Improvised Explosive Device Blast Research Articles

Custom Iris Prosthesis forSubtotal Traumatic Aniridia From Combat Ocular Trauma.

Traumatic aniridia from combat ocular trauma can cause visual disability. A 41-year-old male Army Veteran was referred for evaluation of light sensitivity and glare secondary to subtotal traumatic aniridia of his left eye from an improvised explosive device blast. A custom-made artificial iris prosthesis was implanted in the ciliary sulcus and secured using Gore-Tex sutures. After surgery, the patient reported improvement of his light sensitivity and quality of life. The custom iris prosthesis is a surgical option for visual disability resulting from traumatic aniridia from combat ocular trauma.

Ocular biomechanics during improvised explosive device blast: A computational study using eye-specific models

BackgroundEye injuries comprise 10–13% of civilian improvised explosive device (IED) injuries. The bomb blast wave induces a normal and shear forces on the tissues, causing a large acute IOP elevation. This study calculated the biomechanical stresses and strains in the eye due to IED explosion via eye-specific fluid-structure interaction (FSI) models. MethodsBlast occurred at 2, 3, and 4 m from the front and side of the victim and the weights of the IED were 1 and 2 kg. The ground was covered with the deformable soil to mimic the realistic IED explosion condition and reflect the blast wave. ResultsThe IOP elevation of ∼6,000–48,000 mmHg was observed in the eyes while the highest IOP was occurred with the IED weight and distance of 2 kg and 2 m (front) and the lowest was occurred with the IED weight and distance of 1 kg and 4 m (side). Our findings suggest the importance of the victim location and orientation concerning the blast wave when it comes to ocular injury assessment. IOP elevation of ∼2900 and ∼2700 mmHg were observed in ∼1.6 ms after the blast for the IEDS weight of 2 kg and a victim distance of 2 m in front and side blasts, respectively, in consistence with the literature. Nonetheless, IOPs were considerably higher after ∼1.6 ms due to the merging of the bomb blast wave and its reflection off the ground. ConclusionsThe stresses and strains were highest for the frontal blast. Both side and frontal blasts caused higher stresses and strains at the rectus muscle insertions where the sclera is thinnest and prone to rupture. Blast angle has no considerable role in the resultant IOP. Front blast with a heavier IED resulted a higher stresses and deformations in the eye connective tissues compared to the side blast.

Treatment of Temporomandibular Joint Heterotopic Ossification: A Novel Protocol With Multimodal Therapy Based on Literature Review and Presentation of a Unique Case Report

The purpose of this study was to create a treatment protocol for cases of heterotopic ossification (HO) of the temporomandibular joint (TMJ), particularly those refractory to current TMJ HO protocols. In addition, we demonstrate the success of this protocol on a unique case of recurrent HO that failed multiple TMJ HO protocols in the setting of an improvised explosive device (IED) blast in a wounded warrior. An electronic literature review was conducted via PubMed and Web of Science. Twenty-five studies were identified to provide supporting evidence for a proposed, up-to-date protocol for the treatment of refractory TMJ HO. The authors present a case report of a wounded warrior with HO ankylosis of bilateral TMJs in the setting of IED blast and demonstrate successful use of our surgical and pharmacotherapeutic protocol. Based on the literature review, our proposed protocol consists of pharmacotherapy with celecoxib and etidronate, with weekly forced dilation (brisement) and home physical therapy with the TheraBite Jaw Motion Rehab System. Surgically, the TMJ should be treated with two-stage reconstruction using initial polymethyl methacrylate spacers and subsequent total joint replacement with custom prostheses, fat grafting, and 3-dimensional-navigated total resection of HO. This protocol was successfully utilized in our patient's refractory HO ankylosed TMJ secondary to IED blast, and the patient's maximal incisal opening was regained and has remained stable2years after surgery without recurrent HO. Our method for treatment in this case deviated from the standard TMJ Concepts HO protocol in that it included multimodal pharmacotherapy with celecoxib and etidronate. Based on our literature review and experience, we advise that clinicians utilize our protocol for the management of all craniofacial HO cases, particularly in cases of recurrent HO that fail conventional therapies and/or involving high-order blast trauma.

