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The conflicts of the past decades have given military clinicians a familiarity with blast injury treatment. Management of these complex injuries has significantly advanced since the turn of the millennium. Survival levels amongst UK service personnel increased year on year during the 4th Anglo-Afghan war. Civilian casualties from terrorist activities have also included multiple casualties with similar military-style blast injuries. Civilian clinicians should have an understanding of blast-injured casualties so as to be prepared for future major terrorist attacks involving explosive devices. This article outlines the mechanisms by which blast inflicts injury and describes the management steps required to treat these complex, potentially lethal wounds. It is written from an understanding of UK military operations, and recent information from Ukraine, Gaza and Beirut. [ABSTRACT FROM AUTHOR]

Military clinicians became familiar with blast injuries during recent conflicts. Management of these complex injuries has advanced significantly. Survival amongst UK service personnel increased year on year. Civilian casualties from terrorist activities have included multiple casualties with similar blast injuries. Civilian clinicians should also have an understanding of blast-injured casualties so as to be prepared for a major terrorist attack involving explosive devices. This article outlines the mechanisms by which blast inflicts injury. It describes the management steps required to treat these complex, potentially lethal wounds. [ABSTRACT FROM AUTHOR]

Military clinicians became familiar with the blast injuries during recent conflicts. Management of these complex injuries has advanced significantly, and survival amongst UK service personnel has increased year on year. Civilian casualties from terrorist activities have included multiple casualties with similar blast injuries. Civilian clinicians should now be ready to receive blast-injured casualties in the event of major terrorist attacks. This article outlines the mechanisms by which blast inflicts injury. It describes the management steps required to treat these complex, potentially lethal wounds. [ABSTRACT FROM AUTHOR]

Blast injuries can be described by the following five mechanisms: primary blast injury relates to overpressure, secondary blast injury describes fragmentation, tertiary blast injury is caused by physical displacement of bodies, quaternary blast injury is the name given to other harmful mechanisms such as thermal injury, and quinternary injuries are the reactivation of latent diseases due to immunosuppression. Blast typically causes death within 10 minutes of injury, and creates contaminated wounds. Treatment for blast injuries is summarized as: resuscitation, penicillin, anti-tetanus, debridement, wash, fasciotomize, pack, stabilize, and leave. Resuscitation should address the ‘bloody triad’ of hypothermia, acidosis and coagulopathy. Damage control surgery should aim to correct physiology rather than anatomy. Debridement needs to be thorough to remove all contamination. Muscle should be assessed and devitalized tissue removed, with bone ends being delivered and irrigated copiously. Bony stabilization needs to be achieved, and with damage control surgery this is commonly with external fixation. Fasciotomies should be performed in all vulnerable compartments. Amputation may be considered as a primary treatment option if limbs are unsalvageable or resources are limited. [ABSTRACT FROM AUTHOR]