Download - IED's: america's future
IED’s in AmericaKeynote Presentation from James Phillips MD, Harvard Disaster Medicine
IEDs in America:Is this our future?
James Phillips MD
Health & Safety Institute Conference
San Antonio, Texas
November 1st, 2013
Disclosure
I have no financial relationships to disclose regarding the companies or
products discussed in this presentation.
I will not discuss off label use or investigational use in my presentation.
Purpose
• What is Disaster Medicine?
• What is an IED?
• What are Blast Injuries?
• Discuss the future of IEDs in America.
Disaster Medicine
Medical specialists trained to care for
injuries and illnesses associated with
both natural and man-made disasters,
and who provide education,
consultation, and leadership at all levels
of government and private industry
during all aspects of the disaster cycle.
The Disaster Cycle
Disaster Medicine
• Marriage of emergency preparedness and disaster
management
• A systems oriented specialty – no “disaster clinic”
• Multiple disciplines– Infectious Disease, Trauma, Public Health,
International and Austere Medicine, Counter Terrorism
• EMS Training and Management
• Public Health Focus and Research
April 15th, 2013
Types of Explosives
• Divided into 2 major categories
– HE (High Explosives)
– LE (Low Explosives)
• Are differentiated based on speed of
decomposition of the explosive material
– Greater than speed of sound = High
Explosive
• Military or Industrial Grade Explosives
• Explode by DETONATION
• Creates Blast Wave (Shock Wave)
• Inflict Primary Blast Injury (PBI)
Examples: TNT, C4, Symtex, TATP, Dynamite, Det Cord, ANFO, Nitroglycerin
500 Ton TNT Explosion
Blast Wind
Low Explosives
• Explode by Deflagration
– They do not detonate
• Slower than speed of sound
• No Blast Wave (Shock Wave)
• Used as Propellants
– Black Powder (Gunpowder), Fireworks
Low Explosives
• It IS possible to dramatically increase the
blast pressure of low explosives by
containing them tightly during deflagration.
• By allowing the pressure and heat to build in
an enclosed space, there is a vastly
increased release of energy/time.
Low Explosive Containment
Low Explosive Containment
What is an IED?
• Improvised Explosive Device
– Fabricated in an improvised manner from
chemicals
– designed to destroy, incapacitate, harass, or
distract
– normally devised from nonmilitary components
Roadside IED
Anatomical IEDs
History of IED Use• First saw extensive use in WWII
• “Belarusian Rail War”
“The Troubles”
Worldwide IED Data
IEDs in US Wars
Vietnam War
– Booby Traps
– Tripwires
–Rubber Band Grenades
–Mines
IEDs in US Wars
Global War on Terror
- Primary cause of death and injury to
coalition forces in both Iraq and Afghanistan
theaters.
Roadside IED
Roadside IED
Roadside IED
Notable International IEDs
• “The Troubles”
• Mujahadeen vs Soviets during invasion of
Afghanistan
• Israel
• US Embassies in Beirut, Tanzania, Kenya, Yemen,
Pakistan
• USS Cole (Boat-borne IED)
Notable IEDs on US soil
• Ted Kaczynski (Unabomber)
• Weathermen
• Abortion Clinic Bombings
• 1993 World Trade Center
• 1995 OKC Bombing
• 1996 Olympic Park Bombing
• 2001 9/11 attacks
• 2013 Boston Marathon Bombing
IED Components
• PIES
– Power Supply
– Initiator – “fuse”
– Explosive (HE or LE)
– Switch - both arms and triggers the blast)
From: (EMRTC) Incident Response to Terrorist Bombing
Power Sources
Types of Switches
• Direct Wire
• Timer (e.g. alarm clock, watch, egg timer)
• Remote Control (e.g. garage door opener)
• Radio
• Infrared
• Cell Phone
Blasting Caps
High Explosives
• Dynamite/TNT
• Plastic Explosives (Semtex, C4)
• ANFO/ANMN
• Military artillery shells, mines, etc
High Explosive IEDs
• Detonation
• Damage is mostly due to the primary blast wave
itself, shrapnel, and structural collapse
• Very high energy, supersonic wave
• Shrapnel not necessary
Alfred P. Murrah Building
2000 lbs Ammonium Nitrate and Nitromethane
• Truck parked 6.5 feet from building wall
• AMMN in barrels, initiated by dynamite,
and triggered by a timer.
• Caused near-total structural collapse,
and damaged 300 surrounding buildings
2000 lbs Ammonium Nitrate and Nitromethane
Low Explosive IEDs
• Frighteningly easy to make
• If contained, can be very deadly
• Injuries differ from HE, as no true blast wave is
generated.
