The war in Ukraine is new. The patterns of injuries in that war are anything but. Since the 1867 invention of the world’s first high explosive, TNT, people have been inflicting these same patterns of blast trauma on each other with regularity. Sometimes it seems like we even do it with eagerness. Every few decades, we concoct a new delivery vehicle to enhance the mayhem, such as cluster bombs or thermobarics, but the underlying physics of an explosion, and the vulnerable anatomies of our softest body parts, has not changed.
At the start of each new war, false claims about blast trauma start to fly as quickly as the shrapnel. A month into this one, we already have leading public figures making inaccurate declarations about how thermobarics “suck” the air out of your lungs. (They don’t, but more on that further down.) Regardless of the level and prevalence of the many misunderstandings about blasts, one thing is inarguably, eternally true: People near explosions might die. Here’s how that really works.
Medically speaking, the injuries from an explosion are neatly categorized into one of four tidy bins, which are labeled by numbers: primary, secondary, tertiary, and quaternary. A blast victim might receive only one type, or they can receive a grab bag of trauma containing any painful mixture of the four.
