Introduction to Ballistic, Blast and Burn Injuries



It is imperative for medical personnel to understand the forces at work when casualties are sustained as a result of the use of modern weapons of war.  This knowledge will allow the soldier medic to accurately assess the nature and extent of injuries that a casualty has sustained and to render more effective treatment and evacuation decisions.  The end result will be a reduced died of wounds rate and morbidity from these injuries.

Introduction to ballistic, blasts, and burns injuries

Medical personnel

(1)        Historically ignored weaponry believing that this knowledge had little relevance to being able to perform their job

(2)        Believed in some way conflicted with the status accorded medical personnel under the Geneva Hague treaties


Medical personnel should know how weapons are used and understand their effects on the human body

(1)        Medical personnel are required to protect and defend the lives of their patients

(2)        Medical personnel will be better able to treat the casualties that they encounter

(3)        Enables medical personnel to more accurately predict the number and type of casualties that may result from a combat action so that adequate medical support can be arranged

(4)        Can lead to development of countermeasures and protective equipment


Three types of wounding agents common to all weapons systems employed in conventional warfare

            (1)        Projectiles (bullets) that are fired from small arms

            (2)        Primary and secondary missiles created by explosive munitions

            (3)        Flame and incendiary chemicals used in incendiary munitions


Identify small arms, wounding agents and their effects


Small arms:

Individual or crew served weapons (pistols, rifles, and machine guns) that fire solid projectiles, which have a diameter of 20mm or less


The trend in small arms development weapons capable of generating multiple casualties either by firing more rounds or improved munitions, which will generate multiple casualties per round, fired.


The rationale:

(1)        If a casualty receives multiple random wounds from a weapon, the likelihood that a critical organ will be injured is greater than if the victim were hit with only one projectile

(2)        Weapons that cause multiple wounds require an opponent to use more resources and personnel to treat and evacuate their casualties


Small arms designs commonly found in use today

(1)        Pistols: weapons that may be employed using one or both hands.  The ammunition used in pistols is of relatively low velocity and modest lethality.

(2)        Submachine guns: shoulder fired weapons designed to be fired in either a semi or fully automatic fire mode.  They use pistol caliber ammunition and are usually issued to specialized personnel.

(3)        Shotguns: shoulder fired, pump action or semiautomatic weapons which discharge multiple spherical shot or flechette projectiles with each round fired

(4)        Assault rifles: shoulder fired weapons that are capable of semi or fully automatic fire (e.g. M-16A2, AK-47).  Principle weapon of infantry forces and snipers.

(5)        Machine guns: fully automatic, individual or crew served weapons used to suppress enemy fire rather than hit specific targets.  Three categories of machine guns:

(a)        Light (e.g. M-249 Squad Automatic Weapon, SAW)

(b)        General purpose (e.g. M-60 General Purpose Machine Gun, GPMG)

(c)        Heavy (e.g. M-2 Heavy barrel .50 cal Machine Gun, HMG)


Wound causing agent from small arms fire is the projectile or bullet, which is discharged when the weapon is fired.


Severity of wounds is dependent on several factors:

(1)        Caliber (size)

(2)        Shape

(3)        Design and construction

(4)        Weight

(5)        Velocity

(6)        Type of tissue struck or impacted

(7)        Fragmentation of the projectile


As a bullet passes through body tissue it produces two mechanisms of wounding. 

(1)        A permanent cavity that is created as a bullet penetrates through and crushes the tissue in its path

(2)        A temporary cavity which is a stretching of the surrounding tissues that is created as the energy of the bullet is released into the surrounding tissues ahead of the bullet via a sonic shock wave and hydrostatic energy that is created     


Wounds and complications of wounds resulting from small arms may be manifest in a variety of ways, for example:

(1)        Simple penetrating wounds

(2)        Through penetrating wounds with disproportionately large exit wounds

(3)        Fractures, amputations and massive soft tissue injuries when extremities are involved

(4)        Eviscerations and evacuation of body cavities

(5)        Massive soft tissue and internal organ injuries

(6)        Severe blood loss, shock and death


Emergency medical care for small arms wounds is essentially the same as for any other form of trauma and revolves around the soldier medic Core Skills

(1)        Airway

(2)        Breathing

(3)        Circulation (Bleeding is controlled)

(4)        Shock is prevented or treated appropriately (I.V. therapy is initiated if appropriate)

(5)        Evacuation is accomplished in a timely manner (Ongoing care is provided en-route)


Identify explosive munitions, wounding agents and their effects


Explosive munitions:

Consist of explosive projectiles and other explosive devices such as bombs, rockets, grenades, and mines that are fired from ordnance (e.g. Artillery pieces and cannons), dropped from aircraft, launched (e.g. Multiple Launch Rocket System), thrown, or planted in order to cripple or destroy personnel and equipment


The generic prototype of the exploding munition is the shell


Two basic types of exploding

(1)        Antipersonnel exploding munitions: most commonly encountered in the form of grenades, rockets, bombs, and mines.  They fall into two classifications:

(a)        Random-Fragmentation munitions are munitions where the shell casing splinters unpredictably, and the resulting fragments vary in size, shape and velocity

(b)        Improved-Fragmentation munitions are munitions where the casing is made of a fragmented material that breaks up in a more controlled fashion or they are filled with preformed fragments, which disperse in a much more evenly in the target area

(2)        Antimaterial munitions that have antipersonnel effects

(a)        Kinetic-Energy Antimaterial Warheads (e.g. The Armor Piercing Fin Stabilized Discarding Sabot fired by tanks), these munitions rely on the speed and the density of the projectile to disable or destroy the target.  The principle injuring   mechanisms of the kinetic energy warhead to personnel are:

(i)         The penetrator (Projectile)

(ii)        Fragments from the target when struck

(iii)       Secondary fires

(b)        Explosive Antimaterial Warheads (e.g. Light Anti-tank Weapon LAW, Anti-tank 4 rocket AT4) are most commonly found in the form of a shaped charge or hollow charge warhead. The principle wounding agents from these weapons are:

(i)         Fragments from the casing and or target

(ii)        Blast

(iii)       Flame

(iv)       Secondary fires 


The principle injuring mechanisms of these weapons are caused by a complicated mix of ballistic, blast, and burn injuries.


