In November 2008, a surgical team from The Red Cross Hospital Beverwijk, the Netherlands, went to Afghanistan to attend in the army hospital of Kandahar Air Field (KAF). During the three-month stay, several armored personnel carriers, type MRAP, encountered improvised explosive devices (IEDs). IEDs are homemade explosives that are often used by insurgents and terrorists in the Middle East. In Iraq, in 2005, 10,000 attacks were reported. From June 2003 to January 2008, IEDs caused over 1,500 fatalities. IEDs are similar to mines and are often activated by the victim himself. Often, IEDs incorporate metal fragments and/or animal fecal excrements
[1–4]. IEDs contributed to the majority of injuries in casualties in the British Military Field Hospital, Shaibah, Iraq in 2006
Upon the victims’ arrival in the hospital, after triage, resuscitation and stabilization, it became clear that the occupants in each vehicle had sustained strikingly similar injuries. In this report we will describe the four cases and the trauma mechanisms.
To comprehend the trauma mechanisms, it is important to be well aware of the different types of blast trauma and their impact.
Blast injuries can be classified into four types. Primary blast injuries (explosive forces) are those caused by the direct effect of overpressure on a person. Secondary blast injuries are injuries caused by the effect of projectile fragments incorporated in the bomb, like nails, rocks or scrap metal. Tertiary blast injuries are caused by the effects from the blast wind, resulting in physical displacement. Also in this group are injuries resulting from collapsing buildings. Most fractures, blunt trauma and tissue contusions are tertiary blast effects
[1, 2, 6]. A variety of injuries are classified in the group of quaternary blast injuries, including burns, psychological trauma, toxic inhalation and exposure to radiation
[2, 6]. The cases described below are classified in the tertiary injury group.
Furthermore the magnitude of the effects of an explosion on a person is dependent on several factors. Most important is the magnitude of the explosion, the medium through which the pressure wave passes, the distance of a person to the epicenter and, lastly, the environment of the incident (i.e., open air or enclosed space)
[2, 7, 8].
The aim of the article is to establish whether useful adjuncts in the assessment of blast injury patients can be put forward following the assessment of four paired cases of blast injury.