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Principles and Problems Underlying Testing the Effectiveness of Blast Protective Footwear

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Principles and Problems Underlying Testing the Effectiveness of Blast Protective Footwear J R Army Med Corps 2002; 148: 38-43 J R Army Med Corps: first published as 10.1136/jramc-148-01-08 on 1 March 2002. Downloaded from Principles And Problems Underlying Testing The Effectiveness Of Blast Protective Footwear EJ Chaloner, J McMaster, DE Hinsley ABSTRACT attention. Several new products have been Anti-personnel landmines are a developed and marketed as offering the continuing threat to soldiers and solution to the threat posed by buried blast civilians working overseas in post mines. The majority incorporate aspects of conflict situations. Several groups of the previous design strategies although a governmental and commercial scien- number of new ideas have been developed. tists are currently designing and/or These include the Aigis boot which testing footwear to protect the lower leg incorporates a blast attenuating substance from the effects of close proximity blast. known as TABRE along with a Dyneema The general principles surrounding layer to keep out fragments, the Welco boot testing of protective footwear are from the USA, using honeycombed metal as examined together with an assessment a blast attenuator along with a V shaped sole of the known progress to date and the in an attempt to deflect some of the blast strengths and weaknesses of the designs energy and a ‘spider boot’ developed by produced. MedEng of Canada which uses four pods on Keywords: Anti-personnel landmine; each corner of the boot to reduce the risk of protection; military surgery; war; trauma. mine detonation and enhance stand – off. Some of the newer designs are aimed at the Introduction infantry soldier with the intention that he The global problem with uncleared anti– would be able to wear the blast protective personnel mines is well known (1-4). Despite boot as normal combat footwear, while a recent international treaty to ban these strapping on an overshoe in areas of weapons, there are still significant numbers enhanced mine threat (Wellco Boot, USA), deployed worldwide, and their use is likely to whilst the Aigis and MedEng footwear is remain a feature of conflicts for years to designed for the niche market of specialist come.The commonest injury is caused when mine clearance and engineer survey work. http://militaryhealth.bmj.com/ a person detonates a buried blast mine by Regrettably, many of the designs on the treading on its pressure plate with the foot. market have not been tested adequately for This is known as a Pattern 1 injury (1) clinical effectiveness. Much product according to the International Committee of literature mistakenly equates resilience of the the Red Cross classification. The explosion boot construction with protection of the foot results in a traumatic amputation of part of within. It is quite possible for a boot to the detonating limb with fragmentation remain structurally intact following an damage to the contralateral limb. explosion whilst the foot within is so The mechanism of Pattern 1 antipersonnel damaged as to be unsalvageable by surgery. mine injury has been recognised for many The methodology of the experiments by on September 27, 2021 by guest. Protected copyright. years, and several attempts have been made which testing of several boots has been to design effective footwear to protect against conducted is open to criticism and few programmes have been conducted in a way E J Chaloner BA, detonation of an explosive charge under the FRCS Gen foot. which allows meaningful comparison of The majority of these designs relied on a results between different groups. Adequate Consultant Vascular assessment is also hindered by publication Surgeon, University combination of ballistic composites such as College Hospitals NHS Kevlar (Dupont Corp, USA), honeycombed bias driven by commercial considerations Trust, London. lightweight metals to absorb or deflect blast, and issues of national security. There is a need for consensus to develop Email: [email protected] or a standoff to distance the foot from the explosion. Few of these designs were taken on the principles involved in testing the forward into widespread use due to the effectiveness of such mine protective J McMaster footwear in order for different groups trial BSc, FRCS Edin inability of the designers to produce a boot Specialist Registrar in which had both a reasonable level of methodologies to be harmonised, permitting Orthopaedics, Dept of protection and which was functionally valid comparisons to be drawn between Biomechanics, compatible with wear in the field. experiments. Elimination of some of the Nottingham University. As a consequence of the large number of preconceptions in the mine clearance mine clearance operations now in progress community about the nature of the D E Hinsley MRCS around the world, and the increased number interaction between an anti - personnel mine Research Fellow, Dstl of peacekeeping deployments involving and the lower