Injuries, treatment, and impairment caused by different types of fireworks; results of a 10 year multicenter retrospective cohort study.

OBJECTIVES: The primary aim of this study was to evaluate the number of patients reported to a hospital with injuries from consumer fireworks in the months December-January in the past 10 years, and to describe the association between the type of fireworks, injury pattern, treatment, and permanent impairment. METHODS: A multicenter, retrospective, observational case series. Patients were selected from two hospitals in the Southwest Netherlands: a level 1 trauma center and a specialized burn center. All patients with any fireworks-related injuries treated between December 1 and January 31, during 2007 (December) to 2017 (January), were eligible for participation. The primary outcome was the number of patients with any type of injury caused by fireworks. The secondary outcome measures were patient and injury characteristics, treatment details, and whole person impairment (WPI). The percentage WPI expresses a patient's degree of permanent impairments as a result of fireworks-related injuries. RESULTS: Of the 297 eligible patients, 272 patients were included. From 2007 to 2017, between 21 and 40 patients were treated, and no clear increase or decrease was observed in the number of patients and in the number of patients per type of fireworks. Explosive fireworks mainly caused upper extremity (N = 65; 68%) injuries, while rockets (N = 24; 41%) and aerials (N = 7; 41%) mainly affected the head/neck. Decorative fireworks predominantly resulted in burns (N = 82; 68%), and explosive fireworks in soft tissue lacerations (N = 24; 25%), fractures (N = 16; 17%), and amputations (N = 14; 15%). Patients injured by explosive and homemade fireworks were most often admitted to a hospital (respectively N = 24; 36% and N = 12; 80%), and resulted in the highest proportion undergoing surgical procedures (respectively N = 22; 33% and N = 7; 47%). WPI found in this study was between 0 to 95%, with a median of 0%. In 34 (14%) patients, the injuries resulted in a WPI of ≥1%, mostly as a result of explosive fireworks (N = 18; 53%). CONCLUSION: This study found no increase or decrease in the number of patients treated in two specialized hospitals. Explosive and homemade fireworks could be considered as most dangerous, as they result into the most hospital admissions, surgical procedures, and into the most injuries with permanent impairment as a result.

Feasibility of use of medical dual energy scanner for forensic detection and characterization of explosives, a phantom study.

OBJECTIVE: Detection of explosives is a challenge due to the use of improvised and concealed bombs. Post-bomb strike bodies are handled by emergency and forensic teams. We aimed to determine whether medical dual-energy computed tomography (DECT) algorithm and prediction model can readily detect and distinguish a range of explosives on the human body during disaster victim identification (DVI) processes of bombings. MATERIALS AND METHODS: A medical DECT of 8 explosives (Semtex, Pastex, Hexamethylene triperoxide diamine, Acetone peroxide, Nitrocellulose, Pentrite, Ammonium Nitrate, and classified explosive) was conducted ex-vivo and on an anthropomorphic phantom. Hounsfield unit (HU), electron density (ED), effective atomic number (Zeff), and dual energy index (DEI),were compared by Wilcoxon signed rank test. Intra-class (ICC) and Pearson correlation coefficients (r) were computed. Explosives classification was performed through a prediction model with test-retest samples. RESULTS: Except for DEI (p = 0.036), means of HU, ED, and Zeff were not statistically different (p > 0.05) between explosives ex-vivo and on the phantom (r > 0.80). Intra- and inter-reader ICC were good to excellent: 0.806 to 0.997 and 0.890, respectively. Except for the phantom DEI, all measurements from each individual explosive differed significantly. HU, ED, Zeff, and DEI differed depending on the type of explosive. Our decision tree provided Zeff and ED for explosives classification with high accuracy (83.7%) and excellent reliability (100%). CONCLUSION: Our medical DECT algorithm and prediction model can readily detect and distinguish our range of explosives on the human body. This would avoid possible endangering of DVI staff.

Reducing impacts from ammunitions: A comparative life-cycle assessment of four types of 9mm ammunitions.

