title: Surface wound mapping of battlefield occulo-facial injury.
abstract: BACKGROUND
  Accurately determining the entry location of penetrating eye and face wounds and relating that to mortality and long-term morbidity is of vital importance in the design of future personal protective equipment.
  
  
  METHODS
  Hospital and post mortem records for all UK servicemen sustaining penetrating battle injuries to the face or eye during the period 01 January 2005 to 31 December 2009 were analysed.
  
  
  RESULTS
  Face and eye injuries were found in 391/1187 (33%) and 113/1187 (10%) of all battle-injured servicemen respectively. 27% of eye wounds from explosions resulted in blindness and a further 17% in significant permanently reduced visual acuity (<6/12). Those servicemen that chose not to wear Combat Eye Protection (CEP) were 36 times more likely to sustain an eye injury from explosive fragmentation than those that did. However only 36% of servicemen chose to wear CEP. 7 deaths could potentially have been prevented had the serviceman chosen to wear their CEP. The lower third of the face was most commonly injured (60%) followed by the upper third (24%). CEP reduced facial injuries as a whole (bone and soft tissue) by 15% (p<0.01). Potentially changing the existing material used for chinstrap and helmet covers to that with ballistic protection would further reduce this incidence by up to 9%.
  
  
  CONCLUSIONS
  Although the lower third of the face remains poorly protected, the incidence of lower facial wounds could be further reduced by the use of ballistic visors by servicemen in exposed positions in vehicles (which represented 16% of facial injuries). Such a visor could potentially have prevented 17 deaths. A rigid attachment to the front of a ballistic helmet would allow either a visor, a high visibility LED lamp or a night vision goggle to clip in and we believe this capability should be investigated through future human factor trials.
authors.affiliation: Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, United Kingdom. johnobreeze@doctors.org.uk
authors.forename: J
authors.initials: J
authors.lastname: Breeze
authors.forename: L S
authors.initials: LS
authors.lastname: Allanson-Bailey
authors.forename: N C
authors.initials: NC
authors.lastname: Hunt
authors.forename: M J
authors.initials: MJ
authors.lastname: Midwinter
authors.forename: A E
authors.initials: AE
authors.lastname: Hepper
authors.forename: A
authors.initials: A
authors.lastname: Monaghan
authors.forename: A J
authors.initials: AJ
authors.lastname: Gibbons
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D001766:Blindness / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002755:Choice Behavior; D004867:Equipment Design; D005131:Eye Injuries / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D005135:Eye Protective Devices / Q000706:statistics & numerical data*; D005151:Facial Injuries / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008887:Military Medicine; D008889:Military Personnel; D011481:Protective Clothing / Q000706:statistics & numerical data; D011482:Protective Devices / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D015354:Vision, Low / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*