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Injuries From Explosions: Physics, Biophysics, Pathology, and Required Research Focus

Champion, Howard R. MD, FRCS, FACS; Holcomb, John B. MD, FACS; Young, Lee Ann MA

Journal of Trauma and Acute Care Surgery: May 2009 - Volume 66 - Issue 5 - p 1468-1477
doi: 10.1097/TA.0b013e3181a27e7f
Review Article

Background: Explosions cause more complex and multiple forms of damage than any other wounding agent, are the leading cause of death on the battlefield, and are often used by terrorists. Because explosion-related injuries are infrequently seen in civilian practice, a broader base of knowledge is needed in the medical community to address acute needs of patients with explosion-related injuries and to broaden mitigation-focused research efforts. The objective of this review is to provide insight into the complexities of explosion-related injury to help more precisely target research efforts to the most pressing areas of need in primary prevention, mitigation, and consequence management.

Methods: An understanding of the physics and biological consequences of explosions together with data on the nature or severity of contemporary combat injuries provide an empiric basis for a comprehensive and balanced portfolio of explosion-related research. Cited works were identified using MeSH terms as directed by subtopic. Uncited information was drawn from the authors’ surgical experience in Iraq, analysis of current combat trauma databases, and explosion-related research.

Results: Data from Iraq and Afghanistan confirm that survivable injuries from explosions are dominated by penetrating fragment wounds, substantiating longstanding and well-known blast physics mechanisms. Keeping this factual basis in mind will allow for appropriate vectoring of funds to increase understanding of this military and public health problem; address specific research and training needs; and improve mitigation strategies, tactics, and techniques for vehicles and personal protective equipment.

Conclusions: A comprehensive approach to injury from explosions should include not only primary prevention, but also injury mitigation and consequence management. Recalibration of medical research focus will improve management of injuries from explosions, with profound implications in both civilian and military healthcare systems.

From the Department of Surgery (H.R.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Division of Acute Care Surgery Director (J.B.H.), Center for Translational Injury Research University of Texas Health Sciences Center, Houston, Texas; and Applied Research Associates, Inc. (L.A.Y.), San Antonio, Texas.

Submitted for publication December 4, 2008.

Accepted for publication February 21, 2009.

Authorship certifications: All authors certify that the manuscript represents original and valid work and that neither this manuscript nor one with substantially similar content under their authorship has been published or is being considered for publication elsewhere. All authors have given final approval of the submitted manuscript and have participated sufficiently in the work to take public responsibility for the whole content.

Author roles: All authors made substantial contributions to the intellectual content of the manuscript, specifically conception and design (all), acquisition of data (J.H., L.Y.), analysis and interpretation of data (all), drafting of the manuscript (all), critical revision of the manuscript for important intellectual content, administration/technical support (H.C.), and supervision (H.C., J.H.).

All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

None of the authors has any conflicts of interest.

Address for reprints: Howard R. Champion, MD, 954 Melvin Road, Annapolis, MD 21403; email:

© 2009 Lippincott Williams & Wilkins, Inc.