[Lesions of the cortical part of the auditory analyzer in explosive injury]. / Narusheniya korkovogo otdela slukhovogo analizatora pri vzryvnoi travme.

A survey of 48 victims aged 19-36 years with explosive trauma and combined damage to the auditory system was conducted to assess the level of damage to nerve structures by analyzing the bioelectric activity of the cerebral cortex. All patients underwent electroencephalography (EEG). It is established that akubarotrauma of explosive genesis almost always leads to lesions of the function of the cortical part of the auditory analyzer. Desynchronized activity on the EEG after acubarotrauma is a favorable prognostic sign, indicating only functional disorders of the cortical part of the auditory analyzer. On the contrary, EEG changes of an organic type of cortical or stem nature are an unfavorable prognostic factor, usually accompanied by sensorineural hearing loss with prolonged and incomplete hearing recovery. Promising drugs for the treatment of otoneurological disorders are antihypoxants, in particular, derivatives of triazine indole, which affect the molecular mechanisms of hypoxia development.

Severe Fireworks-Related Injuries: Demographic Characteristics, Injury Patterns, and Firework Types in 294 Consecutive Patients.

OBJECTIVES: The relationship between fireworks and patient characteristics is not known. Our objective was to examine how severe fireworks-related injuries in children and teens compare to adults. METHODS: We conducted a retrospective case series (2005-2015) study of patients who sustained consumer fireworks-related injuries requiring hospital admission and/or operation at a single level 1 trauma/burn center. The distribution of race, use behavior, injury type, body region injured, and firework type was examined by age groups, 1 to 10 years, 11 to 17 years, and 18 years or older. RESULTS: Data from 294 patients 1 to 61 years of age (mean, 24 years) were examined. The majority (91%) were male. The proportion of injuries from different firework types varied by age, with rockets causing the highest proportion in children aged 1 to 10 years, homemade fireworks in those aged 11 to 17 years, and shells/mortars in adults 18 years or older. Compared with adults, children aged 1 to 10 years were more frequently American Indian/Alaska Native, Hispanic, or Asian than White. Compared with adults, children aged 1 to 10 years and 11 to 17 years were more frequently bystanders than active users. Compared with adults, children aged 1 to 10 years and 11 to 17 years had a greater proportion of burn and face injuries. Children aged 1 to 10 years had a decreased proportion of hand injuries. Three patients, 2 adults and 1 child aged 11 to 17 years, died. CONCLUSIONS: Children, teens, and adults experience severe fireworks-related injuries differently, by demographic characteristics, injury patterns, and firework types. Tailored public health interventions could target safety messaging and injury prevention outreach efforts to reduce firework injuries among children and adolescents.

"Don't Blast": blast-in-place (BiP) operations of dumped World War munitions in the oceans significantly increase hazards to the environment and the human seafood consumer.

The seas worldwide are threatened by a "new" source of pollution: millions of tons of all kind of warfare material have been dumped intentionally after World War I and II, in addition to mine barriers, failed detonations as well as shot down military planes and sunken ship wrecks carrying munitions. For example, in the German parts of the North and Baltic Sea approximately 1.6 million metric tons of toxic conventional explosives (TNT and others) and more than 5000 metric tons of chemical weapons are present. Such unexploded ordnance (UXO) constitutes a direct risk of detonation with increased human access (fisheries, water sports, cable constructions, wind farms and pipelines). Moreover, after more than 70 years of resting on the seabed, the metal shells of these munitions items corrode, such that chemicals leak out and distribute in the marine environment. Explosive chemicals such as TNT and its derivatives are known for their toxicity and carcinogenicity. In order not to endanger today's shipping traffic or the installation of pipelines and offshore plants by uncontrolled explosions, controlled blast-in-place (BiP) operations of these dangerous relics is a common practice worldwide. However, blast-in-place methods of in situ munitions disposal often result in incomplete (low-order) detonation, leaving substantial quantities of the explosive material in the environment. In the present free field investigation, we placed mussels (Mytilus spp.) as a biomonitoring system in an area of the Baltic Sea where BiP operations took place and where, by visual inspections by scientific divers, smaller and larger pieces of munitions-related materials were scattered on the seafloor. After recovery, the mussels were transferred to our laboratory and analyzed for TNT and its derivatives via gas chromatography and mass spectroscopy. Our data unequivocally demonstrate that low-order BiP operations of dumped munitions in the sea lead to multiple increases in the concentration of TNT and its metabolites in the mussels when compared to similar studies at corroding but still encased mines. For this reason, we explicitly criticize BiP operations because of the resulting environmental hazards, which can ultimately even endanger human seafood consumers.