Increase of environmental awareness of the population has pressured research activities in the defence area to cover environment and toxicity issues, where have been considered appropriate manners to reduce the environmental and toxicological impacts of ammunition. One of the adopted approaches to achieve such goal involves the replacement of lead and other heavy metals by alternative materials. However, the consequences of using alternative materials in ammunitions manufacturing are uncertain for the other life-cycle phases and trade-offs can occur. The present paper describes the potential benefits from the replacement of lead in the primer and in the projectile of a 9mm calibre ammunition. For that purpose, it is assessed and compared the environmental and toxicological impacts associated with the life-cycle of four ammunitions: combination of two types of projectiles (steel jacket and lead core; copper and nylon composite) with two types of primers (lead primer; non-lead primer). In addition, some potential improvements for the environmental performance of small calibre ammunition are also presented. To assess the impacts two Life-Cycle Impact Assessment methods are applied: CML for six environmental categories and USEtox to three toxicity categories. Results showed that the conclusion drawn for environmental and toxicological impact categories are distinct. In fact, ammunition production phase presents higher impacts for the environmental categories, whilst the operation phase has a higher impact to the toxicity categories. The substitution of lead in the primer and in the projectile provides a suitable alternative from a toxicology perspective; however, the composite projectile still presents some environmental concerns. The conclusions drawn are important for the procurement (and design) of environmental responsible ammunitions, in order to avoid (or decrease) the impacts for their manufacture and the effects on human health (e.g. shooters) and ecosystems near shooting ranges or hunting areas.

Bayesian Integration and Classification of Composition C-4 Plastic Explosives Based on Time-of-Flight-Secondary Ion Mass Spectrometry and Laser Ablation-Inductively Coupled Plasma Mass Spectrometry.

Time-of-flight-secondary ion mass spectrometry (TOF-SIMS) and laser ablation-inductively coupled plasma mass spectrometry (LA-ICPMS) were used for characterization and identification of unique signatures from a series of 18 Composition C-4 plastic explosives. The samples were obtained from various commercial and military sources around the country. Positive and negative ion TOF-SIMS data were acquired directly from the C-4 residue on Si surfaces, where the positive ion mass spectra obtained were consistent with the major composition of organic additives, and the negative ion mass spectra were more consistent with explosive content in the C-4 samples. Each series of mass spectra was subjected to partial least squares-discriminant analysis (PLS-DA), a multivariate statistical analysis approach which serves to first find the areas of maximum variance within different classes of C-4 and subsequently to classify unknown samples based on correlations between the unknown data set and the original data set (often referred to as a training data set). This method was able to successfully classify test samples of C-4, though with a limited degree of certainty. The classification accuracy of the method was further improved by integrating the positive and negative ion data using a Bayesian approach. The TOF-SIMS data was combined with a second analytical method, LA-ICPMS, which was used to analyze elemental signatures in the C-4. The integrated data were able to classify test samples with a high degree of certainty. Results indicate that this Bayesian integrated approach constitutes a robust classification method that should be employable even in dirty samples collected in the field.

[The role of the biological damaging factor in the explosive injury].

This article describes the specific features of the action of the biological damaging factors on the human organism associated with the explosive injury. Both the direct action of the damaging agents contained in the biological weapons and their secondary effects in the form of systemic and local infectious complications of the inflicted wounds are considered. The criteria for the evaluation of the degree of harm to the health of the victims of explosion attributable to the action of the biological damaging factor are proposed.

Characteristics of ballistic and blast injuries.

Ballistic injury wounds are formed by variable interrelated factors, such as the nature of the tissue, the compositional makeup of the bullet, distance to the target, and the velocity, shape, and mass of the of the projectile. This complex arrangement, with the ultimate outcome dependent on each other, makes the prediction of wounding potential difficult to assess. As the facial features are the component of the body most involved in a patient's personality and interaction with society, preservation of form, cosmesis, and functional outcome should remain the primary goals in the management of ballistic injury. A logical, sequential analysis of the injury patterns to the facial complex is an absolutely necessary component for the treatment of craniomaxillofacial ballistic injuries. Fortunately, these skill sets should be well honed in all craniomaxillofacial surgeons through their exposure to generalized trauma, orthognathic, oncologic, and cosmetic surgery patients. Identification of injured tissues, understanding the functional limitations of these injuries, and preservation of both hard and soft tissues minimizing the need for tissue replacement are paramount.

Behavioural and genetic evidence for C. elegans' ability to detect volatile chemicals associated with explosives.

