An explosion injures people in four ways: the pressure wave damages air-filled organs, flying debris causes penetrating wounds, the body is thrown against objects, and burns, smoke and toxins add further harm. Lungs, ears and bowel are most at risk from the pressure wave, and injuries may be hidden at first.
Key symptoms
- Ringing in the ears, hearing loss or ear pain
- Shortness of breath, chest pain or coughing blood
- Abdominal pain, nausea or vomiting
- Bleeding wounds, burns or obvious fractures
- Confusion, headache or loss of consciousness
What you find on exam
- Scene safety first: risk of a second device, fire or building collapse
- Massive bleeding, airway and breathing, then a full primary survey
- Breath sounds for pneumothorax; oxygen saturation
- Eardrums, eyes and the abdomen for blast damage
- Full skin check for small entry wounds from fragments
Tests
- Triage tags at the scene, with START for many casualties
- Chest X-ray or CT for blast lung and pneumothorax
- CT of the abdomen and head as needed; FAST ultrasound
- Blood count, type and crossmatch, lactate, carbon monoxide level if enclosed space
Treatment basics
- Tourniquet or wound packing for severe limb bleeding
- Oxygen; needle decompression for tension pneumothorax
- Avoid large volumes of fluid in blast lung; give blood for shock
- Cover burns with dry, clean dressings and keep the patient warm
- Rapid transport to a trauma center; spinal care when indicated
Red flags
- Low oxygen, coughing blood or increasing breathlessness
- Signs of shock or uncontrolled bleeding
- Worsening abdominal pain or confusion hours after the blast
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; National EMS Education Standards (2021); NREMT psychomotor skill sheets (EMT and Paramedic). Written by Making Synapses. Making Synapses is not affiliated with these organizations.