Conventional Warfare Ballistic, Blast and Burn Injuries, Index

Conventional Warfare: Ballistic, Blast, and Burn Injuries

INDEX

Abdominal injury traumatic, and specific mortality, 226 from blast effects, 223 Mutilating blast injury and mortality, 225 Anaerobic and pathology of primary blast injury, 289 also Anaerobic infections; Gas gangrene and wound ballistics, 149 Anacrobic fasciitis, 2 ABR. See Auditory response (ABR) audiometry See Anaerobic infections; Gas gangrene Abrasions, 223 Anaerobic infections, also Gas gangrene and pathology of primary blast injury, 289 Anaerobic streptococcal myonecrosis, 210 Adult respiratory distress syndrome (ARDS), 279,301 also Anaerobic infections; Gas gangrene and systemic air emboli, 314 Anesthesia Aerodynamic of bullet, 114 complications in gastrointestinal blast injury, Aeromedical evacuation Anesthesia and Critical Cure, 301 and casualties with primary blast injury, 299, 304 Angle of incidence, 250 and casualties with burn injury, Angle of reflection, Air blast, 242 Antibiotics, 93-95 tolerance to, 253-258 as adjunct to surgery, 95 Air embolism early experience, 8I and hypercarbia, 308 in managing ballistic soft-tissue wounds, and management of primary blast injury, 31 1-316 penicillin, 93 definitive physical examination, 3 14 introduction of, 94 diagnostic screening procedures, 314 in Vietnam, 95 evacuation, 312 93-94 initial physical examination and triage, 31 and infection, 94 312 at Pearl Harbor, 94 initiation of life support, 312 See also Management of ballistic wounds of soft tissue; stabilization and life support, 312-3 Management of burn injury; Penicillin treatment, 314-316 Anticoagulants, 31 and mechanical ventilation, 31 1, 314 munitions with antipersonnel effects, 27-3 and age of casualty, 314 explosive antimateriel warheads, 27-3 and mortality from blast, 226 kinetic-energy warheads, 27 and pathology of primary blast injury, Antipersonnel exploding munitions, 16-27 and cardiac effects, 286 cargo-carrying munitions, 23 of retinal artery, 314 cluster 23 and risk anesthesia, improved-fragmentation munitions, and sequelae random-fragmentation munitions, 19 nonspecific treatment for, 316 secondary missiles, 23-27 signs and symptoms, 312 Antisepsis, 89-90 and underwater blast, 319 and mortality rate, 90 Airway, patent and Carl Reyher (1881). 89-90 and air embolism, 3 Antiseptics for casualties with primary blast injury, 303 for ballistic wounds of soft tissue, 189 Allograft skin, 339, 364 and Paul L. Frederich, 97 Alveolovenous fistula, 275 Antitank guided inissiles (ATGMs), 229 Amato, Joseph, 101 APFSDS (armor-piercing, fin-stabilized, discarding-sabot) rounds, Aminoglycoside, 210 27 Ammunition, 2 Apnea and Relative Incapacitation Index (RII), 77 in research animals, 308 Ampicillin, 210 ARDS. See Adult respiratory distress syndrome (ARDS) Amputation Armor-piercing round, 5 and timing of, Armored-vehicle personnel carrier

380 foreign casualty data, 229 Benzinger, 234 Armored vehicles Beretta M9 and PBI. 229-230 and Relative Incapacitation Index, 77 animal 229 3 Arsenical vesicants, 372-373 Biobrane, 364 Asphyxia. and triage, Blast casualties Assault rifle, 9 and asymmetrical pattern. 224 Atelectasis. lobar. 3 I I evaluation of, 298 ATGM Syndrome, 229 gastrointestinal, underwater, 3 Atomic bomb. See Management of primary blast injury Atropine, 3 Blast effects, 16 Auditory brainstem response (ABR) audiometry, 329 See also Pathology of primary blast injury; Primary blast Auditory system injury: Physics and mechanisms

definitive physical examination, 327-329 Blast injury diagnostic screening procedures, 329 and body armor, 230 evacuation. 326-327 definition, 242 initial physical examination and triage, and hearing loss, 232-233 327 from terrorist bombings, 222-226 treatment, 329-330 underwater, 231-232 and pathology of primary blast injury. 289-292 See also Management of primary blast injury; Pathology also Hearing loss; Tympanic-membrane rupture ofprimary blast injury; Primary blast injury: Physics and Autograft skin, 364 mechanisms; Primary blast injury (PBI); Secondary blast rifle, 9 injury; Teniary blast injury Blast loading, 249 See Primary blast injury: Physics and mechanisms Bacteriology Blast lung, 2, 35 of contaminated wounds, 178-188 and PBI, 226,300 94 and specific mortality, 226 Ball ammunition, 5 Blast overpressure, 242 Ballistic coefficient, Blast research Ballistic effects, 16 before World War also Wound ballistics during World War 233-236 Ballistic injuries, 108 American, and gelatin tissue 97 British, 233-234 and kinetic-energy transfer, German. mechanisms of, 96 experimentation, 236 237 and effect on performance, 73-76 morbidity and mortality, 222-226 See also Incapacitation Blast strength, 242 treatment of. 84-95, 96 Blast tolerance. See Primary blast injury: Physics and mechanisms See also Management of ballistic wounds of soft tissue Blast wave, 242, 244 Ballistics, 108 Blast wind, 242 sedation, 3 16 Blind wound, Barotrauma Blood gases, 305-308 caused by primary blast injury, 296 See also Oxygen adequacy from mechanical ventilation, 226 Blood vessels nnd mortality, 226 and pathology of primary blast injury, 287 and 305 and wound ballistics, 154 and risk of anesthesia, 324 Blow-back operation, 14 See also Blunt trauma, 215 Barrel Body armor, 1 in small arms, 12-1 3 and blunt trauma, 215 Barrel spring, 13 Body positioning Beehive round. and embolism, 312

