Doctors need more training to deal with the victims of bomb blasts given the current threat of terrorism, a Lancet paper says.

一篇柳叶刀报纸称，在当前恐怖主义的威胁下，医生需要为炸弹爆炸的受害者进行更多的训练。

The bombing of a London bus took place outside the doctors\' union

The injuries wrought¹（工作） by explosive devices are unique and the chances of survival depend greatly on recognition, US doctors write.

From air entering the arteries² to serious damage to the bowel³（肠） wall, the wounds can be diverse（不同的，相异的）.

UK experts agreed there was an urgent need to understand these injuries.

Figures on terrorism are notoriously（臭名昭著地） controversial in part due to varied⁴ definitions of what constitutes a terrorist act.

But doctors from the Denver Health Medical Center cite "conservative estimates" suggesting such events have risen four-fold from 1999 to 2006 worldwide.

"Special-interest, militant⁵, and extremist groups have realised the profound effect explosions can have in civilian⁶ settings. Nightclubs, trains, subways, planes, and other popular sites have been targeted in recent years by these groups and caused substantial civilian casualties," wrote lead author Stephen Wolf, an emergency medicine specialist.

"Health-care systems must be able to provide care for the people and communities that are affected⁷. Thus, every physician involved with emergency care needs to understand the unique injury patterns and management of people injured by an explosion."

Pressure wave

It is the pressure caused by blasts as air is displaced - generating winds of of several hundred km/h - that causes injury. If a person is standing⁸ next to a wall or in a contained space the blast pressure is intensified⁹ as the wave "reflects back".

This pressure can causes immense damage within the body, particularly those with a direct airway¹⁰ outside the body, for instance the gastrointestinal system（肠胃系统） and the lungs.

Between 17 and 47% of people who die after an explosion have evidence of these pressure injuries in their lungs.

The doctors highlight the problem of potentially fatal arterial（动脉的） air embolisms（栓塞）, when air enter the arteries - seriously reducing blood supply.

In the gastrointestinal system, blast injuries can cause damage to the bowel wall and disrupt blood flow to the intestines¹¹（肠）, requiring particular care.

In the UK, which has a longer history of bomb attacks than the US, there has long been recognition of the need to understand the specific nature of bomb wounds, experts say.

"But there is now an increased risk, and doctors need to be prepared to manage such cases. This paper provides a level of detail which really raises the bar," says Dr John Heyworth, president of the College of Emergency Medicine.

"It has to be a key part of training. Of course you'd hope you would never need it, but doctors often have to be well versed¹² in（精通，熟练） things that they may never in fact see in the course of their career."

Bombings in London four years ago led to calls for all doctors to receive more training in blast wounds. Non-emergency doctors were among the first on the scene when a bus exploded outside BMA House, home of the doctors' union.

But one specialist from Israel said his country's experience illustrated¹³ that good organisation¹⁴ was as crucial as the knowledge and understanding of the injuries inflicted¹⁵（加害，科以）, and potentially more difficult to achieve.

"Most important of all, I believe, is the understanding that blast injury usually occurs in the context of a mass casualty incident, the logistics of which are vastly different than the care of an individual patient, and this is the emphasis we are bringing forward: how to provide the best of care under adverse¹⁶（不利的） conditions," said Dr Pinhas Halperin, head of the Department of Emergency Medicine at Tel Aviv Sourasky Medical Center.

"We assume that the medical aspects are easily learned, while the organisational aspects, the functioning of the individual in the context, need constant drilling beyond the normal scope of training of both doctors and paramedics（护理人员）."