Behind Armour Blunt Trauma - an emerging problem

Behind Armour Blunt Trauma (BABT) is the non-penetrating injury resulting from the rapid deformation of armours covering the body. The deformation of the surface of an armour in contact with the body wall arises from the impact of a bullet or other projectile on its front face. The deformation is part of the retardation and energy absorbing process that captures the projectile. In extreme circumstances, the BABT may result in death, even though the projectile has not perforated the armour. An escalation of the available energy of bullets and the desire of armour designers to minimise the weight and bulk of personal armour systems will increase the risk of BABT in military and security forces personnel. In order to develop materials that can be interposed between the armour and the body wall to attenuate the transfer of energy into the body, it is essential that the mechanism of BABT is known. There is a great deal of activity within UK and NATO to unravel the interactions; the mechanism is likely to be a combination of stress (pressure) waves generated by the rapid initial motion of the rear of the armour, and shear deformation to viscera produced by gross deflection of the body wall. Physical and computer model systems are under development to characterise the biophysical processes and provide performance targets for materials to be placed between armours and the body wall in order to attenuate the injuries (trauma attenuating backings - TABs). The patho-physiological consequences of BABT are being clarified by research, but the injuries will have some of the features of blunt chest trauma observed in road traffic accidents and other forms of civilian blunt impact injury. The injuries also have characteristics of primary blast injury. An overview diagnosis and treatment is described.

[1]  G Mirra,et al.  An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis) , 1998, The New England journal of medicine.

[2]  C. Soderstrom,et al.  A New Nonpenetrating Ballistic Injury , 1978, Annals of surgery.

[3]  W. Pearce,et al.  Significance of the electrocardiogram in heart contusion due to blunt trauma. , 1976, The Journal of trauma.

[4]  D. Viano,et al.  Role of impact velocity and chest compression in thoracic injury. , 1983, Aviation, space, and environmental medicine.

[5]  Aurelio Rodríguez,et al.  Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury. , 1998, The Journal of trauma.

[6]  J. Beal Blunt trauma of the heart and great vessels. , 1979, IMJ. Illinois medical journal.

[7]  J. Richardson,et al.  Lung bacterial clearance following pulmonary contusion. , 1979, Surgery.

[8]  R. L. Fulton,et al.  The progressive nature of pulmonary contusion. , 1970, Surgery.

[9]  Ian V. Hogg,et al.  Jane's infantry weapons , 1978 .

[10]  B. Burbank,et al.  Traumatic wet lung; observations on certain physiologic fundamentals of thoracic trauma. , 1945, The Journal of thoracic surgery.

[11]  Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. , 1986 .

[12]  G. Cooper,et al.  The role of stress waves in thoracic visceral injury from blast loading: modification of stress transmission by foams and high-density materials. , 1991, Journal of biomechanics.

[13]  G. Cooper,et al.  Biophysics of Impact Injury to the Chest and Abdomen , 1989, Journal of the Royal Army Medical Corps.

[14]  R. Jeffrey,et al.  CT diagnosis of unsuspected pneumothorax after blunt abdominal trauma. , 1983, AJR. American journal of roentgenology.

[15]  R. Steckel,et al.  Minimal detectable pleural effusions. A roentgen pathology model. , 1972, Radiology.

[16]  L. F. Parmley,et al.  Nonpenetrating Traumatic Injury of the Heart , 1958, Circulation.

[17]  G. Cooper,et al.  Protection of the lung from blast overpressure by thoracic stress wave decouplers. , 1996, The Journal of trauma.

[18]  D. Viano,et al.  Myocardial conducting system dysfunctions from thoracic impact. , 1978, The Journal of trauma.

[19]  R. Meuli,et al.  Spiral CT aortography: an efficient technique for the diagnosis of traumatic aortic injury , 1998, European Radiology.

[20]  W. O. Crawford,et al.  Classification of parenchymal injuries of the lung. , 1988, Radiology.

[21]  P. Connelly,et al.  Modern war surgery: the experience of Bosnia. 2: The clinical experience. , 1995, Canadian journal of surgery. Journal canadien de chirurgie.

[22]  Dennis C. Schneider,et al.  Cadaver Skeletal Response to Blunt Thoracic Impact , 1975 .

[23]  P. Pepe Acute post-traumatic respiratory physiology and insufficiency. , 1989, The Surgical clinics of North America.

[24]  B. Baxter,et al.  A plea for sensible management of myocardial contusion. , 1989, American journal of surgery.

[25]  David C. Viano,et al.  Interrelationship of Velocity and Chest Compression in Blunt Thoracic Impact to Swine , 1981 .

[26]  H. Schild,et al.  Pulmonary Contusion: CT vs Plain Radiograms , 1989, Journal of computer assisted tomography.

[27]  I S Bush,et al.  FINITE ELEMENT MODELLING OF NON-PENETRATING THORACIC IMPACT , 1988 .

[28]  D C Viano,et al.  A viscous tolerance criterion for soft tissue injury assessment. , 1988, Journal of biomechanics.

[29]  G E Thomas Fatal .45-70 rifle wounding of a policeman wearing a bulletproof vest. , 1982, Journal of forensic sciences.

[30]  Fulton Rl,et al.  The progressive nature of pulmonary contusion. , 1970 .

[31]  X. Li,et al.  Studies on the mechanisms of stress wave propagation in the chest subjected to impact and lung injuries. , 1996, The Journal of trauma.

[32]  G. Cooper,et al.  The biomechanical response of the thorax to nonpenetrating impact with particular reference to cardiac injuries. , 1982, The Journal of trauma.

[33]  G. Cooper,et al.  Experimental evaluation of a rig to simulate the response of the thorax to blast loading. , 1996, The Journal of trauma.

[34]  J. Davis,et al.  Delayed or missed diagnosis in blunt chest trauma. , 1971, The Journal of trauma.

[35]  M. Healey,et al.  Blunt cardiac injury: is this diagnosis necessary? , 1990, The Journal of trauma.

[36]  Y C Fung,et al.  A hypothesis on the mechanism of trauma of lung tissue subjected to impact load. , 1988, Journal of biomechanical engineering.

[37]  D C Viano,et al.  Mechanism of injury from air bag deployment loads. , 1993, Accident; analysis and prevention.

[38]  G. Velmahos,et al.  Routine helical computed tomographic evaluation of the mediastinum in high-risk blunt trauma patients. , 1998, Archives of surgery.