38 1 Ballistic,

record. 298-299 Calcium channel blockers, 3 and tolerance to air blast. 255 Caliber, 4 and underwater blast, 232,260 George. 131, 146. 152-153 Caloric requirements, for bum patients, formulae. Bombings. Terrorist bombings Cannelures, 126 Bombs. Cannister shot. 22 Bone injury Cannons, 3 I and wound ballistics, 152-154 Carbon inonoxide poisoning, 369 Booby traps. 47 Carded for Record Only, 54 Box, 12 Cardiac dysrhythmia. 316 Bore caliber, Cardiac ischemia. study, 57, 7 95 Cardiovascular system Bouncing Betty, 46 and response to blast. in animals, 308 Bounding mine, Cargo carrying munitions. 23 Bradley Fighting Vehicle, 9, 229 Casualty and casualty evaluations. 229 official definition, 54 Bradycardia Casualty classifications animal research, 308 and methodological problems, 61-62 and hypotension, 3 I died of wounds. 61 Brain injuries killed in action. 61 and mortality from blast, 226 wounded action but survived. 61 and wound ballistics. Casually disposition. 59 Breech, Casualty generation block. 33 229 Brunchodilators, 3 assessment, 70 Bronchoscopy. fiberoptic. 3 1 1 methodology, 57 Brown, Harrv. 339 and combat tactics. 63. 6748. 70 Bubble pulses. 258 definitions, 54 Bullets, rubber and plastic, 215 differentiated from lethality. 55 Bullet characteristics. 4, 108-1 distributed weapon, 56-57. and wound morphology, of foreign weapons, 78-80 See Weapons of conventional land warfare by state of weapons technology, 70 Bullet composition See also Weapons effectiveness a:, 96 CAT See (CAT) See ulso Weapons of conventional land warfare Cavitation, 96. Bullet deformation demonstrated, energy in tissue. tissue in Third Declaration of Hague Convention of 1899, 89 See Wound ballistics: Physics and biophysics as wound determinant. 88, 96, 199-202 Cavity. See Permanent cavity; Temporary cavity; Wound ballis- Bullet stability tics: Physics and biophysics and wound morphology, 199-202 Cornelius. 338 and wound severity, 90 Central nervous Burr-care history, 338-340 and air embolism, 3 I2 advances in skin grafting, 339 and from blast, 226 fluid resuscitation developments, Cerebral insult, 3 research and modern treatment, 340 Cerebrovascular accident, 3 I 1 trrating ihr. hum 338 Srr Management of bum injury of round into breech. 13 Burn depth, Chemical injury, Burn injury. of bum injury; Pathophysiology of hydrofluoric acid, 370 burns napalm, 48,370 Burn-wound closure, 361-366 vesicants, 372-373 white phosphorus, 49-50,370 Inhalation injury

382 Chemical warfare and prediction of performance. 74 and leukocyte response, 173-174 and probability of incapacitation, 74 Srr Vesicants, 372-373 and prediction of treatment problem. 74 Chest injury Concussion, zone of, and wound ballistics, Concussion grenades, 40 Chest-tube care Conditional probability and evacuation, 304 mathematical expression. 54 Chest-tube insertion Conoidal bullets for casualties with primary blast injury, 303, 312 and explosive tissue effects, 88 China Minie bullets, 87 and wound ballistics research. 102 wounding effects of, 372 Contamination. Cholesteatoma. 291,326, 330 Wound contamination Churchill, Edward, 93 Contusions Circulatory shock, of lung, 304 Circulatory system from terrorist bombings, 223 and pathology of blast injury. 272. 284-287 CONUS (continental United States). 7 and response to bum injury, 344-346 CONUS echelon of care. Claymore mines, 47 Copeland, W.P., 338 Clindamycin. 210 Cope. Sir Zachary, 232 Closed-plaster technique. 92-93 Corticosteroids, 3 Clostridial 2 Crepitation, subcutaneous, 304 Anaerobic infections; Gas gangrene Crystalloid fluids, 339,351 Clostridial myonecrosis, 210-211 Curling’s ulccr, 340. 366 also Anaerobic infections: Gas gangrene Cut-off wave, 258,260 Clostridial myositis, 182, 210 Cyanosis, 30 I.304 See Anaerobic infections; Gas gangrene Cyclic rate of fire, Cluster munitions, 23 implicated in 1944English air-station accident. 23 used by Germans in battle of the Kursk Salient in 1943. Davis. John Stage. 339 23 Dead space, 174 Cochlea Debridement. 86 and pathology of primary blast injury, 292 evolution of term. Y See Auditory system by the British, Y3 Coefficient of drag, 113-114, in managing penetrating injuries, 92 Colloid-containing fluids. 339, 351 in noninfected wounds, Colt 13.73 for soft-tissue wounds. and Relative Incapacitation Index (RII). 77 Deformation of projectile, 126 Combat tactics and casualty generation, 70 as experimental variable, 96 Combined mechanical and thermal trauma. 369 Delayed primary closure Commensals, I technique for, 92 Comminuted fractures. See Open comminuted fractures of the in World War extremities Density, 108 234 Complex blast wave, 27, 253 Desault, Pierre Joseph, 86 Composite rigid shots, 27 Detonation Composition of explosive munitions, 15-16 Computed axial tomography (CAT) scan, 299, 305 Dexamethasone, 3 and air embolism, 314 Diagnostic peritoneal lavage (DPL). 320 gastrointestinal imaging. 320-324 Diagnostic screening. Management of primary blast injury Computer Man, 73-77, 80 Digestive and incapacitation, 73-77 used in wound treatment, 85 and injury severity, 75 Digestive system methodological limitations, and pathology of primary blast injury, 288-289

