First Aid for Explosions

July 3rd, 2013 by Jeremy Knauff

Explosion

Independence Day is just around the corner, which means there will be a lot of people using all sorts of fireworks. Whether due to alcohol, stupidity, or freak accidents, there are nearly 10,000 firework-related injuries every year.

I’m not going to tell you to stay away from fireworks because anyone with an IQ higher than Jello generally should be able to enjoy them without suffering from injuries or causing injuries to others. What I will tell you is to use them responsibly and be prepared to administer first aid in the event of an injury.

I’ll take it a step further though because the events in Boston taught us that even here in America, we are not immune to bombings. When that happens, we typically see the same type of injuries as with fireworks, only they are far more severe due to increased blast force and shrapnel. During my time in the Marine Corps, I’ve seen plenty of explosions of all sorts, but my job was to cause them—not fix people injured by them, so I though it would be a great idea to bring in someone with first-hand medical experience. I reached out to Dr. Bones from DoomAndBloom.net, an M.D. with decades of experience, one of the best-known medical experts in the survival/prepping community, and the author of The Survival Medicine Handbook: A guide for when help is NOT on the way to get his input on the subject.

What are some of the most common firework-related injuries and how should we treat them until medical professionals arrive?

Most fireworks injuries are some type of burn. Given the intense heat emitted by many, burns can be simple first-degree burns or even reach the level of a third-degree burn. This doesn’t include “fireworks” like M80s. M80s, M100s or M1000s are not fireworks; they are explosive devices. They can cause amputations or other severe injuries. In this circumstance, place the victim in shock position (laying down with feet elevated above the level of the heart and brain). Treat any traumatic injury with pressure if bleeding exists and call 911 ASAP. Run water over the burn for 10-15 minutes or until medical personnel arrive. Don’t use ice: Ice can cause constriction of blood vessels and worsen the damage to already compromised skin.

It’s wise to have a first aid kit nearby before lighting a single firework; what items do you think are essential to that kit?

Anyone who doesn’t have a first-aid kit available whenever they perform potentially dangerous activities is asking for trouble. Consider hand protection like fireman’s gloves as many injuries happen there. Burn gel and non-stick dressings are helpful for burns incurred by fireworks. Beyond that, seek medical help.

Do you have any safety advice from a medical perspective that relates to fireworks?

The safest way to enjoy fireworks is to be a spectator at your municipality’s show. In 2011, fireworks caused an estimated 17,800 reported fires, including 1,200 structure fires, 400 vehicle fires, and 16,300 outside fires. These fires resulted in an estimated eight reported civilian deaths, 40 civilian injuries and $32 million in direct property damage. In 2011, U.S. hospital emergency rooms treated an estimated 9,600 people for fireworks related injuries. Most fireworks injuries are seen in children or teens; unsupervised use of fireworks by children is a very bad idea. I was on the beach watching fireworks one July fourth, and a bottle rocket lit by a 6 year-old whizzed by, missing my head by a few inches.

Let’s step a little further out; we recently saw the carnage that can be inflicted even with basic explosives like black powder during the Boston bombing. If someone detonates an explosive device designed with the intent of killing or injuring others, what types of wounds should we expect and what first aid techniques should be used to treat them?

Explosive devices generate heat and kinetic energy, so expect burns and major trauma. Internal injuries may occur as a result of the blast without necessarily causing penetrating wounds. Triage of mass casualty incidents such as occurred in Boston involves prioritizing injuries so as to do the most good for the most people. In triage, clearing airways and stopping hemorrhage are the major methods of treatment. Tilt the head back and lift the jaw to open airways and apply pressure to bleeding wounds until help arrives. Knowledge of tourniquet use is helpful if applied wisely.

What about military-grade explosive devices that use high-order explosives, like C-4, Semtex, or TNT—should we expect different types of injuries, and how should they be treated?

The wounds you’ll see are similar, it’s just a matter of degree. Highly efficient (read: deadly) military-grade explosives will be more likely to cause amputations and 3rd degree burns.

When talking about explosive devices, people often forget about incendiary devices. Obviously, the primary wound will be burns; what other types of wounds can be expected and what first aid techniques will work best for these?

Burns are the major issue, but the issues caused by the damage to your body’s armor (your skin) later on will be dehydration and infection. Effective fluid replacement and antibiotic therapy will be needed. If modern medicine is available, skin grafts are commonly used for third-degree burns bigger than, say, the diameter of a cigar burn.

Instructions on building IEDs (Improvised Explosive Devises) have become widely available online in every imaginable size and configuration. Is there any commonality to the types of injuries they produce? How should these injuries be treated?

IEDs are meant to mimic military-grade explosive effects; the actual effect will depend on the skill of the demolitions “expert”. Expect the same types of injuries.

How do we determine order of treatment, or triage, for explosive-related injuries?

I’m glad you asked that! Respirations, Perfusion, and Mental Status will be your key factors. You’ll look for these parameters to identify the highest priority (red) patients: 30 respirations, 2 second capillary refill time, can do (follows commands). For a full discussion, here is the link to my 3-part article on mass casualty incident triage.

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The Survival Medicine Handbook: A Guide for When Help is Not on the Way by by Joe Alton, M.D. and Amy Alton, A.R.N.P.

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