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Explosions and Human Health: The Long-Term Effects of Blast Injury

Published online by Cambridge University Press:  17 July 2012

Sarah E. Finlay ,
Michelle Earby ,
David J. Baker  and
Virginia S.G. Murray
Sarah E. Finlay
Affiliation:
Extreme Events and Health Protection Section, Centre for Radiological, Chemical and Environmental Hazards, United Kingdom Health Protection Agency, London, United Kingdom
Michelle Earby
Affiliation:
Extreme Events and Health Protection Section, Centre for Radiological, Chemical and Environmental Hazards, United Kingdom Health Protection Agency, London, United Kingdom
David J. Baker*
Affiliation:
Extreme Events and Health Protection Section, Centre for Radiological, Chemical and Environmental Hazards, United Kingdom Health Protection Agency, London, United Kingdom
Virginia S.G. Murray
Affiliation:
Extreme Events and Health Protection Section, Centre for Radiological, Chemical and Environmental Hazards, United Kingdom Health Protection Agency, London, United Kingdom
*
Correspondence: David J. Baker, FRCA Extreme Events and Health Protection Section Centre for Radiological, Chemical and Environmental Hazards United Kingdom Health Protection Agency 151 Buckingham Palace Road London SW1W 9SZ United Kingdom E-mail david.baker@hpa.org.uk
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Abstract

The immediate patterns of injury from explosions are well documented, from both military and civil experience. However, few studies have focused on less immediately apparent health consequences and latent effects of explosions in survivors, emergency responders and the surrounding community. This review aimed to analyze the risks to health following an explosion in a civil setting.

A comprehensive review of the open literature was conducted, and data on 10 relevant military, civilian and industrial events were collected. Events were selected according to availability of published studies and involvement of large numbers of people injured. In addition, structured interviews with experts in the field were conducted, and existing national guidelines reviewed.

The review revealed significant and potentially long-term health implications affecting various body systems and psychological well-being following exposure to an explosion. An awareness of the short- and long-term health effects of explosions is essential in screening for blast injuries, and identifying latent pathologies that could otherwise be overlooked in stressful situations with other visually distracting injuries and, often, mass casualties. Such knowledge would guide responsible medical staff in implementing early appropriate interventions to reduce the burden of long-term sequelae. Effective planning and response strategies would ensure accessibility of appropriate health care resources and evidence-based information in the aftermath of an explosion.

Finlay SE, Earby M, Baker DJ, Murray VSG. Explosions and human health: the long-term effects of blast injury. Prehosp Disaster Med. 2012;27(4):1-7.

Keywords

blast injuryexplosionhuman health
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 4 , August 2012 , pp. 385 - 391
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

