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Kiriu N, Saitoh D, Sekine Y, Yamamura K, Fujita M, Mizukaki T, Tomura S, Kiyozumi T. Effectiveness of Body Armor Against Shock Waves: Preventing Blast Injury in a Confined Space. Cureus 2024; 16:e57568. [PMID: 38707053 PMCID: PMC11069021 DOI: 10.7759/cureus.57568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Blast injuries in modern society often occur owing to terrorist attacks in confined spaces, particularly in urban settings, indoors, and in vehicles, leading to significant damage. Therefore, it is important to focus on blast injuries in confined spaces rather than in conventional open-field experiments. Materials and methods We used an air-driven shock wave generator (blast tube) established indoors in 2017 and conducted basic research to potentially save the lives of patients with blast injuries. Under general anesthesia, pigs were divided into with body armor (BA) and without BA groups. The pigs were fixed in the measurement chamber with their dorsal chest directly exposed to the shock wave. The driving pressure was set at 3.0 MPa to achieve a mortality rate of approximately 50%. A generated shock wave was directly applied to the pigs. Comparisons were made between the groups with respect to cardiac arrest and survival, as well as apnea, bradycardia, and hypotension, which are the triad of blast lung. Autopsies were performed to confirm the extent of the organ damage. Statistical analysis was performed using Fisher's exact test, and statistical significance was set at p<0.05. The animal experimentation was conducted according to the protocol reviewed and approved by the Animal Ethics Committee of the National Defense Medical College Hospital (approval number 19041). Results Eight pigs were assigned to the BA group and seven pigs to the non-BA group. In the non-BA group, apnea was observed in four of seven cases, three of which resulted in death. None of the eight pigs in the BA group had respiratory arrest; notably, all survived. Hypotension was observed in some pigs in each group; however, there were no cases of bradycardia in either group. Statistical analysis showed that wearing BA significantly reduced the occurrence of respiratory and cardiac arrest (p=0.026) but not survival (p=0.077). No significant differences were found in other vital signs. Conclusions Wearing BA with adequate neck and chest protection reduced mortality and it was effective to reduce cardiac and respiratory arrest against shock wave exposure. Mortality from shock wave injury appears to be associated with respiratory arrest, and the avoidance of respiratory arrest may lead to survival.
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Affiliation(s)
- Nobuaki Kiriu
- Division of Traumatology, Research Institute, National Defense Medical College, Saitama, JPN
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, JPN
| | - Daizoh Saitoh
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, JPN
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, JPN
| | - Yasumasa Sekine
- Division of Traumatology, Research Institute, National Defense Medical College, Saitama, JPN
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, JPN
| | - Koji Yamamura
- Department of Oral Surgery, National Defense Medical College, Saitama, JPN
| | - Masanori Fujita
- Division of Environmental Medicine, Research Institute, National Defense Medical College, Saitama, JPN
| | - Toshiharu Mizukaki
- Department of Aeronautics and Astronautics, School of Engineering, Tokai University, Kanagawa, JPN
| | - Satoshi Tomura
- Division of Traumatology, Research Institute, National Defense Medical College, Saitama, JPN
| | - Tetsuro Kiyozumi
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, JPN
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Shakargy JD, Gendler S, Talmy T, Shushan G, Radomislensky I, Tsur AM, Almog O, Avital G, Benov A, Gelikas S. Blast Injury Patterns Among Israel Defense Forces Fatalities. Mil Med 2023; 188:e1788-e1794. [PMID: 36205252 DOI: 10.1093/milmed/usac280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/03/2022] [Accepted: 09/09/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The incidence of blast injuries on the battlefield has risen over the last several decades. In order to improve prevention and treatment, it is essential to understand the severity and bodily distribution of these injuries. This study aims to characterize blast injury patterns among IDF fatalities. MATERIALS AND METHODS This is a descriptive, retrospective study on postmortem reports of military-blast fatalities between the years 1982 and 2021. Body regions injured according to the Abbreviated Injury Scale (AIS) were described. The frequency of body region injury combinations was mapped, and the correlation between injured body regions was calculated using Pearson's coefficient. Analysis of a subgroup with a postmortem computed tomography (CT-PM) or autopsy was