Most terrorist attacks have involved explosive devices. This review explains the mechanisms of blast injuries. Primary blast injuries may produce rupture of the tympanic membranes, pulmonary damage, air embolization, and rupture of a hollow viscus. There may also be blunt trauma, burns, toxic inhalations, and injuries caused by projectiles and the collapse of buildings. This article explains the strategies for the initial stabilization of patients and for identification of the severity of blast injuries, as well as approaches to treatment.