Over 52,000 US service members were wounded in the wars in Iraq and Afghanistan over two decades of war. These years also witnessed a continued evolution in the treatment of polytraumatized patients, especially those injured in combat. Because most of those wounded in action sustain musculoskeletal injuries, providing skilled treatment as soon as possible after injury has saved the lives of numerous service members and improved the musculoskeletal function of those injured in these conflicts. Orthopaedic surgeons have been crucial members of forward surgical teams that have performed life and limb-saving care under challenging forward-deployed conditions, sometimes under fire. In this setting, military orthopaedic surgery has continued to evolve, building in part on experience gained in smaller conflicts where the United States was not a principal belligerent but where war trauma familiarity was acquired that contributed to improvements in forward orthopaedic care during the recent wars in Iraq and Afghanistan. The presented body of work addresses multiple facets of orthopaedic combat care including the intermingling of surgeon and team preparation, logistics, clinical studies, and the concept of far forward surgical treatment, to increase survival and improve outcomes of those sustaining acute battlefield musculoskeletal trauma.

Many readily available online videos and instructional manuals provide information on how to manufacture aluminum (Al) powder, a component in pyrotechnics and improvised explosive devices (IEDs) using common household materials. Given the ease in acquiring and producing Al powders, it is common to observe Al powder in IEDs. Thus, there is a need to characterize Al powders, in a forensic context, to determine whether there are signatures that could be used for sample differentiation and placing potential constraints on the method of Al powder production. In this study, samples of Al powder that were derived from industrial products (including end-use commercial products) and those made using amateur methods were analyzed. The powders were analyzed using a combination of morphology (viewed with light and scanning electron microscopy (SEM)) and elemental profiling (using energy dispersive X-ray spectroscopy (EDS)). The results demonstrate that Al powder manufactured by industrial processes can be readily differentiated from amateur methods. The gross microscopic morphology of the particles provided the basis for the recognition of several different particle types/classes. These types provide insight into their method of production. Of particular note is the ability of morphological characteristics to differentiate between flake-type powders, which are made by both industrial and amateur methods. This differentiation is primarily due to significant differences in the particle size distribution and the particle edge textures.

Peroxide-based compounds, notably triacetone triperoxide (TATP), have gained notoriety for their extensive use in terrorist activities as improvised explosive devices. The inherent volatility and ease of synthesis from readily available chemicals make these substances particularly appealing for illicit use. Furthermore, the growing concern is the increased risk of explosions and terrorist incidents linked to compounds with similar peroxide-based structures. This alarming trend underscores the urgent need for comprehensive research and understanding of these hazardous materials. In response, research on various possible peroxide structures is being conducted. Investigations using comprehensive quantum chemical calculations including density functional theory, molecular orbital analysis, and thermodynamic modeling provide explosive characteristics and NMR, IR, and Raman spectra for TATP substituted with various substituents and molecules containing peroxide structures, thereby linking preliminary hazard screening with molecular identification. Additionally, quantum chemistry-based mass spectrometry simulation through QCxMS analysis provides decomposition pathways and mass spectral predictions of peroxide structures as complementary identification fingerprints. These integrated computational methods can support conservative hazard prioritization of peroxide-structured explosives and improve detection-oriented identification capabilities.

Establishing the identity of vehicle occupants is a critical component of many criminal investigations. Traditional forensic methodologies for deployed airbags primarily focus on the detection of saliva through salivary activity test to guide sampling. However, the introduction of side curtain airbags, which offer different spatial orientations and deployment mechanics compared to traditional frontal airbags, requires a reassessment of DNA recovery strategies. This case report details a forensic investigation following an improvised explosive device (IED) detonation involving a stolen vehicle. While frontal impact typically results in saliva deposition, the side-impact deployment of curtain airbags in this case necessitated a shift toward the recovery of trace biological material. Based on the specific behavioral context where suspects had to manually displace the deployed curtain airbags to exit the vehicle, the laboratory adapted its strategy from saliva detection to touch DNA recovery. The airbags were divided into sections and sampled using a double swabbing technique for the first time for this evidence type. DNA quantification yielded concentrations ranging from 0.018 ng/μl to 0.133 ng/μl. While most areas produced complex mixtures, one specific driver side section yielded a mixture with a major contributor that resulted in a cold hit within the criminal database, identifying a previously unknown suspect. This case underscores the importance of collaboration between investigators and forensic scientists. It demonstrates that the sequential unmasking of case relevant information allows for the optimization of sampling strategies while mitigating cognitive bias, ultimately leading to successful identifications that standard protocols might miss.

