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,