• Shrapnel and Incendiaries can enhance effect
Boston Marathon Bombing
• Low Explosive Bomb - Used fireworks from
NH
– Placed in a high integrity blast container to
amplify
• Greatly enhanced blast force
• Subsonic, but ? Primary Blast Injury
– Added metal nails, ball bearings
• Shrapnel added for lethality by Secondary
Blast Injury
• Caused vast majority, if not all, deaths and
injuries
Pressure Cooker Bomb
Where Did They Learn?
• Jihadi Literature
• Internet
Blast Physics
• Pressure caused by a blast wave over and above
normal atmospheric pressure – the cause of HE
primary blast injury
Blast Wave Overpressure
Blast Wave
Fireball
• High energy waves that travel through the
organs and tissues of the body at variable
speeds and cause direct injury by shearing.
Shockwaves
Fragmentation vs. Shrapnel
Blast Wind
Blast Injuries
• Types of injuries caused by explosions
• Depend on type of explosive used
– HE vs LE (Blast wave causes Primary Blast
Injury)
– Addition of incendiaries (Time Square attempt)
– Addition of shrapnel
Blast Injuries
Blast Injuries
• Primary
– Primary Blast Wave
• Secondary
– Fragmentation and shrapnel
• Tertiary
– Thrown against walls or ground
• Quaternary
– Burns, structural collapse, other medical problems
• Quinternary
– Addition of CBR (theoretical)
Blast Injuries
• Special Considerations
– Distance from blast is most important
• Primary blast injury
• Shrapnel/Frags
– Location indoors vs outdoors
• Blast waves reflect off walls at 3-10 times strength
– Underwater blasts are much more powerful
• Fluid physics
Primary Blast Injury• Primary Blast Injury
– Affect is caused by supersonic wave of
compressed gas and its effects on air filled
organs.
– Middle Ear is most commonly affected
– Blast Lung Injury is the killer
– Bowel injury is more rare but possible
– Traumatic Brain Injury
– HE may cause traumatic amputations
Middle Ear
• Tympanic Membrane Rupture
• Occurs at pressures as low as 5 psi
• May cause temporary or permanent conductive
or sensorineural hearing loss
• 80% heal nonsurgically
Middle Ear
Blast Lung Injury• Major damage due to massive shearing forces due to
implosion beyond tensile strength of alveoli and pulmonary
capillaries
• ARDS like picture with dyspnea, wheezing, hypoxia,
hemoptysis, PTX, or tension PTX.
• Most common cause of immediate PBI death
– Massive arterial air embolus
Blast Lung Injury
Blast Lung Injury
• May present up to 48 hours after
• Unlikely if no TM rupture, but possible
• Observe for at least 4 hours for
deterioration
• Most are dead or symptomatic on arrival
• Lung protective ventilator strategies if
intubation required.
Blast Abdominal Injuries
• May have delayed presentation up to 8
days
– Small area of severe damage -> perforation
• May present with acute abdomen initially
• More common than blast lung if
underwater
Blast Abdominal Injuries
CNS Injuries
• Unclear mechanism
• Likely coup-contrecoup
• Effects of small air emboli?
Secondary Blast Injuries
• Majority of LE IED injuries
• Fragmentation and Shrapnel
– Includes structural shrapnel
• Soft tissue and bony injuries
– Amputations
• Eye Injuries
– Abrasions
– Globe ruptures
Secondary Blast Injury
Secondary Blast Injury
Tertiary Blast Injuries
• Blast wave pushes person
against walls or thrown to
ground.
• Blunt trauma
– Broken bones, CHI, skull fractures
Tertiary Blast Injuries
Quaternary Injuries
• Thermal burns
– must be close to blast, only likely to see on survivors from LE
• Dust/particulate inhalational injuries
• Death from other medical causes
– Myocardial Infarction, etc
• Structural collapse
– Primary cause of quaternary death and injury
• OKC Bombing Structural Collapse
Quinternary Injuries• Due to radioactive exposure/fallout
• Due to dispersion of toxin/biological agent
• Due to chemical agent
Why “the future?”
• Easy to make in your mom’s kitchen
• Very difficult to predict builders/users
• Compact, transportable, and
powerful
• Easily created with numerous trigger
options
• Bad guys love to copycat
Summary
• What is Disaster Medicine?
• What is an IEDs?
• What are Blast Injuries?
• The future of IEDs in America.
Bibliography
• References can be provided at
request.
Thank you