performed, describing severe (AIS ≥ 3) injury patterns. RESULTS Overall, 222 fatalities suffered from blast injury, with most injuries affecting the upper and lower extremities (63.7% and 66.5%, respectively), followed by the head (57.1%) and the thorax (56.6%). The median number of injured body regions was 4 (interquartile range, 2-5). The most frequent injury combinations were the upper and lower extremities (51%), the upper extremities and the thorax (45%), and the lower extremities and the thorax (41%). In all, 47/222 (21.2%) fatalities had a documented autopsy or CT-PM report. Among the fatalities with CT-PM or autopsy, the head (63.8%) and the thorax (57.4%) were most frequently severely injured (AIS ≥ 3). CONCLUSIONS Among blast fatalities in the military setting, the extremities were most commonly injured. However, data suggest that the head and thorax are more likely to sustain severe blast injuries resulting in mortality. Blast injuries in this cohort were characterized by concomitant involvement of several regions. Development of protective gear to minimize the multisystem injuries inflicted by blast injuries is warranted and should be focused on distinct types and anatomical distribution of severe blast injuries as reported in this study. LEVEL OF EVIDENCE Level III, Retrospective analysis.
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Affiliation(s)
- Josef Daniel Shakargy
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan 02149, Israel
| | - Sami Gendler
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan 02149, Israel
| | - Tomer Talmy
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan 02149, Israel
- Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 91120, Israel
| | - Guy Shushan
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan 02149, Israel
- Ground forces Technology Unit, Tel-Hashomer, Israel Defense Forces, Ramat Gan 02149, Israel
| | - Irina Radomislensky
- The Israel National Center for Trauma & Emergency Medicine Research, Gertner Institute of Epidemiology and Health Policy Research, Tel Aviv 5262000, Israel
| | - Avishai M Tsur
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan 02149, Israel
- Sheba Medical Center Hospital-Tel-Hashomer, Ramat Gan 5262000, Israel
| | - Ofer Almog
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan 02149, Israel
- Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 91120, Israel
| | - Guy Avital
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan 02149, Israel
- Division of Anesthesia, Intensive Care & Pain Management, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
| | - Avi Benov
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan 02149, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel
| | - Shaul Gelikas
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan 02149, Israel
- Sheba Medical Center Hospital-Tel-Hashomer, Ramat Gan 5262000, Israel
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Sekine Y, Saitoh D, Terayama T, Nakamura T, Nemoto M. The survival rate of patients with burns induced by explosions was significantly higher than that of common burn cases: A nationwide observational study using the Japan Trauma Data Bank. Burns 2022:S0305-4179(22)00203-0. [DOI: 10.1016/j.burns.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/06/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
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Duma BG. Special Issue: Concussions. Ann Biomed Eng 2022. [PMID: 35821165 DOI: 10.1007/s10439-022-03009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Yamamura K, Kiriu N, Tomura S, Kawauchi S, Murakami K, Sato S, Saitoh D, Yokoe H. The cause of acute lethality of mice exposed to a laser-induced shock wave to the brainstem. Sci Rep 2022; 12:9490. [PMID: 35676447 PMCID: PMC9177849 DOI: 10.1038/s41598-022-13826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
Air embolism is generally considered the most common cause of death within 1 h of a blast injury. Shock lung, respiratory arrest, and circulatory failure caused by vagal reflexes contribute to fatal injuries that lead to immediate death; however, informative mechanistic data are insufficient. Here we used a laser-induced shock wave (LISW) to determine the mechanism of acute fatalities associated with blast injuries. We applied the LISW to the forehead, upper neck, and thoracic dorsum of mice and examined their vital signs. Moreover, the LISW method is well suited for creating site-specific damage. Here we show that only mice with upper neck exposure, without damage elsewhere, died more frequently compared with the other injured groups. The peripheral oxygen saturation (SpO2) of the former mice significantly decreased for < 1 min [p < 0.05] but improved within 3 min. The LISW exposure to the upper neck region was the most lethal factor, affecting the respiratory function. Protecting the upper neck region may reduce fatalities that are related to blast injuries.
