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Why are blast injuries an important issue right now?
America's armed forces are sustaining attacks by rocket-propelled grenades, improvised explosive devices, and land mines almost daily in Iraq and Afghanistan. These injured soldiers require specialized care from providers experienced in treating traumatic brain injury.
Index
In combat, how often do blasts cause injury?
Blast injuries have become common in civilian disasters and military conflicts. It has been suggested that over 50% of injuries sustained in combat are the result of explosive munitions including bombs, grenades, land mines, missiles, and mortar/artillery shells (Coupland & Meddings, 1999).
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How often do blasts result in brain injuries?
The data on blast injury induced brain injury is very limited. Statistics from the October 23, 1983 terrorist bombing of the US Marine barracks from (Scott et al, 1986) indicated that the large explosion (equivalent to approximately 12 tons of TNT) resulted in 234 immediate deaths and at least 122 injured survivors. Of the immediate deaths, 167 demonstrated evidence of head injury. There was a 59% rate of head injury and a 70% fatality rate from head injury.
Between July and November 2003 DVBIC at Walter Reed Army Medical Center
screened 155 patients who had returned from Iraq and were deemed as being at
risk for brain injury. Ninety-six of the 155 screened or 62% were identified
as having sustained a brain injury. Of the 88 blast cases included in the
total number screened, 54 or 61% were identified as having sustained a brain
injury.
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How does a blast cause injury?
Blast injuries are injuries that result from the complex pressure wave generated by an explosion. The explosion causes an instantaneous rise in pressure over atmospheric pressure that creates a blast overpressurization wave. Primary blast injury occurs from an interaction of the overpressurization wave and the body with differences occurring from one organ system to another. Air-filled organs such as the ear, lung, and gastrointenstinal tract and organs surrounded by fluid-filled cavities such as the brain and spinal are especially susceptible to primary blast injury (Elsayed, 1997;Mayorga, 1997). The overpressurization wave dissipates quickly, causing the greatest risk of injury to those closest to the explosion.
In a blast, brain injuries can also occur by other means such as impact from blast-energized debris, the individual being physically thrown, burns and/or inhalation of gases and vapors.
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What symptoms may indicate a closed head injury?
Difficulties experienced as a result of a closed-head blast injury include post concussion complaints such as decreased memory and attention/concentration, headaches, slower thinking, irritability, and/or depression.
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What is the DVBIC doing to care for those with blast injuries?
The Defense and Veterans Brain Injury Center (DVBIC) works to identify all soldiers who have sustained a closed head injury during combat operations and to ensure that they receive the best care available. For example, at Walter Reed Army Medical Center, DVBIC reviews all incoming casualty reports and screens all patients who may have sustained a brain injury including those injured in blasts, motor vehicle crashes, falls, and gunshot wounds to the head. Brain injury specialists evaluate patients who are identified with a brain injury. Recommendations are made for treatment and duty status.
Index
Blast Injury References
(A partial list follows. This is not a comprehensive list.)
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Cassiday, K. L., & Lyons, J. A. (1992). Recall of traumatic memories following cerebral vascular accident. Journal of Traumatic Stress, 5, 627-631.
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Cernak, I., Wang, Z., Jiang, J., Bian, X., & Savic, J. (2001). Cognitive deficits following blast injury-induced neurotrauma: Possible involvement of nitric oxide. Blast Injury, 15(7), 593-612.
Cernak, I., Wang, Z., Jiang, J., Bian, X., & Slavic, J. (2001). Ultrastructural and functional characteristics of blast injury-induced neurotrauma. The Journal of Trauma Injury, Infection, and Critical Care, 50(4), 695-706.
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Mabry, R. L., Holcomb, J. B., Baker, A. M., Cloonan, C. C., Uhorchak, J. M., Perkins, D. E., Canfield, A. J., & Hagmann, J. H. (2000). United States army rangers in Somalia: An analysis of combat casualties on an urban battlefield. The Journal of Trauma, Injury, Infection, and Critical Care, 49(3), 515-529.
Mayorga, M. A. (1997). The pathology of primary blast overpressure injury. Toxicology, 121, 17-28.
Mellor, S. G., & Cooper, G. J. (1989). Analysis of 828 servicemen killed or injured by explosion in Northern Ireland 1970-84: The hostile action casualty system. British Journal of Surgery, 76, 1006-1010.
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Murthy, J. M. K., Chopra, J. S., & Gulati, D. R. (1979). Subdural hematoma in an adult following a blast injury. Journal of Neurosurgery, 50, 260-261.
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Sylvia, F. R. (2001). Transient vestibular balance dysfunction after primary blast injury. Military Medicine, 166(10), 918-920.
Trudeau, D. L., Anderson, J., Hansen, L. M., Shagalov, D. N., Schmoller, J., Nugest, S., & Barton, S. (1998). Findings of mild traumatic brain injury in combat veterans with PTSD and a history of blast concussion. Journal of Neuropsychiatry, 10(3), 308-313.
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Verma, S. K. (2001). Homicide by improvised explosive device made out of firecrackers. Medicine, Science and the Law, 41(4), 353-355.
Whitlock, R. I. (1981). Charles Tomes Lecture, 1979. Experience gained from treating facial injuries due to civil unrest. Ann R Coll Surg Engl, 63(1), 31-44.
Deborah Warden, M.D., National Director, Defense and Veterans Brain Injury
Center, invites other health care professionals with an interest in blast related brain injury to contact her:
Email: deborah.warden@na.amedd.army.mil
Phone: 1-800-870-9244
DSN: 662-6345
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