56
6 Health Effects of Radiological Weapons
Secondary
Bomb fragments and other projectiles energized by the explosion
cause penetrating and non-penetrating wounds. Any part of the body
may be affected.
Tertiary
Displacement of the body (or of its constituent parts). This mechanism
contributes to the traumatic amputation of limbs. Structural collapse
of buildings (e.g. crush injuries).
Quarternary A miscellaneous collection of all other mechanisms such as: Flash
burns (superficial burns to exposed skin caused by the radiant and
convective heat of the explosion.
Methaemoglobinaemia due to poisoning by dinitrobenzene or potassium perchlorate (components of WWI munitions) [4]
Acute septecemia melioidosis due to inhalation of soil particles
contaminated with Pseudomonas pseudomallei [12]
Explosions are associated with a high incidence of psychological
sequelae in injured and uninjured survivors.
In the textbook Disaster Nursing, Sacco [8] adds a fifth category of blast injury,
Quinary, which “Result from additives to explosives devices and hyperinflammatory
states post-explosion,” adding that “Further investigation into this type is required.”
Sacco goes on to include radiation exposure and its subsequent damaging effects as
a possible additive to an explosive device.
Horrocks notes that the least-understood of these categories are the primary
injuries, those that are due to the shock wave passing through the body. This shock
wave can collapse hollow organs (e.g. the lungs) and it can shear connective tissue.
The strength of the blast wave, while generally dropping in intensity with the inverse
cube of distance from the source of the blast, can reflect from structures and surfaces,
sometimes reinforcing each other to form a stronger shock than expected.
As the shock wave passes through the body it can cause localized damage that
is frequently undetectable from the outside, including small hemorrhages, shear
injuries, and so forth. Having said that, Horrocks also notes that the proximity to
an explosion that would lead to blast injuries will likely also cause visible damage
(lacerations, broken bones, traumatic amputation, and so forth). From the standpoint
of medical responders, what is important to remember is that, for those who were
closest to the blast, there might be severe internal injuries that cannot easily be
detected.
It is worth noting that, while body armor might help to protect against secondary
injuries, it provides limited or no protection against primary and tertiary injury. Thus,
a police officer or military service person who is wearing body armor and who has
few, if any, penetrating injuries might still have internal injuries from the blast.
In addition to injuries caused by the blast wave passing through the body, medical
responders should be aware is the potential for crush injuries and compartment
syndrome, which can be life-threatening if left unrecognized and untreated. Persons
who have had heavy objects fall on them or who are pinned in place are most likely
to suffer from crush injuries; compartment syndrome can arise from crush injuries
as well as from broken bones, or even a partial loss of blood flow for an extended
period of time (Fig. 6.1).
6 Health Effects of Radiological Weapons
Secondary
Bomb fragments and other projectiles energized by the explosion
cause penetrating and non-penetrating wounds. Any part of the body
may be affected.
Tertiary
Displacement of the body (or of its constituent parts). This mechanism
contributes to the traumatic amputation of limbs. Structural collapse
of buildings (e.g. crush injuries).
Quarternary A miscellaneous collection of all other mechanisms such as: Flash
burns (superficial burns to exposed skin caused by the radiant and
convective heat of the explosion.
Methaemoglobinaemia due to poisoning by dinitrobenzene or potassium perchlorate (components of WWI munitions) [4]
Acute septecemia melioidosis due to inhalation of soil particles
contaminated with Pseudomonas pseudomallei [12]
Explosions are associated with a high incidence of psychological
sequelae in injured and uninjured survivors.
In the textbook Disaster Nursing, Sacco [8] adds a fifth category of blast injury,
Quinary, which “Result from additives to explosives devices and hyperinflammatory
states post-explosion,” adding that “Further investigation into this type is required.”
Sacco goes on to include radiation exposure and its subsequent damaging effects as
a possible additive to an explosive device.
Horrocks notes that the least-understood of these categories are the primary
injuries, those that are due to the shock wave passing through the body. This shock
wave can collapse hollow organs (e.g. the lungs) and it can shear connective tissue.
The strength of the blast wave, while generally dropping in intensity with the inverse
cube of distance from the source of the blast, can reflect from structures and surfaces,
sometimes reinforcing each other to form a stronger shock than expected.
As the shock wave passes through the body it can cause localized damage that
is frequently undetectable from the outside, including small hemorrhages, shear
injuries, and so forth. Having said that, Horrocks also notes that the proximity to
an explosion that would lead to blast injuries will likely also cause visible damage
(lacerations, broken bones, traumatic amputation, and so forth). From the standpoint
of medical responders, what is important to remember is that, for those who were
closest to the blast, there might be severe internal injuries that cannot easily be
detected.
It is worth noting that, while body armor might help to protect against secondary
injuries, it provides limited or no protection against primary and tertiary injury. Thus,
a police officer or military service person who is wearing body armor and who has
few, if any, penetrating injuries might still have internal injuries from the blast.
In addition to injuries caused by the blast wave passing through the body, medical
responders should be aware is the potential for crush injuries and compartment
syndrome, which can be life-threatening if left unrecognized and untreated. Persons
who have had heavy objects fall on them or who are pinned in place are most likely
to suffer from crush injuries; compartment syndrome can arise from crush injuries
as well as from broken bones, or even a partial loss of blood flow for an extended
period of time (Fig. 6.1).