Blast Injury in the Field
Objective: Survive the scene, run MARCH, and expect lung and bowel injury even when the skin looks intact.
Why This Is Hard
The explosion is over and everyone is filming. Secondary devices and structural collapse are still in play. TCCC: care under fire vs tactical field care. Civilian translation: do not stand in the kill zone to bandage a scratch.
- If the scene is not safe, it is not your patient yet.
- MARCH still orders the medicine: massive hemorrhage, airway, respirations, circulation, hypothermia.
- Blast lung: dyspnea, hypoxia, cough after a blast — oxygen, careful PPV, destination.
Field Rules (Education)
- Primary blast: gas-filled organs — ears, lungs, gut. Intact skin does not mean intact lungs.
- Secondary: fragments. Tourniquets and packing.
- Tertiary: thrown. TBI, fractures.
- Quaternary: burns, crush, inhalation. See burns and crush.
Field Pitfalls
- Tunneling on a spectacular wound while an artery pumps in the dark.
- PPV that blows a blast lung because you bagged like a marathon.
- No second-device thought.
Practice
60-second drill
Partner: outdoor explosion, two patients, one with a missing foot, one with a normal chest wall and severe dyspnea. Order of care.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- TCCC / CoTCCC — care under fire vs field care; MARCH
- CDC Explosions and Blast Injuries: A Primer for Clinicians — primary through quaternary blast; blast lung is the common fatal primary injury among initial survivors
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.