IED's: america's future


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Lecture over IED, improvised explosive devices, blast injuries, etc.

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  • Id like to start with a brief overview of what Disaster Medicine is, what defines a disaster, and what the basics of disaster management is. This will help to set the stage for the purpose of today’s talk and later session.We will discuss exactly - What is an IED?What is the history of IED? We will discuss some examples of IED’s throughout history, and more importantly, the more well-known IED attacks in the United States. This topic is especially relevant for us following the Boston Marathon attack from April of this year.What are the types of blast injuries and what are the physics of explosions that cause them to occur? We will discuss the mechanics of explosions and the different types of injuries we see from them, and touch on the proper approach to these injuries from an EMS standpoint as well as the ER provider.We will also discuss why this lecture is relevant to all of us, that is, are we going to have to worry about similar attacks in the future? (talk about Boston here) (yes, easy to make (how easy), materials are impossible to regulate, instructions are widely available, and bad guys will continue to want to hurt people)
  • So to start, lets discuss briefly what I do and just what the heck is “disaster medicine.” DM Physicians and others who are specially trained to care for injuries and illnesses associated with both natural and man-made disasters, and who provide consultation, education, and leadership at all levels of government and society during all aspects of the disaster cycle:
  • Mitigation, Preparation, Response, and Recovery.
  • Read and ad lib
  • Now of course one of the major facets of Disaster Medicine is Man-Made disasters, and Terrorism is specific subset of this type. My field has existed for decades and has evolved along the way, functioning mostly in the role of preparing for and responding to natural disasters.. But the attacks on 9/11 seemed to be the game-changer. These attacks resulted in significant interest from the federal government to further develop the medical specialty of Disaster Medicine. The very vast majority of Disaster specialists are emergency medicine physicians, like myself, since disaster management Is a very natural extension of our specialty.
  • It IS however worth teaching that the VAST majority of the terrorist acts worldwide have absolutely nothing to do with the United States. I know it may feel that way since, the only thing our national media really care about is scaring the crap out of you so you’ll tune in and watch their advertisements, but try to really pay attention the next time you choose to watch the news or read a paper, and you will likely hear briefly about bombings overseas. Since the time I even started writing this lecture, there was the Islamist attack on the Mall in Kenya killing 69, including a pregnant Harvard graduate and her husband from Australia, both friends of my girlfriend.
  • That being said, terror attacks are on the rise worldwide, including both at home - and abroad against military and nonmilitary targets. Internationally, the the Heritage Foundation has studied and have demonstrated that bombings are the #1 choice for terror attacks against the US ABROAD, and these are second only to arson HERE on US soil.Terrorism directed at the United States accounts for only 7.8 percent of all terrorism worldwide, as we saw on the previous slide.Between 2001 and 2009:• There were 91 homegrown terrorist attacks of all kinds against the United States, while there were 380international terrorist attacks against the United States;• Internationally, they like to attack our businesses first, and diplomatic offices second. Businesses are typically soft targets, and embassies bring massive press, both attractive to terrorists.• Here at home, the two most common targets were businesses (42.9 percent) and private citizens and property (24.2 percent)• The preferred method of attack against the United States for international terrorists was bombings (68.3 percent), while the preferred method for domestic terrorists was arson (46.2 percent). But we may be seeing a shift in these numbers as new data emerges if my predictions hold true.
  • So let us look now at the terrorism event that has most recently been on everyone's minds.The Marathon Bombing happened on April 15th of this year while I was in an airport in Florida waiting for my scheduled flight to get back to Boston. Lets just say you didn’t wanna be the poor gal at the American Airlines ticket counter that day while I was trying to convince them to put me on an earlier flight. It didn’t work, as Logan airport was immediately closed.2 suspects2 bombs were exploded3 killed, >250 injured, ~18 total amputationsSo Id like to transition into the history and techniques of what these two bad guys and others around the world have done and are doing to perpetrate these crimes. I think you will see that what they did was amateur and frighteningly easy, which is one of the major reasons why I predict we will now see more of these attacks soon. Later, Id like to discuss what the doctors saw that day in Boston’s emergency departments, and why those injuries happen.
  • So as we continue this talk, I plan to teach you about IED’s. That means understanding the basics of the components of an IED. Why don’t we play bombmakers for a little while and learn a little about stuff that blows up, and maybe clarify some terms you have always heard but maybe never really knew the meaning. To begin, we should discuss the most important part of any bomb. [click]
  • The EXPLOSIVE materials themselves.Lets start with the basics - What is an explosive and how are they categorized?An explosive is simply a chemical or compound that contains a very large amount of potential energy within its molecular bonds. When we devise a way to suddenly break those chemical bonds, that energy is released in various forms, including heat, sound, light, and a few other possible types. The effect that that energy release has on the surrounding atmosphere, including rapid gas expansion, is what generates the explosion. This can be as simple as mixing baking soda and vinegar, or as complicated as nuclear fission.We categorize explosives as above: READ
  • So what are High Explosives?High explosives are explosive materials that DETONATE, which means that the explosive material is ignited and decomposes faster than the speed of sound. To put this in perspective, a 50 caliber sniper rifle muzzle velocity is just under 950 m/s on average. That means if I shoot at you, in one second the bullet could hit you at almost ½ mile away. That’s pretty dang fast. In comparison the explosive velocity of a high explosive detonation ranges from 3000 to 9000 m/s, meaning that in 1 second the blast wave from the explosion would hit you at about 5.6 miles away. They are normally employed in mining, demolition, and military applications.They can be secondarily divided into 3 explosives classes differentiated by how sensitive they are: primary explosive (hammer),secondary explosive (blasting cap), tertiary (require booster).
