UMEM Educational Pearls

Category: International EM

Title: Classification of Blast Injuries

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

Posted: 5/4/2016 by Jon Mark Hirshon, MD, MPH, PhD (Emailed: 5/18/2016) (Updated: 5/18/2016)
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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.




Typical Injuries


Caused by blast wave of overpressure

Tympanic membrane rupture, blast lung, intestinal hemorrhage and rupture


Caused by flying debris and shrapnel

Blunt and penetrating traumatic injuries



Due to individual being thrown by blast

Blunt and penetrating traumatic injuries



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


  • 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