The type and severity of wounds sustained is primarily dependent on the casualtiesí distance from the epicenter of the explosion.

(1)        Casualties close to the epicenter of the explosion are likely to suffer from all three wound-causing agents of the munition.

(2)        Those casualties who sustain wounds from all three wound-causing agents usually suffer from mutilating blast injury and are not likely to survive

(3)        Those casualties who are farther away from the epicenter are likely to experience a combination of blast from the explosion and penetrating trauma from primary and secondary missiles created by the explosion


Wounds and complications of wounds resulting from explosive munitions

(1)        Ballistic injuries sustained from the primary and secondary missiles created by exploding munitions are in principle the same type of ballistic injuries sustained from small arms fire.  However, the size of the projectile striking the casualty may be considerably larger and the injuries sustained will be proportional in nature. 

(a)        The nature and extent of ballistic injuries generated by explosive munitions will vary considerably.  Examples of factors, which influence these, are:

(i)         Proximity to the explosion

(ii)        Size and shape of the missile or fragment

(iii)       Velocity of the missile or fragment

(iv)       Tissue struck 

(a)        Primary blast injury: due solely to the direst effects of the pressure wave on the body.  The injury from the primary blast is seen almost exclusively in the gas containing organs of the body, with injury to the lungs causing the greatest morbidity and mortality.   

(b)        Secondary blast injury: occurs from penetrating or nonpenetrating injury caused by ordinance projectiles or secondary missiles, which are energized by the explosion and strike the victim

(c)        Tertiary blast injury: results from whole body displacement and subsequent traumatic impact with environmental objects (Trees, buildings, vehicles, etc.)

(d)        Other indirect effects include crush injury from collapse of structures and toxic effects from inhalation of combustion gases   


Burn injuries

From explosive munitions are the result of heat and flame generated by the detonation of the explosive filler material in the munition casing and secondary fires started on the target.  They usually occur when the casualty is at the epicenter of the explosion or the target is burning.  The further the distance from the explosion the less likely that burns will be suffered from the explosion.


Identify flame and incendiary munitions, their agents and their effects

Flame, incendiary, and phosphorus-containing munitions are weapons that use a combustible material source to expel people from strongholds or hidden positions and destroy material 


Although flame and incendiary munitions theoretically constitute separate classes of weapons, they both use fire as the means to achieve the objectives of the user


The fear of being burned is the crucial incapacitating factor in the effectiveness of these weapons


Flame and incendiary munitions and their means of delivery

(1)        Flame munitions

(a)        Aerial delivered such as Napalm bombs

(b)        Flame throwers

(c)        Rocket launched warheads

(2)        Incendiary weapons

(a)        Aerial delivered bombs

(b)        Grenades

(3)        Phosphorus-containing munitions

(a)        Aerial delivered bombs

(b)        Artillery shells

(c)        Grenades

(d)        Phosphorus ignites spontaneously in air at 111.2 degrees Fahrenheit

(e)        Burns at 1,472 degrees Fahrenheit

(f)         Will continue to burn until it is deprived of air and the continued presence of Phosphorus on the skin results in dermal penetration and tissue necrosis.


The wounding agent for all flame, incendiary, and phosphorus-containing munitions is the intense heat and fires that they generate and from fumes produced by the fires

Injuries and complications of injuries produced by flame, incendiary, or phosphorus-containing munitions. 


(1)        First degree burns

(2)        Second degree burns

(3)        Third degree burns

(4)        Smoke inhalation




Identify the medical implications of conventional weapons

The weapons of conventional land warfare are designed to inflict physical harm on personnel by wounding with bullets or fragments, damaging internal organs with blast effects or burns.


Military medical personnel must be adequately prepared to treat all of these types of injury.


Ballistic injuries

Most casualties in modern conventional hostilities are by weapons that cause ballistic wounds.  Although the severity the wound depends to some extent on the nature of the projectile or fragment the most important factor in a ballistic injury is the anatomical site hit.


Blast injuries

May not be obvious to medical personnel. 

As weapons increasingly take advantage of the physical properties of blast waves, medical personnel should be aware that a blast injury may be present in a casualty whose only overt injuries are the more immediately threatening blunt, penetrating or thermal trauma.   



Responsible for relatively few casualties in conventional warfare

Can be so disfiguring and painful

Have serious psychological implications for both combat and medical personnel, as well as intensive medical-resource allocation requirements.



The importance of this information cannot be overstated if the soldier medic is to be successful  

1.  Introduction to ballistic, blast, and burn injuries

2.  Identify small arms, their wounding agents and their effects

3.  Identify explosive munitions, their wounding agents and their effects

4.  Identify Flame and Incendiary Munitions, their agents and their effects

5.  Identify the medical implications of Conventional Weapons