Strict rules and regulations should be implemented to control illegal, locally-made, improvised explosive devices such as “Hakka Patas” and “Ali Wedi (elephant cracker)” that cause secondary blast injuries due to primary explosives, in order to prevent both morbidity and mortality.
These recommendations were made in case reports and a picture story on “Injuries due to improvised explosive devices” which were authored by K.M.T.B. Gunathilake (attached to the Office of the Judicial Medical Officer of the Ratnapura District General Teaching Hospital) and M. Vidanapathirana (Dean of the Uva Wellassa University's Medical Faculty) and published in the Medico-Legal Journal of Sri Lanka 11th Volume's Second Issue in December of last year (2023).
The illegal possession of improvised explosive devices, which can be detonated and in turn kill and injure people, is not uncommon. Moreover, civilians, who are unprotected from the blast exposure, can be, as noted in W.B. Hubbard, C. Hall, V.S.S.S. Siva, E. Lavik and P. VandeVord's “Examining the lethality risk for rodent studies of primary blast lung injury”, severely harmed by terrorist attacks including bombings that use improvised explosive devices with foreign bodies.
In Sri Lanka, improvised explosive devices are commonly used for hunting, protecting cultivations, etc. Further, they are also used to commit homicides. An improvised explosive device called “Hakka Patas” is produced by the material that is available in firecrackers and causes pressure sensitive blasts. Another improved explosive device called “Ali Wedi”, a larger firecracker, may cause accidental injuries.
The first case
A 15-year-old child received severe crush injuries on her right foot when she stepped on the ground while walking along a jungle in Ratnapura with her parents. She was rushed to the tertiary care Hospital of the area and the wound was found to be grossly contaminated and the X-rays showed a few irregular, radio opaque, foreign bodies. On the second day, a below knee amputation was performed by the surgeon. According to the relatives, the injuries were alleged to have been caused by a “Hakka Patas” explosion that had been planted on the ground to kill small and medium-sized wild animals.
The second case
A farmer received injuries to his right hand while throwing an “Ali Wedi” to chase away elephants. He was rushed to the nearest tertiary care Hospital and was found to have localised crush injuries to the right index finger. However, due to the gross crush injuries, the surgeon amputated the distal phalanx of the right index finger.
Explosives can be classified into three groups, according to W.W. Porterfield's “Inorganic chemistry: A unified approach”, (a) Materials that detonate are said to be “high explosives” such as dynamite, the Research Department explosive, etc., (b) Materials that deflagrate are said to be “low explosives” such as gunpowder and potassium nitrate, and (c) Materials that can be initiated by a relatively small amount of heat or pressure are primary explosives such as potassium chlorate, arsenic sulphide, etc. “Hakka Patas” and “Ali Wedi” are made up of the explosives of crackers and are sensitive to heat and pressure. Therefore, the type of explosive contained in such improvised explosive devices can be classified as primary explosives.
Use of improvised explosives in SL
In Sri Lanka, improvised explosive devices such as “Hakka Patas” are locally made to kill small and medium-sized animals such as wild boar, deer, and sometimes to damage large animals. “Hakka Patas” is usually hidden in animal fodder. Poachers mix the explosives with small stones and coat them with dried fish particles to lure animals, especially wild boar, but elephants too are often unfortunate victims. “Hakka Patas” are inserted into vegetables such as pumpkins and bring about a slow, painful, and inhumane death to the victim elephant. Since they contain primary explosives such as firecracker powder, the explosion is initiated by a relatively small amount of heat or pressure. For example, when munched by small or medium sized animals or stepped on by heavy animals, they explode. Even though they are used to kill animals, accidental injuries to humans are also not uncommon. Sometimes, they are used to commit homicides as well.
“Ali Wedi” is also a kind of improvised explosive device used to chase away wild elephants but may damage both property and people too. Since they contain primary explosives such as firecracker powder, the explosion is initiated by a relatively small amount of heat or pressure. For example, when a flame is applied, it explodes.
Injuries caused
Blast injuries can be classified into four types, per S.J. Wolf, V.S. Bebarta, C.J. Bonnett, P.T. Pons and S.V. Cantrill's "Blast injuries": (a) Primary blast injuries are those caused by the direct effect of overpressure on a person, (b) Secondary blast injuries are the injuries caused by the effect of projectile fragments incorporated in the bomb, like nails, rocks or scrap metal, (c) Tertiary blast injuries are caused by the effects of the blast wind, resulting in physical displacement, where most fractures, blunt trauma, and tissue contusions are tertiary blast effects, and (d) Quaternary blast injuries are a variety of injuries caused by burns, psychological trauma, toxic inhalation and exposure to radiation.
