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IED's: america's future

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

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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

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