Step on a mine
Have the leg amputated in the FST
Next stop the Invictus Games
Slam Bang Dunk
All done and dusted
Except of course it is not quite that simple.
The study of blast injuries commenced with observations by Dr Gilbert Blane in 1785 who was then “Physician to the Fleet”. The term “Wind of Ball” was coined for those who had perished when a cannon ball passed close but did not leave a mark.
In a series arising from the battle of Monte Cassino in spring 1944 evidence of Blast Lung Injury (BLI) was found in 34.5 per cent of a series of 87 autopsies performed in soldiers who died with no external evidence of thoracic injury, while diffuse pulmonary contusions were found in 47 per cent of the fatalities in Northern Ireland in the period between 1969 and 1974.The type of explosive is significant
There are for the, purposes of this website, two categories of explosive : –
The military type have a characteristic and brutal shock wave pattern associated with them.
The shock wave smashes into the victim causing multi organ damage much of which is not immediately apparent. It may be a simple shockwave or if the victim in in an enclosed area a complex multiple shockwave. They both cause multi-system injuries. The mechanism are described as spallation, implosion and inertia.
Blast injury has been classified as having four main elements
Immediate Primary Injuries
The place that is most vulnerable to blast injury is where a solid organ contains or meets a hollow gas filled space; a vulnerable interface. This does not exclude other parts of the body.
Blast throws debris around which has the potential to cause damage.
The victim may be blown to one side or up in the air and there may be damage to uncontrollably flailing limbs
Where does all this start ? The obvious suggestion must be at he moment of injury.
The so-called “unexpected survivors” and those with lesser blast injuries appear to age more quickly, develop hypertension, coronary artery disease and chronic kidney disease sooner than their peers.
They may suffer long term PAIN which is especially challenging to manage.
There are also the obvious long term effects of blast injury – missing limbs, deafness, shortness of breath.
What of conditions that have only been widely recognised since the wars in Iraq and Afghanistan. – Heterotrophic Ossification ? Muscle, tendons and blood vessels which progressively become ossified and turn into bone requiring yet more surgery.
There are less obvious consequences that are a consequence of Traumatic Brain Injury (TBI) ?
It is not all over and done with once the damaged limb is removed.
What has become apparent is that it is very difficult to effectively treat the damage done by explosive blast once the inflammatory storm has been initiated by the the event. In resuscitation anaesthetists have postulated using different types of ventilation ranging from high pressure oscillatory ventilation to low tidal volume ventilation where intuitively they treat the lungs gently. Early resuscitation and provision of supplementary oxygen may very well help.
The prime objective, if blast was not avoided, should undoubtedly be to mitigate the effects of blast in the first place. This is easier said than done. A dismounted soldier may or may not be at more risk than a mounted soldier in an armoured box that contains the blast. It follows on that the design of the box is critical to mitigating the injury. Better IED detection etc, etc