Blast Injury Science and Engineering A Guide For Clinicians and Researchers, 2nd Edition Scribd Download
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Peter F. Mahoney
Centre for Blast Injury Studies
Imperial College London
London, UK
Section Editors
Alison H McGregor Spyros D Masouros
Department of Surgery & Cancer Department of Bioengineering
and Centre for Blast Injury Studies and Centre for Blast Injury Studies
Imperial College London Imperial College London
London, UK London, UK
Arul Ramasamy
Department of Bioengineering
and Centre for Blast Injury Studies
Imperial College London
London, UK
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Foreword
A short walk from the central London campus of Imperial College lies
Sloane Court East. This quiet, tree-lined residential street seems a world
away from our busy university buildings and the work we do in its labora-
tories and classrooms to understand the complex effects of blast injury. Yet
there is a very direct human connection. Anyone walking along Sloane
Court East who cares to look can see two small memorial plaques, one
inserted into the brickwork of a corner wall, and one set into the pavement.
The plaques commemorate the deaths of 77 people who were killed at
07.47 am on 3rd July 1944, when a V1 rocket exploded at the north-west-
ern end of the street. Most of those who died were American service per-
sonnel. It remains the largest single loss of US military life on UK civilian
soil in history. Despite this, the Sloane Court East explosion has been
almost forgotten. Part of this process was deliberate. At the time, there was
heavy press censorship in both Britain and the USA. The operation to lib-
erate Europe, initiated on D-Day (6th June 1944), was less than a month
old. The Allied advance was progressing, but at a slow pace. Neither gov-
ernment wanted their public to hear more bad news than absolutely neces-
sary. Londoners were exhausted by sleepless nights spent dreading the
onslaught of Nazi V1 flying bombs, whose destructive power was both
brutal and inescapable.
The V1 rocket that appeared out of the morning haze over Sloane Court
East on 3rd July carried 850 kg of high explosive in its warhead. Beneath its
path were several six-by-six transport trucks loading up with US service per-
v
vi Foreword
sonnel about to travel to their day’s work at SHAEF offices in central London
or to training camps outside the city. As it was designed to do, the rocket went
silent a moment before gliding into its impact. These few seconds gave some
of the soldiers and civilians just enough time to try to escape, but not enough
for the men in the trucks to scramble out to join them. One young soldier
remembered running around the corner of the street and finging himself to the
ground at the moment of the explosion. He staggered to his feet, ears ringing,
the air around him full of smoke and dust. Around him, other survivors were
also able to stand and stumble back towards the scene of the blast. Although
several of the buildings had been blown apart and there were fires breaking
out in the rubble, many of the dead were lying in the open street, without
crush wounds or other visible signs of injury. One witness remembered run-
ning through 20 or 30 bodies, desperately checking to see if any of them had
a pulse, but their glassy eyes and dead weight told him that they were beyond
his help.
At Sloane Court East, the worst killer had been completely invisible. V1
rocket explosive payloads produced huge blast waves that smashed out at
least 400–600 yards in all directions. In the narrow street, this wave was con-
fined and compressed by the solid stones of the buildings and tarmacadamed
road surface, so its energy was exponentially increased, crashing through
lighter, weaker structures. There was no blast crater where the bomb had
landed, but bricks and masonry close by were pulverised into piles of dust.
The sturdy US trucks and their loads of passengers were lifted into the air and
slammed back on the ground, killing everyone inside. Pedestrians on the
pavement were felled where they stood as the wave tore through their bodies.
Fundamental blast physics explains the vacuum that always follows the initial
blast wave that in turn generates a secondary wave. In Sloane Court East, one
survivor described how it felt to directly experience such an effect where the
building she was in “not only rocked, it did ground loops”. The secondary
wave caused at least three houses and two blocks of apartments to collapse,
trapping many people inside. A first aid post was set up, and survivors pulled
from the ruins of the devastated street, some taking days to be rescued. Later,
the grim business of identifying the dead from the mangled body parts taken
to a nearby morgue was assigned to two young US officers, Lieutenants Riley
and Byleen.1 All the human witnesses to the horror of Sloane Court East are
now long gone. Only its trees remain, planted as saplings in the pavements of
the street in the years before the war, and somehow able to survive the blast
wave’s effects. They can still be seen today, grown as high as the buildings
and apartment blocks that were rebuilt when peace came in 1945.
