On Nov. 17, 2009, Scott Sasser, MD, FACEP, of CDC's Division of Injury Response and Emory University's Department of Emergency Medicine, provided details on the unique triage, diagnostic and management challenges of blast injuries. (
) Dr. Sasser took a few questions from attendees during the live presentation, and here are his responses to the remaining questions that were submitted.
Q: What about the number of individuals killed on Sept.11, 2001? Does the mechanism (i.e., airplanes) not count as bombs?
Dr. Sasser’s response: Very good question. Jet fuel is a low-order explosive, so technically, the planes used in the attack would not be classified as a high-order explosive detonation.
Q: Could you explain "quinary" injuries a little further?
Dr. Sasser’s response: Recently, quinary blast injury has been proposed as an additional or fifth mechanism of blast injury. It refers to a hyper inflammatory state in the bombing victim, which some experts feel may be caused by environmental contaminants and toxic materials added to or in the explosives. For more information on blast injuries, review CDC’s Blast Injury Fact Sheets.
Q: What's being done to prepare for medical surge to ensure necessary supplies are available for treatment and hospital supplies aren't overwhelmed?
Dr. Sasser’s response: Thank you for your question. Since 2006, CDC’s Division of Injury Response has convened three expert panels comprised of a group of diverse experts from the United States and abroad to address the issues of medical surge preparation and hospital readiness. The expert panel has developed specific recommendations for medical surge response for EMS, emergency departments, surgical and intensive care units, radiology units, blood banks, hospitals, hospital administration, pharmacies and nursing units. In addition, the CDC published these recommendations in the report, In a Moment’s Notice: Surge Capacity for Terrorist Bombings, Challenges and Proposed Solutions. The document includes templates containing specific recommendations to assist hospital disaster planners in formulating hospital medical surge response.
Q: With the risk of a second explosion, knowing law enforcement may not be on scene for minutes, what criteria do you provide to those closest to a blast scene on when to go forward and provide first aid?
Dr. Sasser’s response: Secondary explosions are a real threat to EMS providers, and pre-hospital personnel generally should not enter a terrorist bombing scene until it’s secured by law enforcement.
Q: If we see multiple injuries after blast injury and suspected compartment syndrome with multiple pallets in limbs, do we need formal fasciotomy or removal of pallet and debridement?
Dr. Sasser’s response: The soft tissue and musculoskeletal systems have the highest incidence of bodily injury in survivors of bombings. Secondary blast injury to the extremities is marked by penetrating trauma from the bomb casing fragments, materials implanted within the bomb (e.g., nails, screws), flying glass, or local materials made airborne by proximity to the explosion. These injuries may result in severe underlying tissue and bone damage, highly morbid infectious complications, compartment syndrome, and complications from the traumatic implantation of biologic material (e.g., bone fragments) from the bomber or victims. The evaluation and management of these wounds may be complex and involve multiple medical disciplines. For specific wound management guidance, please review the CDC Blast Injury Fact Sheets.
Q: Would patients presenting with blast lung-type patterns of injuries benefit from extracorporeal membranous oxygenation (ECMO) in lieu of traditional intubation and mechanical ventilation?
Dr. Sasser replies: Literature on the use of ECMO on patients with blast lung injury is limited at this time. However, ECMO has been used in some critically injured patients and is typically used after traditional methods have failed. The process of anticoagulation during ECMO also presents an additional risk to these patients.
Q: Will we get any credits for this presentation?
JEMS replies: Yes, participants will receive FREE continuing education opportunity through CDC available at www2a.cdc.gov/TCEOnline/registration/detailpage.asp?res_id=2001.