Underwater blast injury: a review of standards.

The first cases of underwater blast injury appeared in the scientific literature in 1917, and thousands of service members and civilians were injured or killed by underwater blast during WWII. The prevalence of underwater blast injuries and occupational blasting needs led to the development of many safety standards to prevent injury or death. Most of these standards were not supported by experimental data or testing. In this review, we describe existing standards, discuss their origins, and we comprehensively compare their prescriptions across standards. Surprisingly, we found that most safety standards had little or no scientific basis, and prescriptions across standards often varied by at least an order of magnitude. Many published standards traced back to a US Navy 500 psi guideline, which was intended to provide a peak pressure at which injuries were likely to occur. This standard itself seems to have been based upon a completely unfounded assertion that has propagated throughout the literature in subsequent years. Based on the limitations of the standards discussed, we outline future directions for underwater blast injury research, such as the compilation of epidemiological data to examine actual injury risk by human beings subjected to underwater blasts.