Furthermore, the hair cells, the sound receptors found within the cochlea, can be permanently damaged and can result in a hearing loss of a mild to profound degree.

[4] Additionally, the intensity of the pressure changes from the blast can cause injury to the blood vessels and neural pathways within the auditory system.

The combination of these effects can lead to hearing loss, tinnitus, headache, vertigo (dizziness), and difficulty processing sound.

There is general agreement that spalling, implosion, inertia, and pressure differentials are the main mechanisms involved in the pathogenesis of primary blast injuries.

Blast lung refers to severe pulmonary contusion, bleeding or swelling with damage to alveoli and blood vessels, or a combination of these.

[8] Traumatic amputations quickly result in death, unless there are available skilled medical personnel or others with adequate training nearby who are able to quickly respond, with the ability for rapid ground or air medical evacuation to an appropriate facility in time, and with tourniquets (for compression of bleeding sites) and other needed equipment (standard, or improvised; sterile, or not) also available, to treat the injuries.

A blast wave generated by an explosion starts with a single pulse of increased air pressure, lasting a few milliseconds.

The blast wave progresses from the source of explosion as a sphere of compressed and rapidly expanding gases, which displaces an equal volume of air at a very high velocity.

As a result, individuals between the blast and a building generally suffer two to three times the degree of injury compared to those in open spaces.

Tissue destruction initiates the synthesis and release of hormones or mediators into the blood which, when delivered to the brain, change its function.

Individuals exposed to blast frequently manifest loss of memory of events before and after explosion, confusion, headache, impaired sense of reality, and reduced decision-making ability.

However, the first symptoms of blast-induced neurotrauma (BINT) may occur months or even years after the initial event, and are therefore categorized as secondary brain injuries.

[12] The broad variety of symptoms includes weight loss, hormone imbalance, chronic fatigue, headache, and problems in memory, speech and balance.

[12] In addition to known post-traumatic stress disorder (PTSD) risk factors experienced by both civilians and military personnel in combat areas, in early 2018, 60 Minutes reported[13] that neuropathology specialist, Dr. Daniel "Dan" Perl, had conducted research on brain tissue exposed to traumatic brain injury (TBI), discovering a causal relationship between IED blast waves and PTSD.

Perl was recruited to the faculty of the Uniformed Services University of the Health Sciences as a professor of pathology and to establish the Center for Neuroscience and Regenerative Medicine mandated by Congress in 2008.