The liberalization of fireworks legislation and its effects on firework-related injuries in West Virginia.

BACKGROUND: Fifteen states, including West Virginia, have liberalized their laws concerning fireworks possession and sale. Effective June 1, 2016, House Bill 2852 enabled all Class C fireworks to be sold within the state. The effects of this policy on fireworks-related injuries requiring immediate medical care are unknown. The purpose of this study was to determine whether this policy may have affected the fireworks-related injury rate and/or injury severity. METHODS: Data were collected from the electronic medical records of patients treated by West Virginia University Medicine between June 1, 2015-May 31, 2017. The pre and post law periods were defined as June 1, 2015-May 31, 2016 and June 1, 2016-May 31, 2017, respectively. Fireworks-related injuries were identified via International Classification of Disease Clinical Modification codes and by free text searches of the electronic medical records. The rate of injuries pre and post-legislation were compared by Exact Poisson Regression, while demographic characteristics and injury severity were compared via Fisher's Exact tests. RESULTS: 56 individuals were treated for fireworks-related injuries during the study period. The majority of patients were over 25 years of age (64%) and male (77%). Most of the injuries occurred within 7 days of a celebrated U.S. holiday (64%), and 28% were severe in nature. Age, sex, and injury severity did not significantly differ pre and post law passage. The injury rate per 100,000 patients was 39% higher after the law was enacted (p = 0.3475; incidence rate ratio 1.39, 95% Confidence Interval 0.74, 2.68). CONCLUSION: The law increasing access to Class C fireworks may have affected the injury rate, but not injury severity among treated patients. Effective, evidence-based, public health interventions applicable to all age groups may be warranted particularly around national holidays. This study may inform other states looking to amend their legislation.

Dose-Dependent Pulmonary Injury Following Nitrogen Dioxide Inhalation From Kinepak™ Detonation.

BACKGROUND: Nitrogen dioxide (NO2) is a pulmonary irritant produced as a byproduct of bacterial anaerobic metabolism of organic materials, and is also produced as a byproduct of explosive detonations. Significant NO2 exposure results in free-radical-induced pulmonary injury that may be delayed up to 3-30 h after exposure and can progress to acute respiratory distress syndrome (ARDS) and death. Here we present a case series of 3 patients with dose-dependent pulmonary injury consistent with NO2 inhalation following exposure to fumes from detonation of an ammonium nitrate/nitromethane (ANNM) explosive device. CASE REPORTS: Three individuals presented to the emergency department over the course of 16 h, beginning approximately 16 h after exposure to fumes from an ANNM explosive device. Patient 1, with the most significant exposure, developed ARDS necessitating intubation and mechanical ventilation. Patient 2 exhibited hypoxia and findings concerning for diffuse airway inflammation, but ultimately required only supplemental oxygen. Patient 3, with the least exposure, had imaging abnormalities but required no intervention. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Respiratory distress is a common presenting complaint to the emergency department. Because of the delayed presentation and the potential for progressive worsening of symptoms associated with NO2 exposure, it is important that emergency physicians be aware of the multiple potential means of exposure and consider this diagnosis in the proper clinical context. Patients with suspicion of NO2-related lung injury should undergo more extended observation than their initial clinical presentation may suggest.

Owner perceptions and management of the adverse behavioural effects of fireworks on companion animals: an update.

