title: Primary blast injury after a bomb explosion in a civilian bus.
abstract: A 6-kg explosive charge detonated under a seat in the center of a crowded city bus in Jerusalem, killing three passengers immediately. Of the 55 survivors, all of whom were transferred to two major medical centers, 29 were hospitalized. Among those admitted, a high rate of primary blast injuries was found, including perforated ear drums (76%), blast lung (38%), and abdominal blast injuries (14%). Two of the latter patients suffered bowel perforations, which were diagnosed with considerable delay. Eight patients (31%) had sustained life-threatening trauma, consisting of a combination of primary, secondary, and tertiary blast injuries. The overall mortality rate was 10.3%. The large number of primary blast injuries, including the unexpected finding of bowel perforations, is explained by the high amplitude of the air pressure wave (3.8-5.2 atm) and its relatively long duration (2-3 msec) resulting from the detonation of the high-energy explosive charge in the small, enclosed space of the bus. Besides the usual wounds sustained by victims of an explosion that occurs in a confined space, the possibility of primary blast injury to the abdomen and to the lungs should be taken into account by the treating surgeon.
authors.affiliation: Department of Surgery, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Katz
authors.forename: B
authors.initials: B
authors.lastname: Ofek
authors.forename: J
authors.initials: J
authors.lastname: Adler
authors.forename: H B
authors.initials: HB
authors.lastname: Abramowitz
authors.forename: M M
authors.initials: MM
authors.lastname: Krausz
mesh_terms: D000007:Abdominal Injuries / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D001753:Blast Injuries / Q000209:etiology*; D005107:Explosions; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D007557:Israel; D055370:Lung Injury; D008875:Middle Aged; D009104:Multiple Trauma / Q000209:etiology*; D014432:Tympanic Membrane / Q000293:injuries*; D014754:Violence