Blast injuries occur when the body is suddenly exposed to a surge in air pressure from an explosion. The shock wave can rupture the delicate air sacs of the lungs, damage the ears, brain, heart and abdominal organs, and cause bleeding that is not obvious from the outside. Fragments and falling debris add cuts, burns and fractures. The most important rule is that people near an explosion can be seriously injured even when they look well, so all of them need medical assessment.
Signs of Blast Injuries
- Difficulty breathing, and coughing with pink or blood-stained sputum
- Chest or abdominal pain
- Nausea or vomiting
- Cold, pale and sweaty skin with a rapid, weak pulse
- Anxiety, restlessness and thirst
- Drowsiness that can progress to unconsciousness
- Bloodshot eyes and small red spots on the face, neck or chest
- Ringing in the ears or hearing loss
- Black stools with a strong smell, indicating bleeding from the bowel
Lung and bowel damage may not appear for hours.
Scene Safety First
Do not rush into a blast scene. Move away from fire, unstable structures, fumes and the possibility of a second explosion. Wait for emergency services to declare an area safe and follow their instructions. Once you reach a patient, begin the DRABC primary survey.
Blast Injuries First Aid for a Conscious Person
- Call the emergency number and report an explosion with multiple casualties if applicable.
- Help the person into a comfortable position. Sit them upright if they struggle to breathe. Otherwise lay them down and raise the legs.
- Reassure and loosen tight clothing.
- Control bleeding and cover wounds. See severe bleeding first aid.
- Treat burns by cooling and covering them, and look for penetrating wounds, as explained in our sucking chest wound guide.
- Keep them warm but not hot and give nothing by mouth.
- Check pulse, breathing and alertness every five to ten minutes and record them.
If the Person Is Unconscious
Clear the airway and check breathing. If breathing normally, place them in the recovery position and keep watching. If not, begin CPR. Seek urgent medical help for anyone who is unresponsive.
Why Everyone Exposed to Blast Injuries Needs a Medical Check
Primary blast injury affects air-filled organs, so lungs, ears and bowel are most at risk. A person can walk away from the scene and deteriorate later, and internal bleeding cannot be controlled without surgery. Anyone who was close to a blast, who was thrown, or who has breathing symptoms, abdominal pain or hearing problems should be taken for assessment.
Other Injuries That Come With Blast Injuries
Explosions rarely cause pressure injury alone. Flying fragments cause penetrating wounds, collapsing structures cause crush injuries and fractures, and heat produces burns. Hearing damage is common, so speak clearly, face the person and use gestures. Anxiety and confusion are normal reactions, so stay calm and keep the person informed. Mark the time of the explosion and each change in the person’s condition, because the crew will need this information to prioritise treatment.
Frequently Asked Questions
Can a blast injure the lungs without any outer wound?
Yes. The pressure wave can damage the lungs and other organs even when the skin looks unbroken.
Should I move a blast casualty?
Only if the location is dangerous or you need to reach the airway. Otherwise, treat where they are and wait for rescuers.
References and Further Reading
- American Heart Association and American Red Cross, Guidelines for First Aid
- NHS, Blast injuries and trauma
Last updated: October 2026
Prepared by: EHS Guidelines Editorial Team
This article is general educational information and is not a substitute for accredited first aid training or professional medical care. In an emergency, call your local emergency number immediately. Emergency numbers, medicines and protocols differ between countries, so follow local guidance.
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