limb, and the important issues Porton Down, NATO troops, the issue of blast protective involved in protection would be a useful by – Salisbury. footwear has once again become the focus of product. EJ Chaloner, J McMaster, DE Hinsley 39 J R Army Med Corps: first published as 10.1136/jramc-148-01-08 on 1 March 2002. Downloaded from In this paper we highlight the clinical and can make a good functional recovery rather engineering issues involved in the than face an inevitable amputation. pathophysiology of close proximity blast injury to the lower limb, and the important Assessing Protection aspects involved in testing the various Realistically modelling the effects of designs of protective footwear. protective systems on the live human leg is extremely difficult to achieve with a high Pathophysiology degree of biofidelity (the extent to which a The clinical manifestations of blast injury to given injury to the model reflects an injury the unprotected limb have been well to human tissue). The goal therefore is to documented (1). The blast wave causes a devise a satisfactory model, which will traumatic amputation of part of the foot accurately simulate the effect of close and lower leg with stripping of the soft proximity blast on the lower limb of a young tissues from the underlying bone for a healthy individual and from the information variable distance further up the leg. Soil and gleaned to be able to predict the likely other debris is often propelled high into the clinical outcome.The options that have been leg along the tissue planes, and burning, utilised in descending order of biofidelity (in due to the hot gases of detonation, further terms of soft tissue injury and prediction of injures the soft tissues. Although there has outcome) are: been surprisingly little basic research done Whole Cadavers into the mechanics of anti – personnel mine Amputated Human limbs blast injury, a great deal of clinical Synthetic Limb Preparations/Animal experience in this area has been published. Models Some authors have attempted to salvage Metal Rigs limbs exposed to unattenuated close Computer Modelling proximity blast (6-9) with variable results. However, the vast majority of limbs exposed Human Limb Specimens to anti-personnel mine blast require a major Human tissue specimens provide the most formal amputation. The level of the accurate information on the effects of blast amputation is determined by the degree of on the complicated bony structures of the soft tissue damage and contamination foot/ankle complex and offer some rather than by the level of bony injury, information on injury to the soft tissues. because the skin and muscle of the limb is Whole cadavers offer the opportunity to usually damaged proximal to the level of study the effect of the transmission of the bone fracture. blast wave higher up the leg, particularly on Successful protection of the lower limb the knee and the hip joint, whereas isolated http://militaryhealth.bmj.com/ can only be achieved by reducing the energy limb specimens are limited to the foot, ankle transmission into the leg to a level at which and lower leg area (Figure 1). Whole the soft tissue and bony structures can be cadavers also permit movement of the salvaged, either by natural recovery processes, or with reconstructive surgery. Furthermore, simple limb salvage alone does not necessarily imply a satisfactory clinical outcome. If the salvaged limb is consistently painful, or lacks an adequate nerve supply, the patient may be better served by an amputation and mobilisation on September 27, 2021 by guest. Protected copyright. on a prosthetic limb. If amputation is required, rehabilitation is much more successful if the knee joint is preserved, due to the much lower energy requirements of walking on a below knee prosthesis and the added benefits of proprioreception offered by the intact knee joint. Despite the recent advances in boot design, it is highly unlikely that footwear can be produced that will completely protect the foot from all injury resulting from a close proximity anti – personnel mine blast. The phrase ‘defeating the landmine’ should probably be expunged from the vocabulary – anyone standing on an anti – personnel mine will sustain a significant limb injury, regardless of the size of the charge or the type of footwear worn. The challenge is whether that injury can be reduced to one from which the individual Fig 1. Amputated human lower limb model. 40 Testing blast protective footwear J R Army Med Corps: first published as 10.1136/jramc-148-01-08 on 1 March 2002. Downloaded from Fig 2.The Frangible Synthetic Leg (FSL). (Courtesy of the Defence Science and Technology Organisation, Australia). preparation in several planes, rather than exposure to a given amount of blast energy being constrained to one plane by being and the effects on a living foot. fixed in a rig in the case of single limb The more sophisticated artificial limbs experiments. such as the Australian Frangible Synthetic The main drawbacks of human tissue Leg (Figure 2) have certain advantages over work are the ethical and health and safety human tissue.
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