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Is Behind Armour Blunt Trauma a Real Threat to Users of Body Armour? a Systematic Review

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Is Behind Armour Blunt Trauma a Real Threat to Users of Body Armour? a Systematic Review Review J R Army Med Corps: first published as 10.1136/jramc-2013-000161 on 13 November 2013. Downloaded from Is behind armour blunt trauma a real threat to users of body armour? A systematic review 1 1 2 Editor’s choice Debra J Carr, I Horsfall, C Malbon Scan to access more free content 1Impact and Armour Group, ABSTRACT Department of Engineering and Introduction Behind armour blunt trauma (BABT) has Key messages Applied Science, Cranfield fi Defence and Security, Cranfield been de ned as a non-penetrating injury caused by the rapid deformation of body armour. There has been an University, Defence Academy of ▸ Non-perforating impacts on body armour can the United Kingdom, increasing awareness of BABT as an injury mechanism in result in a behind armour blunt trauma (BABT) Shrivenham, Wiltshire, UK both the military and civilian worlds; whether BABT 2 fi injury. Home Of ce Centre for results in serious injuries is debatable. Applied Science and ▸ Body armour standards typically describe the Method A systematic review of the openly accessible Technology, St Albans, measurement of back-face signature (BFS) in literature was conducted using the Preferred Reporting Hertfordshire, UK ‘clay’; BFS does not equate to a severity of Items for Systematic Reviews and Meta-Analyses method BABT injury in humans. Correspondence to to investigate those injuries classified as BABT and their ▸ There is no evidence of life-threatening BABT Dr D J Carr, Impact and severity. Armour Group, Department of injuries caused to people impacted against Results 50 sources were identified that included pertin- Engineering and Applied body armour designed to defeat the projectile Science, Cranfield Defence and ent information relevant to this systematic review on in question. Security, Cranfield University, BABT injuries. Typical injuries reported included skin con- Defence Academy of the tusion, laceration and penetration, rib fracture and con- United Kingdom, Shrivenham, Wiltshire, UK; tusions to lungs, kidneys, spleen and (rarely) the heart. fi d.j.carr@cranfield.ac.uk No evidence of fatal injuries due to BABT was identi ed. and acceleration. A commonly used measure in Conclusions Whether BABT can lead to life-threaten- body armour standard test methods is to record the Received 2 August 2013 ing injuries when small-arms ammunition impacts body Accepted 14 October 2013 depth of the permanent indentation formed in a Published Online First armour components designed to stop that ammunition is block of Roma Plastilina no. 1 (a clay-like material), 13 November 2013 debatable. It should be emphasised that other data may or similar material, when a non-perforating bullet copyright. be available in government reports that are not openly strikes body armour mounted in front of it. The available. Further research should be considered that depth of the deformation is known as the back-face investigates developments in body armour, including signature (BFS). However, the BFS does not correl- initiatives that involve reducing burden, and how they ate to specific behind armour blunt trauma (BABT) affect BABT. injuries in humans.6 Other agencies, particularly those concerned with non-perforating impacts onto plates, use alternative representations of the human INTRODUCTION thorax. In the modern military context, the term personal BABT has been defined as non-penetrating injur- http://militaryhealth.bmj.com/ armour includes body armour (waistcoat or vest- ies caused by the rapid deformation of body like garments covering the torso), helmets (covering armour.7 More recently, a definition for injuries the cranium), face and eye protection (primarily occurring when body armour is impacted, but not visors, glasses, goggles), explosive ordnance dis- perforated, has been suggested that separates injuries posal suits, and ballistic shields.1 More recently, that include skin laceration from those that are pelvic, neck and extremity protection had been dis- restricted to skin contusion and rib damage.8 – cussed and/or developed.2 4 Military body armour Generally, BABT is considered to be a type of blunt provides protection from fragmentation and high- trauma injury; other injury mechanisms included in velocity (rifle) bullets; sharp weapons and low-vel- the same broad grouping are road traffic accidents 79–11 ocity (handgun) bullets are not considered a threat and crush injuries. However, BABT occurs on September 25, 2021 by guest. Protected to military personnel. Body armour generally con- over a shorter period of time, due to an impact sists of two elements, namely, layers of fabric event by a faster projectile. During the impact event, (woven, non-crimp, felted) and plates (ceramic- the body armour and underlying tissues accelerate composite, composite).5 The fabric component of and deformation occurs. Stress waves are generated body armour provides protection from a wide