Managing patients with blast injuries can challenge emergency department operations, as patients can present in multiple waves, with occult or delayed injuries, and by personal transport, without standard prehospital care. Rapid and effective triage and evaluation includes approximation of blast proximity, determination of the category of blast – primary to quinary – and assessment of the body systems that are most likely to be injured from the type, location, and mechanism of the blast. This issue reviews the physics of the various types of explosions, how this affects the types of injuries that may be seen, and recommended treatments. Best-evidence recommendations are made for decision-making for observation, admission, or discharge.
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Following are the most informative references cited in this paper, as determined by the authors.
4. * Born CT, Briggs SM, Ciraulo DL, et al. Disasters and mass casualties: II. explosive, biologic, chemical, and nuclear agents. J Am Acad Orthop Surg. 2007;15(8):461-473. (Review) DOI: 10.5435/00124635-200708000-00003
7. * Halpern P, Tsai MC, Arnold JL, et al. Mass-casualty, terrorist bombings: implications for emergency department and hospital emergency response (Part II). Prehosp Disaster Med. 2003;18(3):235-241. (Review) DOI: 10.1017/s1049023x00001102
10. * Wolf SJ, Bebarta VS, Bonnett CJ, et al. Blast injuries. Lancet. 2009;374(9687):405-415. (Review) DOI: 10.1016/S0140-6736(09)60257-9
29. * Alfici R, Ashkenazi I, Kessel B. Management of victims in a mass casualty incident caused by a terrorist bombing: treatment algorithms for stable, unstable, and in extremis victims. Mil Med. 2006;171(12):1155-1162. (Retrospective editorial; 467 patients) DOI: 10.7205/milmed.171.12.1155
31. * Arnold JL, Halpern P, Tsai MC, et al. Mass casualty terrorist bombings: a comparison of outcomes by bombing type. Ann Emerg Med. 2004;43(2):263-273. (Systematic review; 8364 patients) DOI: 10.1016/s0196-0644(03)00723-6
45. * Nunziato CA, Riley CJ, Johnson AE. How common are civilian blast injuries in the national trauma databank, and what are the most common mechanisms and characteristics of associated injuries? Clin Orthop Relat Res. 2021;479(4):683-691. (Retrospective; 968,834 patients) DOI: 10.1097/CORR.0000000000001642
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Keywords:
Tung-Lin Jesse Yuan, DO; Navin Ariyaprakai, MD, FAEMS, FACEP
Derrick Tin, MD; Benjamin von Schweinitz, MD, FACEP
February 1, 2023
February 1, 2026   CME Information
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits.
Price: $59
+4 Credits!
Tung-Lin Jesse Yuan, DO; Navin Ariyaprakai, MD, FAEMS, FACEP
Derrick Tin, MD; Benjamin von Schweinitz, MD, FACEP
February 1, 2023
February 1, 2026
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits.