Table 1.

Classification of injuries caused by explosions

Classification of injury	Mechanism of injury	Type of injury
Primary	Direct interaction of the supersonic blast wave (spalling, implosion, inertia) with gas-containing and hollow organs of the body	Tympanic membrane rupture Hyoid bone fracture Blast lung, gas embolism, pneumothorax Heart avulsion, aorta laceration Blast intestine, intestinal perforation Traumatic amputations
Secondary	Direct trauma to the victim’s body caused by fragments or materials which have been energized by the explosion	Fragmentation/penetrating injuries such as blunt or sharp force injuries (depending on the nature of the objects) Comminuted fractures
Tertiary	Mass movement of the body or structures/objects against a body propelled by the blast wind	Spiral fractures 3-point bending fractures Axial loadings Traumatic amputations
Quaternary	Miscellaneous causes of injury, the remainder	Burns Crash injury Noxious gas inhalation injuries Traumatic asphyxia Psychological disorders