Terrorist bombings will continue to overwhelm civilian emergency medical se
rvice (EMS) and urban medical systems in the future. Primary blast injury t
o gas-filled organs, such as the lungs and those of the auditory system and
alimentary tract, is certainly a significant cause of morbidity and mortal
ity in explosion injuries. Scene control; expeditious evacuation by skilled
EMS personnel; and timely, expert emergency and perioperative care in the
hospital will provide for the best possible outcome in such dire circumstan
ces.