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References

1. DePalma, RG, Burris, DG, Champion, HR, Hodgson, MJ. Blast injuries. N Engl J Med. 2005;352(13):1335-1341.CrossRefGoogle ScholarPubMed
2. Reuters News: http://uk.reuters.com/. Accessed March 9, 2011.Google Scholar
3. Okie, S. Traumatic brain injury in the war zone. N Engl J Med. 2005;352(20):2043-2047.CrossRefGoogle ScholarPubMed
4. Centers for Disease Control and Prevention. Emergency preparedness and response. Mass casualties – blast and bombing injuries. http://emergency.cdc.gov/masscasualties/blastinjuryfacts.asp. Accessed March 14, 2011.Google Scholar
5. Warden, D. Military TBI during the Iraq and Afghanistan wars. J Head Trauma Rehabil. 2006;21(5):398-402.CrossRefGoogle ScholarPubMed
6. Ford, NL, Rosenfeld, JV. Mild traumatic brain injury and bomb blast: stress, injury or both? ADF Health. 2008;9:68-73.Google Scholar
7. Martin, EM, Lu, WC, Helmick, K, French, L, Warden, DL. Traumatic brain injuries sustained in the Afghanistan and Iraq wars. J Trauma Nurs. 2008;15(3):94-99.CrossRefGoogle ScholarPubMed
8. Darley, DS, Kellman, RM. Otologic considerations of blast injury. Disaster Med Public Health Prep. 2010;4(2):145-152.CrossRefGoogle ScholarPubMed
9. Catchpole, MA, Morgan, O. Physical health of members of the public who experienced terrorist bombings in London on 07 July 2005. Prehosp Disaster Med. 2010;25(2):139-144.CrossRefGoogle ScholarPubMed
10. Nageris, B, Attias, J, Shemesh, R. Otologic and audiologic lesions due to blast injury. J Basic Clin Physiol Pharmacol. 2008;19(3-4):185-191.CrossRefGoogle ScholarPubMed
11. Van Campen, LE, Dennis, JM, Hanlin, RC, King, SB, Velderman, AM. One-year audiologic monitoring of individuals exposed to the 1995 Oklahoma City bombing. J Am Acad Audiol. 1999;10(5):231-247.Google Scholar
12. Radford, P, Patel, HD, Hamilton, N, Collins, M, Dryden, S. Tympanic membrane rupture in the survivors of the 7/7/2005 London bombings - a poor marker of primary blast injury. Otolaryngol Head Neck Surg. 2011;145(5):806-812.CrossRefGoogle Scholar
13. Mallonee, S, Shariat, S, Stennies, G, Waxweiler, R, Hogan, D, Jordan, F. Physical injuries and fatalities resulting from the Oklahoma City bombing. JAMA. 1996;276(5):382-387.CrossRefGoogle ScholarPubMed
14. Miller, IS, McGahey, D, Law, K. The otologic consequences of the Omagh bomb disaster. Otolaryngol Head Neck Surg. 2002;126(2):127-128.CrossRefGoogle ScholarPubMed
15. Van Campen, LE, Dennis, JM, King, SB, Hanlin, RC, Velderman, AM. One-year vestibular and balance outcomes of Oklahoma City bombing survivors. J Am Acad Audiol. 1999;10(9):467-483.Google ScholarPubMed
16. Scherer, MR, Schubert, MC. Traumatic brain injury and vestibular pathology as a comorbidity after blast exposure. Phys Ther. 2009;89(9):980-992.CrossRefGoogle ScholarPubMed
17. Turegano-Fuentes, F, Caba-Doussoux, P, Jover-Navalón, JM, et al. . Injury patterns from major urban terrorist bombings in trains: the Madrid experience. World J Surg. 2008;32(6):1168-1175.CrossRefGoogle ScholarPubMed
18. Roth, Y, Kronenberg, J, Lotem, S, Leventon, G. Blast injury of the ear. Harefuah. 1989;117(10):297-301.Google ScholarPubMed
19. Lucic, M. Therapy of middle ear injuries caused by explosive devices [in Serbian]. Vojnosanit Pregl. 1995;52(3):221-224.Google ScholarPubMed
20. Lebovici, D, Gofrit, ON, Shapira, SC. Eardrum perforation in explosion survivors: is it a marker of pulmonary blast injury? Ann Emerg Med. 1999;34(2):168-172.CrossRefGoogle Scholar
21. Ari, AB. Eye injuries on the battlefields of Iraq and Afghanistan: public health implications. Optometry (St.Louis, Mo.). 2006;77(7):329-339.CrossRefGoogle ScholarPubMed
22. Thach, A. Opthalmic Care of the Combat Casualty - Eye injuries associated with terrorist bombings. Falls Church, Virginia, USA: Office of the Surgeon General; 2003:421-429.Google Scholar
23. Hogan, DE, Waeckerle, JF, Dire, DJ, Lillibridge, SR. Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med. 1999;34(2):160-167.CrossRefGoogle ScholarPubMed
24. Bumbasirević, M, Lesic, A, Mitkovic, M, Bumbasirević, V. Treatment of blast injuries of the extremity. J Am Acad Orthop Surg. 2006;14(10):S77-S81.CrossRefGoogle ScholarPubMed
25. Aldington, D, Mcquay, HJ, Moore, RA. End to End Military Pain Management. Philos Trans R Soc Lond B Biol Sci. 2010;6:1-9.Google Scholar