383 Conventional Warfare: Ballistic, Blast, Burn

Direct of casualties with bums, and lung damage, 226 criteria for, 367 Disseminated intravascular coagulation 287 long-distance, by air, 368 Paul J., 96 and oxygen adequacy, 304 DPL. See Diagnostic peritoneal lavage (DPL) and treatment results, 95 Drag of projectile, 13 Management of primary blast injury Drag-sensitive equipment. 249 Excision therapy by the British, 93 in gastrointestinal injury, 325 for bum wounds, Dum-Dum, India, 89 criteria for, 93 Dumdum bullets, en bloc, 94, 98 and political controversy, 97 excessive, 94 364 See also Debridement: Epluchage; Freshening; Primary 338 Duration effect of blast, 234 Explosive munitions, Dynamic pressure, 249 fragmentation of, and treatment for, Dyspnea. 300.301 See Primary blast injury: Physics and mechanisms Dysrhythmia Explosive wounds and air embolism, 3 12 and hydrodynamic effects, 98 Dziemian, A.J., See Cavitation Extracorporeal membrane oxygenation, 3 1 Extravasation, zones of, 141-142 Ebers and Smith Papyri (1600-1500 B.C.), 338 Extremity wounds, 199-202 Echelons of care. See also echelon of care; First echelon and mortality from blast, 226 of care: Fourth echelon of care: Second echelon of care: Third Eye and echelon of care and pathology of primary blast injury, 289 Effective radius, 3 Effective range, 3 Electrical injury, 340, 373 Fackler, Martin, 102 compartment syndrome, 373 FAE. See Fuel-air explosive (FAE) neurological complications, 373 Fatigue, 173, 262-263 resuscitation, 373 Fatigue factor, 297 Electrocardiogram Fatigue stress, 263 and air embolism, 3 14 FEM. See Finite Element Modeling (FEM) Emergency War I9 194 Fiberoptic bronchoscopy. See Bronchoscopy, fiberoptic Emphysema Fibrothorax, 3 and pathology of primary blast injury. 279 Finite Element Modeling 263-266 See also Interstitial emphysema; Subcutaneous emphy- Firing pin, sema First-degree bum. 342 Empyema, 3 1 1 First echelon 71 En bullet wounds, 94, for ballistic wounds of soft tissue, 195 and wound morphology, for primary blast injury. 297-299 Endocrine system establishing a medical record, 298-299 and rcsponsc to bum injury, 347 cvncuation, 279 Endurance limit, 263 initial physical examination and triage. 298 Energy transfer. See Kinetic energy transfer; Wound ballistics: initiation of life support, 298 Physics and biophysics Flame munitions, 48-50 Enhanced-blast munitions, 35, 37, 38-39, 23 FICchettes, 14,20 Epluchage, 9 I, 93 in Soviet-made weapons, 22 Equations of state, 243 and wound morphology, 199 Escharotomy, Fleming, Sir (World War I), 178-180 Evacuation Fluid-requirement formulae, 339, 35 1-354 and animal research, 299 Fluid resuscitation bum care during, 367-368 in air embolism, 3 12

384 in bum patients. 338-339, 351-354 treatment, for combined bum and pulmonary blast injuries, anesthesia complications, 304 drug therapy, 325 animal research, 303 surgery, 324, 325 See also Volume replacement and underwater blast, 318 Forrest. Nathan 80 and pathology of primary blast injury, 272, 288-289 .45 ACP. See Colt .45 See also Abdominal injury Four Cs, 93, 142, 175-177, 189,208 gun, 3 I Fourth echelon of care Glover, J.L., for ballistic wounds of soft tissue, I95 Golden period, 167 Fractures and invasive sepsis, 98 combined with thermal trauma, 369-370 Graft take, 362 Fragment wounds, 199 Grenade fragments of and wound morphulogy, 193 weapons Grenade launchers. Fragmentation. 126,227 Grenades, See also Secondary blast injury Guarding. 3 18. 3I9 Fragmentation munition Guns, and wound morphology, 199 Gunshot Injuries, 73, 98 See also Explosive munitions See also La Garde, Louis A, Frederich, Paul L., 167, 170 Gut motility Free field, 245 and response to bum injury, 347 French, Ralph, 152-153 Freshening, 98 Friedlander 245 Haber-Weiss reaction, Friendly fire. 66 HACS. See Hostile Action Casualty System (HACS) Fuel-air explosive 35. I Hague Convention of Full metal jackets, 89 Third Declaration of. banning bullets, 6, 89 Fumes Hand grenades, 37-40 and inhalation injury, 299 Harvey, Newton, 135-136, 144-146, 150 Fuse Head injuries in explosive munitions, ballistic wounds of skull and 144-146 and mortality from blast, 226 Headache Gall bladder and air embolism, 3 12 and pathology of primary blast injury, 289 Healing by secondary intent, 92, 93 Gas gangrene. 91. 179-183.210-212 Hearing loss and Alexander Fleming, 178-179 from blast, 232-233 and penicillin. 94, 192-193 combined. 325 animal research, conductive, defined, 325 See Anaerobic infections sensorineural, defined, Gas operation of weapons, treatment, 329 Gastrointestinal tract See also Auditory system: Tympanic-membrane rupture and of blast injury, 3 16-325 Hcan injury definitive physical examination. 3 19-320 and pathology of primary blast injury, 285-286 diagnostic screening procedures, 320-324 and effects of air embolism, 286 diagnostic peritoneal lavage hemorrhage, 320 and wound ballistics, 149 gastrointestinal imaging, 320-324 Heckler Koch GI automatic rifle. 15 evacuation, 3 I9 Hematemesis. 3 initial physical examination and triage. 3 Hematomas. 73 319 Hemoglobin initiation of life support, serial determinations, 299, 320 signs and symptoms, 3 18 Hemopneumothorax. 274,300

