Wind of Ball

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 : –

  • High Order Explosives (HE) – TNT, C-4, Semtex which produce a supersonic over-pressurisation shockwave.
  • Low Order Explosives(LE) -gunpowder, petroleum based bombs.


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

  • Primary injuries – effect of blast wave on gas containing organs
  • Secondary injuries – from flying debris
  • Tertiary injury – damage caused when the body is blown aside
  • Quaternary injury – burns, crush injury, smoke and dust inhalation.

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.

  • Ears – Ruptured or bleeding eardrum, damage to the ossicular bones and damage to the neural pathways.
  • Gastro-intestinal tract – Bleeding and internal rupture of the GIT
  • Lungs – Contusion, air embolism causing occlusion of vessels and thrombosis. ARDS – Adult Respiratory Distress Syndrome
  • Cardiovascular changes – The heart rate and stroke volume fall leading to impaired perfusion
  • Traumatic brain and spinal cord injury – neurotrauma. Death my be immediate, coma may occur and there may be significant long term effects.
  • Metabolic instability may occur as a hypermetabolic state develops in which hyperglycaemia and hyperlactataemia occur.

Secondary Injuries

Blast throws debris around which has the potential to cause damage.

Tertiary Injury

The victim may be blown to one side or up in the air and there may be damage to uncontrollably flailing limbs

Quaternary Injury

Where does all this start ? The obvious suggestion must be at he moment of injury.
An “inflammatory storm” has been postulated where the body tries to defend itself and in the long term establishes a “chronic pro-inflammatory state” which continues to harm the survivors.

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) ?

  • difficulty
  • concentrating
  • anxiety
  • amnesia
  • mood disturbance
  • headache
  • sleeplessness
  • impaired cognitive function

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

Artificial Intelligence Chat GPT

For those who wish to explore the topic further I would suggest starting with AI. Bring up Microsoft “Bing” in your browser and type in “Long term effects of blast injury” Something like the text below should appear :-

The long-term effects of blast injuries can be significant and multifaceted. Let’s explore some of the consequences:

  1. Physical Health Implications:

    • Deformities: Blast victims may experience long-term deformities due to the extreme forces exerted by explosions. Their bodies are thrown harder and further, leading to increased bending of bones. Unfortunately, recovery chances are often limited1.
    • Weight Loss: Blast injuries can result in weight loss, which may persist over time.
    • Hormone Imbalance: The endocrine system can be affected, leading to hormonal imbalances.
    • Chronic Fatigue: Survivors may suffer from chronic fatigue, impacting their daily activities.
    • Headaches: Persistent headaches are common after blast injuries.
    • Memory and Speech Issues: Problems with memory and speech can arise.
    • Balance Problems: Blast-related injuries may affect balance and coordination.
  2. Psychological and Emotional Impact:

    • Post-Traumatic Stress Disorder (PTSD): Witnessing or experiencing blasts can lead to PTSD, affecting mental well-being.
    • Psychological Trauma: Survivors may carry psychological scars, impacting their quality of life.
  3. Delayed Effects and Latent Pathologies:

In summary, understanding the long-term consequences of blast injuries is essential for effective medical care and planning in the aftermath of explosions. It ensures timely interventions and appropriate resources for survivors and responders23.

Sn Sarfait 750x507 Web
Western Dhofar 23 Nov 22 Web 750x544
Sherishitti Sh 980 Deefa 750x656
Sherishitti Caves
Dianas Web 600
Sn Hawf 750x507