Environmental toxicology of blast exposures: injury metrics, modelling, methods and standards

• Published in: BMJ military health 2019-02, Vol.165 (1), p.7-9
• Main Authors: Leggieri Jr, Michael J, Bieler, D, Bjarnason, S, Cernak, I, Franke, A, Kirkman, E, Martineau, L, Orru, H, Ouellet, S, Philippens, M, Risling, M G, Sarron, J-C, Skriudalen, S, Teland, J A, Watts, S, Gupta, R K
• Format: Article
• Language: English
• Subjects: Biomedical Research - standards; Blast Injuries; Casualties; Drug dosages; Explosives; Guidelines as Topic; Humans; Injuries; Interdisciplinary aspects; Laboratories; Medical research; Medicin och hälsovetenskap; Models, Biological; Science; Taxonomy; Terminology as Topic; Toxicology; Toxicology - standards; Trauma
• ISSN: 0035-8665; 2633-3767; 2052-0468; 2633-3775
• DOI: 10.1136/jramc-2018-000963

[...]the primary focus of blast injury research is on the prevention, treatment, rehabilitation and continuum of care for the injured from acute treatment to the return to duty. The US Department of Defense (DoD) reports that the use of IEDs and other explosive devices have led to an injury landscape different from that in previous wars.1 The complexity of physical trauma resulting from direct or indirect exposure to an explosion has challenged medical practitioners across the spectrum of disciplines from surgery to mental health. Especially challenging are blast injuries to the brain where neither injury pathophysiology nor medical diagnosis are well understood. [...]the number of casualties incurred in NATO operations brings urgency to the blast injury research community to use medical information in the design of better protection technologies and the development of new treatment strategies for service members.2 For the purpose of this discussion, the term ‘blast injury’ refers to the entire spectrum of injuries that can result from exposure to an explosion.3 The taxonomy of blast injuries is based on the type of injury into primary, secondary, tertiary, quaternary and quinary (Table 1).Table 1 Taxonomy of injuries from explosive devices adapted with permission from DoD Directive (DoDD) 6025.21E3 Taxonomy of blast injuries Primary Blast overpressure (BOP) injury resulting in direct tissue damage from the shock wave coupling into the body Secondary Injury produced by primary fragments originating from the exploding device (preformed and natural (unformed) casing fragments and other projectiles deliberately introduced into the device to enhance the fragment threat); and secondary fragments, which are projectiles from the environment (debris, vehicular metal, etc.) Tertiary Displacement of the body or part of body by the BOP causing acceleration/deceleration to the body or its parts, which may subsequently strike hard objects causing typical blunt injury (translational injury), avulsion (separation) of limbs, stripping of soft tissues, skin speckling with explosive product residue and building structural collapse with crush and blunt injuries, and crush syndrome development Quaternary Other ‘explosive products’ effects—heat (radiant and convective), and toxic, toxidromes from fuel, metals etc.—causing burn and inhalation injury Quinary Clinical consequences of ‘post detonation environmental contaminants’ including bacteria (deliberate and commensal, with o