385 Ballistic, Blast, arid

and chest tube insertion. 303 history, 72 Hemoptysis, 301. 31 computer simulation, 73-77 definition, 54 and blood vessels, from primary blast injury, 287 See also Relative Incapacitation Index (RII); Weapons of gastrointestinal tract, from primary blast injury, effectiveness 289 Incendiary round. 6 of heart, from primary blast injury, 285-286 Incendiary weapons, 48.49, of lungs, from primary blast injury, 273-279 Incident wave, 245 of other organs, from primary blast injury, Inertia, 234,235 of upper airways, from primary blast injury, 282-283 Infection. 300, I I among burn casualties. 347, 355-360 Herget. C.M., bacteriology of ballistic wounds, 178-188 High-explosive (HEAT) weapons, 28 managing infected soft-tissue wounds, 188-196 I squash-hcad antiarmor I mcdicval of,84 Hildanus. Guilhelmus Fabricius, 338 resistance to. 85, 171-178 Hollow-charge warhead. 27 See also Anaerobic infections; Antibiotics; Antisepsis: Hooker, David, 234 Sepsis; Wound contamination Hopkinson's Rule, 246 Inhalation injury. 340, 369 Horsley, Victor. 98, and medical record, 299 Hostile Action Casualty System (HACS), 229 lnjury casualty statistics, 229 and definition of wound, Housing, Injury severity Howitzer, 34 among British casualties at Normandy 6 I Hunter, John, 85-86, 87, definition, 54 Hydrofluoric acid, 370 degrees Hyperbaric-chamber treatment. 314-3 16 lethal, 74-75 animal research, 3 3I6 serious, 75 complications, 316 also Weapons effectiveness protocols, 316 Injury Severity Score 223 Hypercarbia, 3 Inner-ear damage, 327,328, 330 Hypertonic 352 Insensible water losses. 354 Hypocarhia. 305 Insensitive explosives, 245 Hypopharynx Intercostal markings. 275 physical examination, 304 Interstitial emphysema, 300 Hypo tens ion on roentgenogram, 305 and air embolism. Intestinal perforation etiology. incasualties with primary blast injury, 303.3 and abdominal PBI from blast, 226 triage, 30 Irreversible work, 263 volume replacement. 303.3 3 for soft-tissue ballistic wounds, 189 Ischemic changes and air embolism, 312 and compartment syndrome, latrogcnic aspccts of infcction, 174 gus gangrcnc, 177 blast waves, 245 and resistance to infection, 173 Immune response, 340 See Injury Severity Score (ISS) to infection, 171-178 and response to bum injury, 347 Implosion, lmproved-fragmentation munitions, 19-23 Jacketed bullets, 88-89 Impulse (pressure-time integral), 235 wounding effects, 89 Incapacitation and political controversy, 89, 97 animal research, 73 research using, 98 assessing, 72-77

386 and wound ballistics, Karl Gustav antitank munition. 229 Primary blast injury: Physics and mechanisms; Kidneys Respiratory system: Upper airways and pathology of primary blast injury, 289 and response to burn injury. 346 and soft-tissue ballistic injury, Mach, 250 Kinetic energy Mach stem, 250 and incapacitation, 74 Machine gun, 7-9 of projectile, 109. I I I Machine pistol, 9 and wound management, 95 acetate, 357, 358 and wound severity. 95 Magazine, The physics and biophysics of ballistics Magnetic resonance imager (MRI). 305 Kinetic energy transfer and ballistic injury, and resistance to infection, 173 and cavity size. Management of ballistic wounds of soft tissue, and wound severity. Penetrating injuries also The physics and biophysics of wound ballistics anaerobic infections of military importance. 210-212 Knockdown power, 73 gas gangrene, 2 10-2 Kocher. Emile Theodor. 96-97, 101. anaerobic fasciitis, 210 clostridial myonecrosis, streptococcal myositis. 21 La Garde, Louis 73, 88-89, 96. 98-99 tetanus, 212 and incapacitation research. 73 bacteriology of contaminated penetrating wounds, Lacerations, 223 188 Dominic Jean, 86-87 battlefield observations, 178-186 and penetrating wound as dynamic entity, World War I: Bacillus Laudable pus. 85 I78 LAW, 28.229 Lead poisoning. 178-188 Lethal area, 78-79 World War I: gas gangrene, of underwater blast, 297 180 Lethality World War pre-antiobiotic era, assessing, 69-70 methodology, 56 World War early antibiotic era. definitions, differentiated from casualty generation, 55 World War anaerobic infections, See Weapons effectiveness Letterman Army Institute of Research (LAIR), Korean War, I Light antitank weapons 28 Vietnam War, 184-186 Lindsey, D.. 101 Yom War, I86 Lister, Joseph, 89 animal research, 187-188, 193-194 3 management overview, 188-194 Liver antibiotics, and ballistic injury, systemic antibiotics. laceration from blast, 226 topical antimicrobials, and pathology of primary blast injury, 289 antiseptics, Long-rod penetrators, 27 clinical and experimental therapeutic Lund-Browder diagram, 340,341 Lungs penicillin prophylaxis of gas gan- and direct blast damage, 226 grene in sheep, 192-193 and examination for primary blast injury. nonoperative treatment of hemorrhage, in animals, 308 rifle wounds in swine, 193-194 and pathology of primary blast injury, 273-282 survival with untreated soft-tissue hemorrhage. 273-279 ballistic wounds,

