Blast injury in enclosed spaces

doi:10.1136/bmj.331.7509.119

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Eddie Chaloner, consultant vascular surgeon (eddie.chaloner@btopenworld.com)

Lewisham University Hospital, London SE13 6LH

All doctors should know the basic management of patients injured by explosive blast

The bomb attacks on the transport network in London on 7 July 2005 have illustrated the lethality of explosions in confined urban spaces. Such indiscriminate attacks could occur again in the near future. The management of casualties injured by blasts is mainly the preserve of the military doctor, but the bombing of a bus outside BMA House graphically illustrates that any doctor may be called on to manage patients injured in explosions.

While all casualties injured in explosions should be managed initially according to the advanced trauma life support (ATLS) guidelines, starting with airway, breathing, and circulation,1 general doctors should also be aware of the specific features of blast injury. Detailed advice and clinical guidance for the non-specialist on managing casualties injured by blasts is freely available online from the …