Predicting Outcomes of Fragmentation Injuries Sustained by Soldiers Wearing New Methods of Ballistic Face Protection
Combat face and eye wounds are responsible for significant morbidity experienced by both UK and US soldiers deploying to Afghanistan [1, 2]. The use of ballistic eyewear reduces the incidence of eye injuries when worn but the remaining face remains unprotected. Visors and mandible guards have been suggested as methods of covering this remaining area [2], but are not currently utilised due to a lack of evidence to substantiate their procurement.
Method
Wound entry locations of all UK soldiers sustaining face or eye injuries due to explosive fragments between 01 January 2010 and 31 December 2011, were prospectively entered into a novel computerised tool. Comparisons were made between different designs of eye protection, visors and mandible guards in terms of immediate outcome using the Abbreviated Injury Score (AIS) and long term outcome using the predicted Functional Capacity Index (pFCI) scores.
Results
90/199 (45%) of soldiers wore ballistic sunglasses at the time of injury and were 7 times less likely to sustain an eye injury than those that chose not to. Those 38% of soldiers that chose not to wear eye protection demonstrated 33% and 50% worse mean AIS and pFCI scores respectively. Based on these wound locations, the use of a visor was predicted to halve the incidence of facial wounds and further reduce morbidity compared to ballistic eyewear alone.
Discussion
pFCI scores were better able to differentiate between the effects of wearing different types of occulofacial protection better than the AIS, primarily due to the refined morbidity severity scores attributed to eye wounds. There was no medical evidence to support the use of a mandible guard in the current operational environment. Based on our research, a visor attached to the helmet would be expected to significantly reduce morbidity greater than eye protection alone. However user acceptability may potentially still prevent their use and we would therefore recommend future ergonomics assessments before full implementation.
References
1. Thomas R, McManus JG, Johnson AJ, Mayer P, Wade CE, Holcomb JB. Ocular injury reduction from ocular protection use in current combat operations. J Trauma 2009; 66(4): S99-103.
2. Breeze J, Allanson- Bailey LS, Hunt NC, Midwinter MJ, Monaghan AM, Gibbons AJ. Surface Wound Mapping of battlefield Occulofacial injury. Injury 2012; 43(11): 1856-60.