Table 1.

Taxonomy of injuries from explosive devices per DoD Blast Injury Research Coordinating Office.

Blast injury category	Description	Examples
Primary	Result from the high pressures, or blast overpressure, created by explosions. Blast overpressure can crush the body and cause internal injuries. Primary blast injuries are the only category of blast injuries that are unique to the blast or high pressures that occur.	Blast lung (pulmonary barotrauma) Tympanic Membrane rupture and middle ear damage Abdominal hemorrhage and perforation Globe (eye) rupture Concussion (mild traumatic brain injury (mTBI) without physical signs of head injury)
Secondary	Result when strong blast winds behind the pressure front propel fragments and debris against the body and cause blunt force and penetrating injuries.	Penetrating ballistic (fragmentation or blunt injuries) Eye penetration Closed or open brain injuries
Tertiary	Result from strong blast winds and pressure gradients that can accelerate the body and cause the same types of blunt force injuries that would occur in a car crash, fall, or building collapse.	Bone fractures Traumatic amputations Blunt injuries Crush injuries Closed or open brain injuries
Quaternary	Result from other explosive products (such as heat and light) and from exposure to toxic substances from fuels, metals, and gases that can cause burns, blindness, and inhalation injuries.	Burns (flash, partial, and full thickness) Injury or incapacitation from inhaled toxic fumes (breathing problems from dust, smoke, or toxic fumes)
Quinary	Refer to the clinical consequences of post-detonation environmental contaminants, including chemical (e.g., sarin), biological (e.g., anthrax), and radiological (e.g., dirty bombs) substances.	Chemical burns Radiation exposure Viral or bacterial infections

Office (4).