A Novel Computerised Surface Wound Mapping Tool to Compare the Effectiveness of Methods for Ballistic Neck Protection
Neck injuries from explosively propelled fragments are present in 11% of injured UK soldiers and result in significant mortality and long-term morbidity. US forces in contrast only sustain neck wounds in 3-4% of those injured [2], which is believed to be due to their greater acceptance in the wearing of issued neck protection. Putting ballistic material into the collar of an under body armour shirt is a novel method of protecting this anatomically vulnerable area; such an approach has recently been shown to be successful in terms of fit and equipment integration but a method for objectively comparing the effectiveness of different designs in terms of potential injury prevention is desired.
Method
Wound locations and resultant outcomes of all penetrating neck wounds sustained by UK soldiers injured by explosive fragmentation between 01 January 2010 and 31 December 2011 were prospectively entered into a novel computerised tool designed by our team. Comparisons were made between three ballistic neck collar designs in terms of injury incidence. The difference in predicted outcome between wearing each prototype and no neck protection was made using the Abbreviated Injury Score (AIS) system.
Results
Neck wounds were present in 81/871 (9%) of combat- injured UK soldiers during this period, all of whom had chosen not to wear their currently issued neck protection. Reinforcing the collar of the current design of under body armour shirt will leave vulnerable areas of the neck at the front and back, both of which were associated with a poor outcome if injured. Those collar designs with stand-off from the neck demonstrated greater protective capabilities than those closer to the neck both in terms of wound incidence and outcome.
Discussion
This approach enabled robust comparisons of predicted injury severity between designs and we believe it should also be trialled for wounds to other areas of the body. Specific collar design features have been identified that should be incorporated into future ballistic neck protection for UK soldiers which will reduce mortality and morbidity from combat neck injury.
References
1. Breeze J, Allanson-Bailey LS, Hunt NC, Hepper AE, Clasper JC. Mortality and morbidity from combat neck injury. J Trauma 2012; 72: 969-74.
2. Owens BD, Kragh JF Jr, Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma 2008; 64(2): 295-9.