Aims: To provide updated results on the adverse behavioural effects of fireworks on companion animals in New Zealand, measures that owners use to mitigate these effects, and opinions on a ban on the sale of fireworks. Method: A cross-sectional survey of companion animal owners in New Zealand was conducted between 2 November and 5 December 2016 using an online survey. The survey was modelled after a similar study conducted in 2006. Owners were asked to provide information on the types and severity of behaviours observed in their animals that were frightened by fireworks, what they did for their frightened animals and whether they would support a ban on the sale of fireworks. Results: There were 4,293 respondents who completed the online survey and they owned 15,871 companion animals, of which 11,750 (74.4%) were frightened of fireworks. For the 7,464 fearful animals with individual data available, the most commonly reported adverse behaviours were hiding (5,287; 70.8%), shivering (4,058; 54.3%) and cowering (3,324; 44.5%). Owners reported that 345 animals had been physically injured as the result of fireworks. Of 3,682 owners with frightened animals, 2,649 (71.9%) had not sought help or treatment for their animal. Frightened animals were mostly kept inside (3,479/7,464; 46.%) or comforted (2,112/7,464; 28.2%). Of all 4,325 respondents, 3,631 (84.0%) were supportive of a ban on the private sale of fireworks, with 370 (8.6%) against and 315 (7.3%) undecided. Owners with ≥1 animal that was fearful towards fireworks were more likely to support a ban (3,137/3,412; 91.9%) than owners whose animals were not afraid (466/561; 83.1%) (OR = 2.32; 95% CI = 1.80-2.98). Conclusion and Clinical Relevance: Among respondents to this survey, many owners of companion animals reported that their animals were adversely affected by fireworks, but few of them sought advice about strategies to mitigate the impacts. The majority of respondents supported a ban on the private sale of fireworks. Campaigns to raise public awareness of treatment strategies for managing fear behaviours during anticipated fireworks displays may be beneficial.

Exposure to firework chemicals from production factories in pregnant women and risk of preterm birth occurrence in Liuyang, China.

In the production of fireworks, various pollutants including particles of metals and organic compounds are released into the environment. Although the adverse effects of these air pollutants are known, the impact on pregnant women residing in this area remains to be determined. The aim of this study was to examine the association between maternal exposure to fireworks production chemicals and frequency of preterm birth in Liuyang, China. Maternal exposure to fireworks production was estimated at the residential district level and assessed using factory density, which was defined as the number of fireworks factories per 1000 residents in each district. The association of maternal exposure to particulates released from fireworks production plants with frequency of preterm birth was determined using data obtained from a cohort study conducted in Liuyang, China. Data were analyzed utilizing linear regression and logistic regression. There was no significant association between factory density and spontaneous preterm or medically induced preterm birth. Unexpectedly, pregnant women residing in areas with higher density of fireworks factories were at a reduced risk of preterm premature rupture of membranes (PPROM). Data demonstrated that residential density of fireworks factories appeared to be negatively correlated with preterm birth rate as evidenced by PPROM. At present, it is difficult to reconcile the inverse relationship between firework chemical exposure and frequency of preterm births as ambient particulate inhalation is known to adversely affect preterm birth occurrence.

An Impaled Potential Unexploded Device in the Civilian Trauma Setting: A Case Report and Review of the Literature.

BACKGROUND: The management of patients with impaled unexploded devices is rare in the civilian setting. However, as the lines of the traditional battlefield are blurred by modern warfare and terrorist activity, emergency providers should be familiar with facility protocols, plans, and contact information of their local resources for unexploded devices. CASE REPORT: A 44-year-old male sustained a close-proximity blast injury to his lower extremities while manipulating a mortar-type firework. He presented to the regional trauma center with an open, comminuted distal femur fracture and radiographic evidence of a potential explosive device in his thigh. His management was coordinated with the local Explosive Ordinance Disposal and the fire department. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Explosive devices pose a grave threat when encountered. Familiarization with protocols to manage these patients can mitigate disaster. Emergency providers should expect and be prepared to coordinate care for these patients.

Impact of traumatic upper-extremity amputation on the outcome of injury caused by an antipersonnel improvised explosive device