Lower Leg Injury Mechanism Investigation During an IED Blast Under a Vehicle Using an Anatomic Leg Model.

Attacks with improvised explosive device (IED) constituted the main threat to, for example, Polish soldiers in Iraq and Afghanistan. Improving safety during transport in an armored vehicle has become an important issue. The main purpose of the presented research is to investigate the mechanism of lower leg injuries during explosion under an armored vehicle. Using a numerical anatomic model of the lower leg, the analysis of the leg position was carried out. In all presented positions, the stress limit of 160 (MPa) was reached, which indicates bone damage. There is a difference in stress distribution in anatomic elements pointing to different injury mechanisms.

Improvised Explosive Device Blast Injuries to the Craniofacial Region: Wound Characteristics and Management.

Improvised explosive device blast injuries frequently report at our center and showed the maximum amount of contamination and damage, both in the facial soft tissues and the skeletal tissues with impregnation of splinters with size ranging from 2 mm to 10 mm. Should splinters be always explored is questionable and varies with every case. The reconstruction in such cases was done with titanium mini-plates along with extensive use of local vascular flaps for soft tissue repair in majority of the cases. Soldier who sustained splinter injuries wrt orbital floor were managed with splinter exploration using C-arm and orbital floor reconstruction using titanium mesh.

Red Blood Cell Response to Blast Levels of Force Impartations Into Freely Moveable Fluid Surfaces Inside a Closed Container

Background: Blast waves have plagued mankind for centuries, yet their interaction with blood has been largely overlooked. Recent studies of ways to mitigate traumatic brain injury (TBI) in sport have utilized slosh reducing techniques with varying success. However, hydrodynamic principles have not been used to assess the interaction of intense blast waves and the red blood cells themselves. Objective: To establish the benefits of slosh reduction by analyzing the degree of damaging effects from a blast wave imparted on human red blood cells both fully and partially contained by rigid surfaces. Methods: Approximately 40 mL of blood was collected from 13 males and 25 females ages 18 – 55 and aliquoted into three separate steel containers (5 cc- control, 15 cc- full and 10 cc -partially filled) in preparation for blast testing. An improvised explosive device (IED) blast level model (Vandenberg) was developed by using a nail gun plunger to impart approximately 150 kPa of pressure over a 4 to 6 microsecond timespan into a target container. Blood in steel containers, with and without IED blast exposure, was assayed for cell hemolysis products including serum free hemoglobin (HgB), lactate dehydrogenase (LDH), and potassium (K-ABL) when the containers were fully-filled or partially filled (no-slosh versus slosh). Hemolysis products were measured 1 hour, 4 hrs, 24 hrs, 48 hrs, and 72 hrs after blast exposure. Results: In both the slosh and no-slosh groups, hemolysis increased significantly at each time point after IED blast energy impartation. However, the no-slosh blood samples had less hemolysis. Compared to the slosh group, blood from the no slosh group contained less extracellular HgB (p<.0001), lactate dehydrogenase (LDH) (p<.0001), and potassium (K+) (p<.0001) at all time points. Conclusions: Damage to human blood resulting from the impartation of a force similar to an IED blast was mitigated by fully containing blood within a volume and thereby reducing fluid slosh.

Using bombs to bomb-proof cars

When an improvised explosive device (IED) detonates under a military vehicle, it is often not the blast that kills people inside--it is the extreme acceleration. But a new vehicle design in which rocket motors fitted to the roof exert a counterforce could save lives. The idea isn't as mad as it may seem. The upward force of an IED blast can instantly catapult a vehicle many meters into the air. Although vehicle floors are strengthened to prevent debris hitting occupants, people often sustain serious or fatal internal injuries from the jarring acceleration, which causes damage to vital organs.