Due to the ease of synthesis and use, improvised explosive devices pose a significant global security threat. Triacetone triperoxide (TATP) is a commonly used peroxide-based explosive with a detonation strength reported to be about 88% higher than that of trinitrotoluene (TNT). Detection of TATP at security-sensitive locations such as airports and railway stations is particularly challenging because its molecular structure lacks nitrogen-containing functional groups (e.g., N-NO2 or N-N bonds) typically targeted by conventional explosive detection systems. In addition, TATP readily sublimes at room temperature and, unlike most nitro-explosives, leaves minimal or no detectable post-blast residues. In certain analytical assays, TATP can generate products like hydrogen peroxide (H2O2) when chromogenic reagents such as titanyl oxalate are used in microfluidic paper-based devices, although the color intensity is significantly weaker. Various technical type detection approaches have been reported, including using trained animals, spectroscopic techniques, electrical conductivity-based gas sensing, fluorogenic detection (quenching- or enhancement-based), colorimetric assays, etc. Recent studies have also highlighted nanomaterial-assisted sensing strategies, including nanoparticle- and nanocluster-based detection employing current variation, fluorescence alteration and color change. Spot analysis was also documented in this aspect.

Musculoskeletal injuries from underbody blasts due to the detonation of improvised explosive devices (IED) impart dynamic loading to the human vertebral column via the pelvis region, and the primary insult from the IED is absorbed first by the lumbar spine before it traverses to the thoracic and cervical spines. Injuries from these scenarios have been documented in many clinical and retrospective studies. Although the dynamic response index continues to be used to predict lumbar spine injuries, it is based on the accelerations of the seat pan. A need exists to develop lumbar spine injury criteria for human surrogates. The objective of this study was to develop lumbar spine injury criteria, in the form of injury assessment risk curves, specific to the Hybrid III anthropomorphic test device under the underbody blast vertical impact load vector. The Hybrid III human surrogate was prepared with load cells at the superior and inferior ends of the lumbar spinal column. The dynamic impact loading was applied to the inferior end of the spinal column spine using a custom vertical accelerator device. The peak axial, shear, and resultant forces at the ends of the column were obtained. The compressive force-based injury mechanism was confirmed with results from previous human cadaver lumbar spine results conducted under the same experimental protocol. The parametric survival analysis using the Weibull distribution was used to develop lumbar spine injury assessment risk curves, and using the ±95% confidence interval bounds, the quality of the risk curves at discrete injury probability levels were calculated for all metrics. At the superior end, at the mid-risk level, the estimated axial force was 14.7 kN, shear force was 2.1 kN, and resultant force was 14.8 kN, and at the 10% risk level, the estimated axial force was 6.7 kN, shear force was 0.9 kN, and resultant force was 6.7 kN. At the inferior end and at the mid-risk level, the estimated axial force was 16.7 kN, shear force was 2.8 kN, and resultant force was 16.8 kN. At the 10% risk level, the estimated axial force was 7.2 kN, shear force was 0.8 kN, and resultant force was 7.3 kN. The confidence intervals and quality of risk curves are reported in the paper. Axial forces were consistently greater than shear forces at both ends, mimicking the injury mechanisms based on fractures reported in clinical and cadaver studies from underbody blast loading scenarios. Injury risk curves at the superior end of the spine were shifted to the left for the axial, shear, and resultant forces compared to the inferior end, confirming the energy absorption and transmittal of the axial force along the spinal column. Resultant forces can be used as injury criteria because shear forces were low. The present survival analysis-based injury assessment risk curves can be used as a preliminary Hybrid III lumbar spinal column injury criteria for improving the Warfighter safety and evaluating current and future military vehicles under vertical impacts.

