Lived to tellBMJ 2005; 331 doi: https://doi.org/10.1136/sbmj.0510366 (Published 01 October 2005) Cite this as: BMJ 2005;331:0510366
- Philip Hendy, final year medical student1,
- Christopher John Williams, fourth year medical student2,
- Jonathan Digby-Bell, fourth year medical student2
- 1University College London
- 2University of Bristol
On 7 July 2005 four bombs ripped through London's crowded commuter transport system in a coordinated terrorist attack, resulting in the death of 52 people and injuring around 700.1 On 23 July 2005 in Sharm-ElSheikh, Egypt, three bombs exploded in central locations around the city, leaving as many as 88 people dead and 700 injured, the majority of whom were Egyptian.2 The coauthors of this article were on medical elective in Sharm-El-Sheikh and experienced first hand the reality of the management of blast victims and of dealing with the aftermath of a terrorist bomb.
Both bombs were homemade but of contrasting types. Police currently believe that each of the four London transport bombs contained less than 5 kg of the explosive TATP (triacetone triperoxide).3 This can be manufactured from scratch from over the counter products including bleach and acetone. By contrast, the Sharm-EI-Sheikh bombs are believed to have contained over 500 kg of “highly explosive material,” most likely to be TNT (trinitrotoluene)4 reclaimed from military shells possibly dating back to the 1967 six day war between Egypt and Israel.
Mechanisms of blast injury
The detonation of a bomb results in the generation of a blast wave that radiates outwards from the source of the explosion. It has two components. Firstly, a high pressure shock wave which may cause damage to gas-containing organs and body spaces. Secondly, the blast wind, a layer of high velocity air, which may propel fragments and people, resulting in penetrating and blunt injuries:5
In general, the blast waves in open spaces decrease exponentially with distance from the epicentre, while explosions in confined spaces are subject to the summed effects of reflections and …