Pre hospital and emergency department management for blast injury
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Pre-hospital and Emergency Department Management for Blast Injury. Nat Krairojananan MD FRCST Department of Trauma and Emergency Medicine Phramongkutklao Hospital. Physics of the explosive. Sudden rapid conversion from chemical component to gas, heat, pressure, light and flame

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Pre-hospital and Emergency Department Management for Blast Injury

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Pre hospital and emergency department management for blast injury

Pre-hospital and Emergency Department Management for Blast Injury

Nat Krairojananan MD FRCST

Department of Trauma and Emergency Medicine

Phramongkutklao Hospital


Physics of the explosive

Physics of the explosive

  • Sudden rapid conversion from chemical component to gas, heat, pressure, light and flame

  • Low-order explosive devices < 400 m/sec.

  • High-order explosive devices 1400-9000 m/sec.


Type of explosives

Type of explosives

Manufactured explosives

  • Military:C4

  • Industrial:TNT


Pre hospital and emergency department management for blast injury

Type of explosives

  • Improvise Explosive Devices(IED)

  • Pipe bomb

  • ANFO (Ammonium Nitrate Fuel Oil)


Factors influence severity of injuries

Factors influence severity of injuries

  • Size and amount of explosive

  • Distance from the detonation

  • Media (air VS water)

  • Detonation in the closed space


Blast injury categorization

Blast injury categorization

Primary blast injury

Secondary blast injury

Tertiary blast injury

Quaternary blast injury

Quinary blast injury


Primary blast injury

Primary blast injury

  • Caused by high order explosive only

  • Over pressure to air-filled organs

  • Blast lung: PTX, pulmonary contusion, PE

  • Blast bowel: ruptured hollow viscus peritonitis

  • Blast ear: TM perforation

  • Blast brain: concussion

  • Blast eye


Secondary blast injury

Secondary blast injury

  • Penetrating injury/ laceration

  • Fragmentation of case/shell or Shrapnel

  • Secondary fragment


Secondary blast injury1

Secondary blast injury


Tertiary blast injury

Tertiary blast injury

  • Blast wave

  • Propulsion of body onto hard surface

  • Propulsion of object onto individuals

  • Structural collapsed

  • Fall from height

  • Blunt injury

  • crush syndrome

  • compartment syndrome


Quaternary blast injury

Quaternary blast injury

Not caused by primary, secondary or tertiary blast injury

  • Fire (burn)

  • Inhalation injury

  • Asphyxia


Quinary blast injury

Quinary blast injury

  • Toxic fume

  • Chemical injury

  • Radiation

  • Biological agents


Part i scene management

Part IScene Management

For EMS personnel


Scene management

Scene management

  • Scene sized up (scene safety)

  • Scene triage

  • Scene treatment

  • Evacuation


Ics in bombing event

ICS in bombing event

  • Commander

  • Security

  • Search and rescue

  • Treatment team

  • Evacuation team


Scene sized up

Scene sized up

Recognition of specific hazardswith bombing

  • Secondary device

  • Environmental hazards (fires, toxin)

  • Structural instability

  • Other threat; sniper


Pre hospital and emergency department management for blast injury

Safe distance?


Scene triage

Scene Triage

  • MASS triage

  • START triage


Mass triage

MASS Triage

M: Move

A: Assess

S: Sort

S: Send

  • Presence of threat


Pre hospital and emergency department management for blast injury

MOVE

  • Quickly evacuate all patients from scene

  • Move unresponsive patients first

  • Use of appropriate stabilization and equipment

  • Stretcher or SKED

MASS triage


Assess

ASSESS

  • According to Pre-Hospital Trauma Life Support (PHTLS) protocol by assess life threatening injury first

MASS triage


Sort categorize and tag patients into groups for rx and evacuation

SORTCategorize and tag patients into groups for Rx and evacuation

MASS triage


Pre hospital and emergency department management for blast injury

SEND

  • Expedient patients to appropriate resources

  • Trauma center

  • En route care: monitors

  • Proper stabilization

MASS triage


Start triage

START Triage

Simple Triage And Rapid Treatment


Start triage1

START triage

Scene Sized up

Ask patients to walk to your voice

Unable to walk

Able to walk

Ask patients to raise hand or leg

GREEN(minimal)

Walk to assigned area


Start triage cont

START Triage (cont.)

Ask patient to raise hand or leg

No response

Breathing

5 /min or more

Assess breathing

Obey command

No breathing

YELLOW

Delayed Rx possibility

RED

Immediate AW treatment

BLACK or BLUE

Supportive treatment with limited resources


Initial management

Initial management

  • Treat life threatening injuries

  • Prevent disability

START triage


Evacuation

Evacuation

  • Expedient patients to appropriate resources

  • Trauma center

  • En route care: monitors

  • Proper stabilization

START triage


Part ii emergency department management

Part IIEmergency Department Management

For clinicians, nurses


Emergency department management

Emergency department management

  • Triage and Patient categorization

  • Treatment zones by color code

  • follow Advance Trauma Life Support (ATLS) protocol


Primary blast injury treatment

Primary blast injury treatment


Secondary blast injury treatment

Secondary blast injury treatment


Tertiary blast injury treatment

Tertiary blast injury treatment


Quaternary blast injury treatment

Quaternary blast injury treatment


Quinary blast injury treatment

Quinary blast injury treatment


Special consideration

Special consideration

  • ‘upside down’ or ‘reverse’ triage

  • Estimated incoming patient

    Total number of patient = Number in first hour x 2


Special consideration1

Special consideration

CBRNE event

  • Decontamination

  • Personal Protective Equipment


Pre hospital and emergency department management for blast injury

EMS personnel preparation


Decontaminating station

Decontaminating station


Thank you

Thank you

Comments and question are welcome


Three suspected

Three suspected

captured

injured


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