  • This photo, from the 1950s demonstrates 500 tons, or one half kiloton of TNT exploded on shore. Note not only the blast itself, but the large condensation wave that surrounds it. This is where the very high pressure, supersonic blast wave is propagating outward from the blast. This is the shock wave, if you will, that does the most damage of the entire blast. As you can see, even though the burning gas that you see on the right is what you typically think of as the explosion, what is actually happening at this second is that massive damage is about to befall that decommissioned NAVY ship sitting several thousand meters from the fireball, caused by that blast front. It diminishes as it travels at supersonic speeds, only lasts several milliseconds, and has such rapid expansion that a vacuum is left behind it. This vacuum sucks the surrounding air, materials, and shrapnel back into itself, creating air movement in the opposite direction of the blast wave. This is known as blast wind, and is what gives a mushroom cloud its distinct look. Lets take a little closer look at blast wind, because its so weird:
  • Blast wind: At the explosion site, a vacuum is created by the rapid outward movement of the blast. This vacuum will almost immediately refill itself with the surrounding atmosphere. This creates a very strong pull on any nearby person or structural surface after the initial push effect of the blast has been delivered. As this void is refilled, it creates a high-intensity wind that causes fragmented objects, glass and debris to be drawn back in toward the source of the explosion. Don’t worry, if you are close enough to the detonation site to be affected by the blast wind, you are already toast due to the primary blast injury you received from the blast front expanding outward first.
  • The blast win can be best seen in this amazing nuclear detonation, the ultimate high explosive. The camera is 10s of miles away, and you can see the blast wind come at the speed of sound and affect it. There is the characteristic mushroom cloud forming. It derives its shape from the hot gases expanding upward, and the stem is formed from the blast WIND sucking back in toward the bomb site, and rolling upward with the heat.
  • So that leads us to Low Explosives. They are called, low, so they must be safe, right?Low explosives are compounds where the rate of decomposition proceeds through the material at less than the speed of sound. The decomposition is propagated not by a blast front or shock wave, but by a flame front (which we call deflagration) which travels much more slowly through the explosive material than a shock wave of a high explosive. Under normal conditions, low explosives undergo deflagration at rates that vary from a few centimeters per second to approximately 400 metres per second.Low explosives are normally employed as propellants. Included in this group are gunpowders and light pyrotechnics, such as flares and fireworks
  • Lets take a look at physics within a gun barrel. This is Texas after all, and I am sure half of you are packing heat, anyway.This graph demonstrates a gun barrel and how High vs Low explosives behave when ignited. As we learned, gunpowder is a low Explosives, so it deflagrates, and does so at a relative low speed as compared to the detonation of a high explosive – Low and Slow. This generates much less peak pressure, does not violate the structural integrity of the barrel, and allows gunpowder’s use as an effective propellant of bullets towards bad guys. Gunpowder is NOT used primarily as an explosive in any military or industrial capacity. The dotted line in the graph represents the pressure generated by a HIGH explosive when detonated inside a gun barrel. High explosives are not ideal for bullet propellants because they detonate almost instantaneously and generate too great of an initial energy, called peak overpressure, and puts the structural integrity of the gun barrel at risk of rupture. This is why your 9mm bullets don’t contain dynamite.
  • So, It IS possible to dramatically increase the blast pressure of low explosives by containing them tightly during deflagration.By allowing the pressure and heat to build in an enclosed space, there is a vastly increased release of energy/time.This makes bullets go really fast when all that energy is released out of the end of a barrel. What happens if there is no hole for the energy to escape through?Now onto one of our other teaching points.
  • Everyone know what this is called?Yep, a black cat. A very low amount of black powder, wrapped in paper, and ignited by transferred heat from a simple fuse cord. Sitting on the ground like this, causes virtually no damage. What if you hold it in your open palp and set it off? [click]-Yep, pretty bad second-degree burns to the hand. 3 weeks from now he wont even have any scars. But what if he an even bigger dummy, and he decided to close his hand?[click]
  • And this is why placing a low explosive, even a very small one, in a container, greatly magnifies its effects.
  • So, now to one of the major teaching points: What is an IED. The Department of Defense uses my favorite definition:A device placed or fabricated in an improvised manner incorporating destructive, lethal, noxious, pyrotechnic, or incendiary chemicals and designed to destroy, incapacitate, harass, or distract. It may incorporate military stores, but is normally devised from nonmilitary components.
  • There are in fact many sub-types of IED’sFirst, there is the “Plain’ Ol’ IED” as I call it. These are bombs hidden in places, waiting for you to come by so somebody can explode it all over you. They are buried road-side, hidden in piles of rocks or trash, implanted in animal carcasses, and even placed in dead bodies. They are placed singly, or in series along a stretch of road. They can also be done over time, so that you run from the first one, and then the second one blows you up, which may have been the plan in Boston. Another prefered method is to wait until the rescuers rush in to help the victims, and the the secondary, larger device explodes in the same spot, killing the good guys.These are very commonly used in the Middle East and are hidden and wired to explode in many ways. Its these types, usually made from unexploded or stolen military ordinance, that killed the most troops in the wars.
  • Vehicle Borne IED, a sub category, are simply car bombs. These can be detonated remotely, such as in Oklahoma City, but seem to most often be a type of suicide bomb used to get close to target vehicles or structures that normally have protective security. A little humor from our troops overseas.
  • Victim-triggered IED, AKA Booby Traps, are another type of IED that have been around for a long time. Conventional or homemade explosives are rigged to go off when the victim does something to trigger it, such as this Grenade hidden behind a poster of Saddam Hussein that some cowardly Iraqi was hoping an American Troop would rip down, thus triggering a fuse to explode the bomb. This is not just overseas. Do you know why you can’t buy pseudophed over the counter anymore? Right, people like to make meth. Well, meth can make you paranoid to a level beyond schizophrenia, and meth cook houses get booby trapped all the time, How a tweaker gets a grenade is beyond me, but terrifying.
  • Person borne-IEDs, aka the infamous suicide bomb vest. Made in many forms, designed to be as well-hidden as possible, to allow the attack to be active instead of passive. We havent seen a fully operational one in the US yet, although a student at the University of Oklahoma DID blow himself up on a park bench using a powerful pipe a few years ago. I put the infamous shoe bomber and underwear bombers in this category.
  • Anatomical IED’s. Now, this is a term that I invented to describe something that scares the hell out of me: a surgically implanted device that cannot be detected and may board a plane or get near an assassination target. There is a known physician terrorist overseas who has openly claimed to be developing these both inside the abdomen, as well as in breast implants. While no successful SURGICALLY placed bombs have been reported yet, there HAVE have in fact been two attempts to assassinate political targets using a bomb that has been placed in . In prison, where I spent some time moonlighting back when I was a resident in surgery, this method of smuggling is known as “Keestering” – as in – “Hey homie, how’d you get that cell phone here in prison?” “Easy man, I keestered it when I was home.”
  • Used to destroy thousand of tracks used by German trains 1943-44. Locals repurposed unexploded military ordinance and created devices to attach them to the tracks and attempt to destroy German trains.
  • During the period of violence in Northern Ireland from 1969-1997 known as “The Troubles”, IEDs were used extensively and creatively by the Provisional IRA . We saw probably the greatest technological advancements in IED history. It was during this time that anti-movement components such as mercury switches, shown here were invented, radio-controlled triggers were improvised from toys, and roadside bombs grew to such prominence that the British military began using helicopters only to enter some areas. The good news is that many of the technologies to find, jam, destroy, and otherwise render useless these various forms of IED’s were developed in response by the British.
  • Sorry if this image makes any of you nauseated this morning following your Halloween party last night. if you like Guinness beer, than you know that there is a mix of Guinness and an ale that is quite tasty. Anyone know the name? Right, its called a Black and Tan. But let this young Irish doctor teach you a side lesson for your travels [click]
  • Please do not order a “black and tan” in Ireland or from an Irish barkeep. They find the term very inappropriate and offensive. Why? During the War for Irish Independence around 1920, the Brits sent a group of notoriously violent reinforcements to Ireland to quell the Irish revolutionaries. These Brits did not have enough complete military uniforms, so they were sent in piecemeal uniforms of khaki and dark green, earning them the nick name the “Black and Tans” – still widely used and derided to this day. If you go to Ireland, or have a bartender from Ireland, order a “Half and Half” instead.
  • There have been increases in IED usage world wide. In particular, there are a few places of focus, or so called “hotspots”. We would be remiss if we did not mention here the contribution to anti-IED and terrorism bombings research from the Israelis. They have taken extraordinary measures to prevent bombings, including walls, fences, and checkpoints. I had lunch with KobiPeleg 2 days ago in Boston, the Director of the Israeli National Trauma and Emergency Medicine Research Center to discuss these things. An entire conference could be dedicated to the Israeli experience alone. The period of bombings in Israel that occurred during the 2nd Intifada, where a country the size of Delaware was seeing 3-4 suicide bombers per day, is my biggest fear for the future of our own country.We have seen similar violence in Sri Lanka with the Tamil Tigers terrorist group, Al Qaeda and affiliates throughout the middle east, and also in the Chechen conflicts during the 1990’s-2000’s.
  • To put it in numbers, this very busy graph of now unclassified data, shows the number of IED incidents worldwide during each month from Aug 2010 to Aug 2012. Red represents actual bombs exploded during that month worldwide, yellow are unexploded bombs found, and green are caches of bomb-making materials not yet deployed. According to these government findings, on average there are worldwide, 272 detonations per month, 255 unexploded bombs found, and 70 chaches of materials to make them. 310 people were killed and roughly 800 were injured monthly during that time period. And here is the kicker -- this DOES NOT include data from Iraq or Afghanistan. Maybe 5% of these made the American news.
  • Do we have anyone in the audience who served in Vietnam? We saw the use of Victim-triggered IEDs extensively during the Vietnam War, where it is estimated that 10-15% of all deaths and casualties were the result of booby traps. Most of these involved an improvised explosive of some sort, including the infamous trip wire, or other improvised uses of hand grenades such as the simple rubber band grenade designed to hold the striker lever of an armed grenade in place stashed inside huts. [click]
  • When US troops burned suspicious VC huts, as was common practice, the rubber band would melt, and the hidden grenade would detonate.
  • IEDs in the GWOT have been the leading cause of death of all coalition forces, including US troops. Most of these are improvised uses of military ordinance, most of which appears to be left over from the 1980’s military invasion of Afghanistan. The trend in these wars is toward maximum cowardice, similar to tactics in Northern Ireland against the British, by the use of ROADSIDE IED’s, hidden along roads and detonated remotely. These are designed to be powerful enough to penetrate even some of the toughest armor.
  • It can be buried, look like trash such as this bottom picture, or hidden any number of ways. The top photo shows a well-known technique called the daisy chain, in which a series of explosives are set up in a series along a road, in anticipation of a convoy of vehicles. A stalled vehicle, such as a bus (in green), will block the road and trap the convoy. Then a single trigger is used to remotely detonate many simultaneous explosives.
  • They can have immense destructive force, and can even be shaped to have directed blast forces directly at the convoy or vehicle.
  • And its easy to see why they have been able to kill and injure so many.
  • Internationally, there have been several very high profile IED uses, and not just against american targets. Some of these we have discussed.Provisional IRA vs English Army during The Troubles in Northern Ireland 1969-1997Mujahadeenvs Soviets during invasion of Afghanistan in 1979-1980Israeli vs numerous Islamic forcesBombing of US Embassies in Beirut, Tanzania, Kenya, Yemen, Pakistan, etc.USS Cole (boat borne IED)
  • I find the attack on the USS Cole very interesting and particularly nasty. In 2000, a small boat loaded with explosives was able to avoid countermeasures and detonated next to the hull of the USS Cole, killing 17 and injuring 39 American sailors off the coast of Yemin. Amazing what a speedboat laden with a home made bomb can do. Truthfully, while this was creative, the Japanese actually pioneered this with kamikaze boats during WWII.
  • Ted Kazynski (Unabomber) – 16 LE bombs sent through mail, on an aircraft, etc.Weathermen / Weather Underground Organization 1970’s bombingsAbortion Clinics (since 1977 in the United States and Canada, property crimes committed against abortion providers have included 41 bombings, 173 arsons, 91 attempted bombings or arsons, 619 bomb threats)1993 World Trade Center1995 OKC Bombing Murrah Building1996 Olympic Park Bombing2001 9/11 attacks
  • According to the Energetic Materials Research and Testing Center (EMRTC) in the courseware for Incident Response to Terrorist Bombing:"An IEDs has four basic components which can be recalled by the acronym PIES:" P - Power Supply (Typically a battery that powers the initiator, which in turn detonates the main charge)I - Initiator - the component that starts the explosive chain ie squibs, blasting caps, flash bulbs, exposed filament) E - Explosive either high or low. Can be commercial such as ANFO, Military such as SEMTEX or Low explosives like gunpowder or fireworksS - Switch (Two Categories- mechanical or electrical) Switches usually perform two functions, safety arming & detonating by timer or remote. When the switch is activated, it completes an electrical circuit from the power source to the explosive charge. Then, either by heat, electricity, or a small initiating charge, the main explosive is set off.
  • The types of power source are usually very simple. In traditional explosives use, a simple dynamite plunger provides a small electrical charge to blow up dynamite. In most IED’s today, a simple battery supplies the power needed to initiate the explosion, such as this Rechargeable C-cell battery used to set off one of the pressure cooker bombs at the Boston Marathon.
  • The switch, also known as the bomb trigger, is a component that that completes a circuit and fires the initiator in order to set off the main explosive. The simplest of these is two wires placed in the explosive material, then attached to a battery in order to transmit electricity and heat and set off the reaction. In increasing complexity, I have listed other common methods, including setting a timer whose alarm is rigged to transmit the electric signal, or triggering the initiator by using remote controls such as radios transmitters, garage door openers, infrared remotes, or cell phones.
  • Types of initiators depend on the type of explosive used in the main charge. The job of this component is to take the electricity provided by the power source, which has now travelled through the switch when the circuit is made complete, and then use that electricity initiate the explosion. In many explosives, those called including those low order explosives used in Boston, the heat from a light bulb filament a spark between to naked copper wire tips is enough to set it off. This simple method of initiation is also used in certain High Explosives, too, call Primary High Explosives, which are very sensitive. [click] There are however, high explosives that require a more powerful initiation to get the main charger to blow up. These, called Secondary High Explosives, require that a smaller, primary charge be exploded, thus setting off the main charge and the big detonation. This is where the “blasting cap” comes in, as you have all seen in cool Rambo movies when he sticks them into some plastic explosive while setting a trap. In fact, C4 plastic explosive, as secondary high explosive, is really cool in this regard. As proof that it requires a blasting cap to initiate it, as opposed to a simple spark or flame, soldiers in Vietnam actually used to set their C4 on fire and use the burning brick to boil water and cook food. Cool, huh?
  • There are however, high explosives that require a more powerful initiation to get the main charger to blow up. These, called Secondary High Explosives, require that a smaller, primary charge be exploded, thus setting off the main charge and the big detonation. This is where the “blasting cap” comes in, as you have all seen in cool Rambo movies [click] when he sticks them into some plastic explosive while setting a trap [click]. In fact, C4 plastic explosive, as secondary high explosive, is really cool in this regard. {click} As proof that it requires a blasting cap to initiate it, as opposed to a simple spark or flame, soldiers in Vietnam actually used to set their C4 on fire and use the burning material to boil water and cook food. Cool, huh?
  • So lets now discuss the types of explosives used in IED’s once more. First we should mention the use of high explosives. Now, shining examples of high explosives are listed here. These are mainly used in mining and military, although there are many others that can be made at home with the right chemicals, right knowledge, and wrong brain. An interesting tidbit about Dynamite – do you know who invented this product and made great profits from it?
  • A quick note about Dynamite. Anyone know who invented it? [click] This old guy, in 1867. [click] This may help. Alfred Nobel invented dynamite, [click] the first stable high explosive, made from nitroglycerin and diomataceous earth, and was made for mining purposes. It later became a weapon, go figure. In 1888 Alfred's brother died and a French newspaper erroneously published Alfred's obituary. It condemned him for his invention of dynamite and is said to have brought about his decision to leave a better legacy after his death. The obituary stated "The merchant of death is dead" and went on to say, "Dr. Alfred Nobel, who became rich by finding ways to kill more people faster than ever before, died yesterday."[click] So he left donated all his money to a series of prizes to further peace and science.
  • So back to high explosives. In review, we learned earlier that these detonate, and in doing so create a very powerful, supersonic shock wave that creates incredible, nearly instantaneous damage to your body and everything else around you. It can send missiles of shrapnel and fragments outward to strike you, but this really isnt necessary to kill you, since the shock wave itself causes the majority of injuries and destruction. If a nuclear bomb goes off, no one is gonna worry about weather a bunch of nails or BB’s were packed around the plutonium, right?So lets look at the most well studied terrorist bombing in history. It happened on April 19th, 1995. [click]
  • On this day in OKC, the Federal Building in downtown OKC was bombed by two domestic, American terrorists simply because they were angry, and it was vulnerable. There was little to no target hardening put in the plan of the building, and as you can see on your left, anyone can pull a car right up next to the building. The front was made of glass, and there was no separation from the road by bollards, curbs, or distance, as is the new standard. The building housed not only DEA, ATF, Social Security Administration, and recruiting offices for the Army and Marine Corps, but also a day care center for its employees’ young children.Most people haven’t thought of this as an IED attack, but it was. So how’d they do it?
  • They rented a truck, mixed up 2 tons of fertilizer and nitromethane, creating a high explosive slurry. They filled this into barrels in the back of the moving truck.
  • They rented a truck, mixed up 2 tons of fertilizer and nitromethane, creating a high explosive slurry. They filled this into barrels in the back of the moving truck.
  • In an instant, 168 were dead, including 19 children under the age of 5 who were in the first floor nursery while their parents worked.
  • Included here are photos from minutes after the detonation, and the iconic and Pulitzer prize winning photograph of OKC Firefighter Chris Fields holding a deceased BayleeAlmon.
  • Low explosive IED’s and how they are made will be the main topic here today, as high explosives are very complicated to make, and fortunately, we have not seen much in the way of serious use Domestically since OKC.
  • Ad libSo
  • So lets discuss the now-infamous pressure cooker bomb, made popular in the media as the devices used in the Boston Marathon Bombings. This is a type of bomb that is made from a low explosive, and relies on the concepts of enhancing the force of the blast by housing it within a rigid container. The explosive is placed inside with a fuse trigger attached to a timer or receiver that allows remote initiation. Its almost identical to a standard pipe bomb, except that the remaining area inside the pressure cooker packed with shrapnel, usually BB’s, ballbearings, nails, etc. The pressure cooker is then closed and sealed. These particular bombs were not the genius invention of a pair of brothers from Cambridge, MA. These have been used in the GWOT against coalition forces for over a decade. So what does it mean that it’s a pipe bomb?
  • This is a typical pipe bomb, exactly like the one that redneck kid from your high school got arrested for that one time. Designed to contain the explosion and increase pressure and heat until catastrophic structural failure occurs, sending heat, fragments, and shrapnel out ward at high speeds. These are super slow motion photos demonstrating the explosion of a pipe bomb and the enormity of the pressure and force. I do not know what material was used as an explosive, but safe to say it was probably black powder. Notice the use of very strong end caps – applied because this is the typical failure site, and you want to use these so that the entire casing ruptures instead of the end popping off and turning the device into a rocket. Lets take a look at this in slow motion.
  • Pressure buildup as the low order explosive begins to deflagrate within the pipe bomb.
  • Here we can see the pressure has built up within the pipe to a point that there is now loss of structural integrity over the entire pipe. The whole metal casing is fragmenting and explode outward at very high speeds as projectiles that can cause significant damage.
  • So where did two young brothers from my neighborhood learn how to do this?
  • To the best of what has been released, then learned from internet research. The media reports that they found a copy of this literature from Inspire magazine on their hard drive – a well known terrorist propaganda tool of very high quality. [click]
  • This is the actual page showing how to use a kitchen timer circuit as a Switch. When the wire wrapped hand strike the nail that has been placed at 3 o’clock, the circuit is completed. This turns on a simple christmaslightbulb with the tip melted off of it, causing the exposed filament to ingnite the highly flammable black powder that it is buried in.
  • OK, for a few slides, lets talk briefly about how bombs actually hurt people and property.
  • So lets talk about some definitions from the explosives world as we being to discuss blast injuries in a moment. A quick refresh from earlier: Blast wave: When a HIGH EXPLOSIVEbomb explodes, the area around the explosion becomes overpressurized, resulting in highly compressed air particles that travel faster than the speed of sound. This wave will dissipate over time and distance and will exist only for a matter of milliseconds. This initial blast wave inflicts the most damage, and travels much faster than the fireball of burning gas and debris. When this blast wave reaches a structure or person, two things will initially happen. First, the person will feel the force of the blast, which is the initial impact and causes shockwaves to travel through the tissues. This is essentiallylike getting hit with a brick wall at Mach 1.The explosion may also create a fireball and high temperatures, which will result in burns on a human body or even cause secondary fires or explosions, depending on whether any other fuel sources or flammable materials are located near the blast. Things added to a bomb to create fire are called incendiaries.