Because of other wars in our own time, our understanding of blast effects
and injury has been transformed. Blast injury studies have become an estab-
lished and productive part of our academic infrastructure at Imperial College
London, as well as providing a globally influential model for effective multi-
disciplinary co-operation across clinical, medical and bioengineering
domains. We can model, predict and seek to mitigate the invisible wave and
1
Thank you to Alex Schneider, of www.londonmemorial.org, who has preserved the his-
tory of the Sloane Court East explosion.
Foreword vii
its effects. Few mysteries remain. Wherever this work is done, it should be in
the remembrance that blast injury always begins with a blast. Every blast
event comes with the primary, secondary, tertiary and quaternary effects
detailed and analysed so effectively in this volume. We should also be mind-
ful of the other, less quantifiable effects: the horror, agony and fear just before
the darkness and the silence. What for some is the point of wounding is for
many others the point of dying. As we work to secure better ways for human
beings to survive blast injury, we should also honour those beyond our help
but never beyond our memory.
There have been many advances in the field of blast injury research since the
publication of the first edition of Blast Injury Science and Engineering in
2016. As such, we believed that now is the right time to collate the second
edition, allowing us to expand on the content of the book and update several
chapters with important new research and knowledge.
Many of the chapters in this second edition are built on the foundation of
the chapters in the first edition, incorporating additional research to bring
them up to date. We have also added several new chapters and included an
entirely new section on Rehabilitation. We believe that the addition of the
Rehabilitation section is crucial to such a resource as this, given that under-
standing of blast injuries, and importantly their long-term impact, does not
stop at the point of wounding. People’s lives are changed by their injuries and
acknowledgement and collation of the breadth of work being undertaken in
the field of rehabilitation is an important consideration.
The editors would like to thank all those that contributed to the second
edition of the book. This includes more than 60 authors who have given their
time and who have brought together expertise in science, engineering and
medicine, from both military and civilian perspectives. We would also like to
thank the new section editors who worked on this second edition of the
book—Dr Spyros Masouros, Dr Arul Ramasamy and Professor Alison
McGregor.
Finally, we would like to thank all the funders that have enabled the
research which is discussed in this book. In particular, the editors would like
to thank the Royal British Legion who have funded a significant amount of
the research that has come from the authors based at Imperial College London.
We hope you enjoy this second edition of the Blast Injury Science and
Engineering book.
ix
Contents
7 Section Overview������������������������������������������������������������������������������ 93
Peter F. Mahoney and Jon Clasper
8
Weapon Construction and Function���������������������������������������������� 95
Elizabeth M. Nelson
9 Blast Injury Mechanism������������������������������������������������������������������ 103
Jon Clasper and Dafydd Edwards
10
Analysis of Explosive Events���������������������������������������������������������� 115
Maria Bishop, Anthony M. J. Bull, Jon Clasper, Mike Harris,
Karl Harrison, Alan E. Hepper, Peter F. Mahoney, Ruth
McGuire, Daniel J. Pope, Robert Russell, and Andrew J.
Sedman
11 Injury Scoring Systems�������������������������������������������������������������������� 133
Phill Pearce
xi
xii Contents
Part V Rehabilitation
43 Sockets
and Residuum Health�������������������������������������������������������� 447
Matthew Hopkins, Louise McMenemy, Shruti Turner, and
Alison H. McGregor
44 Bone
Health in Lower-Limb Amputees����������������������������������������� 479
Joshua J. Kaufmann, Louise McMenemy, Andrew T. M.
