First Aid brushup: Blast Injuries

Hi everyone,

What this is about

A while back I wrote about the need for a focus on well-organised civil defence as part of responding to the threat of terror.  With that in mind, I'm going to write a series of first-aid themed posts covering the sorts of injuries which might be expected in a terrorist incident, as these are (understandably) often only lightly covered in first aid courses.  This is the first such post.

Sources, Disclaimer and Legal Jiggery-Pokery

Unless otherwise stated, I'm taking this from Kym Eden, Fun with First Aid (11th ed., National First Aid, n.p., 2013).  While the book has a light-hearted style, it covers things in good detail.  

I should disclose that while I hold a first aid certificate, I am not a medical practitioner, nurse or paramedic (although I'd welcome any comments or contradictory opinions from people better qualified than me).  The advice I post is effectively unqualified and any liability you incur from following it is yours alone.  I strongly recommend that every person should seek formal first-aid training from a suitable agency in their jurisdiction.

Blast Injuries

Identification

The circumstances may make it obvious that the casualty has been injured by a blast.  However, the following will make clear that this has been the cause -

1. Extensive multiple soft tissue injuries (shrapnel wounds).
2. Fractures and Burns.  Burns will be fairly obvious.  Fractures can be identifed by severe pain at the location of the injury; the injury site may be deformed or bent at a strange angle, as well as being bruised or discoloured, swollen, inflamed and tender.  If a limb is affected, the casualty may be unable to move it.  The fractured bones may audibly grate together, and the casualty may report the limb to be numb or tingly.
3. Coughing up of bloodstained fluids.
4. Deafness or bleeding from the ears.
5. Shock.  Shock is essentially the effect of significant internal or external blood loss.  Initially shock an be indicated by a raised heartrate and rapid breathing, and by pale or cold skin.  As it progresses, parts of the the casualty's body may start to have a grey-blue colour (if you squeeze their fingernail, the colour may take some time to return).  They may report being nauseous or may throw up.  They may also report feeling weak, dizzy, restless and thirsty.  If the condition worsens even further, they may become confused and disoriented, drowsy (and start yawning) and begin to slip into unconsciousness.  If untreated, death will result.

Management

For every casualty -

1. Assess any danger in the area (for example, fire, downed power lines, unstable walls or ceilings, suspicious packages).  Do not place yourself in significant danger in order to help: nobody needs a dead hero.
2. Send for help
3. Identify and control any bleeding.

• For external bleeding, place direct pressure on the wound, ideally with a clean pad.  Secure the pad in place with a bandage.  The bandage needs to be tight enough to keep the pressure on, but not so tight circulation is affected.  If a limb is affected, and if it is possible, lift the limb above the level of the heart to reduce the blood flow.  Reassure the patient so as to reduce their heart rate.  Ideally, you should never remove the first pad placed on the wound because this disrupts the blood-clotting process.  Consider instead placing a second pad on top of the first.
• Internal bleeding may be suggested by the signs of shock, and also by blood emerging from any of the body's natural openings.  Internal bleeding cannot be treated by first aiders, save (where the patient is conscious) raising his or her legs to improve blood supply to vital organs.

Conscious patient

1. Help the casualty into a comfortable position.
2. If necessary and appropriate, loosen clothing around the casualty's neck, chest and waist to assist them to breathe.
3. Keep the casualty warm (covered if necessary) and provide reasurance.
4. Do not provide the casualty with food or drink as this may make later medical care (particularly administering anaesthetics) difficult.  If they become thirsty, moisten their lips with water.

Perform a "secondary survey" to identify further possible injuries.  Working from the head down -

• Check for anything that suggests a head injury - lumps and bumps, swelling or minor wounds, and also discharges from the ears or nose.  Is the face swollen or discoloured, and have the eyes been affected?
• Ask the patient to breath deeply to see if discomfort is caused to the neck, shoulders or chest.  Are there signs of swelling, inflammation or fractures.
• In the patient can be log rolled, are there wounds or abnormalities to their back, and are they complaining of pain.
• Check the arms and legs for abnormalities or injuries (and also check for any medicalert bracelets).
• Check the abdomen and pelvis for pain, distension or incontinence

The ideal positions for casualties with certain injuries will be

• Chest wound: Sitting upright, leaning forward and towards their injured side.
• Abdominal wound: Lying on their back, with the head and shoulders raised on a pillow (or something similar) and the knees slightly bent (also supported by a pillow or something similar)
• Burns: These injuries should be cooled and covered with non-adherent dressings. Cooling is best done with cool running water or compresses.
• Fractures: These injuries should be supported and immobilised.

Unconscious patient

If the casualty is not breathing, check their airway for obstructions.  If they are still not breathing, perform cardiopulmonary resuscitation and use a defibrillator if one is available.

If the casualty regains consciousness, follow the instructions above.  If they remain unconscious but resume normal breathing, move them into the recovery position and attend to any other wounds they have.  If at all possible, remain with them and monitor their breathing and general condition.

Giveaway

I have a second-hand copy of the second edition of Kym Eden's book to give away.  Although it's out of date, there's still good material in it.  If you'd like to claim it, leave me a message in the comments.