BACKGROUND: Automated standoff detection and classification of explosives based on their characteristic vapours would be highly desirable. Biologically derived odorant receptors have potential as the explosive recognition element in novel biosensors. Caenorhabditis elegans' genome contains over 1,000 uncharacterised candidate chemosensory receptors. It was not known whether any of these respond to volatile chemicals derived from or associated with explosives. METHODOLOGY/PRINCIPAL FINDINGS: We assayed C. elegans for chemotactic responses to chemical vapours of explosives and compounds associated with explosives. C. elegans failed to respond to many of the explosive materials themselves but showed strong chemotaxis with a number of compounds associated with commercial or homemade explosives. Genetic mutant strains were used to identify the likely neuronal location of a putative receptor responding to cyclohexanone, which is a contaminant of some compounded explosives, and to identify the specific transduction pathway involved. Upper limits on the sensitivity of the nematode were calculated. A sensory adaptation protocol was used to estimate the receptive range of the receptor. CONCLUSIONS/SIGNIFICANCE: The results suggest that C. elegans may be a convenient source of highly sensitive, narrowly tuned receptors to detect a range of explosive-associated volatiles.

Blast injuries.

Health-care providers are increasingly faced with the possibility of needing to care for people injured in explosions, but can often, however, feel undertrained for the unique aspects of the patient's presentation and management. Although most blast-related injuries (eg, fragmentation injuries from improvised explosive devices and standard military explosives) can be managed in a similar manner to typical penetrating or blunt traumatic injuries, injuries caused by the blast pressure wave itself cannot. The blast pressure wave exerts forces mainly at air-tissue interfaces within the body, and the pulmonary, gastrointestinal, and auditory systems are at greatest risk. Arterial air emboli arising from severe pulmonary injury can cause ischaemic complications-especially in the brain, heart, and intestinal tract. Attributable, in part, to the scene chaos that undoubtedly exists, poor triage and missed diagnosis of blast injuries are substantial concerns because injuries can be subtle or their presentation can be delayed. Management of these injuries can be a challenge, compounded by potentially conflicting treatment goals. This Seminar aims to provide a thorough overview of these unique primary blast injuries and their management.

Classification of materials for explosives from prompt gamma spectra by using principal component analysis.

Data from the elemental composition-ratios and experimental prompt gamma spectra of samples were used to develop suitable discriminant classes for suspect samples. The collected data and gamma spectra were applied to principal component analysis (PCA) to discriminate explosives from non-explosive materials.

The lasting legacy of war: epidemiology of injuries from landmines and unexploded ordnance in Afghanistan, 2002-2006.

INTRODUCTION: Due to several decades of armed conflict and civil unrest, Afghanistan is one of the countries most affected by landmines and unexploded ordnance worldwide. OBJECTIVE: The study was performed to assess the magnitude of injuries due to landmines and unexploded ordnance in Afghanistan during 2002-2006 and to describe epidemiological patterns and potential risk factors for these events. METHODS: Surveillance data including 5,471 injuries caused by landmines and unexploded ordnance in Afghanistan during 2002-2006 were analyzed. The International Committee of the Red Cross collects data on such injuries from 490 reporting health facilities and volunteers throughout the country. These surveillance data were used to describe injury trends, victim demographics, injury types, risk behaviors, and explosive types related to landmine and unexploded ordnance accidents. RESULTS: The largest number of injuries (1,706) occurred in 2002. The number declined sharply to 1,049 injuries in 2003, and remained relatively stable with slight decline thereafter. Overall, 92% of victims were civilians, 91% were males, and 47% were children <18 years of age. The case-fatality ratio was 17%. Approximately 50% of all injuries were caused by unexploded ordnance and 42% by landmines. Among children, 65% of injuries were caused by unexploded ordnance and only 27% by landmines, whereas in adults, most injuries (56%) were caused by landmines. The most common risk behaviors among children were tending animals, playing, and tampering with explosive devices. In adults, most common risk behaviors were traveling, performing activities of economic necessity, and tampering with explosives. Twenty-eight percent of the surviving victims who received mine awareness training and 2% of those who did not receive such training reported that the area where event occurred was marked. CONCLUSIONS: The large number of injuries and high proportion of child victims suggest that clearance and risk education activities fall short of achieving their goals, and must be substantially improved or expanded. Especially concerning is the high proportion of injuries caused by unexploded ordnance, and the high number of injuries sustained while tampering with explosive devices. Because unexploded ordnance is more visible than are landmines, and ordnance-contaminated areas are cheaper to clear than are minefields, these injuries are highly preventable and should be a priority for clearance and risk education efforts.