387 Conventional Warfare: Ballistic, Blast, Burn

topical antimicrobial treatment of hydrofluoric acid. 370 large soft-tissue wounds. 193 napalm, 370 irrigation, 189 vesicants, 372-373 surgery, white phosphorus, 370 military soft-tissue wound care, 166 combined mechanical and thermal trauma, 369-370 practical aspects of managing soft-tissue combat wounds, electrical injury, 373 compartment syndrome, 373 echelons of care, 195 neurological complications, 373 management decisions, 202-204 resuscitation, 373 management options, evacuation, 367-368 matching injuries and options, 195-199 care during transport, 36 soft-tissue trauma: typical combat wounds, evacuation criteria, 367 unique features of aeromedical transport, 368 surgical interventions, inhalation injury, 369 dehridement, 205-208 research and future directions of hum therapies, primary and secondary suture tech- 375 niques, treatment of hums, 350-367 resistance to infection: modifying factors, 171-178 burn-wound closure, 361-366 animal-tissue research, 175 excision, 361-364 human-tissue research, 175-177 skin grafts, 364-366 dead soft tissue in combat wounds, 174-17X bum-wound management, 355-360 compartment syndrome, controlling infection, anatomical features that predispose initial wound care, 355 to skeletal muscle death, 177 managing bum-wound infections, major vessel injury, 174 357-360 iatrogenic factors, 174 complications, dead space, 174 escharotomy, 354-355 drains. 174 fluid resuscitation, 35 1-354 suture material, 174 assessing resuscitation adequacy, systemic factors, 352-354 circulatory shock, 173 colloid or crystalloid, 351 compromised leukocyte response in hypertonic resuscitation, 352 unconventional warfare, 173-174 resuscitation the second day, 354 malnutrition, and cold, support, 360-361 173 miscellaneous early care, 354 wound tract factors, 171-173 Management of primary blast injury, 296-330 dead. injured. and ischemic skeletal definitive physical examination. 299 muscle, 173 for air embolism, 314 hematomas and extravasated blood. for auditory system injury, 327-328 172- I73 for gastrointestinal tract injury, 3 soil and other foreign bodies, for respiratory system injury, 172 diagnostic screening procedures, 299-300 wound ballistics: ancillary aspects, 21 for air embolism, 314 215 329 behind armor, 2 15 for tract injury, 320-324 rubber and plastic bullets, 215 for respiratory system injury, 305 retained projectiles. 2 13-215 establishing a medical record, 298-299 lead poisoning, evacuation, 299 migrating projectiles, 213 for air embolism, 312 wound contamination, 166-1 70 for auditory system injury, mechanics, 167 for gastrointestinal tract injury, 3 type and magnitude, 167-1 70 for respiratory system injury, 304 Management of burn injury, 350-376 initial physical examination and triage, 298 chemical injury, 370-373 for air embolism. 31 1-312

388 for auditory system injury. 326-327 M 1 13 cnrricr, for gastrointestinal tract injury. 3 18-319 Morbidity and mortality for respiratory system injury, 301-303 in Northern Ireland, 229 initiation of life support, 298 and organ-system injuries. for air embolism, 312 from terrorist bombings, 222-226 for gastrointestinal tract injury, 319 statistics, 223 respiratory system injury, 303-304 Mortars, 1-33 stabilization and life support, MRI. Magnetic resonance imager (MRI) for air embolism, 312-314 assault rifle for respiratory injury, 305-31 and bullet kinetic energy, 95 300 and for air embolism, 3 14 and wounding potential, 95 for auditory system injury, 329-330 M bounding mine, 46 for for respiratory system injury, 3 and casualty evaluations. 229 Mannitol, 316 MTF. See Medical Treatment Facility (MTF) Mass M2 antitank mines, 47 center of, Multiple 297 of fragment, and resulting incapacitation, 74-75 Multiple-Launch Rocket System (MLRS), 35 of projectile, 108 Munition, 2 MASHs. See Mobile Surgical Hospitals (MASHs) Mustard gas, 372 Mean area of effectiveness Mutilating blast injury, 242 definition, 79 Muzzle, 13 mathematical expression. 78-79 range, Material speed, 243 velocity, 88 Mechanical ventilation Myocardial 31 I and air embolism. 314 and air embolism, 3 12 and age of casualty. 3 animal research, 3 and barotrauma, 226 Napalm, 48,370 and CAI'scan results, Narcotics and evacuation prohibition, 304 and hypercarbia, 308 and pneumothorax, 300 Nasogastric decompression, 319 in primary blast injury, 308 3 11 Natural period (resonating frequency), pulmonary contusion, I I Necrotizing 210 special risks, 31 314 See also Anaerobic infections: Gas gangrene Medical record Nelson-Lazarus DPL technique, 320 establishment of, 298-299 Neosporin, 186, requirements, 298-299 Nerve damage Medical Treatment Facility 54, and wound ballistics, MI 8 antipersonnel mines, Neurological complications of electrical injury, 373 Melt sheet, 28 Nitrates, 316 Mendelson, J.A., 101, 175 Nitrogen mustards. 372 support for bum pnticnts, 340, 360-361 contamination, 178 Metronidazole, 2 Nuclear blast waves, 249 Military soft-tissue wound care, Milan. 229 Mines, 44 bullets, 87 of bullet, 108-110 Minute 308 Open comminuted fractures of the 92 M 97 hand grenade, 55 and closed-plaster technique, 92 Mobile Army Surgical Hospitals (MASHs), of, 92-93 M A I Abrams tank mortality rates, 56 and casualty evaluations. 229 and need for wound closure, 93

