Primary Blast Injury
Primary injuries are caused by the pressure wave and affect air-filled organs. These include tympanic membrane rupture, blast lung, and bowel perforation. Patients may look fine initially, then deteriorate hours later.
Secondary and Tertiary Injury
Secondary injuries come from shrapnel and debris, causing penetrating trauma and lacerations. Tertiary injuries occur when the victim is thrown, causing blunt trauma, fractures, and head injuries. Treat these using standard trauma principles.
Quaternary and Scene Concerns
Quaternary injuries include burns, inhalation injury, crush injury, and exacerbation of chronic illness. Secondary devices targeting responders are a real threat, so assess the scene carefully. Prioritize hemorrhage control, airway, and rapid transport to a trauma center.