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"Wind of Ball"
(Blast)
Step on a mine
Have the leg amputated in the FST
Next stop the Invictus Games
Slam Bang Dunk
All done and dusted

Except of course it is not quite that simple.
The study of blast injuries commenced with observations by Dr Gilbert Blane in 1785 who was then "Physician to the Fleet". The term "Wind of Ball" was coined for those who had perished when a cannon ball passed close but did not leave a mark.

In a series arising from the battle of Monte Cassino in spring 1944 evidence of Blast Lung Injury (BLI) was found in 34.5 per cent of a series of 87 autopsies performed in soldiers who died with no external evidence of thoracic injury, while diffuse pulmonary contusions were found in 47 per cent of the fatalities in Northern Ireland in the period between 1969 and 1974.

The type of explosive is significant
There are for the, puposes of this website, two types of explosive
  • Non-military explosives   -   sodium chlorate, fertiliser types
  • Military explosives          -  the type found in mines, shells, mortar bombs
The military type have a characteristic and brutal shock wave pattern associated with them.
Shock wave diagram
The shock wave smashes into the victim causing multi organ damage much of which is not immediately apparent. It may be a simple shockwave or if the victim in in an enclosed area a complex multiple shockwave. They both cause multi-system injuries. The mechanism are described as spallation, implosion and inertia.

It has been classified as having four main elements
  • Primary injuries - effect of blast wave on gas containing organs
  • Secondary injuries - from flying debris
  • Tertiary injury - damage caused when the body is blown aside
  • Quaternary injury - burns, crush injury, smoke and dust inhalation.
Immediate Primary Injuries

The place that is most vulnerable to blast injury is where a solid organ contains or meets a hollow gas filled space; a vulnerable interface. This does not exclude other parts of the body.
  • Ears - Ruptured or bleeding eardrum, damage to the ossicular bones and damage to the neural pathways.
  • Gastro-intestinal tract - Bleeding and internl rupture of the GIT
  • Lungs - Contusion, air embolism causing occlusion of vessels and thrombosis. ARDS - Adult Respiratory Distress Syndrome
  • Cardiovascular changes - The heart rate and stroke volume fall leading to impaired perfusion.
  • Traumatic brain and spinal cord injury - Death my be immediate, coma may occur and there may be significant long term effects.
  • Metabolic instability may occur as a hypermeta bolic state developes in which hyperglycaemia and hyperlactataemia occur.
Long term Effects

Where does all this start ? The obvious suggestion must be at he moment of injury.
An "inflammatory storm" has been postulated where the body tries to defend itself and in the long term establishes a "chronic pro-inflammatory state" which continues to harm the survivors.

The so-called "unexpected survivors" appear to age more quickly, develope hypertension, coronary artery disease and chronic kidney disease sooner than their peers.

They may suffer long term PAIN which is especially challenging to manage.

There are the obvious long term effects of blast injury - missing limbs, deafness, shortness of breath.

What of conditions that have only been widely recognised since the wars in Iraq and Afghanistan. - Heterotrophic Ossification ? Muscle, tendons and blood vessels which progressively become ossified and turn into bone requiring yet more surgery.

 There are less obvious consequences that are a consequence of Traumatic Brain Injury (TBI) ?
The overpressure wave damage to the brain may be direct or via the vascular or spinal fluid pathways. Current research has identified multiple long term consequences. Detail is outside the scope of this website but makes fascinating reading.

Practically how may this affect the victim ? Alongst the long term effects the following have been ascribed to bTBI as part of a Post Concussive Syndrome.
  • difficulty concentrating
  • anxiety
  • amnesia
  • mood disturbance
  • headache
  • sleeplessness
  • impaired cognitive function
 
It is not all over and done with once the damaged limb is removed.
 
One of the injured from the battle at Mirbat died a few months later in the UK.

On arrival in the FST he had a shattered lower right jaw from what was probably a bullet from an AK-47; up to 1500ft lbs of muzzle energy at 2,500 ft per second.

There was considerable rumour about the cause of his death including malaria but the one that has most currency is that it was a portion of tooth blasted deep into a lung. The tooth fragment may have contributed but it is not unreasonable to suggest that the blast wave of the bullet hitting his upper respiratory tract caused damage throughout his lungs whch eventually proved to be fatal and that attributing it simply to the tooth fragment is over-simplistic.