389 Conventiowal Warfare: Ballistic, Blast, and Burn

and treatment in World War 92 Penicillin, 93 Orbit. Eye and orbit as adjunct to surgery, 94.95 Orbital blowout, 289 and bacterial contamination, 188 Organ-system injuries introduction of, 94 and mortality from blast, 224-226 and gas gangrene, 94, 192-193 Orthopedic injuries and infection, combined with thermal trauma, 369 to prevent infection, 95 Ossicular chain in Vietnam, 95 and pathology of primary blast injury, 291-292 in Kippur War, 95 Ossicular damage, 327, 328, 330 See also Antibiotics 326, 327 ide 245 Overtriage, 224. 298 Perforation, of gastrointestinal tract, 289 Oxygen adequacy Peritoneal irritation, 319 and air embolism, 312 Permanent cavity, 100, 79, I40 animal research, 308 See also Cavitation and chest-tube care, 304 Permanent wound tract. 76. and evacuation risk, 304 Phenyldichloroarsine, 372 restoration of, Phosphorus-containing munitions, 49-50 also Mechanical ventilation See White phosphorus Physical examination. See Management of primary blast injury Physics and biophysics. See Primary blast injury: Physics and Paint-brush ecchymoses, 289 mechanisms; and Wound ballistics: Physics and biophysics Pancreas Pistol, 10-12 and pathology of primary blast injury, 289 Pneumomediastinum, 300,301, 304, 31 Park, Ambroise, 85,338 Pneumonia Pathogens, 18 1 after thermal injury, 367 Pathology of primary blast injury, 272-292 Pneumoperitoneum. 305 See Management of primary blast injury; Primary blast injury: Physics and mechanisms and air embolism, 312 Pathophysiology of bums, 340-347 definition, 300 assessing extent ot thermal bums, 340-342 and evacuation, 304 bum depth, 342 mechanism, 300 physiological response, 342-347 and roentgenogram, 305 circulatory system, signs and symptoms, 300, 304 endocrine system, 347 treatment, 3 11 gut motility, 347 triage. 301 immune response, 347 Pollock, George, 339 pulmonary function, 347 Polybactrin, 191 renal function, Pool, Lieutenant Colonel Eugene H. (World War I), 204 thermoregulation, 347 treatise on soft-tissue wound management, 205-209 PBI. Primary blast injury (PBI) Pop-up mine, 46 Penetrating wounds Positive duration, 242 appearance, in Civil War, 87 Positive phase impulse, 247 92 225, 3 11 debridement for, 86 in air embolism, 314 as dynamic entity, See Mechanical ventilation; Oxygen adequacy management of. Precursor shock wave, 249 with antibiotics, 93-95 Pressure waveform, 245 history, 84-95 Pressure-time history, 242 natural history of, research, Primary blast injury 40, 222, 242,296-297 surgical treatment of, 91-93 animal research, 297 also Management of ballistic wounds of soft tissue; inside armored vehicles, 229-230 and Wound ballistics: Physics and biophysics inside body armor, 230 Penetration of projectile, 119 and concussion grenades, 40

390 297 military expcrience, 227-273 Projectiles American data. 227 definition. of, and organ-system injury, 229 Friederich's conclusions about, 97-98 statistics. 226 migrating. 213 in terrorist bombings, 226 research, severity of, in enclosed space. 226 retained, 2 13-2 and underwater detonation, 297 and shcaring effcct, 101 of primary blast injury; Pathology size of, of primary blast injury; Primary blast injury: Physics and velocity of. mechanisms as wound determinant, 85 Primary blast injury: Physics and mechanisms. 242-268 S EE Management of ballistic wounds of tissue; blast and blast and Wound ballistics: Physics and biophysics blast wave, Pulmonary contusion? 300 conventional explosivcs, 245-246 and air embolism. 3 nuclear blast waves. 249 resolution, 300 physical characteristics of wave propagation. symptoms, 300 treatment. 3 I I pressure waveform, 245 See also Respiratory system scaling laws. Pulmonary edema blast and effects, 249 among casualtics with primary blast injury, 303 blast-pressure measurement, 249 and pathology of primary blast injury. 279-280 complex blast waves, 253 Pulmonary function structural blast loading and wave reflection, and response to bum injury, 347 249-25 I Pulmonary laceration primary blast to the lung. 260-268 treatment. 3 1 1 modern view on mechanisms, 262-263 Pulmonary organ distortion and tissue stress, and mortality from blast. 226 262 See Primary blast injury Respiratory system rapid response to blast loading. 262 Pulse oximetry. 305 tissue stress and injury, 262-263 new models of injury. 263-268 blast distortion, 266 parenchymal distortion tissue 266 tissue stress to injury, 266-268 Rebound tenderness. 318,319 tolerance to air blast, gun, 2 effects of body positioning, Reduced-power loading. 96 effects of rcpeatcd cxposurc, Reflected pressure, 249 underwater blast. 258-260 Reflected region. 249-250 Primary closure, 92 Regular reflection, 250 arid adequate Relative Incapacitation Index 76-77 for 92 field testing. 77 Delayed primary closure assessment of, Primary See Temporary cavitation Primary wound excision Renal function by the British. 93 and response to bum injury, 346 and dynamic nature of wound, failure interaction, I00 and mortality from blast. 226, 301 energy transfer in, 120-130 Respiratory system physical aspects and management of primary blast injury, Cavitation; Wound ballistics: Physics and animal research, 300

