Page 57 - 2022 Ranger Medic Handbook

Blast Injury Assessment
TCCC Application
INITIAL EVALUATION AND TREATMENT PER APPROPRIATE TRAUMA PROTOCOL
All unit members exposed to blast will be assessed for blast injuries as soon as tactically feasible, with documentation
if possible. Any indications or complications from blast injuries should warrant immediate evacuation for evaluation at
a more capable facility.
Blast injuries have a wide range from minor tympanic membrane (TM) ruptures to hollow organ overpressure injuries. All SECTION 2
personnel must be evaluated and monitored for at least 6 hours for injuries. Submersion or confined space environments
significantly increase the incidence of injury. Special caution should be taken when examining these patients.

Signs & Symptoms
HEENT – Careful inspection for TM rupture during examination. Intact TMs do NOT exclude significant blast injury to
other parts of the body. Check for ear discharge, tinnitus, and hearing loss.
Pulmonary – Evaluate for shortness of breath and abnormal breath sounds.
Neurologic – Evaluate for TBI with MACE 2 and neurological exam.
Abdomen – Monitor until 48–72 hours post injury.
Management
1. All asymptomatic patients should be monitored for at least 6 hours after the event to rule out late presenting
complications.
2. TM: Keep ear canal dry/covered (use cotton balls if possible) in case of TM rupture. Refer to ENT for evaluation when
possible.
3. MACE 2 examination needs to be accomplished on all personnel affected by the blast.
4. Pulmonary decompensation: High-flow O 2 if available. Use caution with high-pressure ventilation; this may worsen
the patient’s condition. Follow rules for hypovolemic resuscitation given risk for pulmonary edema. Have high suspi-
cion for tension pneumothorax. Be prepared for needle decompression. Consider tube thoracostomy: recurrence or
persistence of respiratory distress after two needle decompressions OR evacuation time > 1 hour OR patient requires
positive pressure ventilation. For air evacuation, fly at the lowest tactically feasible altitude.
5. Abdomen: Any abdominal pain or tenderness within 48–72 hours of a blast exposure should be presumed to be a
bowel perforation and warrants urgent surgical evaluation. Follow Abdominal Pain Protocol for urgent evacuation.
6. Consider possibility of arterial gas embolism (AGE) in patients with focal neurological deficits after pulmonary blast
injury. AGE may require recompression therapy. See Barotrauma Protocol.
7. Spine injury: Patients involved in vehicular blasts or thrown by explosions are at high risk for spinal injury. Maintain
a high index of suspicion for spinal injury, especially in unconscious patients. Manage IAW Spinal Trauma Protocol.

Disposition & Evacuation
1. TM rupture without complications – RTD after 6 hours of observation
2. TM rupture with hearing loss – Routine evacuation
3. Neurologic Injury – Urgent for neurosurgical evaluation
4. Pulmonary complications – Urgent evacuation
5. Abdominal pain – Urgent evacuation
6. AGE or barotrauma – Urgent evacuation
7. Spinal injury – Urgent evacuation to neurosurgical capability

2022 RANGER MEDIC HANDBOOK 43