Reconstruction of improvised explosive device blast loading to personnel in the open

Significant advances in reconstructing attacks by improvised explosive devices (IEDs) and other blast events are reported. A high-fidelity three-dimensional computational fluid dynamics tool, called Second-order Hydrodynamic Automatic Mesh Refinement Code, was used for the analysis. Computer-aided design models for subjects or vehicles in the scene accurately represent geometries of objects in the blast field. A wide range of scenario types and blast exposure levels were reconstructed including free field blast, enclosed space of vehicle cabin, IED attack on a vehicle, buried charges, recoilless rifle operation, rocket-propelled grenade attack and missile attack with single subject or multiple subject exposure to pressure levels from \(\sim \)27.6 kPa (\(\sim \)4 psi) to greater than 690 kPa (\(>\)100 psi). To create a full 3D pressure time-resolved reconstruction of a blast event for injury and blast exposure analysis, a combination of intelligence data and Blast Gauge data can be used to reconstruct an actual in-theatre blast event. The methodology to reconstruct an event and the “lessons learned” from multiple reconstructions in open space are presented. The analysis uses records of blast pressure at discrete points, and the output is a spatial and temporal blast load distribution for all personnel involved.

High-level vestibular impairment in a veteran with mild traumatic brain injury

Background: Imbalance, dizziness and impaired dual tasking are common symptoms reported by veterans with mild traumatic brain injury (mTBI). According to a Congressional Research Service report in 2014, approximately 220 000 veterans have sustained TBI in Iraq and Afghanistan wars, with 82.4% diagnosed with mTBI. Symptoms of subtle balance impairment, resulting in decreased ability to dual-task are frequently overlooked during the initial evaluation. Therefore, clinicians need to detect these symptoms and establish a treatment plan to address the underlying causes. Currently, few studies have addressed imbalance as a result of subtle balance impairment in patients with mTBI, and none has examined veterans with mTBI. Aims: The aim of this study was to develop a systematic approach to the assessment and treatment of imbalance in a veteran with mTBI. The imbalance was a result of impairment in the constitutional components, i.e. somatosensory, vestibular and visual inputs to the brain. Methods: The patient was a 56-year-old veteran with mTBI and post-traumatic stress disorder, secondary to improvised explosive device blast exposure during the Iraq war in 2005. He was evaluated with clinical vestibular assessments, Dizziness Handicap Inventory, Activities-specific Balance Confidence Scale, functional gait and balance analyses, and posturography to determine sensory organisational deficits. The patient's past medical history did not show any comorbidity resulting in imbalance. The patient received one therapy session per week for 8 weeks to address his balance and sensory deficits. Data from outcome measures were analysed and compared with those collected at baseline. Results: The results indicated that the patient improved significantly on measures of balance and sensory integration deficits after the treatment protocol. Conclusions: Data from the sensory organisation test provided a reliable basis for the identification and treatment of balance deficits in a veteran with mTBI. An intervention, emphasising visual, vestibular and somatosensory integration, may result in significant improvement of the patient's functional balance.

Blast Injuries: From Improvised Explosive Device Blasts to the Boston Marathon Bombing.

Although most trauma centers have experience with the imaging and management of gunshot wounds, in most regions blast wounds such as the ones encountered in terrorist attacks with the use of improvised explosive devices (IEDs) are infrequently encountered outside the battlefield. As global terrorism becomes a greater concern, it is important that radiologists, particularly those working in urban trauma centers, be aware of the mechanisms of injury and the spectrum of primary, secondary, tertiary, and quaternary blast injury patterns. Primary blast injuries are caused by barotrauma from the initial increased pressure of the explosive detonation and the rarefaction of the atmosphere immediately afterward. Secondary blast injuries are caused by debris carried by the blast wind and most often result in penetrating trauma from small shrapnel. Tertiary blast injuries are caused by the physical displacement of the victim and the wide variety of blunt or penetrating trauma sustained as a result of the patient impacting immovable objects such as surrounding cars, walls, or fences. Quaternary blast injuries include all other injuries, such as burns, crush injuries, and inhalational injuries. Radiography is considered the initial imaging modality for assessment of shrapnel and fractures. Computed tomography is the optimal test to assess penetrating chest, abdominal, and head trauma. The mechanism of blast injuries and the imaging experience of the victims of the Boston Marathon bombing are detailed, as well as musculoskeletal, neurologic, gastrointestinal, and pulmonary injury patterns from blast injuries.