  • Shockwaves:After a blast wave strikes a surface or body, high-velocity shockwaves, or stress waves, will continue to pass through -- in the body, they travel through the organs and tissues. Shockwaves carry energy through the medium they pass through; they're supersonic and transport more energy than sound waves. Currently, there are no effective ways to prevent shockwaves from passing through protective clothing, and in some cases protective measures may even amplify the destructive effects.
  • Did you know that there is a difference between shrapnel and fragments? Fragmentation is physical disruption of the container in which a bomb is held. The pieces of the container fly outward as projectiles as a consequence of the explosion and can cause damage, as seen in the slide of the pipe bomb earlier. The container can be specially designed to fragment for maximum damage, as in the case of this comon US government fragmentation grenade, or “FRAG.” This fragmentation is commonly referred to incorrectly as shrapnel, which is fine since it is treated the same way, but from a bomb-making standpoint is technically incorrect. Fragmentation comes from NON-intentional explosions as well, such as a natural gas tanker explosion.Shrapnel, by its strictest bomb making definition, are pieces of hard material specifically added to an explosive device with the intention of causing penetrating trauma to soft tissues, in addition to the fragmentation from the container. Typical shrapnel includes nails, ballbearings, marbles, and nuts and bolts. The bottom left picture shows a shrapnel nail and ballbearings added to on of the Marathon Pressure Cooker Bombs, as well as a zipper from the backpack which would be considered a fragment.
  • As already discussed earlier, Blast wind: At the explosion site, a vacuum is created by the rapid outward movement of the blast. This vacuum will almost immediately refill itself with the surrounding atmosphere. This creates a very strong pull on any nearby person or structural surface after the initial push effect of the blast has been delivered. As this void is refilled, it creates a high-intensity wind that causes fragmented objects, glass and debris to be drawn back in toward the source of the explosion.
  • Blast Injuries are those caused by explosions, and vary somewhat based on the type of bomb and additives.Most importantly is whether a high vs. low explosive was used. The generation of a blast wave requires detonation of high explosives, and only this supersonic blast causes what we call Primary Blast Injury, which we will talk about in a second. Low Explosives do not kill by primary blast injury, but instead by fragments and additional shrapnel, as well as by concussive forces from being thrown. In theory, as in Boston, there is a possibility of a blast from strongly-contained low explosives that can rival a low yield high explosive.Additional factors such as the container, if used, creating fragmentation, the optional addition of shrapnel, optional addition of incendiaries such as gasoline, propane, white phosphorous, etc, all can change the effectiveness of a bomb, especially of the low explosive type.
  • So now that we have the basics down, let us define the 4 major types of blast injury. In standard medical jargon, we refer to these in decreasing order of severity as primary through Quaternary. This explosion here represents a high explosive such as an artillery shell. Your survival, as common sense tells you, is based on your distance from the blast, and this is because distance determines what type of injuries, primary through quaternary, you are going to receive.
  • So the types of blast injuries are listed here, and are almost identical between low order and high order explosions, with notable exceptions. First we know that Primary Blast Injuries are those caused by the blast wave that is propagated outward only from a high explosive blast whose energy is exploded outward faster than the speed of sound and causes devastating shockwaves through your body or the building you are inside. Low order explosives, such as in Boston, do NOT create an appreciative shock wave, and therefore do not cause primary blast injury.The next most deadly issue are Secondary blast injuries, those caused by fragmentation of the container, and penetrating trauma from the shrapnel projectiles purposely placed around the bomb. These cause significant severity and amount of soft tissue damage depending on type used and distance from target. If you are close enough, as in Boston, the shrapnel can be concentrated enough and powerful enough to cause traumatic amputations. We should distinguish this from amputations caused by Primary Blast Injury, where the person is so close to the detonation that the blast wave itself causes traumatic amputation. Being this close is almost universally fatal.Tertiary injuries occur when the blast wave is powerful enough to throw you or make you fall. When you hit the wall or the ground, it can cause injury, and these are considered Tertiary injuries, and are typically closed head injuries, orthopedic trauma, and severe contusions. Quaternary injuries are caused by structural collapse, burns from incendiary burns, or other medical problems exacerbated by the explosion, such as coronary artery disease or respiratory impairment. Now you will see the theoretical category of Quinternary injuries listed, which are due to explosions that disperse chem, biological, toxin, or radioactive substances into the air. Died from a mustard gas shell hitting your neigbor’s house? That’s Quinternary Blast Injury.
  • The magnitude of damage due the blast wave is dependent on: 1) the peak of the initial positive pressure wave (bearing in mind that an overpressure of 60-80 PSI is considered potentially lethal)2) the duration of the overpressure3) the medium in which it explodes4) the distance from the incident blast wave5) the degree of focusing due to a confined area or walls. For example, explosions near or within hard solid surfaces become amplified two to nine times due to shock wave reflection. As a result, individuals between the blast and a building generally suffer two to three times the degree of injury compared to those in open spaces.If you are in the corner of the room, you will die. This increases lethality not only in buildings, but inside foxholes during war and inside buses and trains during terrorist attacks.The force of the blast wave decreases exponentially as you increase distance from it. This does not mean you are safe from shrapnel, only the primary blast wave.Underwater blasts are transmitted through water, which unlike air, is virtually incompressible. This means the blast wave propagates much further, faster. It is lethal at significantly greater distances, roughly 3 times further, than if the same blast occurred in air.
