title: Improvised explosive device bombing police bus: Pattern of injuries, patho-physiology and early management.
abstract: OBJECTIVE
  To understand the different types of blast injuries, their mechanisms, patho-physiology of wounds and clinical consequences caused by improvised explosive device detonation, and their early management.
  
  
  METHODS
  The retrospective study related to 70 Special Security Unit personnel of police travelling on duty in a bus that was struck with an Improvised Explosive Device on February 13, 2014, at 7:48am.The data of triage, primary survey and resuscitation and secondary survey on arrival at the Accident and Emergency section of Jinnah Postgraduate Medical Centre, Karachi, were noted and later analysed.
  
  
  RESULTS
  Police commandos aged 20-32 years were brought to hospital within 35-55 minutes of blast by ambulances. Triage at Emergency labelled 11(15.7%) Black, 15(21.4%) Red, 19(27.2%) Yellow and 25(35.7%) Green. Primary blast waves led to 11 closed blast lung presenting as pneumothorax in 9(12.8%) patients; 11(15.7%) chest tube thoracotomies were performed. Primary blast waves also produced ear drum and eyeball perforation. Seven (10%) patients received calcaneal fractures; 2(2.8%) with bilateral calcaneal fractures. Tertiary blast waves also caused amputations, and lower leg open fractures. Patients who died had received multi-system involvement injuries due to combined primary and secondary blast waves.
  
  
  CONCLUSIONS
  Improvised explosive devices produce a variety of serious and uncommon injuries requiring special care and early multi-disciplinary response. Repeated primary and secondary survey in Accident and Emergency are very important.
authors.affiliation: Jinnah Postgraduate Medical Centre (JPMC), Karachi.
authors.forename: Muhammad Saeed
authors.initials: MS
authors.lastname: Minhas
authors.affiliation: Jinnah Postgraduate Medical Centre (JPMC), Karachi.
authors.forename: Kashif Mahmood
authors.initials: KM
authors.lastname: Khan
authors.affiliation: Demonstrator Professional Development Center JSMU, Karachi.
authors.forename: Jahanzeb
authors.initials: J
authors.lastname: Effendi
authors.affiliation: Jinnah Postgraduate Medical Centre (JPMC), Karachi.
authors.forename: Anisuddin
authors.initials: A
authors.lastname: Bhatti
authors.affiliation: Demonstrator Professional Development Center JSMU, Karachi.
authors.forename: Seemi
authors.initials: S
authors.lastname: Jamali
keywords: Improvised explosive device, Injury pattern, Path physiology, Repeated survey.