Primary

Impact of supersonic blast wave on body

Preferentially affects hollow or gas-filled structures

Pulmonary barotrauma (blast lung)

Tympanic membrane rupture and middle ear damage

Abdominal hemorrhage and intestinal perforation

Eyeball rupture

Mild traumatic brain injury (concussion)

Secondary

Impact of debris from blast onto body

Penetrating or blunt injuries

Eye penetration (evident or occult)

Tertiary

Impact of body thrown by blast onto environmental surfaces or debris

Fractures and traumatic amputations

Closed and open brain injury

Quaternary

Processes independent of primary, secondary, or tertiary blast injury (eg, burns, toxic inhalation, crush injury from entrapment under debris, aggravation of medical disorders)

Burns

Crush injuries with rhabdomyolysis and compartment syndrome

Respiratory tract injury from inhaled toxicants

Asthma, angina, or myocardial infarction triggered by the event

Quinary

Injuries resulting from toxic materials absorbed by the body from the blast and post detonation environment (eg, radiological, biological substances)

Radiation burns or acute radiation sickness (see alsoBiological Agents as Weapons and Toxins as Mass Casualty Weapons for specific symptoms)