As hospitals across Israel assess casualties from recent ballistic missile impacts, critical care specialist at Rambam Health Care Campus (Rambam) highlight the unique dangers of blast trauma—injuries that may progress silently long after impact.
Experts from Rambam are warning of ongoing risks following the direct impact of recent missile strikes across Israel that exposed civilians to powerful explosions. Although many of the individuals treated in emergency rooms throughout Israel have visible injuries such as lacerations, fractures, or shrapnel wounds, a Rambam specialist emphasise that blast pressure itself remains the most dangerous and least detectable threat.
Professor Yaron Bar‑Lavie, Rambam’s director of the Coronary Care unit and former director of the Division of Critical Care Medicine, and chair of the Israeli Society for Critical Care Medicine, describes the phenomenon known as “blast injury.” Unlike shrapnel or fractures, this type of injury leaves no external marks but can cause systemic collapse.
A 500-kilogram warhead, makes an impact, it rapidly expands into a high pressured gas
Injuries are often more severe in dense urban environments. When an explosive device, such as a 500-kilogram warhead, makes an impact, it rapidly expands into a high-pressure gas, producing a surge of extreme pressure waves, followed by an abrupt vacuum. These waves may dissipate in open areas; however, in built environments, walls act as reflectors, repeatedly bouncing secondary pressure waves back onto victims. Secondary hazards, such as flying glass and structural instability, can impact residents even in buildings relatively far from the impact zone.
Professor Bar-Lavie explains that blast‑related trauma affects the body on several levels. Organs that contain air — particularly the lungs, intestines, and middle ear — are vulnerable to sudden pressure changes, which may result in tearing, perforation, or progressive internal injury. Additional mechanisms, such as heat exposure, inhalation of smoke, flying debris, and forceful bodily impact, further complicate the clinical picture. Many of these injuries do not present immediately and may worsen over several hours.
Damage to internal organs can develop slowly
Patients exposed to blast waves may present with relatively minor injuries, but damage to internal organs can develop slowly. Visible wounds do not necessarily reflect the severity of underlying trauma.
Professor Bar-Lavie advises that individuals exposed to blast waves undergo early whole‑body CT imaging, accompanied by continuous monitoring to detect delayed changes in respiratory status, Hemodynamic stability, and organ function. Complications such as internal bleeding, infection, and air or fat emboli remain significant concerns that require proactive evaluation.
As Northern Israel’s only Level 1 trauma center, Rambam plays a central role in shaping national standards for the evaluation and management of blast‑related injuries.
Based on a Hebrew language article from N12.
