C in North Am 1996;14:399–412.CrossRefGoogle Scholar
  59. 59.
    Hofmeister, EP, Shin, AY. The role of prophylactic fasciotomy and medical treatment in limb ischemia and revascularization. Hand C in 1998;14: 457–464.Google Scholar
  60. 60.
    Uretzky G, Cotev S. The use of continuous positive airway pressure in blast injury of the chest. Crit Care Med 1980;8:486–489.PubMedCrossRefGoogle Scholar
  61. 61.
    Batistella FD. Ventilation in the trauma and surgical patient. Crit Care Clin 1998;14:731–742.CrossRefGoogle Scholar
  62. 62.
    Sorkine P, Szold 0, Kluger Y, et al. Permissive hypercapnia ventilation in patients with severe pulmonary blast injury. J Trauma 1998;45:35–38.PubMedCrossRefGoogle Scholar
  63. 63.
    Desaga H. Blast injuries. In: German Aviation Medicine: World War II. Office of the Surgeon General of the United States Air Force. Washington DC. 1950. pp. 1274–1293.Google Scholar
  64. 64.
    Weiler-Ravell D, Adatto R, Borman JB. Blast injury of the chest: a review of the problem and its treatment. Isr J Med Sci 1975;11:268–274.PubMedGoogle Scholar
  65. 65.
    Phillips YY, Zajtchuk JT. The management of primary blast injury. In: Bellamy RF, Zajtchuk R, eds. Conventional Warfare: Ballistic, Blast, and Burn Injuries. Office of the Surgeon General of the United States Army, Washington DC, 1991, pp. 295–335.Google Scholar
  66. 66.
    Maynard RL, Coppel DL, Lowry KG. Blast injury of the lung. In: Cooper GJ, Dudley HAF, Gann DS, Little RA, Maynard RL, eds. Scientific Foundations of Trauma. Butterworth-Heineman, Oxford, 1997, pp. 214–224.Google Scholar
  67. 67.
    Mubarak SJ, Owen CA. Compartment syndrome and its relation to the crush syndrome: a spectrum of disease. Clin Orthop 1975;113:81–89.PubMedCrossRefGoogle Scholar
  68. 68.
    Better OS. Rescue and salvage of casualties suffering from the crush syndrome after mass disasters. Mil Med 1999; 164:366–369.PubMedGoogle Scholar
  69. 69.
    Bouachour G, Cronier P, Couello JP, et al. Hyperbaric oxygen therapy in the management of crush injuries: a randomized double-blind, placebo-controlled, clinical trial. J Trauma 1996;41:333–339.PubMedCrossRefGoogle Scholar
  70. 70.
    Kerr AG, Byrne JET. Concussive effects of bomb blast on the ear. J Laryngol Otol 1975;89:131–143.PubMedCrossRefGoogle Scholar
  71. 71.
    Garth RJN. Blast injury of the ear. In: Cooper GJ, Dudley HAF, Gann DS, Little RA, Maynard RL, eds. Scientific Foundations of Trauma. Butterworth-Heineman, Oxford, 1997, pp. 225–235.Google Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2004

Authors and Affiliations

  • John M. Wightman
  • Barry A. Wayne

There are no affiliations available

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