391 Warfare: Ballistic, Blast, and Burn Injuries

definitive physical examination, Sectional density of projectile, I I diagnostic screening procedures, 305 Seizure evacuation, 304 and air embolism, 3 I2 initial physical examination and triage, Self-loading weapon, 13 303 Semiautomatic weapon, initiation of life support, 303-304 Sepsis, stabilization and life support, 305-3 1 after bum injury, 367 treatment, 3I 1 increased likelihood of, in war wounds, and pathology of primary injury, 272-283 invasive, and temporal relationship with wound con- See also Lungs: Upper airways tamination, 97-98 Srr ballistic of after electrical injury, 373 soft tissue; Management of burn injury; Wound con- Retroperitoneal hemorrhage tamination and primary 289 Shape Return spring, 13-14 of fragment, and resulting incapacitation, 74-75 Reyher, Carl, 89-90 of projectile, 108-1 Rib markings, 275 cross-sectional area, 1 1 Rich, Norman, 108-1 Rifle grenades, 40 sectional density, Rifling, 12, 117 Shaped-charge warheads, RII. See Relative Incapacitation Index (RII) See also Rocket-propelled grenade (RPG) Ring hemorrhages, 278 Shear waves, 130 Rocket-propelled grenade (RPG), 68 Shell, 15 See also Shaped-charge warhead improved-fragmentation, and lethality, 70 Rockets, 35-37 random-fragmentation, and lethality, 70 Robert, 234 Shock, 318 Round, 3 Shock wave, 242 RPG. See Rocket-propelled grenade (RPG) Shot, 84 Shrapnel, Rule of Nines, 340 Shunting, and lung hemorrhage, 308 Rupture modulus, 130 Silvadene, 357,367 Rusca, Franchino, 233 Silver 357 Single-shot rifle, 7 Skeletal muscle damage Sabot, 27 and resistance to infection, 173, 177 Sagger, 229 Skin grafts, Scaled distance, 246 advances in, 339 Scaling effect, 135 Skull injury Scaling laws, 246-247 explosive wounds, 98 Second-degree bum, 342 and mortality from blast, 226 Schardin, Hubert, and wound ballistics, 144-146 Second echelon of care Slugs, 22 for ballistic wounds of soft tissue, 195 Small arms 4-14 for casualties with primary blast injury, 299-300 blow-back operation, 14 definitive physical examination, 299 developmental trends, 14-15 diagnostic screening, 299-300 firing sequence of, 13 stabilization and life support, 299 gas operation, treatment, 300 historical development of, 6-12 Secondary blast injury, 222, 242, 272,296 mechanisms and operations of, 12-14 fragmentation, 227 parts of, 12-13 Secondary closure of soft-tissue wounds, recoil operation, 13-14 Secondary explosives, 245 Small-arms ammunition, Secondary intent. Healing by secondary intent design and construction of, 6 Secondary missiles, 23-27 measurement of, 4

392 Index

military objectives of, in gastrointestinal blast injury, 324 tactical conditions, ot penetrating wounds, Y 1-93 velocity of. 4 for soft-tissue wounds, 94-95,188-1 89 Soft-tissue wounds in World War 11, 93 and research of, 99-100 Seealso Debridement; Management of ballistic wounds and cavitation, 96 of soft tissue; Management of injury infection rates, 95 Suture, primary and secondary techniques, 209 in Vietnam War, 95 Suture material. 174 in Yom Kippur War, 95 Systemic antibiotics, I management of, 93-95 mortality rates, 94 and sepsis prevention, 94 Tachycardia, 30I and results, 94-95 Tachypnea, 301.304 See also Management of ballistic wounds of soft tissue; Target media Wounds; Wound Physics and as experimental variable in wound ballistics, 96 biophysics TBSAB (total body surface area burned), 342 27 Temporary cavitation. 76, 234 and aspiration of foreign material, 101 Specific 224 contemporary research, 101 Spitzer bullets. 90 See also Cavitation: Relative Incapacitation Index (RII): wounding effects, 1 Wound ballistics: Physics and biophysics Spleen Temporary cavity, 77 and pathology of primary blast injury, 289 and projectile velocity, 101 Stability, of projectile, 18, determinants of cavity dimensions, center pressure I energetics of, 131 fin stabilization. 118 size and energy transfer, 100 gyroscopic stabilization, 14 also Wound ballistics: Physics and biophysics internal and external ballistic factors, 117 Temporary threshold shift (TTS),325,326 precession and yaw, I 17 319 rifling, Tensile strength, 262 stability equation. Tension. 262 tumbling, 114 Tension pneumothorax Stabilization. Management of primary blast injury; Wound definition, 300 ballistics: Physics and biophysics risk of. with mechanical ventilation, 31 1 State of a gas, 242 and triage, I Static (side-on) pressure, 249 and tube 303,304,305 Stopping power, 73.76 Tension wave, 258 See also Relative Incapacitation Index (RII) Terrorist bombings, 222-226 Streptococcal myositis, 182,21 1-212 and explosive location, 224 See also Anaerobic infections; Gas gangrene morbidity and mortality, 222-226 Strew points, 262 and primary blast injury, 226 Stripped-epithelium lesions, 280-282 Tertiary blast injury, 222,242,272,296 Subcaliber. 27 Testicles Subcutaneous emphysema. and pathology of primary blast injury, Submachine gun, 9 Tetanus Sulfamylon, 186, 338,357.367 in casualties' soft-tissue ballistic wounds. 2 Antibiotics, sulfonamides See also Anaerobic infections: Gas gangrene Suppuration Tetracycline of penetrating wounds, 84, in Vietnam, 95 and sulfonamides, effects, 16 Surgical treatment Bum care history: Management of burn injury: for ballistic wounds of soft tissue, 204-209 Pathophysiology of bums and combat conditions, 93 Thermal injury. See Bum care history; Bum injury; Management epluchage, 9 I of burn injury; Pathophysiology of burns