Background: We have previously reported a higher than expected rate of upper-extremity amputation (UEA) in victims of an antipersonnel improvised explosive device (AP-IED) compared with a similar cohort injured by antipersonnel mines (APM). The goal of this study was to describe the rate, severity and impact of UAE caused by an AP-IED. Methods: We analyzed a prospective database of 100 consecutive dismounted AP-IED victims with pattern 1 injuries to compare the outcomes of the cohort with UEA to that without. Results: We found that UEA (8 above elbow, 19 below elbow, 1 through elbow, 3 hand, 15 digit(s)) was much more prevalent with AP-IED than with APM (40% v. 6%, p < 0.001). In addition, UEA was associated with a higher rate of multiple amputations (39 [98%] v. 32 [53%], p < 0.001), bilateral lower-extremity amputation (LEA; 33 [82.5%] v. 30 [53.3%], p = 0.003) and facial injury (8 [20%] v. 4 [6.4%], p = 0.044), but not with pelvic disruption (10 [25%]), genitoperineal mutilation (19 [48%]), eye injury (6 [15%]), or skull fracture (6 [15%]). The fatality rate was higher in patients with UEA than in those without (12 [30%] v. 7 [12%], p = 0.022). Conclusion: Upper-extremity amputation is more prevalent with AP-IED than APM. Presence of UEA is associated with more severe injury and increased risk of death in AP-IED victims. Upper-limb injury has significant consequences for rehabilitation from LEA, which universally accompanies UEA in AP-IED victims. Upper-extremity injury should be amenable to prevention by innovative personal protective equipment designed to protect the flexed elbow.

Contexte: Nous avons déjà fait état d'un taux plus élevé que prévu d'amputations des membres supérieurs (AMS) chez les victimes d'engins explosifs artisanaux (EEA) comparativement à une cohorte similaire blessée par des mines antipersonnel (MAP). L'objectif de cette étude est de décrire le taux, la gravité et l'impact des AMS causées par des EEA. Méthodes: Nous avons analysé une base de données prospective de 100 victimes consécutives d'EEA alors qu'elles se trouvaient hors de leur véhicule et présentant des blessures de type 1 afin de comparer les résultats des cohortes ayant subi ou non des AMS. Résultats: Nous avons constaté que l'AMS (8 au-dessus du coude, 19 sous le coude, 1 au niveau du coude, 3 mains et 15 doigts) était beaucoup plus prévalente avec les EEA qu'avec les MAP (40 % c. 6 %, p < 0,001). De plus, l'AMS a été associée à un taux plus élevé d'amputations multiples (39 [98 %] c. 32 [53 %], p < 0,001), d'amputations bilatérales des membres inférieurs (AMI) (33 [82,5 %] c. 30 [53,3 %], p = 0,003) et de blessures au visage (8 [20 %] c. 4 [6,4 %], p = 0,044), mais non de blessures au bassin (10 [25%]), de mutilations génitopérinéales (19 [48 %]), de blessures oculaires (6 [15 %]), ou de fractures du crâne (6 [15 %]). Le taux de létalité a été plus élevé chez les patients ayant subi une AMS que chez ceux qui n'en ont pas subi (12 [30 %] c. 7 [12 %], p = 0,022). Conclusion: L'amputation des membres supérieurs est plus prévalente avec les EEA qu'avec les MAP. L'AMS est associée à des blessures plus graves et à un risque plus grand de décès chez les victimes d'un EEA. Les blessures aux membres supérieurs ont de graves conséquences sur la réadaptation nécessaire après l'AMI, qui accompagne presque toujours l'AMS chez les victimes d'un EEA. Les blessures aux membres supérieurs devraient pouvoir être évitées grâce à de l'équipement de protection individuelle novateur conçu pour protéger le coude fléchi.

Fireworks type, injury pattern, and permanent impairment following severe fireworks-related injuries.

BACKGROUND: There is a paucity of clinical data on severe fireworks-related injuries, and the relationship between firework types, injury patterns, and magnitude of impairment is not well understood. Our objective was to describe the relationship between fireworks type, injury patterns, and impairment. METHODS: Retrospective case series (2005-2015) of patients who sustained consumer fireworks-related injuries requiring hospital admission and/or an operation at a Level 1 Trauma/Burn Center. Fireworks types, injury patterns (body region, injury type), operation, and permanent impairment were examined. RESULTS: Data from 294 patients 1 to 61years of age (mean 24years) were examined. The majority (90%) were male. 119 (40%) patients were admitted who did not undergo surgery, 163 (55%) patients required both admission and surgery, and 12 (5%) patients underwent outpatient surgery. The greatest proportion of injuries was related to shells/mortars (39%). There were proportionally more rocket injuries in children (44%), more homemade firework injuries in teens (34%), and more shell/mortar injuries in adults (86%). Brain, face, and hand injuries were disproportionately represented in the shells/mortars group. Seventy percent of globe-injured patients experienced partial or complete permanent vision loss. Thirty-seven percent of hand-injured patients required at least one partial or whole finger/hand amputation. The greatest proportion of eye and hand injuries resulting in permanent impairment was in the shells/mortars group, followed by homemade fireworks. Two patients died. CONCLUSIONS: Severe fireworks-related injuries from homemade fireworks and shells/mortars have specific injury patterns. Shells/mortars disproportionately cause permanent impairment from eye and hand injury.

