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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. 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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  1. Pre-hospital and Emergency Department Management for Blast Injury Nat Krairojananan MD FRCST Department of Trauma and Emergency Medicine Phramongkutklao Hospital

  2. 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.

  3. Type of explosives Manufactured explosives • Military: C4 • Industrial: TNT

  4. Type of explosives • Improvise Explosive Devices(IED) • Pipe bomb • ANFO (Ammonium Nitrate Fuel Oil)

  5. Factors influence severity of injuries • Size and amount of explosive • Distance from the detonation • Media (air VS water) • Detonation in the closed space

  6. Blast injury categorization Primary blast injury Secondary blast injury Tertiary blast injury Quaternary blast injury Quinary blast injury

  7. 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

  8. Secondary blast injury • Penetrating injury/ laceration • Fragmentation of case/shell or Shrapnel • Secondary fragment

  9. Secondary blast injury

  10. 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

  11. Quaternary blast injury Not caused by primary, secondary or tertiary blast injury • Fire (burn) • Inhalation injury • Asphyxia

  12. Quinary blast injury • Toxic fume • Chemical injury • Radiation • Biological agents

  13. Part IScene Management For EMS personnel

  14. Scene management • Scene sized up (scene safety) • Scene triage • Scene treatment • Evacuation

  15. ICS in bombing event • Commander • Security • Search and rescue • Treatment team • Evacuation team

  16. Scene sized up Recognition of specific hazardswith bombing • Secondary device • Environmental hazards (fires, toxin) • Structural instability • Other threat; sniper

  17. Safe distance?

  18. Scene Triage • MASS triage • START triage

  19. MASS Triage M: Move A: Assess S: Sort S: Send • Presence of threat

  20. MOVE • Quickly evacuate all patients from scene • Move unresponsive patients first • Use of appropriate stabilization and equipment • Stretcher or SKED MASS triage

  21. ASSESS • According to Pre-Hospital Trauma Life Support (PHTLS) protocol by assess life threatening injury first MASS triage

  22. SORTCategorize and tag patients into groups for Rx and evacuation MASS triage

  23. SEND • Expedient patients to appropriate resources • Trauma center • En route care: monitors • Proper stabilization MASS triage

  24. START Triage Simple Triage And Rapid Treatment

  25. 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

  26. 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

  27. Initial management • Treat life threatening injuries • Prevent disability START triage

  28. Evacuation • Expedient patients to appropriate resources • Trauma center • En route care: monitors • Proper stabilization START triage

  29. Part IIEmergency Department Management For clinicians, nurses

  30. Emergency department management • Triage and Patient categorization • Treatment zones by color code • follow Advance Trauma Life Support (ATLS) protocol

  31. Primary blast injury treatment

  32. Secondary blast injury treatment

  33. Tertiary blast injury treatment

  34. Quaternary blast injury treatment

  35. Quinary blast injury treatment

  36. Special consideration • ‘upside down’ or ‘reverse’ triage • Estimated incoming patient Total number of patient = Number in first hour x 2

  37. Special consideration CBRNE event • Decontamination • Personal Protective Equipment

  38. EMS personnel preparation

  39. Decontaminating station

  40. Thank you Comments and question are welcome

  41. Three suspected captured injured

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