Demonstrating the effectiveness of body armour: a pilot prospective computerised surface wound mapping trial performed at the Role 3 hospital in Afghanistan.
BACKGROUND
Modern body armour clearly reduces injury incidence and severity, but evidence to actually objectively demonstrate this effect is scarce. Although the Joint Theatre Trauma Registry (JTTR) alone cannot relate injury pattern to body armour coverage, the addition of computerised Surface Wound Mapping (SWM) may enable this utility.


METHODS
Surface wound locations of all UK and NATO coalition soldiers, Afghan National Army and Police and local nationals injured by explosively propelled fragments and treated in the Role 3 UK-led Field Hospital in Camp Bastion, Afghanistan, between 8 July and 20 October 2012 were prospectively recorded. The Abbreviated Injury Scores (AIS) and relative risk of casualties sustaining injuries under a type of body armour were compared with those that did not wear that armour.


RESULTS
Casualties wearing a combat helmet were 2.7 times less likely to sustain a fragmentation wound to the head than those that were unprotected (mean AIS of 2.9 compared with 4.1). Casualties wearing a body armour vest were 4.1 times less likely to sustain a fragmentation wound to the chest or abdomen than those that were unprotected (mean AIS of 2.9 compared with 3.9). Casualties wearing pelvic protection were 10 times less likely to sustain a fragmentation wound to the pelvis compared with those that were unprotected (mean AIS of 3.4 compared with 3.9).


CONCLUSIONS
Computerised SWM has objectively demonstrated the ability of body armour worn on current operations in Afghanistan to reduce wound incidence and severity. We recognise this technique is limited in that it only records the surface wound location and may be specific to this conflict. However, gathering electronic SWM at the same time as recording injuries for the JTTR was simple, required little extra time and therefore we would recommend its collection during future conflicts.
Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK Biomedical Sciences Department, Dstl Porton Down, Salisbury, UK.
Johno
J
Breeze
Biomedical Sciences Department, Dstl Porton Down, Salisbury, UK.
L S
LS
Allanson-Bailey
Biomedical Sciences Department, Dstl Porton Down, Salisbury, UK.
A E
AE
Hepper
Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
M J
MJ
Midwinter
D015998:Abbreviated Injury Scale; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000517:prevention & control*; D017076:Computer-Aided Design; D004867:Equipment Design; D005107:Explosions; D006801:Humans; D008889:Military Personnel; D060051:Occupational Injuries / Q000453:epidemiology / Q000517:prevention & control*; D010865:Pilot Projects; D011446:Prospective Studies; D011482:Protective Devices; D006113:United Kingdom
FORENSIC MEDICINE; ORAL & MAXILLOFACIAL SURGERY; TRAUMA MANAGEMENT; body armour; combat helmet