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BLAST INJURIESPrehospital Care

BackgroundBecause a terrorist bombing can cause a large number o seriously injured persons, prehospital care systemsplay a critical role in managing the emergency medical response to this kind o mass casualty event. Thequality o prehospital emergency medical response will aect the quality o all subsequent clinical careactivities, and it may directly aect patient mortality and morbidity rates. The complexity and scope o a masscasualty event caused by an explosion requires that prehospital emergency medical care systems address theollowing issues:

Recognition o specifc hazards associated with a terrorist bombing, such as secondary devices,environmental hazards (e.g., toxins, fres) and structural instability.

Identifcation patients with signifcant blast related injuries.

Eective communication with acute care medical resources and emergency management resources.

Expedient patient triage to match available resources with patient needs.

In the United States, the majority o emergency medical service (EMS) systems are organized and coordinatedat the local level. Nationwide, this results in an incredibly diverse prehospital emergency medical care systemthat is oten markedly dierent in operational and clinical approaches among jurisdictions. According to theInstitute o Medicine, EMS systems are challenged by the ollowing key issues: insufcient coordination,response time disparities, inconsistent quality o care, lack o disaster readiness, divided proessional identity,and limited evidence base or the proession.

Even though it aces these challenges, the prehospital medical care system will play a pivotal role in blastevent medical management by identifcation and transport o patients with potentially signifcant injuries to

appropriate trauma centers, and direction o less injured patients to other medical acilities.

Challenges for EMS ProvidersNumerous challenges and potential concerns must be addressed by EMS providers.

Blast sites are dangerous; EMS personnel must be saety conscious and alert or hazards such as:

secondary device explosions; and

fre, environmental exposure, or structural collapse.

Exhaustive prehospital evaluations o survivors are impractical due to limited resources and potentialdangers at the bombing scene.

Patients with mild to moderate injuries may rapidly move on their own rom the explosion site to theclosest hospital(s).

Eective prehospital triage is an essential component o medical management or an explosive event.

Due to inrequent occurrence and the diversity o blast events, rigorous study o triage methodologiesis difcult.

A nationally standardized triage methodology does not currently exist.

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Challenges for EMS Providers (continued) Prehospital medical responders have adopted a variety o commercially available and locally created

methodologies, many o which possess similar processes and defnitions; however, subtle dierencesamong them may cause conusion during a chaotic situation.

Overtriage may deplete limited resources, thus degrading patient care and increasing mortality rates othose critically injured.

Improving Prehospital Care After Blast EventsIn the absence o a defned national prehospital triage methodology, agencies with responsibility or triage atmass casualty events should make every eort to standardize processes and defnitions at the local level. Aneective prehospital triage system includes:

common terminology and processes;

easily understood protocols or providers with varying amounts o medical education;

deployable tools and record keeping instruments or apparatus possibly used during an emergencyresponse; and

unctional exercises where prehospital medical providers demonstrate understanding o emergencyresponse processes and defnitions.

Eective management o the emergency medical response to a mass casualty bombing requires substantialpreparation by prehospital medical care systems. Integration into the local trauma system and understandingits emergency response methodology are critically important to ensuring that the most severely injuredbombing victims are transported to acilities that have the resources required to care or them. Prehospitalmedical system administrators should ocus on:

acilitating interagency collaboration by standardizing command structure, lines o communication, andtriage methodology.

ensuring that prehospital medical care providers have a basic understanding o blast pathophysiology andthe complex injury patterns produced by such an event.

training prehospital medical providers to recognize external signs o signifcant blast injury and designing triageguidelines that acilitates moving these patients to the highest level trauma center(s) in the local system.

This fact sheet is part of a series of materials developed by the Centers for Disease Controland Prevention (CDC) on blast injuries. For more information, visit CDC on the Web at:

www.emergency.cdc.gov/BlastInjuries.

http://www.emergency.cdc.gov/BlastInjurieshttp://www.emergency.cdc.gov/BlastInjurieshttp://www.emergency.cdc.gov/BlastInjuries