DOI:10.2214/AJR.06.1433
AJR 2007; 189:W47
© American Roentgen Ray Society
Suicide Bombers Are Not Explosives!
Zane Sherif and
Michaels Molloy
St. Michaels Hospital Dun Laoghaire, Ireland
Connolly Hospital Dublin, Ireland
WEB—This is a Web exclusive article.
Benjaminov et al. [1], in
their recent article, describe the comprehensive role of a radiology service
in evaluating terror attack victims. They do, however, err in describing the
types of explosives that are usually involved in such attacks as
"remotely controlled explosives and suicide bombers." Explosives
are categorized as high-order or low-order explosives. High-order explosives
are chemical materials with a high reaction rate or detonation that converts
the material almost instantaneously into a gas at high pressure and
temperature, thereby creating a blast wave. Low-order explosives are designed
to burn and thus release energy more slowly; these are often called
propellants because they are most commonly used to propel projectiles through
barreled weapons. Explosives may also be characterized based on their source
as either manufactured or improvised. Both of the types referred to by
Benjaminov et al. may be high or low order, and they are most likely
improvised devices. What Benjaminov et al. refer to in the first instance is
the triggering mechanism of the device or explosive and in the second instance
is the delivery method of the explosive.
Far more relevant in this era is the second example, namely suicide
bombers. Of prime importance to survivors of such terror activities is whether
they have been exposed to infectious diseases in the form of "body part
shrapnel" from the bomber, thereby bringing a whole new dimension to the
phrase dirty bomb [2].
Physicians will, of course, perform primary and secondary surveys, treating
victims according to ATLS (advanced trauma life support) protocols. However,
occult microbiological injuries are difficult to diagnose in such settings and
may not even be considered in the initial triage onsite in the walking-wounded
group, some of whom may not go on to receive definitive medical care. Metal
shrapnel should be easily recognized on radiographs or CT images to localize
fragments [3]; however, foreign
bodies or bone from other victims or the bombers could be far more difficult
to diagnose if present at the site of a compound comminuted fracture. The
Israeli Ministry of Health has recently ordered that injured patients in
bombings should receive active immunization against hepatitis B
[4]. Apparently minor injuries
may not be so minor when one considers the potential exposure a patient with
broken skin may have had after a bombing.
References
- Benjaminov O, Sklair-Levy M, Rivkind A, Cohen M, Bar-Tal G, Stein
M. Role of radiology in evaluation of terror attack victims.
AJR 2006; 187:609
-616[Abstract/Free Full Text]
- Eshkol Z, Katz K. Injuries from biologic material of suicide
bombers. Injury 2005;36
: 271-274[CrossRef][Medline]
- Shaham D, Sella T, Makori A, Appelbum L, Rivkind AI, Bar-Ziv J. The
role of radiology in terror injuries. Isr Med Assoc J2002; 4:564
-567[Medline]
- Braverman I, Wexler D, Oren M. A novel mode of infection with
hepatitis B: penetrating bone fragments due to the explosion of a suicide
bomber. Isr Med Assoc J 2002;4
: 528-529[Medline]
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