Blast injuries are divided into four classes: primary, secondary, tertiary, and quaternary.
Primary injuries
Primary injuries are caused by blast overpressure waves, or shock waves. These are especially likely when a person is close to an exploding munition, such as a land mine.[1] The ears are most often affected by the overpressure, followed by the lungs and the hollow organs of the gastrointestinal tract. Gastrointestinal injuries may present after a delay of hours or even days.[1] Injury from blast overpressure is a pressure and time dependent function. By increasing the pressure or its duration, the severity of injury will also increase.[1]
In general, primary blast injuries are characterized by the absence of external injuries; thus internal injuries are frequently unrecognized and their severity underestimated. According to the latest experimental results, the extent and types of primary blast-induced injuries depend not only on the peak of the overpressure, but also other parameters such as number of overpressure peaks, time-lag between overpressure peaks, characteristics of the shear fronts between overpressure peaks, frequency resonance, and electromagnetic pulse, among others. There is general agreement that spalling, implosion, inertia, and pressure differentials are the main mechanisms involved in the pathogenesis of primary blast injuries. Thus, the majority of prior research focused on the mechanisms of blast injuries within gas-containing organs/organ systems such as the lungs, while primary blast-induced traumatic brain injury has remained underestimated. Blast lung refers to severe pulmonary contusion, bleeding or swelling with damage to alveoli and blood vessels, or a combination of these.[2] It is the most common cause of death among people who initially survive an explosion.[3]
Secondary injuries
Secondary injuries are due people being injured by shrapnel and other objects propelled by the explosion.[4] These injuries may affect any part of the body and sometimes result in penetrating trauma with visible bleeding. At times the propelled object may become embedded in the body, obstructing the loss of blood to the outside. However, there may be extensive blood loss within the body cavities. Shrapnel wounds may be lethal and therefore many anti-personnel bombs are designed to generate shrapnel and fragments.
Most casualties are caused by secondary injuries.[4] Some explosives, such as nail bombs, are deliberately designed to increase the likelihood of secondary injuries.[4] In other instances, the target provides the raw material for the objects thrown into people, e.g., shattered glass from a blasted-out window or the glass facade of a building.[4]
Tertiary injuries
Displacement of air by the explosion creates a blast wind that can throw victims against solid objects.[1] Injuries resulting from this type of traumatic impact are referred to as tertiary blast injuries. Tertiary injuries may present as some combination of blunt and penetrating trauma, including bone fractures and coup contre-coup injuries.
Young children, because they weigh less than adults, are at particular risk of tertiary injury.[4]
Quaternary injuries
Quaternary injuries, or other miscellaneous named injuries, are all other injuries not included in the first three classes. These include flash burns, crush injuries and respiratory injuries.[4]
Traumatic amputations are rare in survivors, and are often accompanied by significant other injuries.[4] The rate of eye injury may depend on the type of blast.[4] Psychiatric injury, some of which may be caused by neurological damage incurred during the blast, is the most common quaternary injury, and post-traumatic stress disorder may affect people who are otherwise completely uninjured.[4]
