US Department of Defense
Advancing Blast Injury Research to Protect and Heal Those Who Serve

What is Blast Injury?

A blast injury is a complex type of physical trauma resulting from direct or indirect exposure to an explosion. Blast injuries range from internal organ injuries, including lung and traumatic brain injury (TBI), to extremity injuries, burns, hearing, and vision injuries.

To define the scope of injuries caused by exposure to blast, the Department of Defense (DoD) adopted the Taxonomy of Injuries from Explosive Devices, which is codified in Department of Defense Directive (DoDD) 6025.21E and provides a common framework for characterizing blast injuries within the DoD. This taxonomy assigns blast injuries to five categories—Primary, Secondary, Tertiary, Quaternary, and Quinary-based on the mechanism of injury.

Primary blast injuries

Primary blast injuries

result from the high pressures, or blast overpressure, created by explosions. Blast overpressure can crush the body and cause internal injuries. Primary blast injuries are the only category of blast injuries that are unique to the blast or high pressures that occur and include:

  • Blast lung (pulmonary barotrauma)
  • Tympanic Membrane rupture and middle ear damage
  • Abdominal hemorrhage and perforation
  • Globe (eye) rupture
  • Concussion (mild traumatic brain injury (mTBI) without physical signs of head injury)

Note: The existence of concussions caused by the primary mechanism of blast alone, without secondary or tertiary head impacts, is a topic of continuing debate within the scientific community.

Secondary blast injuries

Secondary blast injuries

result when strong blast winds behind the pressure front propel fragments and debris against the body and cause blunt force and penetrating injuries including:

  • Penetrating ballistic (fragmentation or blunt injuries)
  • Eye penetration
  • Closed or open brain injuries
Tertiary blast injuries

Tertiary blast injuries

result from strong blast winds and pressure gradients that can accelerate the body and cause the same types of blunt force injuries that would occur in a car crash, fall, or building collapse and may include:

  • Bone fractures
  • Traumatic amputations
  • Blunt injuries
  • Crush injuries
  • Closed or open brain injuries
Quaternary blast injuries

Quaternary blast injuries

result from other explosive products (such as heat and light) and from exposure to toxic substances from fuels, metals, and gases that can cause burns, blindness, and inhalation injuries.

  • Burns (flash, partial, and full thickness)
  • Injury or incapacitation from inhaled toxic fumes (breathing problems from dust, smoke, or toxic fumes)
Quinary blast injuries

Quinary blast injuries

refer to the clinical consequences of post-detonation environmental contaminants, including chemical (e.g., sarin), biological (e.g., anthrax), and radiological (e.g., dirty bombs) substances.

  • Chemical burns
  • Radiation exposure
  • Viral or bacterial infections
Last modified: 04-Apr-2023