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

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


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



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



Scene triage
Scene Triage

  • MASS triage

  • START triage


Mass triage
MASS Triage

M: Move

A: Assess

S: Sort

S: Send

  • Presence of threat


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


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






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


EMS personnel preparation



Thank you

Thank you

Comments and question are welcome


Three suspected
Three suspected

captured

injured


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