UMEM Educational Pearls

Title: Classification of Blast Injuries

Keywords: Blast, Bombings, Explosions, Terrorism (PubMed Search)

Posted: 5/4/2016 by Jon Mark Hirshon, PhD, MPH, MD (Updated: 5/18/2016)
Click here to contact Jon Mark Hirshon, PhD, MPH, MD

The classification of blast injuries was first described by Zuckerman in 1941 and is still widely used today. This system organizes injuries by the mechanism through which they are sustained and classifies them as primary, secondary, tertiary and quaternary. These injuries may occur in isolation or in combination with each other.

Category	Mechanism	Typical Injuries
Primary	Caused by blast wave of overpressure	Tympanic membrane rupture, blast lung, intestinal hemorrhage and rupture
Secondary	Caused by flying debris and shrapnel	Blunt and penetrating traumatic injuries
Tertiary	Due to individual being thrown by blast	Blunt and penetrating traumatic injuries
Quaternary	Thermal, toxic, and asphyxiant effects	Thermal burns, chemical burns, exposure to toxins, asphyxiation

The term quinary blast injury has also been used to describe delayed effects of explosions, such as infections, radiation exposure, and other toxic exposures.

Author: R. Gentry Wilkerson

References

Zuckerman S. Discussion on the problem of blast injuries. Proc Roy Soc Med 1941;34:171-192.
Champion HR, Holcomb JB, Young LA. Injuries from explosions: Physics, biophysics, pathology, and required research focus. J Trauma 2009;66:1468-1477.
Wilkerson RG, Lemon C. Blast Injuries. Trauma Reports 2016; 17:1-16