In the United States, trauma remains the leading cause of death in patients aged 46 and younger and the fourth leading cause of mortality across all age groups. Trauma fatalities are mostly due to catastrophic hemorrhage and traumatic brain injury. Most hemorrhage-related traumatic deaths occur in the first 2 hours after injury, though around one-fourth of the cases are preventable. Proper prehospital care, including swift medical or surgical hemorrhage control, can dramatically impact mortality and patient outcomes. The use of extremity tourniquets is perhaps the most well-known prehospital intervention for traumatic hemorrhage. Tourniquets control hemorrhage, occluding the injured artery by applying constant, firm circumferential pressure proximal to the bleeding site. As with other aspects of evidence-based trauma care, military data provided the earliest robust evidence for tourniquets' usefulness in controlling hemorrhage. The widespread application of extremity tourniquets in recent Iraq and Afghanistan wars successfully reduced hemorrhage-related mortality. Subsequently, in 2015, a federal interagency workgroup launched a nationwide public health campaign called “Stop the Bleed.” The program translates combat medicine's hemorrhage control techniques to the civilian sphere by teaching basic bystander actions that stem life-threatening bleeding. Additionally, tourniquets have become increasingly available to trained civilian EMS providers. After seeing the success of extremity tourniquets, the focus has now shifted to preventing battlefield deaths by exsanguination from sites not amenable to tourniquet use. Traditional trauma education programs teach that 6 locations must be considered as sources of potentially fatal hemorrhage in a trauma patient: 1. Chest cavity. 2. Abdominal cavity. 3. Retroperitoneum. 4. Pelvis. 5. Long bone fractures. 6. “Street” (scalp or other external sources). While identifying the bleeding site is critical, determining whether or not it is manually compressible is also vital. Deep areas of internal bleeding, such as solid organ injury in the abdominal cavity, clearly cannot be easily controlled or recognized in the prehospital setting. However, hemorrhage from an extremity long bone fracture may be controlled by proper proximal tourniquet application. Scalp and other external wounds may respond to direct manual pressure, wound packing, or pressure dressings.   Enemy use of Improvised Explosive Devices (IED) in recent wars led to an increase in pelvic fracture cases with associated groin or high leg injuries. The term "junctional hemorrhage" was introduced in the literature in 2009, referring to hemorrhage in the junction between the torso and the neck or one or more extremities. That time was also marked by renewed efforts to develop techniques and devices for junctional hemorrhage control both on the battlefield and at home. Sites involved in junctional hemorrhage include the groin, axilla, perineum, shoulder girdle, and base of the neck. Hemorrhage in these areas is potentially life-threatening and must not be missed during prehospital management. Junctional hemorrhage may or may not be manually compressible. However, it is generally not amenable to traditional tourniquets due to the injury's proximal location. Rapid exsanguination and death may result from uncontrolled junctional hemorrhage. Studies estimate that 19% of preventable Iraq and Afghanistan battlefield deaths between 2001 and 2011 involved junctional hemorrhage.  When compressible, junctional injuries often require constant, direct manual pressure against the site. This is often challenging to achieve due to the typically limited personnel and unpredictability of circumstances in prehospital settings. Wound packing, hemostatic agents and dressings, junctional tourniquet devices, and others may be necessary to control junctional hemorrhage in the field and increase survival rates. Emergency Medical Services (EMS) providers must be trained to properly and promptly recognize, assess, and manage junctional injuries. This article will review the considerations and most current management options for prehospital junctional hemorrhage control.

Explosive ordnance (EO), including AXO (abandoned explosive ordnance), IEDs (improvised explosives devices), and UXO (unexploded ordnance), are widely recognised for their blast and fragmentation hazards, but they also represent a persistent and under-addressed source of occupational chemical exposure for explosive ordnance disposal (EOD) personnel. EOD core activities liberate mixed metals and energetic chemicals, resulting in exposures that are multi-route (inhalation of dusts and fumes, dermal loading amplified by sweat and glove occlusion, and ingestion via hand-to-mouth transfer during eating, drinking, or smoking) and multi-temporal (repeated low-dose background plus task-driven spikes), as well as chemically complex. Clinically, this can present as syndromic overlap across acute and chronic domains, with symptoms that are easily misattributed to heat stress, dehydration, infection, or fatigue. Acute effects of concern include neurotoxic presentations (headache, dizziness, confusion, tremor, and seizure), respiratory and mucosal irritation following dust or fume events, gastrointestinal symptoms, and patterns suggestive of acute hepatic or renal stress, particularly when high-intensity tasks occur in hot environments that compound physiologic strain. Chronic outcomes relevant to repeatedly exposed EOD personnel include renal function decline, neurocognitive effects that can degrade operational decision making and safety, persistent haematologic abnormalities, and endocrine disruption signals, with long-latency risks requiring cautious interpretation given sparse longitudinal data and confounding co-exposures. This review synthesises the current evidence base through an EOD lens and translates it into pragmatic clinical and programmatic actions: task-based exposure characterisation; tiered biomonitoring and medical surveillance aligned to operational tempo; incident-triggered assessment pathways after high-residue events; and prevention strategies that work under field constraints, including contamination control zones, hygiene enforcement, glove and respiratory protection optimisation, tool and vehicle decontamination, and measures to prevent secondary transfer and take-home exposure. The central takeaway is practical: EOD programs can reduce morbidity and improve readiness by treating explosive ordnance as a chemical mixture exposure problem, adopting mixture-aware clinical triage, and embedding surveillance and controls that match how EOD work is actually performed.

