Explosive munitions injure through four major mechanisms. The number of mechanisms a person is exposed to depends on their distance from the explosion, with persons closer to blasts being exposed to more mechanisms of injury. (See Figure 2 below.) Primary blast injuries occur from a pressure wave known as a blast wave. The blast wave can sheer off tissue, damage solid organs, and damage hollow viscus injuries from pressure changes in the air contained within the organs. These injuries may manifest several days after the blast and are typically discovered on serial examinations of the injured patient. Secondary blast injuries are penetrating injuries which result from particles contained within the munition or from debris from the surrounding environment distributed by the blast. Tertiary blast injuries comprise two subtypes of injury. The first is a negative pressure wave called a blast wind which follows the positive pressure of a blast wave. Similar injuries are produced by both blast wind and blast waves. The second subtype of injury is blunt trauma resulting from large objects being projected into a body, or a person’s body being projected into the surrounding environment, like a wall or the ground. When a blast hits a vehicle, occupants are susceptible to being injured by sequential pressure waves as they reflect around the inside of the vehicle. Quaternary blast injuries also comprise two major subtypes. The first subtype is burn injuries, which are treated as outlined in the JTS Burn Care Clinical Practice Guideline. The second are CBRNE injuries (Chemical, Biological, Radiological, Nuclear, and Environmental Injuries) and are managed as outlined in CBRNE guidelines.