{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T01:35:38Z","timestamp":1787621738053,"version":"build-2736575974"},"reference-count":18,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J R Army Med Corps"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:p>The use of explosives by terrorists, or during armed conflict, remains a major global threat. Increasingly, these events occur in the civilian domain, and can potentially lead to injury and loss of life, on a very large scale. The environment at the time of detonation is known to result in different injury patterns in casualties exposed to blast, which is highly relevant to injury mitigation analyses. We describe differences in pelvic injury patterns in relation to different environments, from casualties that presented to the deployed UK military hospitals in Iraq and Afghanistan. A casualty on foot when injured typically sustains an unstable pelvic fracture pattern, which is commonly the cause of death. These casualties die from blood loss, meaning treatment in these should focus on early pelvic haemorrhage control. In contrast, casualties injured in vehicle present a different pattern, possibly caused by direct loading via the seat, which does not result in pelvic instability. Fatalities in this cohort are from injuries to other body regions, in particular the head and the torso and who may require urgent neurosurgery or thoracotomy as life-saving interventions. A different strategy is therefore required for mounted and dismounted casualties in order to increase survivors.<\/jats:p>","DOI":"10.1136\/jramc-2018-000977","type":"journal-article","created":{"date-parts":[[2018,12,22]],"date-time":"2018-12-22T20:04:17Z","timestamp":1545509057000},"page":"15-17","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Environment at the time of injury determines injury patterns in pelvic blast"],"prefix":"10.1136","volume":"165","author":[{"given":"Claire Elizabeth","family":"Webster","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Clasper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I","family":"Gibb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S D","family":"Masouros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,12,22]]},"reference":[{"issue":"3","key":"2020050722374618000_165.1.15.1","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.injury.2015.12.021","article-title":"40 years of terrorist bombings - A meta-analysis of the casualty and injury profile","volume":"47","author":"Edwards","year":"2016","journal-title":"Injury"},{"key":"2020050722374618000_165.1.15.2","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-2014-000245"},{"key":"2020050722374618000_165.1.15.3","doi-asserted-by":"crossref","unstructured":"Covey DC , Ficke JR . Blast and Fragment Injuries of the Musculoskeletal System,\u201d in Orthopedics in Disasters, Berlin, Heidelberg: Springer Berlin Heidelberg, 2016:269\u201380.","DOI":"10.1007\/978-3-662-48950-5_25"},{"key":"2020050722374618000_165.1.15.4","doi-asserted-by":"crossref","unstructured":"Edwards DS , Clasper J . \u201cBlast Injury Mechanism,\u201d in Blast Injury Science and Engineering, Cham: Springer International Publishing, 2016:87\u2013104.","DOI":"10.1007\/978-3-319-21867-0_6"},{"key":"2020050722374618000_165.1.15.5","doi-asserted-by":"crossref","unstructured":"Singleton JA , Gibb IE , Hunt NC , et al . Identifying future \u2019unexpected' survivors: a retrospective cohort study of fatal injury patterns in victims of improvised explosive devices. 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Characterization of lower extremity blast injury. Mil Med 2018.doi:10.1093\/milmed\/usx126","DOI":"10.1093\/milmed\/usx126"},{"key":"2020050722374618000_165.1.15.12","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1016\/j.injury.2012.05.001","article-title":"Lower limb injuries caused by improvised explosive devices: proposed \u2019Bastion classification' and prospective validation","volume":"45","author":"Jacobs","year":"2014","journal-title":"Injury"},{"key":"2020050722374618000_165.1.15.13","unstructured":"Webster C , Masouros S , Gibb I , et al . Fracture patterns in pelvic blast injury: a retrospective analysis and implications for future preventative strategies. 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