Altitude can influence the propagation of shock waves and induce various pathophysiological changes due to different air pressure and oxygen levels, resulting in distinct characteristics of blast injury. This study was performed to investigate the characteristics of biological effects of blast waves at different altitudes and explore how altitude influences the characteristics of blast injuries. In total, 126 goats were exposed to blast waves at low, medium, and high altitudes while positioned at four different distances. Injury severity was quantified according to percentage of surface area contused. Blast overpressure data were collected using blast test devices placed at locations that represented the goats’ exposure. Blood gas data were collected using a portable blood gas analyzer before injury and 1, 3, 6, and 24 h after injury. Our results showed that the shock wave attenuated significantly as the distance increased ((p< 0.05)) but did not significantly change as the altitude increased. The mortality rate, lung coefficient, and blood gas indices were significantly higher among the goats at high altitude ((p< 0.05)). The injury severity gradually increased as the altitude increased ((p< 0.05)). The goats at high altitude developed more severe and prolonged injuries than at low altitude. The main mechanism involved the low air pressure, which reduced the injury threshold of air-containing organs, and the low oxygen partial pressure, which exacerbated the injury severity and duration. These results suggested that altitudes greater than 3000 m (the medical altitude) significantly influenced the blast injury severity and duration while low air pressure and low oxygen were the primary contributing factors.
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