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Affiliation(s)
- Koji Yamamura
- Department of Oral and Maxillofacial Surgery, National Defense Medical College, Tokorozawa, Japan.
| | - Nobuaki Kiriu
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan.,Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Satoshi Tomura
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan
| | - Satoko Kawauchi
- Division of Bioinformation and Therapeutic Systems, Research Institute, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kaoru Murakami
- Department of Oral and Maxillofacial Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Shunichi Sato
- Division of Bioinformation and Therapeutic Systems, Research Institute, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan.,Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Hidetaka Yokoe
- Department of Oral and Maxillofacial Surgery, National Defense Medical College, Tokorozawa, Japan
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Boutillier J, Cardona V, Magnan P, Ogier M, De Mezzo S, Montespan F, Menini W, Mosnier J, Naz P, Prat NJ. A New Anthropomorphic Mannequin for Efficacy Evaluation of Thoracic Protective Equipment Against Blast Threats. Front Bioeng Biotechnol 2022; 9:786881. [PMID: 35155403 PMCID: PMC8828739 DOI: 10.3389/fbioe.2021.786881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022] Open
Abstract
Exposure to blast is one of the major causes of death and disability in recent military conflicts. Therefore, it is crucial to evaluate the protective capability of the ballistic-proof equipment worn by soldiers against the effects of blast overpressure (i.e., primary blast injuries). A focus will be made on thoracic protective equipment (TPE). An anthropomorphic mannequin, called BOPMAN, and anesthetized swine both wearing soft, hard or no ballistic protection, were subjected to an open-field high-intensity blast. For swine, thoracic wall motion (acceleration and velocity) was recorded during blast exposure and severity of lung injury was evaluated postmortem. Different data were collected from BOPMAN thoracic responses, including reflected and internal pressure, as well as the force at the rear face of the instrumented part. The severity of blast-induced lung injuries (contusion extent, Axelsson Severity Scale) and the thoracic wall motion were decreased in animals protected with thoracic ceramic hard plates as compared to those wearing soft or no protection. There was a clear trend towards greater lung injury in animals protected with the soft body armor used, even when compared to unprotected animals. In line with these experimental data, the measured force as well as the force impulse measured using BOPMAN were also decreased with a ceramic hard plate protection and increased when a soft ballistic pack was used compared to no protection. Comparison of data collected on BOPMAN and swine equipped with the same protection level revealed that those two force parameters were well correlated with the level of blast-induced lung injury (force, R2 = 0.74 and force impulse, R2 = 0.77, p < 0.05). Taken together, our results suggest that the force and the force impulse data from BOPMAN may help estimate the efficiency of existing TPE regarding lung protection under blast exposure and may represent an important tool for development of future TPE.
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Affiliation(s)
- Johanna Boutillier
- French-German Research Institute of Saint-Louis (ISL), Saint-Louis, France
- *Correspondence: Johanna Boutillier,
| | - Venetia Cardona
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny sur Orge, France
| | - Pascal Magnan
- French-German Research Institute of Saint-Louis (ISL), Saint-Louis, France
| | - Michael Ogier
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny sur Orge, France
| | - Sébastien De Mezzo
- French-German Research Institute of Saint-Louis (ISL), Saint-Louis, France
| | - Florent Montespan
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny sur Orge, France
| | - William Menini
- French Military Training Hospital Saint-Anne, Toulon, France
| | - Joël Mosnier
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny sur Orge, France
| | - Pierre Naz
- French-German Research Institute of Saint-Louis (ISL), Saint-Louis, France
| | - Nicolas J. Prat
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny sur Orge, France
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