Special Considerations

The following special considerations should be taken into account in patients presenting with blast injuries:

Pregnancy

In some ways the foetus is protected from primary blast injury, having no gas-filled organs. However, being suspended in amniotic fluid does potentially expose it to substantial blast forces.

As with other forms of trauma, the best way to look after the foetus is to look after the mother.

Sonography should be performed for all pregnant patients exposed to a blast, to exclude uterine rupture and placental abruption.

Rhesus-negative pregnant women should receive anti-D immunoglobulin within 72 hours of blast injury.

Infection

A suicide bomber’s fragmented body may cause penetrating (secondary) blast injury.

In recent years there has been concern that this biological material may cause cross-infection with the hepatitis and human immunodeficiency viruses.

In Israel there have been a number of incidents where human material from suicide bombers has tested positive for HBV or HbsAg [16,17].

Any biological fragments removed from wounds in patients involved in a blast should be sent for virological examination [16].

It is the author’s recommendation that accelerated hepatitis B vaccination should be considered in all patients with open wounds who have been involved in a blast, if it is possible that the explosion has been the result of a suicide bombing. Patients should also receive anti-tetanus toxin.

Learning Bite

All patients with penetrating trauma following suicide bombing should receive accelerated hepatitis B vaccination.