Notes – Blast Injuries

Blast Injuries

Patient Safety Considerations

  1. Ensuring scene safety is especially important at the scene of an explosion.
    1. Consider possibility of subsequent explosions, structural safety, possible toxic chemical contamination, the presence of noxious gasses, and other hazards
    2. In a possible terrorist event, consider the possibility of secondary explosive devices
  2. Remove patient from the scene as soon as is practical and safe
  3. If the patient has sustained burns (thermal, chemical, or airway), consider transport to specialized burn center

Notes/Educational Pearls

Key Considerations

  1. Scene safety is of paramount importance when responding to an explosion or blast injury
  2. Patients sustaining blast injury may sustain complex, multi-system injuries including: blunt and penetrating trauma, shrapnel, barotrauma, burns, and toxic chemical exposure
  3. Consideration of airway injury, particularly airway burns, should prompt early and aggressive airway management
  4. Minimize IV fluid resuscitation in patients without signs of shock
  5. Consider injuries due to barotrauma
  6. Tension pneumothorax
    1. Hypotension or other signs of shock associated with decreased or absent breath sounds, jugular venous distension, and/or tracheal deviation
  7. Tympanic membrane perforation resulting in deafness which may complicate the evaluation of their mental status and their ability to follow commands
  8. Primary transport to a trauma or burn center is preferable, whenever possible

Pertinent Assessment Findings

  1. Evidence of multi-system trauma, especially:
    1. Airway injury/burn
    2. Barotrauma to lungs
    3. Toxic chemical contamination

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914045 – Exposure-Explosive/Blast Injury

Key Documentation Elements

  • Airway status and intervention
  • Breathing status:
    • Quality of breath sounds (equal bilaterally)
    • Adequacy of respiratory effort
    • Oxygenation
  • Documentation of burns, including Total Burn Surface Area (TBSA) [see Burns guideline]
  • Documentation of possible toxic chemical contamination

Performance Measures

  • Airway assessment and early and aggressive management
  • Appropriate IV fluid management
  • Transport to trauma or burn center
  • EMS Compass® Measures (for additional information, see http://www.emscompass.org)
    • PEDS-03: Documentation of estimated weight in kilograms. Frequency that weight or length-based estimate are documented in kilograms
    • Trauma-01: Pain assessment of injured patients. Recognizing that pain is undertreated in injured patients, it is important to assess whether a patient is experiencing pain
    • Trauma-02: Pain re-assessment of injured patients. Recognizing that pain is undertreated in injured patients, it is important to assess whether a patient is experiencing pain
    • Trauma-04: Trauma patients transported to trauma center. Trauma patients meeting Step 1 or 2* or 3** of the CDC Guidelines for Field Triage of Injured Patients are transported to a trauma center
      • *Any value documented in NEMSIS eInjury.03 – Trauma Center Criteria
      • **8 of 14 values under eInjury.04 – Vehicular, Pedestrian, or Other Injury Risk Factor match Step 3, the remaining 6 value options match Step 4

References

  1. Explosions and Blast Injuries; A Primer for Clinicians. CDC.gov. http://www.cdc.gov/masstrauma/preparedness/primer.pdf. Accessed August 27, 2017.