Torso body armour coverage defined according to feasibility of haemorrhage control within the prehospital environment: a new paradigm for combat trauma protection

Abstract

Developments in military personal armour have aimed to achieve a balance between anatomical coverage, protection and mobility. When death is likely to occur within 60 min of injury to anatomical structures without damage control surgery, then these anatomical structures are defined as ‘essential’. However, the medical terminology used to describe coverage is challenging to convey in a Systems Requirements Document (SRD) for acquisition of new armour and to ultimately translate to the correct sizing and fitting of personal armour. Many of those with Ministry of Defence responsible for the procurement of personal armour and thereby using SRDs will likely have limited medical knowledge; therefore, the potentially complex medical terminology used to describe the anatomical boundaries must be translated into easily recognisable and measurable external landmarks. We now propose a complementary classification for ballistic protection coverage, termed threshold and objective, based on the feasibility of haemorrhage control within the prehospital environment.

Using CT scans to determine the optimal sizes of hard armour plates to protect the torso for UK female Armed Forces personnel

“…2 The minimum size a front or rear plate must achieve has been defined as 'threshold', supplemented ideally with coverage of additional anatomical structures defined as 'objective'. 3 For side coverage, the maximum upper height that hard armour can physically fit is the anterior axillary fold; hence, this defines the upper limit of both objective and threshold side coverage. The lateral lower height bound is informed by the configuration of the STV.…”

“…This definition of essential coverage was subsequently modified to reflect those structures that would likely result in death prior to damage control surgery (DCS) being performed. 3 For example, bleeding from the thoracic component of the torso cannot be compressed and requires surgical thoracotomy to arrest it. NATO doctrine recommended that DCS should be performed 'within 60 min but no more than 2 hours post injury'.…”

“…Such essential medical coverage reflects protection of those anatomical structures, which if injured are likely to result in death within 60 min of injury (Figure 1). This definition of essential coverage was subsequently modified to reflect those structures that would likely result in death prior to damage control surgery (DCS) being performed 3. For example, bleeding from the thoracic component of the torso cannot be compressed and requires surgical thoracotomy to arrest it.…”

“…For example, the suprasternal notch can be related to the arch of the aorta, the 10th rib to the lower border of the liver and the superior border of the iliac crest to the bifurcation of the aorta 2. The minimum size a front or rear plate must achieve has been defined as ‘threshold’, supplemented ideally with coverage of additional anatomical structures defined as ‘objective’ 3. For side coverage, the maximum upper height that hard armour can physically fit is the anterior axillary fold; hence, this defines the upper limit of both objective and threshold side coverage.…”

Torso hemorrhage: noncompressible? never say never

“…However, limbs and torso are still the most vulnerable sites of dismounted complex blast injuries on the battlefield where improvised explosive devices are increasingly used [ 29 , 30 ]. This phenomenon reflects that the process of PPE from “basic protection” to “ideal protection” still contains many technical problems to be solved [ 26 ]. To fully achieve the flexibility of individual tactics, warfighters rarely use PPE for limb protection.…”