The Medical Impacts of Thermobaric Weapons: A Scoping Review

Thermobaric weapons (TW) are a class of explosive weapons designed to use oxygen from the surrounding environment to deliver blasts generating intense pressure and heat, penetrating structures more efficiently than conventional weapons. Despite the increasing use of TW in conflicts globally, no comprehensive evaluation of the literature on TW has been published to date. This review aims to assess current evidence on the medical Impacts of TW.

A scoping review of the literature was conducted in accordance with PRISMA Scoping Review (PRISMA-ScR) methodology. Structured searches of databases including Web of Science, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Global Index Medicus, Military and Government Collection, Global Health, SciELO, and Google Scholar as well as grey literature sources were performed to identify records that described injuries related to TW use.

The search identified 7,365 records. After title-abstract, full text screening and exclusion of duplicative data, 16 eligible reports, including 3 grey literature reports, were included in analysis. Represented regions included Eastern Europe, the Middle East, East Africa, and Southeast Asia. Of the reports, 8 were narrative reviews, 3 were case series, one was a case control, one was a modelling study, and 3 were grey literature reports. Four reports were conducted in high-resource settings in North America and Europe, although 6 were in low-resource conflict settings in the Middle East and Eastern Europe. Ten reports described disability, with only 6 reports presenting primary data, and no reports including analysis on patient physiology, hemodynamics, or psychological trauma. Six reports collected data from combatants only, one incorporated both combatant and civilian data, and the remaining did not specify population status. Non-uniform reporting across eligible reports prevented pooled analysis thus limited conclusions that could be drawn.

All reports included in analysis highlighted the complex multidimensional injury patterns associated with TW, exceeding the severity of normal blast injury including pulmonary barotrauma, full-thickness burns, chemical inhalation injuries, and tertiary injuries resulting from confined-space detonations. Despite the significance of TW use and impact on casualties in modern conflict, this review identified a significant gap in the evidence base on the medical effects of TW. This lack of primary clinical data significantly constrains efforts to guide data-driven approaches to treatment algorithms, performance improvement, and rehabilitation needs for survivors of TW-related injuries. The establishment of a global registry on TW could address this evidence gap through documentation of the injuries caused by TW.