Wednesday, July 2, 2014

Blast Injury by Dr. Eichelberger



*Please note that some links may lead to graphic information not suitable for all audiences.

The Fourth of July inspires celebration - sometimes fireworks, bonfires and other fun activities can lead to serious injuries. This can be even scarier when children are involved. While thinking about "bombs bursting in air" and all of the week's news from war-torn countries, we turn our attention to an issue that is prevalent around the world, and unfortunately hit close to home last year in Boston.

Injury is the number one killer of kids in America and kills many worldwide. Unfortunately, over the last 10 years, children around the world are not just being injured by vehicles or gunfire or falls, but they are actually sustaining injury from explosion, a blast injury. This injury is rare in the United States, but the episode at the Boston Marathon bombings reveals that a new mechanism of injury can occur.  

The explosion creates a pressure wave that results in a blast injury. The most common and dangerous devices are land mines, unexploded devices or “improvised” explosive devices (IEDs), otherwise known as a roadside bomb. In a war-torn country, many of the bombs don’t explode upon impact. These devices have blue, yellow and red tags and children play with the tags, sometimes pulling the pin that detonates the device. These kids become victims of an explosion that result in a unique injury. 

In countries that are experiencing a civil war, such as Colombia, India, Chile, Iraq and Afghanistan, there are millions of “active” land mines. Even when enemies are not fighting, these devices are buried waiting to go off. Innocent children are out there walking and playing where it's easy for them to step upon a land mine.  

Historically, war creates the opportunity to learn new medical techniques and approaches to treatment of the injured patient, which is applicable to the adult patient and to children. When American and other military medical personnel are in these areas, they treat the children as well as the soldiers. Their experience and treatment techniques learned in the field are extremely valuable in saving children around the world. This process is going on right now! For example, in trauma centers we are changing the way we resuscitate pediatric patients with a new concept known as damage control resuscitation. We realize that when a child develops severe shock due to a critical injury, they do much better when we reduce the amount of crystalloid fluid typically given to these kids and instead, immediately treat hemorrhage with infusion of blood products. This approach is more focused upon the importance of coagulation of circulating blood to the survival of the child. Quickly sharing this information saves lives - Sami is an example.

Most American civilian surgeons know little about the effects of a blast from an explosion. Military surgeons who have treated a significant number of children with a blast injury are able to transfer the knowledge to their civilian colleagues to improve the capacity to care for children. A blast pattern is something that most surgeons in the U.S. will never see until there is a devastating emergency. That is one of the reasons we developed the web-based, Childress Pediatric Trauma Symposium and held three of them in the last two years. Our hope is to share knowledge and experiences with our colleagues around the world in time to save lives.

The Boston Marathon bombing is a critical example of why we need to know how to treat a child following a blast injury. If we can share techniques developed to treat children, we can save the lives of children worldwide.

Martin R.Eichelberger, M.D., Professor of Surgery and of Pediatrics, George Washington University, Children’s NationalMedical Center, Washington D.C.

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