Severe Hand Injuries From Fireworks: Injury Patterns, Outcomes, and Fireworks Types.

PURPOSE: The purpose of this study was to characterize injury patterns and outcomes of fireworks-related hand injuries and determine if there was an association with certain fireworks types. METHODS: A retrospective cohort study was conducted on patients treated at a trauma center between 2005 and 2015. A total of 105 patients sustaining operative hand injuries due to fireworks were identified. Medical records were reviewed to identify injury patterns, treatment outcomes, and fireworks types. RESULTS: Eighty-eight patients (84%) sustained 92 thumb and/or first web space injuries. There were 12 thumb soft tissue-only injuries (13%) and 80 thumb fractures/dislocations (87%). Of these, there were 52 thumb carpometacarpal (CMC) joint dislocations (57%) and 36 thumb fractures outside the thumb CMC joint (39%). Fifteen hands (16%) sustained both thumb CMC joint dislocations and additional thumb fractures. Twenty-three hands (25%) required thumb revision amputation. The number of surgeries for acute reconstruction ranged from 1 to 7, with 17 patients (19%) requiring 3 or more. Sixty-three hands had deep first web space injuries, and 11 (17%) required flaps acutely for first web space reconstruction. Six hands required secondary reconstruction of a first web space contracture. An external fixator was applied to 6 hands to maintain the first web space; none of these required secondary web reconstruction. Excluding isolated pin removals and dressing changes under anesthesia, 19 patients (22%) required later-stage surgeries. Shells/mortars (59%) were the most common fireworks type causing injury. CONCLUSIONS: Among operative hand injuries, fireworks most commonly fracture the thumb, destabilize the thumb CMC joint, and deeply damage the first web space. The first web space requires particular consideration because deep injury may result in adduction contracture and require secondary reconstruction if not prevented. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Six-year clinical study of firework-related eye injuries in North China.

PURPOSE: To analyse the demographic data, clinical characteristics, management and prognosis of patients with firework-related eye injuries. METHODS: A retrospective review was performed of patients with eye injuries related to fireworks referred to TianJin Eye Hospital in North China from 2008 to 2013. Demographic information, clinical features, management and visual outcome were analysed and prognosis factors were evaluated. RESULTS: Ninety-nine patients (86 men) with 118 eye injuries were enrolled in the study. The average age of the patients was 32.0±20.5 years; 70/99 (70.7%) were aged >20 years. Eighty-one of the patients had been lighting the fireworks while the rest were bystanders. The main ophthalmic manifestations were hyphaema, vitreous haemorrhage, corneal/sclera/corneoscleral open globe injury, eyelid laceration, traumatic cataract, retinal/choroid detachment, endophthalmitis and intraocular foreign body (IOFB). Ninety patients required surgical intervention including repair of open globe injury, vitrectomy, cataract extraction and enucleation. 56/118 eyes (47.5%) received multiple operations. After treatment, final best-corrected visual acuity (BCVA) significantly improved (p=0.015). Some factors were significantly correlated with better final BCVA, including initial BCVA (p=0.036), closed globe injury (p=0.031), absence of endophthalmitis (p=0.014), absence of IOFB (p=0.024) and absence of retinal detachment (p=0.046). CONCLUSIONS: Firework-related eye injuries mainly occur in adult men and result in severe visual damage. The most common clinical manifestations are hyphaema and vitreous haemorrhage. Better initial BCVA and closed globe injury have a better visual result while endophthalmitis, IOFB and retinal detachment have a negative visual outcome. Improved eye protection, along with enhanced public education and legal ban on fireworks, could reduce the incidence of eye injuries.

Blast Injuries.