  • PBI is caused by the interaction of the blast wave with the human body. The wave is comprised of super compressed gas at greater than 1 atm of barometric pressure. Most of this force is reflected off of you due to differences in density. But enough of it transmits into you to cause rapid compression of air filled organs, such as the middle ear, lungs, and bowels. This rapid compression, also known as implosion, causes severe shearing forces on the tissues. In water, which is nearly the same density as your entire body, almost none of the blast wave is reflected, and instead most transmits through your body.
  • Is NOT a rule out for BLI as was once thought
  • 4 weeks post blast. Typically wait 3 months before discussion of surgical repair.
  • Bilateral fluffy appearing infiltrates demonstrating intra-alveolar fluid accumulation and hemorrhage.
  • Gas-containing sections of the GI tract are most vulnerable to primary blast effect. This can cause immediate bowel perforation, hemorrhage (ranging from small petechiae to large hematomas), mesenteric shear injuries, solid organ lacerations, and testicular rupture.Children more suscepitble due to thin abdominal wall and larger solid organs, which does increase risk of solid organ damage.Blast abdominal injury should be suspected in anyone exposed to an explosion with abdominal pain, nausea, vomiting, hematemesis, rectal pain, tenesmus, testicular pain, unexplained hypovolemia, or any findings suggestive of an acute abdomen. Clinical findings may be absent until the onset of complications: May be delayed for several days.Colon is most common site of injury.
  • Ad lib
  • Tertiary injuries are those caused by almost everything else after the explosion. These include thermal burns, seen most often after a low order explosive or one containing an incendiary petroleum based product such as gasoline. We may see inhalational injuries from particulate matter, similar to the effects of 9/11 at ground zero, which was functionally an explosion when the buildings collapsed. The two most commonly seen types of quaternary injury are those due to other medical problems, and deaths from structural collapse. In Atlanta in 1996, one of the deaths at the Olympic Park Bombing was due to a rescue working running to the site to render aid when he fell and died from a heart attack.
  • Quaternary injuries most commonly are due to structural collapse. Impalement Crush Injuries with rhabdomyolysis need for on scene amputation
  • Quinternary injuries are theoretical in terrorist bombings to this point. Chlorine has been tried and failed.
  • Why the future? Well, they are already here! We have seen them used on american soil hundreds of times. Now, thanks to Boston, we know that it can be done at home, with instructions widely available online. We know that if done well, they are very difficult to defend against. We know that it doesn’t have to be a suicide bomb, which appeals to our western life values (yep even the bad guys). Lastly, we know that bad guys like to copy cat things. So be prepared. We are changing laws annually to try to make it harder to get your hands on dangerous materials. Trust me, its way harder to buy large quantities of fertilizer these days than it is to buy a pack of pseudophed.
  • So we had abriefoverview of what Disaster Medicine is, what defines a disaster, and what the basics of disaster management are. We discussed the history of IED and explosives, types, how they are used, and sort of, how to build one.We discussed the types of blast injuries and what are the physics of explosions that cause them to occur, the mechanics of explosions and the different types of injuries we see from them, and the differences depending on what class of explosives was used.And I think you can all agree that this is something we will most certainly see again soon.
  • Instead of the bibliography of information, I instead am providing my inspiration; the bibliography of my career, if you will. My Father Tommy on your left, a 25 year veteran of the Oklahoma City Fire Department, and my mom’s brother, my Uncle Joey McGroarty on the right, a 30 year veteran of the NYCFD. Thank you.
  • IED's: america's future

    1. 1. IED’s in America Keynote Presentation from James Phillips MD, Harvard Disaster Medicine
    2. 2. I have no financial relationships to disclose regarding the companies or products discussed in this presentation. I will not discuss off label use or investigational use in my presentation.
    3. 3. • What is Disaster Medicine? • What is an IED? • What are Blast Injuries? • Discuss the future of IEDs in America.
    4. 4. Medical specialists trained to care for injuries and illnesses associated with both natural and man-made disasters, and who provide education, consultation, and leadership at all levels of government and private industry during all aspects of the disaster cycle.
    5. 5. • Marriage of emergency preparedness and disaster management • A systems oriented specialty – no “disaster clinic” • Multiple disciplines– Infectious Disease, Trauma, Public Health, International and Austere Medicine, Counter Terrorism • EMS Training and Management • Public Health Focus and Research
    6. 6. April 15th, 2013
    7. 7. Types of Explosives
    8. 8. • Divided into 2 major categories – HE (High Explosives) – LE (Low Explosives) • Are differentiated based on speed of decomposition of the explosive material – Greater than speed of sound = High Explosive
    9. 9. • Military or Industrial Grade Explosives • Explode by DETONATION • Creates Blast Wave (Shock Wave) • Inflict Primary Blast Injury (PBI)
    10. 10. • Explode by Deflagration – They do not detonate • Slower than speed of sound • No Blast Wave (Shock Wave) • Used as Propellants – Black Powder (Gunpowder), Fireworks
    11. 11. • It IS possible to dramatically increase the blast pressure of low explosives by containing them tightly during deflagration. • By allowing the pressure and heat to build in an enclosed space, there is a vastly increased release of energy/time.
