Explosion injuries
- Finding
An explosion injures in four ways: the pressure wave, the fragments, the body being thrown, and other effects such as fire and gases.
What it is
Explosion injuries are classed by four mechanisms. Primary injury is caused by the overpressure wave of high-order explosives and mainly affects air-filled organs: middle ear, lung and bowel. Secondary injury is caused by fragments and flying debris, and it is the most common. Tertiary injury happens when the body is thrown against objects or trapped under a collapse. Quaternary injury covers everything else: burns, crushing, inhaled smoke and gases, and worsening of existing illness. In Colombia, antipersonnel mines and unexploded ordnance still cause casualties: according to UNMAS, by 30 June 2021 the authorities had recorded 12,062 victims since 1990. The typical mine injury is traumatic amputation of the leg with eye injuries.
How to tell it apart
- Versus gunshot wounds: fragments are irregular and numerous, with no regular abrasion ring and no gunshot-type powder residue.
- Versus a fire without an explosion: primary injury and fragment wounds are absent.
- An intact eardrum does not rule out severe primary injury to other organs.
- A body very close to the device may be fragmented; those further away may have only secondary or tertiary injuries.
How to recognise it
- Distribution of injuries by position relative to the device: the side of the body nearest to it takes more fragments and burns.
- Fragment wounds: many, of irregular size and shape, often with soil or device debris embedded.
- Traumatic amputations with ragged edges, above all of the lower limbs with mines.
- Flash burns on exposed skin and singed hair.
- At autopsy: lung haemorrhages, eardrum rupture and bowel contusions or perforations in primary injury.
How it forms
- High-order explosives detonate and create a supersonic overpressure wave; low-order ones deflagrate without that wave and injure through fragments, blast wind and heat.
- The pressure wave mainly damages interfaces between tissue and air, which is why it affects the ear, lung and bowel.
- Explosions in enclosed spaces or with structural collapse cause more deaths and more severe injuries.
Mechanisms of blast injury (CDC)
| Mechanism | Cause | Typical injuries |
|---|---|---|
| Primary | Overpressure wave of high-order explosives | Blast lung, eardrum rupture, bowel perforation, globe rupture |
| Secondary | Fragments and flying debris | Penetrating or blunt wounds anywhere; eye injuries |
| Tertiary | Body thrown or structural collapse | Fractures, traumatic amputations, head injury |
| Quaternary | Fire, gases, dust and other effects | Burns, crushing, inhaled smoke and toxic gases, worsening of illness |
Next step: what to do and document
- In a survivor, check the ears, chest and abdomen, and observe for blast lung even if the patient arrives stable.
- Record the distribution of injuries on a body chart: it points to the victim's position relative to the device.
- Radiograph every body and every set of remains, and recover device fragments under chain of custody for the explosives laboratory.
- Keep the clothing separately and in paper: it may carry explosive residue.
- With several victims, number each body and each set of remains separately and follow the disaster victim identification procedure.
- Notify the competent authority and, if the person is a mine victim, record the event for care and reparation.
Common mistakes
- Not radiographing every body and every set of remains: device fragments that identify the explosive are lost.
- Discharging a survivor of an enclosed-space explosion without observation: blast lung can appear later.
- Attributing all injuries to one mechanism: in an explosion all four usually coexist.
- Mixing human remains from several victims in one bag, which complicates identification.
Test yourself
Think of the answer, then tap the question to see it.
Which organs does the overpressure wave of an explosion mainly injure?
Those that contain air: the middle ear (eardrum rupture), the lung (blast lung) and the bowel; also the eyeball.
What is the most common mechanism of injury in an explosion?
Secondary: wounds from fragments and debris thrown by the explosion.
Which fatal injury must be watched for in a survivor who arrives stable after an explosion?
Blast lung, the most common fatal injury among those who survive the initial explosion.
What injury pattern does an antipersonnel mine typically produce?
Traumatic amputation of the leg, fragment wounds over the rest of the lower limb and eye injuries.
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Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.
Sources: Explosions and Blast Injuries: A Primer for Clinicians (Centers for Disease Control and Prevention, 2003); Pattern of blast injuries. A systematic review: Part 2 - Landmines, unexploded ordnance and terrorism (European Journal of Trauma and Emergency Surgery, PubMed Central, 2026); Autopsy-Based Analysis of Landmine Blast Fatalities Associated With Left-Wing Extremism (Cureus, PubMed Central, 2026); Boletín Mensual Colombia, julio 2021 (United Nations Mine Action Service (UNMAS), 2021).
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