26. Wong, JM, Marsh, D, Abu-Sitta, G, Lau, S, Mann, HA, Nawabi, DH, Patel, H. Biological foreign body implantation in victims of the London July 7th suicide bombings. J Trauma (Injury Infection & Critical Care). 2006;60(2):402-404.CrossRefGoogle ScholarPubMed
27. Potter, SJ, Carter, GE. The Omagh bombing--a medical perspective. J R Army Med Corps. 2000;146(1):18-21.CrossRefGoogle ScholarPubMed
28. Edgar, DW, Goodwin-Walters, A. First response, rehabilitation, and outcomes of hand and upper limb function: survivors of the Bali bombing disaster. A case series report. J Hand Ther. 2006;19:283-298.CrossRefGoogle ScholarPubMed
29. Silla, RC, Fong, J, Wright, J, Wood, F. Infection in acute burn wounds following the Bali bombings: a comparative prospective audit. Burns. 2006;32(2):139-144.CrossRefGoogle ScholarPubMed
30. Owers, C, Morgan, JL, Garner, JP. Abdominal trauma in primary blast injury. Br J Surg. 2011;98(2):168-179.CrossRefGoogle ScholarPubMed
31. Crabtree, J. Terrorist homicide bombings: a primer for preparation. J Burn Care Res. 2006;27(5):576-588.CrossRefGoogle ScholarPubMed
32. Katz, E, Ofek, B, Adler, J, Abramowitz, HB, Krausz, MM. Primary blast injury after a bomb explosion in a civilian bus. Ann Surg. 1989;209(4):484-488.CrossRefGoogle Scholar
33. Wani, L, Parray, FQ, Sheikh, T, et al. . Spectrum of abdominal organ injury in a primary blast type. World J Emerg Surg. 2009;21(4):46.CrossRefGoogle Scholar
34. Mayorga, MA. The pathology of primary blast overpressure injury. Toxicology. 1997;121(1):17-28.CrossRefGoogle ScholarPubMed
35. Aharonson-Daniel, L, Klein, Y, Peleg, K, ITG. Suicide bombers form a new injury profile. Ann Surg. 2006;244(6):1018-1023.CrossRefGoogle Scholar
36. Clark, M, Walker, R, Gironda, R, Scholten, J. Comparison of pain and emotional symptoms in soldiers with polytrauma: unique aspects of blast exposure. Pain Med. 2009;10(3):447-455.CrossRefGoogle ScholarPubMed
37. Siegel-Itzkovich, J. Israeli minister orders hepatitis B vaccine for survivors of suicide bomb attacks. BMJ. 2001;323(7310):417.CrossRefGoogle ScholarPubMed
38. Braverman, ID, Wexler, D, Oren, M. A novel mode of infection with hepatitis B: penetrating bone fragments due to the explosion of a suicide bomber. Isr Med Assoc J. 2002;4(7):528-529.Google Scholar
39. HPA. http://www.hpa.org.uk/Topics/EmergencyResponse/ExplosionsAndFires/HealthEffectsOfExplosions/PostExposureProphylaxisAgainstBloodBorneViruses/. Accessed March 18, 2011.Google Scholar
40. Wolf, DG, Polacheck, I, Block, C, et al. . High rate of candidemia in patients sustaining injuries in a bomb blast at a marketplace: a possible environmental source. Clin Infect Dis. 2000;31(3):712-716.CrossRefGoogle Scholar
41. Bhattacharyya, MR, Steptoe, A. Emotional triggers of acute coronary syndromes: strength of evidence, biological processes, and clinical implications. Prog Cardiovasc Dis. 2007;49(5):353-365.CrossRefGoogle ScholarPubMed
42. Ruidavets, JB, Paterniti, S, Bongard, V, Giroux, M, Cassadou, S, Ferrières, J. Triggering of acute coronary syndromes after a chemical plant explosion. Heart. 2006;92(2):257-258.CrossRefGoogle ScholarPubMed
43. Helgeson, M, Lehman, R, Cooper, P, Frisch, M, Anderson, R, Bellabarba, C. Retrospective review of lumbosacral dissociations in blast injuries. Spine (Phila Pa 1976). 2011;36(7):E469-E475.CrossRefGoogle ScholarPubMed
44. Museve, GK. The 7th August 1998, Nairobi American Embassy bomb blasts: survivors with orthopaedic conditions. East African Orthopaedic Journal. 2007;1(1).Google Scholar
45. Freiman, S, Marom, L, Ofer, A, Hoffman, A, Calif, E. Multiple sequential posttraumatic pseudoaneurysms following high energy injuries: case report and review of the literature. J Orthop Trauma. 2002;16(7):520-522.CrossRefGoogle ScholarPubMed
46. Kluger, Y, Nimrod, A, Biderman, P, Mayo, A, Sorkin, P. The quinary pattern of blast injury. Am J Disaster Med. 2007;2(1):21-25.CrossRefGoogle ScholarPubMed
47. Cernak, I, Savic, J, Ignjatovic, D, Jevtic, M. Blast injury from explosive munitions. J Trauma (Injury, Infection and Critical Care). 1999;47(1):96-103.CrossRefGoogle ScholarPubMed
48. Birmes, P, Raynaud, JP, Daubisse, L, et al. . Children's enduring PTSD symptoms are related to their family's adaptability and cohesion. Community Ment Health J. 2009;45(4):290-299.CrossRefGoogle ScholarPubMed
49. North, CS. A tale of two studies of two disasters: comparing psychosocial responses to disaster among Oklahoma City bombing survivors and Hurricane Katrina evacuees. Rehabil Psychol. 2010;55(3):241-246.CrossRefGoogle ScholarPubMed