BACKGROUND: Blast injuries in the United States and worldwide are not uncommon. Partially due to the increasing frequency of both domestic and international terrorist bombing attacks, it is prudent for all emergency physicians to be knowledgeable about blasts and the spectrum of associated injuries. OBJECTIVE: Our aim was to describe blast physiology, types of blast injuries associated with each body system, and manifestations and management of each injury. DISCUSSION: Blast injuries are generally categorized as primary to quaternary injuries. Primary injuries result from the effect of transmitted blast waves on gas-containing structures, secondary injuries result from the impact of airborne debris, tertiary injury results from transposition of the entire body due to blast wind or structural collapse, and quaternary injuries include almost everything else. Different body systems are affected and managed differently. Despite previous dogma, multiple studies now show that tympanic membrane perforation is a poor predictor of other blast injury. CONCLUSIONS: Blast events can produce a myriad of injuries affecting any and every body system. All emergency physicians should be familiar with the presentation and management of these injuries. This knowledge may also be incorporated into triage and discharge protocols guiding management of mass casualty events.

Misuse and modification of fireworks with fatal injury.

Fireworks deaths are a rare event in the United States with minor injuries comprising most adverse events. We report the case of misuse and modification of a large "mortar" firework with fatal results. In this case, the firework charge was modified with additional fuses and placed into the launcher upside down. The decedent then held the mortar base closely to his chest and lit the modified fuse. The resulting explosion caused severe blunt force trauma with significant hydrostatic shock damage to the heart and liver. This cause highlights the dangers of fireworks, particularly when misused.

Thermal shell fragment craniofacial injury: biophysics, pathophysiology, and management.

This article aims to bring attention to unique risks and burns by thermal shell fragment craniofacial soft tissue injury. Hot shrapnel may inflict burns to major vessel walls and lead to life-threatening hemorrhaging or death, which adds a new challenge for craniofacial surgeons. Morbidity of thermal deep tissue may lead to deep tissue necrosis and infection.Thermal energy (TE) physics, biophysics, and pathophysiological effects relate directly to the amount of heat generated from shell casing detonation, which transfers to skin, deep tissue, as well as brain and leads to life-threatening burning of organs; this is different from shrapnel kinetic energy injury.The unprecedented increase in using a large range of explosives and high-heat thermobaric weapons contributes to the superfluous and unnecessary suffering caused by thermal injury wounds.Surgeons and medics should recognize that a surprising amount of TE can be found in an explosion or detonation of a steel-encased explosive, resulting in TEs ranging from 400 F up to 1000 F.

Management of an Unexploded Intracorporeal Firework in a Low Resource Setting: Case Report and Tips.

Surgical removal of unexploded ordnance has been described in literature, usually in the context of the military. We describe a case of a 31-year-old gentleman who presented with a traumatic fireworks injury resulting in an unexploded three-inch aerial shell lodged in his left upper thigh. The sole regional Explosive Ordinance Disposal (EOD) expert was not available, so a local pyrotechnic engineer was contacted and he helped in identification of the firework. The firework was removed without the use of electrocautery, irrigation, or metal instrument contact after skin incision. The patient recovered well after prolonged wound healing. Creativity needs to be employed in low resource settings to identify all available resources that can impart knowledge when medical training is not enough. People with knowledge of explosives can be, as in our case, local pyrotechnics engineer or can be local cannon enthusiasts, veterans, or active military personnel at a nearby military base.

Injury modelling for strategic planning in protecting the national infrastructure from terrorist explosive events.

Terrorist events in the form of explosive devices have occurred and remain a threat currently to the population and the infrastructure of many nations worldwide. Injuries occur from a combination of a blast wave, energised fragments, blunt trauma and burns. The relative preponderance of each injury mechanism is dependent on the type of device, distance to targets, population density and the surrounding environment, such as an enclosed space, to name but a few. One method of primary prevention of such injuries is by modification of the environment in which the explosion occurs, such as modifying population density and the design of enclosed spaces. The Human Injury Predictor (HIP) tool is a computational model which was developed to predict the pattern of injuries following an explosion with the goal to inform national injury prevention strategies from terrorist attacks. HIP currently uses algorithms to predict the effects from primary and secondary blast and allows the geometry of buildings to be incorporated. It has been validated using clinical data from the '7/7' terrorist attacks in London and the 2017 Manchester Arena terrorist event. Although the tool can be used readily, it will benefit from further development to refine injury representation, validate injury scoring and enable the prediction of triage states. The tool can assist both in the design of future buildings and methods of transport, as well as the situation of critical emergency services required in the response following a terrorist explosive event. The aim of this paper is to describe the HIP tool in its current version and provide a roadmap for optimising its utility in the future for the protection of national infrastructure and the population.