Objectives: Traumatic fractures represent a considerable burden to military personnel across nations. Despite substantial research examining traumatic fracture incidence and risk factors, there is no comprehensive synthesis of evidence on traumatic bone fractures in military populations. This study aimed to identify and synthesise findings from studies reporting on the incidence of, and risk factors for, traumatic fractures in military personnel. Design: Systematic review. Methods: A structured search was performed in PubMed, EBSCO, CINAHL, and ProQuest using key terms related to fractures, occupational exposure, and risk. Eligible studies were screened, and key findings including risk factors, incidence rates, and effect sizes were systematically extracted and summarised. Results: Twenty-nine studies were included, with four studies reporting on recruits/trainees and 25 on qualified personnel. Recruit incidence ranged from 21.8 to 105.3 fractures per 1000 person-years, while the incidence in qualified personnel ranged from 1.9 to 57.6 fractures per 1000 person-years. Enlisted personnel, younger servicemembers (18-29 years), and personnel of the Army and Marine Corps branches were at increased risk. Traumatic fractures predominantly occurred in the lower extremities. Risk factors and mechanisms for traumatic fractures in military personnel included sports participation and physical training. Other common mechanisms included motor vehicle accidents and collisions, and (in combat settings) blasts from improvised explosive devices and gunshot wounds. Conclusions: Traumatic fractures are a substantial source of injury across military careers, not limited to initial training. Army and Marine Corps personnel face higher fracture risks, particularly in the lower limbs, with sports/physical training and combat-related risk factors associated with increased susceptibility.

Threat detection in X-ray security screening is critical for preventing concealed threats in airports and other high-security venue where Improvised Explosive Devices (IEDs) remain among the most persistent and dangerous threats. The lack of a representative, and publicly available IED dataset has limited the development of machine-learning based automated threat detection systems. To address these issues, we propose an open access dataset, called IEDXray constructed for automated detection of IEDs. The dataset comprises 17,360 X-ray images captured under a strategic concealment protocol, covering scenarios ranging from isolated threats to heavily cluttered baggage environments. It includes diverse IED types-homemade explosives, batteries, and modified devices such as laptops, mobile phones, pagers, and walkie-talkies. To validate the dataset, we benchmark state-of-the-art detection models, including YOLOv10, Faster R-CNN, DETR, and GroundingDINO, establishing baseline results across multiple security-screening tasks. By reflecting real-world threat concealment, clutter, and variability, IEDXray provides the research community with a high-fidelity benchmark to advance automated explosive detection and improve x-ray security screening.

Background The utilization of landmine detonations, frequently facilitated via improvised explosive devices (IEDs), continues to be a favored strategy employed by Maoist insurgents in regions of India afflicted by left-wing extremism (LWE). Personnel tasked with anti-insurgency operations face an elevated probability of incurring fatal blast-related injuries. Conducting a forensic analysis of such fatalities is crucial to establishing consistent patterns of injury, enhancing protective measures, and guiding medico-legal protocols. Methodology A retrospective analysis was conducted at the Department of Forensic Medicine and Toxicology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand. Autopsy records of six security personnel who sustained fatal injuries in a landmine blast during an anti-Naxalite operation in Jharkhand were reviewed. External and internal injuries, patterns of anatomical involvement, and immediate causes of death were systematically documented and analyzed. Results All individuals who succumbed were male, with their ages spanning from 27 to 36 years. The significant injuries noted comprised traumatic amputations of the legs, major lacerations, and fractures that were comminuted. Injuries were predominantly localized to the inferior segment of the body, which aligns with the mechanics associated with landmine detonation. In every recorded instance, death was attributed to hemorrhagic shock in conjunction with polytrauma. Standard-issue protective equipment demonstrated a significant lack of efficacy in mitigating injuries resulting from high-energy secondary and tertiary blast forces. Conclusion This study reveals a consistent and characteristic pattern of injuries in landmine blast fatalities among security personnel in Maoist-affected regions. The findings underscore the need for enhanced forensic documentation, targeted improvements in personal protective equipment, and refined tactical protocols. Multidisciplinary efforts combining forensic insights, trauma care, and strategic planning are vital to reducing operational casualties in insurgency zones.

In forensic practice, the reconstruction of criminal behavior and charge determination are often entrusted solely to law enforcement, with forensic medicine playing a marginal, confirmatory role. Nonetheless, accurate injury analysis remains fundamental and, in specific contexts, may be decisive. The authors present a case that underscores the crucial role of interdisciplinary forensic collaboration - particularly between forensic pathologist and ballistics expert - in the reconstruction of the event dynamics and in supporting judicial decision-making aimed at the accurate charge determination of the event. On the shutter of a bookstore a ticking object wrapped in white cloth was discovered. A bomb disposal technician intervened to neutralize the device. During the operation, the device exploded, causing the amputation of the left hand, loss of the right eye and bilateral thigh lacerations with retained foreign bodies. The technician claimed the explosion occurred spontaneously. Based on this, charges included mass murder, considering the alleged explosive power. A multidisciplinary forensic analysis integrating crime scene investigation, injury pattern review, radiological imaging and explosive residue testing was conducted. A detailed injury analysis and technical assessment of the device disproved this version, redefining the victim's position at the time of detonation and substantially reducing the inferred explosive capacity. This led to the reclassification of some criminal charges.