Cervical spine injury in dismounted improvised explosive device trauma.

The injury pattern from improvised explosive device (IED) trauma is different if the target is in a vehicle (mounted) or on foot (dismounted). Combat and civilian first response protocols require the placement of a cervical collar on all victims of a blast injury. We searched the Joint Theatre Trauma Registry (JTTR) and the Role 3 Hospital, Kandahar Airfield (KAF) database from Mar. 1, 2008, to May 31, 2011. We collected data on cervical fracture; head injury; traumatic amputation; initial blood pressure, pulse, injury severity score (ISS), Glasgow Coma Scale (GCS) score and base excess; and patient demographic information. The concordance rate between JTTR and KAF databases was 98%. Of the 15 693 admissions in JTTR, 326 patients with dismounted IED injuries were located. The rate of cervical collar prehospital placement was 7.6%. Cervical fractures were found in 19 (5.8%) dismounted IED victims, but only 4 (1.2%) were considered radiographically unstable. None of these 19 patients had prehospital placement of a collar. Patients with cervical spine fractures were more severely injured than those without (ISS 18.2 v. 13.4; GCS 10.1 v. 12.5). Patients with head injuries had significantly higher risk of cervical spine injury than those with no head injury recorded (13.6% v. 3.9%). No differences in frequency of cervical spine injury were found between patients who had associated traumatic amputations and those who did not (5.4% v. 6.0%). Dismounted IED is a mechanism of injury associated with a low risk for cervical spine trauma. A selective protocol for cervical collar placement on victims of dismounted IED blasts is possible and may be more amenable to combat situations.

Experience in Treating Combat Burns in Afghanistan by Using Silver-Nylon Dressing

On the battlefield, insidious and devastating weapons like the improvised explosive device (IED) rapidly emit extreme heat (thousands of degrees), create a shock wave (overpressure) that can hurl bodies long distances (inducing secondary fall lesions), and deliver thousands of pieces of shrapnel over hundreds of meters.Very often, Soldiers injured by an IED blast are inside their vehicle. Subsequently, they are exposed to the thermal effects of the blast. Frequently, these patients have complex wounds that consist of extensive burn areas, bone fractures, and internal organ lesions. The use of silver-nylon burn wrap dressing is widely documented for its bactericidal properties. Silverlon® Burn Dressings is an elastic bandage made of nylon and plated with pure metallic silver.In summer 2008, in a U.S. advanced Role 2 facility, two U.S. Soldiers with extensive second- and third-degree burn injuries were successfully treated with the use of Silverlon Burn Dressings and Silverlon® Burn Gloves.From this experience emerged the ease of use silver-nylon dressing in treating badly burned Soldiers on the battlefield.

Right Traumatic Transradial Amputation and Left Brachial Plexus Injury in a Dismounted Improvised Explosive Device Blast: A Case Report

Right Traumatic Transradial Amputation and Left Brachial Plexus Injury in a Dismounted Improvised Explosive Device Blast: A Case Report

