Bomb blast injuries are always hollow organ injuries; Delhi Blast Update

1.      Primary blast injuries are the injuries to the hollow gas-filled organs like the lungs, ear drum or intestines leading to their rupture. These occur as a direct result of the impact of the over pressurized blast wave on the body.

2.       Secondary blast injuries occur due to flying debris and bomb fragments leading to penetration or penetrating injuries such as to the eyes.

3.       Tertiary blast injuries occur when individuals are thrown by the blast wind leading to fractures as a result of the fall.

4.       Quaternary blast injuries are due to direct effect of burn or crush injuries.

The most important triage to manage blast injuries is not to waste energies and resources on patients with non-serious injuries.  The first thing is to check for eardrum rupture and signs of respiratory imbalance. Their absence indicates a non-serious injury.

All patients exposed to a blast must have eardrum examination as the first step. If the ear drums are intact, the patient can be discharged with first-aid treatment. If ear drum is ruptured, an X-ray chest should be done immediately. All such patients should be observed for eight hours as primary blast injuries are notorious for delayed presentation.

Doctors should therefore focus only on two exams: otoscopic ear exam and pulse oximetry. Blast lung injury is unlikely without tympanic or ear membrane rupture. This is used as a screening procedure for admitting a patient. Decreased oxygen saturation on pulse oximetry signals early blast lung injury, even before symptoms become apparent.

Half of all initial casualties seek medical care over first hour. Double this number after one hour and you will know the total casualties. This formula is often used by the media to predict the tolls. It is also useful to predict demand for care and resource needs.

Always expect upside down triage as the most severely injured arrive after the less injured who self-transport to the closest hospitals.

With the increasing use of explosives in terrorist events in our country in recent times, doctors, especially Emergency Doctors, should undergo orientation training every six months so that they are prepared and better equipped to manage several casualties all at one time.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Chairman Ethics Committee Delhi Medical Council, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association and Past Academic and Research Wing Heads IMA.

The bomb blasts traige

The Mumbai terrorist attack update: Bomb blast injuries are always hollow organ injuries

How do bomb blast cause injuries? It is crucial that we know this to handle the aftermath of bomb blasts.

Primary blast injuries are the injuries to the hollow gas-filled organs like the lungs, ear drum or intestines leading to their rupture. These occur as a direct result of the impact of the over pressurized blast wave on the body.

Secondary blast injuries occur due to flying debris and bomb fragments leading to penetration or penetrating injuries such as to the eyes.

Tertiary blast injuries occur when individuals are thrown by the blast wind leading to fractures as a result of the fall.

Quaternary blast injuries are due to direct effect of burn or crush injuries.

The most important triage to manage blast injuries is not to waste energies and resources on patients with non-serious injuries.

The first thing is to check for eardrum rupture and signs of respiratory imbalance. Their absence indicates a non-serious injury.

All patients exposed to a blast must have eardrum examination as the first step. If the ear drums are intact, the patient can be discharged with first-aid treatment. If ear drum is ruptured, an X-ray chest should be done immediately. All such patients should be observed for eight hours as primary blast injuries are notorious for delayed presentation.

Doctors should therefore focus only on two exams: Otoscopic ear exam and pulse oximetry. Blast lung injury is unlikely without tympanic or ear membrane rupture. This is used as a screening procedure for admitting a patient. Decreased oxygen saturation on pulse oximetry signals early blast lung injury, even before symptoms become apparent.

Half of all initial casualties seek medical care over first hour. Double this number after one hour and you will know the total casualties. This formula is often used by the media to predict the tolls. It is also useful to predict demand for care and resource needs.

Always expect upside down triage as the most severely injured arrive after the less injured who self-transport to the closest hospitals.

The Government should take all steps so that blasts do not occur. With the increasing use of explosives in terrorist events in our country in recent times, doctors, especially Emergency Doctors, should undergo orientation training every six months so that they are prepared and better equipped to manage several casualties all at one time. There is a need for constant updation. Govt. should formulate guidelines, which should be available on their website and can be followed by all.

Mumbai Blasts: The psyche behind terrorism

More blasts in Mumbai… yesterday Mumbai was hit by serial blasts yet again

What is it that makes people kill others? Why is there so much of unrest or turmoil in the mind of people that they can kill others. We need to understand the psyche behind the mind of a terrorist.

“We are what deep rooted desires are” is an old saying in the Upanishads. The reality can be shaped by altering the way one thinks. This principle is often used by terrorist camps to brainwash new young terrorists who are used either as suicide squads or for other terror attacks.

According the Bhagwad Gita, the human nature is a mix of Rajas, Tamas and Satva gunas or nature. This is the era of Tamasik-Rajasik society. People like to read and hear stories full of rape, anger, aggression, terrorism, extra marital affairs etc. Today the hero plays a negative character in a movie and yet always ends up with the sympathy of the viewers. In the Rajsik and Tamsik era, the collective consciousness of the people is towards negative mentality and tolerating corruption. Hence, building a suicide squad is easy in these times. “Satya, Tapas, Pavitrata (purity) and Daan” are the four pillars of dharma. The first three are absent in Kalyuga, where the only prevalent and accepted behavior is Daya and/or Daan (charity).

Many years back, Maharishi Mahesh Yogi had adopted an army of children aged 4-5 years and trained them over the next ten years as Shastra Pandits. After their training, these children spread the message of Indian Shastras all over the world. During these years of hard work, the Vedic knowledge was affixed to their consciousness.

Similar squads can be prepared on any subject. A boy born and brought up by dacoits would only know that this profession is a noble one. Youngsters, similarly trained for decades in terrorism will only perform violent acts. Over a period of time, the mind gets conditioned for the said act on which they are trained.

Even Chanakaya used the concept of ‘Vishkanya – the poisonous girl’ and justified its use to kill the enemies. Today many terrorist groups are using the same concept through ‘HIV Kanya’.

We often wonder what makes such people take courage and risk their lives during terrorist attacks. The answer is simple. It’s the same psyche which applies to army soldiers during a war or to doctors who treat serious infections with high incidence of cross infection or to film stars who attempt to shoot risky scenes themselves and to a journalist who covers live news from the warfront or other dangerous areas. At that time, the only psyche is to achieve something new or to do something which is unusual.

Each one of us is born with some needs. These may be physical (food, clothing, shelter and other body needs), mind, intellect and ego (brain washed totally in one aspect) or at the level of soul (trained to do the jobs in the name of the God). Most terrorist camps fulfill the basic physical needs of their trainees.

Some will exploit the needs on the basis of a sacrifice. Many movies have a storyline where the hero is willing to sacrifice his or her life to fulfill the needs of the family, for example, marriage of sister or treatment of the ailing mother. Some movies have also shown a hero ready to become a negative man to fulfill the needs of the family after he was found to be suffering from an incurable nearing death illness.

Our history also plays a role in this aspect. The way our movies project people like Bhagat Singh and Chandrashekhar Azad, it makes one think that if they succeed in their terrorist attack they can achieve what they want and if they die they would be revered in history just as Bhagat Singh, Chandrashekhar Azad and others are revered today.

If we want terrorism to stop, then the negative mind in the collective consciousness of the people should change. We must shift our status from that of lower leader to a higher leader. We must learn to control violence in our own minds first. We must learn to control our shadow self and behave the same whether or not we achieve success in life.