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A 6-kg explosive charge detonated under a seat in the center of a crowded city bus in Jerusalem, killing three passengers immediately. Of the 55 survivors, all of whom were transferred to two major medical centers, 29 were hospitalized. Among those admitted, a high rate of primary blast injuries was found, including perforated ear drums (76%), blast lung (38%), and abdominal blast injuries (14%). Two of the latter patients suffered bowel perforations, which were diagnosed with considerable delay. Eight patients (31%) had sustained life-threatening trauma, consisting of a combination of primary, secondary, and tertiary blast injuries. The overall mortality rate was 10.3%. The large number of primary blast injuries, including the unexpected finding of bowel perforations, is explained by the high amplitude of the air pressure wave (3.8-5.2 atm) and its relatively long duration (2-3 msec) resulting from the detonation of the high-energy explosive charge in the small, enclosed space of the bus. Besides the usual wounds sustained by victims of an explosion that occurs in a confined space, the possibility of primary blast injury to the abdomen and to the lungs should be taken into account by the treating surgeon.
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Eliezer Katz
Psyadon Pharmaceuticals (United States)
Boaz Ofek
Hebrew University of Jerusalem
J Adler
Loewenstein Hospital Rehabilitation Center
Annals of Surgery
Hadassah Academic College
Shaare Zedek Medical Center
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Katz et al. (Sat,) studied this question.
synapsesocial.com/papers/6a093f5536c3abab504592f6 — DOI: https://doi.org/10.1097/00000658-198904000-00016