Management of Decompressive Craniectomy Defects

Decompressive craniectomy has become a critical and standard life-saving maneuver in the theater of war. The high number of patients returning with large cranial defects and complex craniofacial injuries often involving the upper orbits or associated with the sunken skin flaps are a reconstructive challenge. We present a review of our treatment protocol highlighting the evolution of decompressive craniectomy and the development of a modern cranial defect treatment algorithmic approach to reconstruct these difficult clinical cases. A review of previously published data and current data from our warfare treatment unit that reported the treatment of decompressive cranial defects from 2004 to 2011 was performed. Reported data included mechanism of injury, evacuation time, initial Glasgow Coma Scale (GCS), GCS on arrival to the continental United States, type of decompressive craniectomy, type of implants used for reconstruction, and complications such as implant infections, exposures, and removals. Secondary reconstruction techniques used to salvage failed cranioplasty cases with free tissue transfers and cranial bone or dermal fat grafts as indicated were also reviewed and outcomes were reported. From March 2003 to July 2011, more than 200 patients were identified who underwent cranioplasty after decompressive craniectomy. Patient average age was approximately 25 years (range, 18-53 y), and all patients were male. Average follow-up was 870 days (2.4 y). Average GCS at initial presentation was 7 and was 9 on arrival to the continental United States. Average time to evacuation to the continental United States was 6 days. Of all injuries, 46% were associated with an improvised explosive device blast. Of the patients, 90% underwent hemicraniectomies with the remaining 10% having received bifrontal craniectomies. Successful reconstruction and retention of the implant was present in 95% of the overall cohort. Contour abnormalities were the most common adverse outcome encountered (10% of patients after cranioplasty), whereas infections resulting in implant loss (5%) and seizures (<5%) were the most common complications that occurred after cranioplasty reconstruction. Warfare-related decompressive craniectomy defects can be safely reconstructed using custom alloplastic implants with low morbidity and mortality. Risk factors that increase the rate of infection and require implant removal included orbital extension of the craniectomy defect, proximity to facial sinuses, and large contour abnormalities with corresponding large dead spaces. Staging reconstruction of high-risk cranial defects followed by definitive cranial defect reconstruction improved the likelihood of implant retention and successful cranioplasty outcome.

IED Blast Postconcussive Syncope and Autonomic Dysregulation

Concussions are the most frequent battle injury sustained in Afghanistan. The Concussion Restoration Care Center provides multidisciplinary care to concussed service members in theater. The Concussion Restoration Care Center has managed over 500 concussions, the majority being from improvised explosive device (IED) blasts. Syncope following a concussion without a loss of consciousness is rarely reported in the literature. The pathophysiology of concussion from a blast injury may be distinct from a concussion secondary to blunt trauma. Two cases of syncope following concussions with an alteration of consciousness are presented, and a mechanism of action is proposed. Post-IED blast concussive symptom frequency at initial presentation on a cohort of patients is reported, with 1.3% of patients experiencing postconcussive syncope. Syncope following an IED blast may be related to centrally mediated autonomic dysregulation at the brain stem level. Syncope should be added to the list of possible symptoms that occur following concussions, in particular concussions following a blast injury.

(A20) Injury Pattern and Disaster Plan for Landmines and Improvised Explosive Device Blast

Landmines and improvised explosive device (IED) explosions induce bodily injuries through the primary, secondary, tertiary, and quaternary mechanisms of blast among civilians, mostly children which results in a complicated, multidimensional injury pattern. If &gt; 80 percent of countries can ensure the security of their borders without using anti-personnel mines, surely India can too. A change in mindset and a change in defense doctrine are needed, as well as an UN-backed world body campaigning against the use of landmines to urge the Indian government to sign a global treaty to ban the weapons. An estimated four to five million anti-personnel mines exist in India, which is the sixth-largest stockpile in the world. Non-state armed groups in the central, southern, northern, and northeastern regions frequently have used anti-personnel mines and improvised explosive devices to target convoys of soldiers and civilians. Using historical, current research and related literature reviews, this study provides description about the types of explosion, the device, pattern of injury, prehospital and emergency department care, and challenges for the disaster plan. Hand amputation is the most common type of upper limb amputation (more common among the 7–18-year age group) and below-knee amputation is the most common type of lower limb amputation. Using these data, a focused disaster response for future attacks has been created. It includes the planning, monitoring, and coordination of all aspects by hospitals and the regional disaster system's plan—“upside-down” triage—the most severely injured arrive after the less injured, which bypass emergency medical services (EMS) and go directly to the nearest hospitals. Details about the nature of the explosion, potential toxic exposures and environmental hazards, and casualty location from police, fire, EMS, health department, and reliable news sources must be recorded.

