ACEP ID:
Background
Victims presenting from the scene of an explosive event, as well as those participating in recovery and transport efforts, including first responders, are at risk of exposure to bloodborne pathogens via body fluids and foreign bodies such as bone, contaminated weapon fragments, or other debris. For victims near the scene of an explosive event, biological foreign bodies such as bone can become projectiles that contribute to the spectrum of blast injury.
As noted in the U.S. Public Health Service guidelines for occupational exposure of health care workers, exposure to blood and other body fluids increases the risk of exposure to hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).
Clinical Presentation
Individuals presenting from the scene of a bombing can subsequently be categorized into one of three major risk categories for exposure to blood or bodily fluids:
- Category 1. Penetrating injuries or nonintact skin exposures
- Category 2. Mucous membrane exposures
- Category 3. Superficial intact skin exposures without mucous membrane involvement
Initial Management
See Table 1 for summary.
Table 1. Recommended post-exposure management by risk category and specific pathogen
Risk Category | HBV | HCV | HIV |
Category 1. | INTERVENE | CONSIDER TESTING | GENERALLY NO ACTION |
Category 1. | INTERVENE | GENERALLY NO ACTION | GENERALLY NO ACTION |
Category 1. | NO ACTION | NO ACTION | NO ACTION |
Special Considerations regarding PEP Recommendations
Consultation from health care specialists knowledgeable about HBV, HCV, and HIV is ideal, in particular for pediatric patients and pregnant women. Health care professionals should be knowledgeable about consulting existing guidelines and recommendations regarding contraindications and precautions, counseling and education, testing, medical follow-up and, if PEP is initiated, management of adverse events. In addition, it should be recognized that following these recommendations in response to a mass casualty event could create a hepatitis vaccine demand that exceeds local resources.
Special Considerations regarding HIV PEP Recommendations
This fact sheet is part of a series of materials developed by the Centers for Disease Control and Prevention (CDC) on blast injuries. For more information, visit CDC on the Web at: www.emergency.cdc.gov/BlastInjuries.
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
June 2009