    12. 12. • Improvised Explosive Device – Fabricated in an improvised manner from chemicals – designed to destroy, incapacitate, harass, or distract – normally devised from nonmilitary components
    13. 13. • First saw extensive use in WWII • “Belarusian Rail War”
    14. 14. Vietnam War – Booby Traps – Tripwires – Rubber Band Grenades – Mines
    15. 15. Global War on Terror - Primary cause of death and injury to coalition forces in both Iraq and Afghanistan theaters.
    16. 16. • “The Troubles” • Mujahadeen vs Soviets during invasion of Afghanistan • Israel • US Embassies in Beirut, Tanzania, Kenya, Yemen, Pakistan • USS Cole (Boat-borne IED)
    17. 17. • Ted Kaczynski (Unabomber) • Weathermen • Abortion Clinic Bombings • 1993 World Trade Center • 1995 OKC Bombing • 1996 Olympic Park Bombing • 2001 9/11 attacks • 2013 Boston Marathon Bombing
    18. 18. • PIES – Power Supply – Initiator – “fuse” – Explosive (HE or LE) – Switch - both arms and triggers the blast) From: (EMRTC) Incident Response to Terrorist Bombing
    19. 19. • Direct Wire • Timer (e.g. alarm clock, watch, egg timer) • Remote Control (e.g. garage door opener) • Radio • Infrared • Cell Phone
    20. 20. Blasting Caps
    21. 21. • Dynamite/TNT • Plastic Explosives (Semtex, C4) • ANFO/ANMN • Military artillery shells, mines, etc
    22. 22. • Detonation • Damage is mostly due to the primary blast wave itself, shrapnel, and structural collapse • Very high energy, supersonic wave • Shrapnel not necessary
    23. 23. • Truck parked 6.5 feet from building wall • AMMN in barrels, initiated by dynamite, and triggered by a timer. • Caused near-total structural collapse, and damaged 300 surrounding buildings
    24. 24. • Frighteningly easy to make • If contained, can be very deadly • Injuries differ from HE, as no true blast wave is generated. • Shrapnel and Incendiaries can enhance effect
    25. 25. • Low Explosive Bomb - Used fireworks from NH – Placed in a high integrity blast container to amplify • Greatly enhanced blast force • Subsonic, but ? Primary Blast Injury – Added metal nails, ball bearings • Shrapnel added for lethality by Secondary Blast Injury • Caused vast majority, if not all, deaths and injuries
    26. 26. • Jihadi Literature • Internet
    27. 27. • Pressure caused by a blast wave over and above normal atmospheric pressure – the cause of HE primary blast injury
    28. 28. • High energy waves that travel through the organs and tissues of the body at variable speeds and cause direct injury by shearing.
    29. 29. • Types of injuries caused by explosions • Depend on type of explosive used – HE vs LE (Blast wave causes Primary Blast Injury) – Addition of incendiaries (Time Square attempt) – Addition of shrapnel
    30. 30. • Primary – Primary Blast Wave • Secondary – Fragmentation and shrapnel • Tertiary – Thrown against walls or ground • Quaternary – Burns, structural collapse, other medical problems • Quinternary – Addition of CBR (theoretical)
    31. 31. • Special Considerations – Distance from blast is most important • Primary blast injury • Shrapnel/Frags – Location indoors vs outdoors • Blast waves reflect off walls at 3-10 times strength – Underwater blasts are much more powerful • Fluid physics
    32. 32. • Primary Blast Injury – Affect is caused by supersonic wave of compressed gas and its effects on air filled organs. – Middle Ear is most commonly affected – Blast Lung Injury is the killer – Bowel injury is more rare but possible – Traumatic Brain Injury – HE may cause traumatic amputations
    33. 33. • Tympanic Membrane Rupture • Occurs at pressures as low as 5 psi • May cause temporary or permanent conductive or sensorineural hearing loss • 80% heal nonsurgically
    34. 34. Middle Ear
    35. 35. • Major damage due to massive shearing forces due to implosion beyond tensile strength of alveoli and pulmonary capillaries • ARDS like picture with dyspnea, wheezing, hypoxia, hemoptysis, PTX, or tension PTX. • Most common cause of immediate PBI death – Massive arterial air embolus
    36. 36. • May present up to 48 hours after • Unlikely if no TM rupture, but possible • Observe for at least 4 hours for deterioration • Most are dead or symptomatic on arrival • Lung protective ventilator strategies if intubation required.
    37. 37. • May have delayed presentation up to 8 days – Small area of severe damage -> perforation • May present with acute abdomen initially • More common than blast lung if underwater
    38. 38. • Unclear mechanism • Likely coup-contrecoup • Effects of small air emboli?
    39. 39. • Majority of LE IED injuries • Fragmentation and Shrapnel – Includes structural shrapnel • Soft tissue and bony injuries – Amputations • Eye Injuries – Abrasions – Globe ruptures
    40. 40. • Thermal burns – must be close to blast, only likely to see on survivors from LE • Dust/particulate inhalational injuries • Death from other medical causes – Myocardial Infarction, etc • Structural collapse – Primary cause of quaternary death and injury
    41. 41. • OKC Bombing Structural Collapse
    42. 42. Quinternary Injuries • Due to radioactive exposure/fallout • Due to dispersion of toxin/biological agent • Due to chemical agent
    43. 43. • Easy to make in your mom’s kitchen • Very difficult to predict builders/users • Compact, transportable, and powerful • Easily created with numerous trigger options • Bad guys love to copycat
    44. 44. Summary • What is Disaster Medicine? • What is an IEDs? • What are Blast Injuries? • The future of IEDs in America.
    45. 45. Bibliography