Massive Facial Trauma following Improvised Explosive Device Blasts in Operation Iraqi Freedom

To investigate the association of massive facial trauma with brain and eye injuries, injury severity scores, and blood transfusion utilization. Retrospective study. Air Force Theater Hospital, Balad, Iraq. Retrospective review of US service members injured by improvised explosive devices and treated at the Air Force Theater Hospital in Iraq from October 2004 to September 2007. Massive facial trauma was defined as any injury to the face involving 3 or more facial aesthetic units. The anatomic injury patterns, injury severity scores, and blood transfusion rates of simple and massive facial trauma were compared. One hundred four patients who sustained facial trauma from improvised explosive device blasts were reviewed, including 29 patients with massive facial trauma. The average injury severity score was 13.9 in the simple facial trauma group and 21.7 in the massive facial trauma group (P = .006). Sixteen (55%) of the patients in the massive facial trauma group received transfusions compared with only 21 (28%) in the simple facial trauma group (P = .009). The rate of associated eye injury was 55% in the massive facial trauma group and 27% in the simple facial trauma group (P = .006). Brain injuries occurred in 48% of the patients with massive facial trauma and 28% of the patients with simple facial trauma (P = .05). There is an association between massive facial trauma higher injury severity scores, higher transfusion rates, and an increased risk for eye and brain injuries.

Recollections of a Radiology Resident at War1

HomeRadiologyVol. 244, No. 2 PreviousNext Reviews and CommentaryEditorialsRecollections of a Radiology Resident at War1Olga R. BrookOlga R. BrookAuthor Affiliations1From the Department of Diagnostic Imaging, Rambam Medical Center, POB 9602, Haifa 31096, Israel. Received October 20, 2006; accepted January 29, 2007; final version accepted March 20.Address correspondence to the author (e-mail: [email protected]).Olga R. BrookPublished Online:Aug 1 2007https://doi.org/10.1148/radiol.2442061881MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: 2007 FiguresReferencesRelatedDetailsCited ByHealth care workers in conflict and post-conflict settings: Systematic mapping of the evidenceLamaBou-Karroum, AmenaEl-Harakeh, InasKassamany, HusseinIsmail, NourEl Arnaout, RanaCharide, FarahMadi, SarahJamali, TimMartineau, FadiEl-Jardali, Elie A.Akl, Jai K.Das2020 | PLOS ONE, Vol. 15, No. 5An Academic Medical Center Under Prolonged Rocket Attack—Organizational, Medical, and Financial ConsiderationsYaronBar-El, MosheMichaelson, GilaHyames, KarlSkorecki, Shimon A.Reisner, RafaelBeyar2009 | Academic Medicine, Vol. 84, No. 9Recommended Articles Blast Injuries: From Improvised Explosive Device Blasts to the Boston Marathon BombingRadioGraphics2016Volume: 36Issue: 1pp. 295-307Customer Service in Radiology: Satisfying Your Patients and ReferrersRadioGraphics2018Volume: 38Issue: 6pp. 1872-1887Multidetector CT of Laryngeal Injuries: Principles of Injury RecognitionRadioGraphics2019Volume: 39Issue: 3pp. 879-892CT of Penetrating Abdominopelvic TraumaRadioGraphics2021Volume: 41Issue: 4pp. 1064-1081Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic InjuriesRadioGraphics2019Volume: 39Issue: 4pp. 1183-1202See More RSNA Education Exhibits Overlooked Blunt Bowel and Mesenteric Injuries: Imaging Findings and ImplicationsDigital Posters2020Rules to Scan By: Criteria for Guiding Imaging Workup in TraumaDigital Posters2019Optimizing The Radiologist Work Environment: Actionable Tips To Improve Workplace Satisfaction, Efficiency, And Minimize Burnout!Digital Posters2020 RSNA Case Collection Osteochondritis dissecansRSNA Case Collection2020Pancreatic lacerationRSNA Case Collection2020Pancreatic LacerationRSNA Case Collection2021 Vol. 244, No. 2 Metrics Altmetric Score PDF download