The first case had localised, grossly contaminated injuries in the right limb, which was confirmed by the presence of irregular, radio opaque foreign bodies in the X-rays. Therefore, the findings are compatible with the injuries caused by the effect of projectile fragments incorporated in an improvised explosive device like nails, rocks, or scrap metal. Therefore, the type of blast category is secondary blast injuries.
These local improvised explosive devices are made of primary explosives extracted from firecrackers. Since they contain a relatively large amount of low explosives, they have caused severe local damage with contamination. Therefore, the clinicians had to amputate the affected part of the body.
Usually, amputations are done to remove non-vital tissues and to overcome the sepsis due to contamination or as a life saving process. Improvised explosive devices used in warfare contain high explosives and a frequently seen injury pattern, according to A.M. Cross, C. Davis, J. Penn-Barwell, D.M. Taylor, W.F.D. Mello and J.J. Matthews's “The incidence of pelvic fractures with traumatic lower limb amputation in modern warfare due to improvised explosive devices”, is traumatic lower-limb amputation. Since they are high explosives, the injuries may not be confined to the impact site and may demonstrate a higher incidence of pelvic fractures in patients with traumatic lower limb amputations. Blast injuries caused by high explosive explosions are accompanied by high pressure waves, and as noted in M.T. Ozer, A.K. Coskun, H. Sinan, M. Saydam, E.O. Akay, S. Peker, G. Ogunc, S. Demirbas and Y. Peker's “Use of self expanding covered stent and negative pressure wound therapy to manage late rectal perforation after injury from an improvised explosive device: A case report”, produce diffuse injuries such as tissue damage in the acute period, followed in the later period by circulatory disorders due to vascular endothelial damage and related tissue necrosis. Since the injuries in these two cases are mainly confined to the site of the blast and the amputations had not been due to the blast but had been performed by the surgeons, the explosives are primary explosives.
Usually, local, improvised explosive devices produce local crush injuries with blood vessel damage, contamination and they may die due to complications of haemorrhage or infections. These local improvised explosive devices are filled with metal objects found in the locality such as nuts, bolts, bicycle balls, etc. Because of the low velocity, they remain inside the injury. The embedded fragment wounds containing metal and metal mixtures may cause consequences, as observed in J.F. Hoffman, V.B. Vergara, A.X. Fan and J.F. Kalinich's “Effect of embedded metal fragments on urinary metal levels and kidney biomarkers in the Sprague-Dawley rat” and J.F. Kalinich, E.A. Vane, J.A. Centeno, J.M. Gaitens, K.S. Squibb, M.A. McDiarmid and C.E. Kasper's “Chapter 4 embedded metal fragments”.
Medico-legal background
Clinicians and pathologists should also be aware that there is a risk when they deal with patients injured by improvised explosive devices. Though they usually come across metal fragments from improvised explosive devices being embedded in patients, there have been instances where, as found in S. Pengelly, N. Moore, D. Burgess, M. Mahlon, T. Rowlands and T. Cubison's “Home-made explosive found inside injured Afghan” and I.S. Nikolic and I.V. Zivkovic's “Penetrating intracranial injury caused by an unusual home-made iron pyrotechnic device”, the partially detonated home-made explosive device had been found embedded in limbs. Therefore, the safe disposal of the improvised explosive device substance should be done in order to overcome the risk to the patient, the surgical team, and the pathologist.
In these cases, scene visits are important as parts of the improvised explosive device may be available at the scene. However, in injuries due to local improvised explosive devices, the injury patterns are atypical. Therefore, proper records should be maintained by way of sketches, notes, photographs, and X-rays as was done in these two cases.
The recovered evidence in these two cases was submitted for analysis while maintaining the chain of evidence. The recovery of metal fragments and projectiles are helpful in deciding whether the improvised explosive device is home-made or factory made. The direction of the metal projectiles and their pattern may also be helpful in order to decide the direction of the blast.
Forensic pathologists should be familiar with the atypical patterns of injuries produced by improvised explosive devices for better medico-legal interpretations and management.