Defining the minimum anatomical coverage required to protect the axilla and arm against penetrating ballistic projectiles

Breeze, John; Fryer, Robert; Lewis, Eluned; Clasper, Jon

doi:10.1136/jramc-2015-000453

Cited by 5 publications

(9 citation statements)

References 46 publications

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“…Defining the boundaries in this way also ensures coverage to the essential and desirable structures. To note, 80 mm is used for defining the lower boundary of upper arm coverage, as a tourniquet is easier to apply closer to the axilla 16…”

Section: Discussionmentioning

confidence: 99%

“…Breeze et al 16 have previously postulated that the outer boundary of essential medical coverage for limb ballistic protection should be the point at which a tourniquet can be applied consistently. Such a concept has recently been used in the redefined coverage requirements for upper arm protection using brassards 16 17. Using this premise, the highest point on the thigh to where a tourniquet may be applied is the gluteal fold of the buttocks, which corresponds to a point just below the ischial tuberosity of the pelvis.…”

Section: Methodsmentioning

confidence: 99%

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Defining the medical coverage of ballistic protection to the pelvis and thigh

2020

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IntroductionPelvis, lower limb and associated genital injury caused by explosive devices was responsible for mortality and considerable long-term morbidity for the UK Armed Forces during combat operations in Afghanistan, resulting in the issue of a pelvic protection system in 2010. The aim of this current research was to determine the medical coverage of the pelvis and thigh and to define the vertical dimensions of ballistic protective material for future pelvic protection (PP).MethodCT scans from 120 male UK Armed Forces personnel were analysed to identify the anthropometric landmarks and vertical boundaries of coverage for the pelvis and thigh. Pelvic height was the vertical distance between the upper border of the iliac crest in the midaxillary plane to the most inferior point of the ischial tuberosity of the pelvis. Upper thigh height was proposed as a 100 mm fixed distance below the ischial tuberosities, enabling a tourniquet to be reproducibly applied. These distances were compared with the ballistic component of the five sizes of tier 1 PP using a paired t-test.ResultsThe vertical components of coverage measured using CT scans were all significantly less (p<0.01) compared with all five sizes of tier 1 PP; for example, the ballistic component of the smallest size of tier 1 PP measured 410 mm, which was larger than the 99th percentile male, which measured 346 mm on CT scans.ConclusionsWhile all sizes of tier 1 PP provide coverage to the pelvis and upper thigh structures, there is an opportunity to optimise future PP. For example, comparing the large size of tier 1 PP to the 50th percentile male demonstrated an opportunity to reduce the ballistic protective component by 31%. Reducing the quantity of material used will improve heat dissipation and user comfort and reduce material mass and acquisition costs.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Defining the medical coverage of ballistic protection to the pelvis and thigh

2020

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“…Protection of the upper arm from fragmentation threats has been available for use by UK service personnel since the introduction of the KESTREL and OSPREY personal armour systems in 2006 2. This protection has been in the form of integral (non-detachable) brassards for KESTREL and removable brassards that attached using press studs to the body armour vest for OSPREY (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

“…The VIRTUS personal armour and load carriage system, introduced in 2015, has replaced OSPREY as the personal armour system worn by the high readiness component of the UK Armed Forces 3. VIRTUS uses a single size of brassard, and following recommendations from previous arm coverage work,2 there is no longer a separate shoulder guard component (Figure 2A). However, at the time of procurement, there was no medical evidence to recommend the size of the brassard.…”

Section: Introductionmentioning

confidence: 99%

“…However, there is a limit to how close to the torso that a tourniquet can be applied. Multidisciplinary medical consensus has therefore recommended that the position at which a tourniquet can reliably be applied and tightened should determine the extent that the arm should be covered by ballistic protective materials 2. The limits to how closely tourniquets can be applied to the torso are the anterior and posterior axillary folds of the armpit (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

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Sizing of ballistic arm protection for the VIRTUS body armour and load carriage system

Breeze

Davis

Fryer³

et al. 2020

BMJ Mil Health

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IntroductionSevere haemorrhage from the arm that is unresponsive to direct pressure necessitates the application of a tourniquet. Detachable arm protection, referred to as brassards, are used by the UK Armed Forces to protect the upper arm from fragmentation threats. However, the coverage they originally provided was based on limited medical evidence. Medical consensus has determined that the dimensions of arm protection should in future be related to how far up the arm a tourniquet can be applied.MethodCT scans of 120 male Armed Forces personnel were analysed to ascertain the vertical distances from acromion process to the point at which a tourniquet can applied, equating to the anterior axillary fold. These values were statistically compared with those derived from the 2007 UK Military anthropometric survey using a paired t-test. Additional distances were added to account for tourniquet width and slippage, with the total value compared with VIRTUS brassard length.ResultsNo significant difference (p<0.01) was found in mean acromion to axilla length (114 mm) compared with that found in the anthropometric survey confirming sample validity. The deltoid insertion lay 24 mm below the axillary fold for the 50th percentile value from CT. Essential arm coverage for the 99th percentile male in this study was calculated as 201 mm.ConclusionsBased on this research, a single new brassard for the VIRTUS body armour and load carriage system was recommended and manufactured based on the 99th percentile. This is over 30% shorter than the existing VIRTUS brassard, reducing the overall weight burden for the soldier and improving heat dispersion, integration and interoperability. The new brassard has been issued to Armed Forces personnel since October 2018. The reduced mass of ballistic protective material in conjunction with requiring only a single size of brassard has already saved the Ministry of Defence £20 000 in procurement costs.

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