Table 3.

Blast-induced injury terminology and definitions as provided in Department of Defense Directive “Medical Research for Prevention, Mitigation, and Treatment of Blast Injuries” (DoDD 6025.21E, July 5, 2006).

Term	Definition
Primary blast injury	“Blast overpressure injury resulting in direct tissue damage from the shock wave coupling into the body.”
Secondary blast injury	“Injury produced by primary fragments originating from the exploding device (performed and natural (unformed) casing fragments, and other projectiles deliberately introduced into the device to enhance the fragment threat); and secondary fragments, which are projectiles from the environment (debris, vehicular metal, etc.).”
Tertiary blast injury	“Displacement of the body or part of the body by the blast overpressure causing acceleration/deceleration to the body or its parts, which may subsequently strike hard objects causing typical blunt injury (translational injury), avulsion (separation) of limbs, stripping of soft tissues, skin speckling with explosive product residue and building structural collapse with crush and blunt injuries, and crush syndrome development.”
Quaternary blast injury	“Other “explosive products” effects—heat (radiant and convective) and toxic, toxidromes from fuel, metals, etc.—causing burn and inhalation injury.”
Quinary blast injury	“Clinical consequences of “post detonation environmental contaminants” including bacteria (deliberate and commensal, with or without sepsis), radiation (dirty bombs), tissue reactions to fuel, metals, etc.”