Emergency Clinicians Need Training to Treat Blast Injuries

With terrorism threat, emergency teams need to know how to treat injuries from explosions
By Jeff Muise
HealthDay Reporter

THURSDAY, July 23 (HealthDay News) -- With the increasing incidence of terrorist attacks worldwide, civilian emergency clinicians need training on managing the unique injuries that occur in explosions, according to a paper published online July 23 in the The Lancet.

Stephen J. Wolf, M.D., of the Denver Health Medical Center, and colleagues describe the complex of injuries that explosions cause, including primary blast injury, a class of unique injury caused by a pressure wave passing through the body. These can include pulmonary injuries (hemorrhage, contusions, barotrauma, and arterial air embolism), ruptures in the gastrointestinal tract, concussion, and so-called "compartment syndromes."

Because of the chaos that exists after a terrorist explosion, and because clinicians likely will not recognize those blast injuries that are subtle or delayed in presentation, the authors note that special training is needed for civilian clinicians. Also, blast injury therapies can conflict with one another, complicating management. For example, positive pressure ventilation to aid respiration can worsen pulmonary barotrauma and increase the risk of arterial air embolism.

"The rise in urban warfare tactics by terrorist and paramilitary groups means that local health systems must be prepared to manage devastating explosion-related injuries. Acute care providers (i.e., physicians, nurses, and ancillary staff of emergency medicine, surgery, orthopedics, and anesthesiology), who are most likely to be the first receivers of injured people, have an urgent responsibility to know and understand the diagnostic and management issues unique to blast injuries," the authors write.

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