Explosive eye injuries: characteristics, traumatic mechanisms, and prognostic factors for poor visual outcomes.

BACKGROUND: Explosions can produce blast waves, high-speed medium, thermal radiation, and chemical spatter, leading to complex and compound eye injuries. However, few studies have comprehensively investigated the clinical features of different eye injury types or possible risk factors for poor prognosis. METHODS: We retrospectively reviewed all consecutive records of explosive eye injuries (1449 eyes in 1115 inpatients) in 14 tertiary referral hospitals in China over 12 years (between January 2008 and December 2019). Data on demographics, eye injury types, ocular findings, treatments, and factors affecting visual prognosis were extracted from a standardized database of eye injuries and statistically analyzed. RESULTS: Mechanical ocular trauma accounted for 94.00% of explosion-related eye injuries, among which intraocular foreign bodies (IOFBs) resulted in 55.17% of open globe injuries (OGIs) and contusion caused 60.22% of close globe injuries (CGIs). Proliferative vitreous retinopathy (PVR) was more common in perforating (47.06%) and IOFB (26.84%) than in penetrating (8.79%) injuries, and more common with laceration (24.25%) than rupture (9.22%, P < 0.01). However, no difference was observed between rupture and contusion. Ultimately, 9.59% of eyes were removed and the final vision was ≤ 4/200 in 45.82% of patients. Poor presenting vision [odds ratio (OR) = 5.789], full-thickness laceration of the eyeball ≥ 5 mm (OR = 3.665), vitreous hemorrhage (OR = 3.474), IOFB (OR = 3.510), non-mechanical eye injury (NMEI, OR = 2.622, P < 0.001), rupture (OR = 2.362), traumatic optic neuropathy (OR = 2.102), retinal detachment (RD, OR = 2.033), endophthalmitis (OR = 3.281, P < 0.01), contusion (OR = 1.679), ciliary body detachment (OR = 6.592), zone III OGI (OR = 1.940), and PVR (OR = 1.615, P < 0.05) were significant negative predictors for poor visual outcomes. CONCLUSIONS: Explosion ocular trauma has complex mechanisms, with multiple eyes involved and poor prognosis. In lethal level I explosion injuries, eyeball rupture is a serious condition, whereas contusion is more likely to improve. In level II injuries, IOFBs are more harmful than penetrating injuries, and level IV represents burn-related eye injuries. PVR is more associated with penetrating mechanisms than with OGI. Identifying the risk predictors for visual prognosis can guide clinicians in the evaluation and treatment of ocular blast injuries.

Military Exposures Predict Mental Health Symptoms in Explosives Personnel but Not Always as Expected.

OBJECTIVE: The aim of this study was to determine the unique and combined associations of various military stress exposures with positive and negative mental health symptoms in active duty service members. MATERIALS AND METHODS: We investigated 87 male U.S. Navy Explosive Ordnance Disposal (EOD) technicians (age M ± SE, range 33.7 ± 0.6, 22-47 years). Those who endorsed a positive traumatic brain injury diagnosis were excluded to eliminate the confounding effects on mental health symptoms. Using a survey platform on a computer tablet, EOD technicians self-reported combat exposure, deployment frequency (total number of deployments), blast exposure (vehicle crash/blast or 50-m blast involvement), depression, anxiety, posttraumatic stress, perceived stress, and life satisfaction during an in-person laboratory session. RESULTS: When controlling for other military stressors, EOD technicians with previous involvement in a vehicle crash/blast endorsed worse mental health than their nonexposed counterparts. The interactions of vehicle crash/blast with deployment frequency and combat exposure had moderate effect sizes, and combat and deployment exposures demonstrated protective, rather than catalytic, effects on negative mental health scores. CONCLUSIONS: Military stressors may adversely influence self-reported symptoms of negative mental health, but deployment experience and combat exposure may confer stress inoculation.