Phillips, and Alison H. McGregor
45 Musculoskeletal
Health After Blast Injury������������������������������������ 489
Anne K. Silverman, Brad D. Hendershot,
and Alison H. Mcgregor
46 Biomechanics
of Blast Rehabilitation�������������������������������������������� 499
Anthony M. J. Bull
47 Pain���������������������������������������������������������������������������������������������������� 507
Paul Wood, Peter F. Mahoney, and Dominic J. Aldington
Glossary���������������������������������������������������������������������������������������������������� 521
Index���������������������������������������������������������������������������������������������������������� 525
Part I
Basic Science and Engineering
Section Overview
1
Spyros D. Masouros
The multidisciplinary nature of blast injury, cov- blast, the behaviour of materials, biomechanics,
ering its pathophysiology, treatment, protection, computational modelling, and biology and physi-
and rehabilitation, requires an appreciation of a ology. The objective is to bring the reader, irre-
broad spectrum of topics in science and engineer- spective of background, up to speed with the
ing. This section covers the science and engineer- clinical, scientific, and engineering aspects
ing foundations required to follow the rest of the required to follow comfortably the contents of
book. It introduces main principles, language, this book.
and techniques associated with the physics of
S. D. Masouros (*)
Department of Bioengineering and Centre for Blast
Injury Studies, Imperial College London,
London, UK
e-mail: [email protected]
and the blast wave travels at a velocity faster than High explosives, correctly called high order
the speed of sound in air. explosives include TNT, HMX, RDX and PETN
Explosives form part of a range of materials often mixed with other chemicals to make the
classified as ‘energetic materials’; other mem- resulting explosive composition more stable, easier
bers of this class include propellants and pyro- to process industrially or fit into cavities within a
technics. The distinguishing feature of energetic munition. When these materials detonate, they
materials compared to other materials is the very release their energy due to the passage of a reactive
fast rate of energy release. This release rate and shock wave. A shock wave is a high-pressure stress
nature of the reaction products determine the use and temperature pulse which moves through the
of the material. material at supersonic speed. In the case of many
The basic chemical components in an explosive compositions used in munitions, the shock wave
are a fuel, an oxidiser and a material that allows a consists of a thin, often sub-millimetre, region
rapid ignition of reaction. In terms of total energy where the explosive turns from a solid or liquid into
released, energetic materials are not particularly a hot, high-pressure gas (Fig. 2.1). The velocity of a
distinguished from other chemical reactions: petrol detonation wave is of the order 5–8 km s−1 and the
and butter release more energy per molecule when energy release rate is of the order of Gigawatts; that
oxidised than tri-nitro toluene (TNT), probably the is the same output as a large electrical plant over the
most famous explosive. This difference is that, time of a few microseconds. The pressure associ-
while petrol needs to be mixed with air and then set ated with detonation waves is many hundreds of
alight, the explosive comes with the fuel and oxi- thousands of atmospheres. The product gases
diser intimately mixed, sometimes with both fuel expand quickly; a rule of thumb gives that the gas
and oxidiser present in the same molecule. The expands ~a quarter of the detonation velocity; it is
chemical or composition used gives information on effectively a 7200 km h−1 wind. It is not surprising
intended application. Materials containing TNT, that such aggressive energy release can be used to
nitroglycerine, pentaerythritol tetranitrate (PETN), shatter and push fragments at high velocities.
cyclotrimethylenetrinitramine (RDX) or tetrahex- Within the class of high explosives, there is a
amine tetranitramine (HMX) are likely to be bulk sub-division between so-called ideal and non-
explosives; these materials produce significant ideal explosives. Ideal explosives have very thin
quantities of hot, high-pressure gas. Compositions detonation-reaction zones where the reaction
using silver azide, lead azide, picric acid and the takes place on a sub-microsecond basis. Ideal
fulminates are sensitive to impact and flame, explosives have a more pronounced shattering
explode relatively easily, and so tend to be used in effect, or brisance, on materials placed in contact
initiators, also called detonators; these materials with them; this class of materials includes
are, however, very sensitive and so it would be TNT. Non-ideal explosives have much thicker
unwise to use them as a main explosive charge. reaction zones and give out their energy over
slightly longer timescales, up to several microsec-
onds. The most widely used explosive in the
world, Ammonium Nitrate: Fuel Oil (ANFO),
falls into this class. The chemical make-up of
ANFO results in much lower pressures of detona-
tion, about a quarter of the pressure seen in high
explosives, producing less shattering effect.
ANFO, however, generates a lot of gas, which
gives the mixture a lot of ‘heave’, the ability to lift
and move the surrounding material. The low deto-
nation pressure means this mix produces cracks in
rocks which are then pushed open, heaved, by the
detonation gas. These materials tend to be used in
Fig. 2.1 Schematic of detonation process the mining and quarrying industry.