50. Pffefferbaum, B, North, CS, Flynn, BW, Norris, FH, DeMartino, R. Disaster mental health services following the 1995 Oklahoma City bombing: modifying approaches to address terrorism. CNS Spectr. 2002;7(8):575-579.CrossRefGoogle Scholar
51. Brewin, CR, Fuchkan, N, Huntley, Z, et al. . Outreach and screening following the 2005 London bombings: usage and outcomes. Psychol Med. 2010;40(12):2049-2057.CrossRefGoogle ScholarPubMed
52. North, CS, Pfefferbaum, B, Kawasaki, A, Lee, S, Spitznagel, EL. Psychosocial adjustment of directly exposed survivors 7 years after the Oklahoma City bombing. Compr Psychiatry. 2011;52(1):1-8.CrossRefGoogle ScholarPubMed
53. North, CS, Nixon, SJ, Shariat, S, et al. . Psychiatric disorders among survivors of the Oklahoma City bombing. JAMA. 1999;282(8):755-762.CrossRefGoogle ScholarPubMed
54. Whibley, A. Bali bomb lessons helped shape Australia's mental health response to terrorism and trauma. http://www.innovations-report.com/html/reports/medicine_health/report-84491.html. Accessed March 21, 2011.Google Scholar
55. Gillespie, K, Duffy, M, Hackmann, A, Clark, DM. Community based cognitive therapy in the treatment of posttraumatic stress disorder following the Omagh bomb. Behav Res Ther. 2002;40(4):345-357.CrossRefGoogle ScholarPubMed
56. Warden, D. Military TBI during the Iraq and Afghanistan Wars. J Head Trauma Rehabil. 2006;21(5):398-402.CrossRefGoogle ScholarPubMed
57. Sansone, RA, Roman, EJ. The experience of psychiatric residents with disaster support: a descriptive report. J Okla State Med Assoc. 1996;89(7):238-241.Google ScholarPubMed
58. Tucker, P, Dickson, W, Pfefferbaum, B, McDonald, NB, Allen, G. Traumatic reactions as predictors of posttraumatic stress six months after the Oklahoma City bombing. Psychiatr Serv. 1997;48(9):1191-1194.Google ScholarPubMed
59. Luce, A, Firth-Cozens, J, Midgley, S, Burges, C. After the Omagh bomb: post traumatic stress disorder in health service staff. J Trauma Stress. 2002;15(1):27-30.CrossRefGoogle ScholarPubMed
60. Collins, S, Long, A. Too tired to care? The psychological effects of working with trauma. J Psychiatr Ment Health Nurs. 2003;10(1):17-27.CrossRefGoogle ScholarPubMed
61. Hoek, MR, Braceridge, S, Oliver, I. Health impact of the Buncefield oil depot fire, December 2005: study of accident and emergency case records. J Public Health (Oxf). 2007;29(3):298-302.CrossRefGoogle ScholarPubMed
62. Riviere, S, Albessard, A, Gardette, V, Lapierre-Duval, K, Schwoebel, V, Lang, T. Psychosocial risk factors for depressive sympoms after the AZF chemical factory explosion in Toulouse, France. Eur J Public Health. 2010;20(6):625-630.CrossRefGoogle Scholar
63. North, CS, Tivis, L, McMillen, JC, et al. . Psychiatric disorders in rescue workers after the Oklahoma City bombing. Am J Psychiatry. 2002;159(5):857-859.CrossRefGoogle ScholarPubMed
64. North, CS, Tivis, L, McMillen, JC, et al. . Coping, functioning, and adjustment of rescue workers after the Oklahoma City bombing. J Trauma Stress. 2002;15(3):171-175.CrossRefGoogle ScholarPubMed
65. Matthews, G. Pregnancy and blast injury. ADF Health. 2008;9:79-83.Google Scholar
66. Matthews, G, Hammersley, B. A case of anternal pelvic trauma following a road traffic accident, associated with fetal intracranial haemorrhage. J Accid Emerg Med. 1997;4:115-117.CrossRefGoogle Scholar
67. 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(2):307-310.CrossRefGoogle ScholarPubMed
68. Lavery, GG, Horan, E. Clinical review: communication and logistics in the response to the 1998 terrorist bombing in Omagh, Northern Ireland. Crit Care (London, England). 2005;9(4):401-408.CrossRefGoogle Scholar
69. McGuigan, R, Spinella, P, Beekley, A, et al. . Pediatric trauma: experiance of a combat support hospital in Iraz. J Pediatr Surg. 2007;42:207-210.CrossRefGoogle Scholar
70. Benjaminov, O, Sklair-Levy, M, Rivkind, A, Cohen, M, Bar-Tal, G, Stein, M. Role of radiology in evaluation of terror attack victims. AJR. 2006;187:609-616.CrossRefGoogle ScholarPubMed
71. Pfefferbaum, B. The impact of the Oklahoma City bombing on children in the community. Mil Med. 2001;166(12):Suppl 49-50.CrossRefGoogle ScholarPubMed
72. Pfefferbaum, B, Jeon-Slaughter, H, Pfefferbaum, RL, Houston, JB, Rainwater, SM, Regens, JL. Media coverage and children's reactions to disaster with implications for primary care and public health. J Okla State Med Assoc. 2008;101(12):312-317.Google ScholarPubMed