ied's: america's future

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Lecture over IED, improvised explosive devices, blast injuries, etc.

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  • 1. IEDs in America Keynote Presentation from James Phillips MD, Harvard Disaster Medicine

2. 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. 3. What is Disaster Medicine? What is an IED? What are Blast Injuries? Discuss the future of IEDs in America. 4. Medical specialists trained to care for injuries and illnesses associated with both naturaland 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. 5. 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 6. April 15th, 2013 7. Types of Explosives 8. 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 9. Military or Industrial Grade Explosives Explode by DETONATION Creates Blast Wave (Shock Wave) Inflict Primary Blast Injury (PBI) 10. Explode by Deflagration They do not detonate Slower than speed of sound No Blast Wave (Shock Wave) Used as Propellants Black Powder (Gunpowder), Fireworks 11. 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 anenclosed space, there is a vastly increased release of energy/time. 12. Improvised Explosive Device Fabricated in an improvised manner from chemicals designed to destroy, incapacitate, harass, or distract normally devised from nonmilitary components 13. First saw extensive use in WWII Belarusian Rail War 14. Vietnam War Booby Traps Tripwires Rubber Band Grenades Mines 15. Global War on Terror- Primary cause of death and injury to coalition forces in both Iraq and Afghanistan theaters. 16. The Troubles Mujahadeen vs Soviets during invasion of Afghanistan Israel US Embassies in Beirut, Tanzania, Kenya, Yemen, Pakistan USS Cole (Boat-borne IED) 17. 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 18. PIES Power Supply Initiator fuse Explosive (HE or LE) Switch - both arms and triggers the blast) From: (EMRTC) Incident Response to Terrorist Bombing 19. Direct Wire Timer (e.g. alarm clock, watch, egg timer) Remote Control (e.g. garage door opener) Radio Infrared Cell Phone 20. Blasting Caps 21. Dynamite/TNT Plastic Explosives (Semtex, C4) ANFO/ANMN Military artillery shells, mines, etc 22. Detonation Damage is mostly due to the primary blast wave itself, shrapnel, and structural collapse Very high energy, supersonic wave Shrapnel not necessary 23. Truck parked 6.5 feet from building wall AMMN in barrels, initiated by dynamite, and triggered by a timer. Caused near-total structural collapse, anddamaged 300 surrounding buildings 24. 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 25. 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 26. Jihadi Literature Internet 27. Pressure caused by a blast wave over and above normal atmospheric pressure the cause of HE primary blast injury 28. High energy waves that travel through theorgans and tissues of the body at variable speeds and cause direct injury by shearing. 29. 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 30. 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) 31. 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 32. 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 33. Tympanic Membrane Rupture Occurs at pressures as low as 5 psi May cause temporary or permanent conductive or sensorineural hearing loss 80% heal nonsurgically 34. Middle Ear 35. 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 36. 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 ifintubation required. 37. 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 38. Unclear mechanism Likely coup-contrecoup Effects of small air emboli? 39. Majority of LE IED injuries Fragmentation and Shrapnel Includes structural shrapnel Soft tissue and bony injuries Amputations Eye Injuries Abrasions Globe ruptures 40. 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 41. OKC Bombing Structural Collapse 42. Quinternary Injuries Due to radioactive exposure/fallout Due to dispersion of toxin/biological agent Due to chemical agent 43. Easy to make in your moms kitchen Very difficult to predict builders/users Compact, transportable, and powerful Easily created with numerous trigger options Bad guys love to copycat 44. Summary What is Disaster Medicine? What is an IEDs? What are Blast Injuries? The future of IEDs in America. 45. Bibliography