393 Blast, Burn

Thcrmorcgulation Undcrwatcr blast, 242, 258 260 and response to bum injury, 347 and gastrointestinal casualties, 3 19-320 Third-degree hum, 342 research, Third echelon of care resulting injury. 231-232 for ballistic wounds of soft tissue. 195 Upper airways for casualties with primary blast injury, 300 compromise of, and triage, 301 Thoracic injury and pathology of primary blast injury, 282-283 from blast effects. 223 See also Lungs; Respiratory system and mortality. 225 Urinary bladder Threshold overpressure, 255 and pathology of primary blast injury. 289 Tidal volume. 308 Tinnitus, 326, 327 Tolerance to air blast, 253-258 Vacuum 37 Topical antimicrobials, 191, 369 Vaporific effect, 229 Torque. 114 Velocity Total 249 of fragment, resulting incapacitation, 74-75 98 Velocity of projectile. 4-5. TOW 229 as experimental variable, 96 Tracer round, 5 and kinetic energy, Trajectory and wound severity. 95-100 of fragment, and effect, 74-75 Ventilation. See Mechanical ventilation of projectile, 108 Vertigo, 326, 327 Traumatic lung cysts. 300 Vesicants. 372-373 Treatment. Management of ballistic wounds of soft arscnicnl 372-373 Management of hum injury; Management of primary blast injury mustard gas, 372 Trendelenhurg position nitrogen mustards, 372 contraindicated. with air embolism, 312 See also Chemical warfare Triage. See Management of primary blast injury: Overtriage; Vestibular dysfunction, 326 Undertriage Viscoelastic thorax model, 261 Trigger, 13 Volume bombs. 37 Triple point, 1 Volume replacement, 303-304 Troop health in air embolism. 312 and treatment results, 95 animal research, 303 Trueta, Raspall, Jose, 92, 93, 177 in hyporension, 3 18, 319 Truncal injuries in shock, 3 18 and mortality from blast, 224 See Fluid resuscitation TTS. See Temporary threshold shift (TTS) Von Karl. 2. albuginea and pathology of primary blast injury, Twist, 117 Warhead, Tympanic-membrane rupture, 325, 326 Wave propagation, 243 definitive physical examination, 327 Wave speed. 243 diagnostic screening procedures, 329 Wavefomi. See Pressure waveform; Primary blast injury: Physics evacuation needs, 326-327 and mechanisms initial physical examination and triage, WDMET. See Wound Data and Munitions Effectiveness Team in Northern Ireland. 229 (WDMET) from primary blast injury, 226,272, 290-291 Weapon noise, 242 treatment, 329-330 Weapons development See Auditory system; Hearing loss and wound severity, 95 See also Weapons of conventional land warfare Ultimate strength, 263 Weapons effectiveness, 53-80 Underhill, Frank, 338 distributed by weapon or projectile Undertriage, 298 in Bougainville Campaign 58-60 impact on mass casualties, 224 InBritishcasualties InNorthern Ireland(

394 present), and biophysics; Management ballistic wounds of soft inBritishdatafrom Normandy invasion tissue 60-6 Wound ballistics: Physics and biophysics. 108-159 German-Russian front energy trnnsfcr in intcrnction in in Israeli casualties in Israeli-Lebanon War 120-130 (I 67-68 and projectile characteristics. 30 deformation. 126 62-64 fragmentation, in casualties Vietnam shape at impact, 123-126 64-67 stability, 126-129 in U.S. casualties in World War 61-62 velocity. 129-130 and echelons of mcdical care. 71-72 total energy transfer, 120-123 of foreign 78-80 nonuniform energy transfer, medical asscssmcnt critcrin for, 7 1-72 122 See Casualty generation: Incapacitation; Injury se- wound profile, 122-123 verity; Lethality mechanisms of energy transfer in tissue, 130-136 Weapons of conventional land warfare, 2-50 cutting, 130 characteristics. 5 heating, 130, 136 ammunition. pressure transients around temporary cavity, developmental trends, 14-15 I35 historical development, stress waves, 135-136 mechanisms and operations, 12-14 stretch and shear, explosive munitions, 1547 determinants of cavity dimensions, munitions with antipersonnel ef- 135 fects, 27-3 1 energetics of cavity formation, 13 antipersonnel exploding munitions, gross characteristics, 13 35 ordnance using explosive munitions. 3147 cavitation, flame and incendiary munitions, 48-50 organ-specific wounds, 144-155 flame munitions, 4849 abdomen, 149-152 weapons. 49 brain, phosphorus-containing munitions. 49-50 chest, 146-149 See White phosphorus heart, Weapons technology lungs, and 70 extremities, White phosphorus. 49-50,340,370 blood vessels, 154 Wilson, Louis, 99 bone, I 52-154 Woodruff. Charles, I44 nerves. 154-155 Wound skull. definition, 54 permanent cavity, 140 Wound Ballistics, 98. I projectile characteristics, 108-1 Wound ballistics coefficient of drag, and cavitation, 96 drag, 112-1 13 data collection, kinetic energy. 1 12 definition, 108 mass, and gelatin tissue simulant. 97 shape, history. 85-87, 87-95 stability, 114-1 85-87 velocity, 1 Pierre Joseph, 86 projectile penetration, Hunter, John, soft-tissue ballistic wounds, 139-142 Larrey, Dominic Jean, pathomorphology, 140 Pari, Ambroise, 85 permanent cavity, 140 research, 96-102 zones of extravasation and concussion, in China, 142 See Penetrating injuries: Wound ballistics: Physics tissue damage, by debrided muscle,

395 Wound wounding, 73 theoretical basis for, between wars. 93 and weapons 57 Wound contamination and wound-tract morphology, infections, Wound management bacteriology. 178-188 and kinetic energy, 95 and environmental factors, 91, Wound morphology in soft tissue and differing bullets, 188, 199-202 mechanics, 167 Wound profile, 122-123 type and magnitude, 70 Wound severity temporal relationship between, and sepsis. and kinetic energy, 95 and weapons development, See Infection; Management of ballistic wounds of Wound tract, 171-173 soft tissue; Sepsis and drains, 174 Wound and Munitions Effectiveness Team (WDMET), Y5, Wounded 227 definition. 54 and abdominal injury, 150-152 98 and Man, 75-76 and lethality, and migrating projectile, 213 Xenograft, 339, 364 and casualties, 48 and primary blast injury, and pulmonary injury, Zuckennan, 100

GOVERNMENT PRINTING OFFICE 1991 0 - 250-233 QL 1 396 PIN :