Radiologic diagnosis of explosion casualties


  • Brian J. Eastridge, MD
  • Lorne Blackbourne, MD
  • Charles E. Wade, PhD
  • John B. Holcomb, MD



explosion, blast, fragment, trauma, injury, radiology, diagnosis


The threat of terrorist events on domestic soil remains an ever-present risk. Despite the notoriety of unconventional weapons, the mainstay in the armament of the terrorist organization is the conventional explosive. Conventional explosives are easily weaponized and readily obtainable, and the recipes are widely available over the Internet. According to the US Department of State and the Federal Bureau of Investigation, over one half of the global terrorist events involve explosions, averaging two explosive events per day worldwide in 2005 (Terrorism Research Center. Available at Accessed April 1, 2007). The Future of Emergency Care in the United States Health System: Emergency Medical Services at the Crossroads, published by the Institute of Medicine, states that explosions were the most common cause of injuries associated with terrorism (Institute of Medicine Report:The Future of Emergency Care in the United States Health System: Emergency Medical Services at the Crossroads.Washington DC: National Academic Press, 2007).
Explosive events have the potential to inflict numerous casualties with multiple injuries. The complexity of this scenario is exacerbated by the fact that few providers or medical facilities have experience with mass casualty events in which human and material resources can be rapidly overwhelmed. Care of explosive- related injury is based on same principles as that of standard trauma management paradigms. The basic difference between explosion-related injury and other injury mechanisms are the number of patients and multiplicity of injuries, which require a higher allocation of resources.With this caveat, the appropriate utilization of radiology resources has the potential to impact in-hospital diagnosis and triage and is an essential element in optimizing the management of the explosive-injured patients.

Author Biographies

Brian J. Eastridge, MD

US Army Institute for Surgical Research, Fort Sam Houston, Texas.

Lorne Blackbourne, MD

US Army Institute for Surgical Research, Fort Sam Houston, Texas.

Charles E. Wade, PhD

US Army Institute for Surgical Research, Fort Sam Houston, Texas.

John B. Holcomb, MD

US Army Institute for Surgical Research, Fort Sam Houston, Texas.


CDC: Explosions and blast injuries: A primer for clinicians. CDC Emergency Preparedness and Response Web site.Available at Accessed April 1, 2007.

Bowen TE, Bellamy RF: Emergency War Surgery: Second United States Revision of Emergency War Surgery NATO Handbook. Washington, DC: US Government Printing Office, 1988.

Stuhmiller JH, Phillips YY, Richmond DR: The physics and mechanisms of primary blast injury. In Bellamy AFR, Zajtchuk R (eds.): Conventional Warfare: Ballistic, Blast, and Burn.Washington, DC: US Government Printing Office, 1991: 247-270.

Cernak I, Savic J, Ignjatovic D, et al.: Blast injury from explosive munitions. J Trauma. 1999; 47(1): 96-103; discussion 103-104.

Guy RJ, Kirkman E,Watkins PE, et al.: Physiologic responses to primary blast. J Trauma. 1998; 45(6): 983-987.

Irwin RJ, Lerner MR, Bealer JF, et al.: Cardiopulmonary physiology of primary blast injury. J Trauma. 1997; 43(4): 650-655.

Katz E, Ofek B, Adler J, et al.: Primary blast injury after a bomb explosion in a civilian bus. Ann Surg. 1989; 209(4): 484-488.

Leibovici D, Gofrit ON, Stein M, et al.: Blast injuries: Bus versus open-air bombings—A comparative study of injuries in survivors of open-air versus confined-space explosions. J Trauma. 1996; 41(6): 1030-1035.

Mayorga MA: The pathology of primary blast overpressure injury. Toxicology. 1997; 121(1): 17-28.

Wightman JM, Gladish SL: Explosions and blast injuries. Ann Emerg Med. 2001; 37(6): 664-678.

Argyros GJ: Management of primary blast injury. Toxicology. 1997; 121(1): 105-115.

Yeung KW, Chang MS, Hsiao CP, et al.: CT evaluation of gastrointestinal tract perforation. Clin Imaging. 2004; 28(5): 329-333.

Saku M, Yoshimitsu K, Murakami J, et al.: Small bowel perforation resulting from blunt abdominal trauma: Interval change of radiological characteristics. Radiat Med. 2006; 24(5): 358-364.

Shaham D, Sella T, Makori A, et al.: The role of radiology in terror injuries. Isr Med Assoc J. 2002; 4: 564-657.

Hare SS, Goddard I,Ward O, et al.: The radiological management of bomb blast injury. Clin Radiol. 2007; 62: 1-9.

Marti M, Parron M, Baudraxler F, et al.: Blast injuries from Madrid terrorist bombing attacks on March 11, 2004. Emerg Radiol. 2006; 13: 113-122.

Asensio J, Arroyo H, Veloz W, et al.: Penetrating thoracoabdominal injuries: Ongoing dilemma-which cavity and when? World J Surg. 2001; 26: 539-543.

Beekley A, Sebesta J, Blackbourne L, et al.: Selective non-operative management of penetrating abdominal injury from combat fragmentation wounds. J Trauma. 2008; 64(2 Suppl): S108-S106; Discussion S116-S117.

Benjaminov O, Sklair-Levy M, Rivkind A, et al.: Role of radiology in evaluation of terror attack victims. AJR Am J Roentgenol. 2006; 187: 609-616.

Sosna J, Sella T, Shaham D, et al.: Facing the new threats of terrorism: Radiologists’ perspectives based on experience in Israel. Radiology. 2005; 237: 28-36.




How to Cite

Eastridge, MD, B. J., L. Blackbourne, MD, C. E. Wade, PhD, and J. B. Holcomb, MD. “Radiologic Diagnosis of Explosion Casualties”. American Journal of Disaster Medicine, vol. 3, no. 5, Sept. 2008, pp. 301-5, doi:10.5055/ajdm.2008.0037.