and propagate through the body armour and the range of threats including, but not limited to, frag- underlying tissues (including those not in direct mentation, low-velocity (handgun) bullets and stab contact with the armour); they may be transmitted and slash injuries as chain-mail and metallic plates and/or reflected by the armour components and/or may be incorporated.5 Plates are used to provide various tissues depending on the speed of sound in – protection from high-velocity (rifle) threats. the material.11 14 The applied shear stresses may – When body armour is impacted by a projectile, result in tearing of tissue.71517 It is generally deformation occurs on the rear face and can lead accepted that the gross deformation of the chest and To cite: Carr DJ, Horsfall I, to injury. This deformation is described in the lit- the duration and rate at which this deformation Malbon C. J R Army Med erature using physical size (depth, ‘diameter’, occurs affect the injuries observed.71417However, – Corps 2016;162:8 11. volume) and/or dynamic properties such as velocity it is worth noting that the majority of studies 8 Carr DJ, et al. J R Army Med Corps 2016;162:8–11. doi:10.1136/jramc-2013-000161 Review J R Army Med Corps: first published as 10.1136/jramc-2013-000161 on 13 November 2013. Downloaded from reported in the literature that investigate the formation of such Injury mechanisms stress waves consider hard plates rather than soft armour. In work published in 1990, a single ‘typical’ pressure-time There has been an increasing awareness of BABT as an injury history is reported during BABT experiments which consisted of mechanism in both the military and civilian worlds; however, two peaks: a peak pressure of ∼1750 mbar occurred at ∼0.5 ms – whether BABT results in serious injuries is debatable.7151720 after the impact event, which was followed by a peak of This work aimed to systematically review the literature regard- ∼900 mbar at ∼3 ms.32 This response is very similar to that ing the risk of a life-threatening BABT injury occurring behind reported by later researchers.12 22 25 31 These later researchers body armour. used high speed imaging of impacts onto gelatine, pressure sensors mounted in gelatine, and accelerometers mounted on METHOD ribs of, and pressure sensors in, anaesthetised pigs to record the A systematic review of the open literature was conducted using stress waves.12 26 31 It is broadly accepted that the short duration the Preferred Reporting Items for Systematic Reviews and first peak is related to the initial impact event onto the body Meta-Analyses (PRISMA) method. Sources of peer-reviewed armour; the second and later peak is related to the macroscopic information from databases were identified using Web of deformation of the armour into the body.17 31 32 Both peaks, but Knowledge, Science Direct, Google Scholar and the Ballistics particularly the first, are affected by armour construction.25 32 37 Injury Archive, which provides a database for military research Pencilling is considered to be a particular type of BABT and purposes for Service and H.M. Government Officers and has been defined as ‘… a deformation characteristic of body Research Establishments. US Government reports were identi- armour, which is only associated with the evolution of lightweight fied using the Defense Technical Information Center, an online and flexible armours’ and ‘… comparable to an entry wound depository of Department of Defense and government funded from a ballistic injury’.27 29 A narrow, tapered, deep deformation research. The Barrington Digital Library, Cranfield University’s of the soft body armour into the torso occurs. Pencilling was Library at The Defence Academy of the UK, was also searched observed, but not described as such, by several organisations particularly for MSc and PhD theses of interest. A full set of the during the mid-1990s when Dyneema Fraglight was assessed as a Personal Armour Systems Symposium (PASS) proceedings was possible future fabric for use in military body armour. hand-searched. PASS was started in 1990 as the Ballistic Testing of Personal Armour Symposium (BTPA) at the former Stores and Clothing Research and Development Establishment in Wounded personnel Colchester. In this PRISMA review, proceedings from Injuries to two police officers wearing a seven layer soft armour BTPA1990 to PASS 2012 inclusive were consulted. design to provide protection from 0.38 calibre ammunition has Keywords used for these searches were ‘body armour’, been described.915Field trials of such body armour comprising copyright. ‘behind armour blunt trauma’, ‘BABT’, ‘female’, ‘injur*’ and of seven-layers of Kevlar 29 began in the USA in December ‘fatalit*’. Reference lists from the articles, reports, theses and 1975. In both of the recorded incidents, police officers were conference papers identified were hand-searched to identify struck on the thorax at close range by 0.38 calibre bullets. Both additional resources. Only primary sources were used in the lit- officers were able to chase their assailants, having suffered only erature review.
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