thedrifter
05-04-03, 08:45 AM
War in Iraq Showed Body Armor's Value
Most Nonfatal Injuries of U.S. Troops Were on Limbs, Not on Protected Torsos
By David Brown
Washington Post Staff Writer
Sunday, May 4, 2003; Page A28
The vast majority of American soldiers who suffered life-threatening wounds in combat in Iraq were hit in the limbs, not the torso, suggesting that the body armor now worn by all soldiers is remarkably effective.
The first look at the injured soldiers found that 58 percent were wounded in the hands, feet, arms or legs. Only 9 percent were injured in the abdomen, chest, back or groin. The findings are based on a study of 118 Army troops who suffered battlefield injuries severe enough to require that they be evacuated to Europe or the United States.
The military has not yet analyzed the injury pattern in soldiers killed in combat, but it is clear that most died of chest, abdominal or head injuries too severe to be prevented by protective vests and helmets under any circumstances. Among nonfatal wounds, however, the highly skewed pattern suggests that the latest armor provided real protection.
The search for ways to protect the vital organs during combat goes back to the dawn of warfare. Since the invention of gunpowder, however, few protective devices have been able to stand up to explosives and bullets. This appears no longer to be true.
"The few truncal injuries seen so far in the Iraq operation indicate the effectiveness of body armor," said Col. Terry J. Walters, the physician who is chief of health policy in the office of the Army's surgeon general. At least anecdotally, a similar pattern is being seen among soldiers wounded in the ongoing combat operations in Afghanistan, she said.
In the 1991 Persian Gulf War, the first major conflict in which all U.S. troops were provided with body armor, soldiers wore vests made of the synthetic fabric Kevlar. The vests were capable of stopping shell and grenade fragments and, when fitted with ceramic plates, could stop bullets. But the fully loaded vests weighed 25 pounds apiece and were used only in unusual circumstances, generally by Special Operations troops.
In subsequent conflicts in the Balkans and in Afghanistan, combat units were outfitted with vests that became successively better and lighter. They are now routinely worn with the ceramic plates in place. The Interceptor Body Armor used in Afghanistan and Iraq is said to stop fragments and 9mm slugs without the plates, and high-velocity 7.62mm rifle bullets -- capable of piercing light armored vehicles -- with the plates in place. Loaded, they weigh a little more than 16 pounds.
Even in situations in which blast injuries were fatal, the effectiveness of the body armor was evident, said the chief medical examiner for the armed forces.
"We've seen injury patterns where the truncal area is protected while there are shrapnel wounds to the head and extremities," Navy Cmdr. Craig Mallak said.
As of two weeks ago, Mallak and other forensic pathologists at Dover Air Force Base in Delaware had performed 154 autopsies on soldiers killed in Iraq. Although the causes of death have not been analyzed, head wounds made up the largest category, Mallak said.
Compared with that from the first Gulf War, data from the latest fighting also reveal a dramatic reversal in the ratio of combat to noncombat casualties.
Twelve years ago, 50 percent more soldiers died in accidents (235) than in battle (147). In the recent war, there were only a third as many noncombat fatalities (36) as deaths in battle (101). The same pattern appears to hold for nonfatal injuries, with the data on evacuated Army troops showing that 107 had noncombat injuries, compared with 118 who had combat wounds.
Walters attributed the steep drop in noncombat deaths and injuries, in part, to the Army's effort to improve driver safety and to ensure that soldiers were well-rested when operating vehicles. In the first Gulf War, motor vehicle accidents alone accounted for about half of all serious injuries. "Because this was such a motorized effort, we expected many more accidents than we actually saw. I think this is a definitive success story," she said.
The "rather large number of ankle and foot injuries" was partly the result of parachute jumps by soldiers with loads of gear, Walters said.
The Iraq war data strongly reinforce the evidence of body armor's usefulness that has been accumulating since World War II.
Army Air Corps crews that bombed Germany from high altitudes from 1943 to 1945 -- whose planes were routinely subjected to barrages of antiaircraft fire -- were the first modern troops to routinely wear protective vests. The Army collected data on airmen's wounds for two seven-month periods -- the first before "flak jackets" were introduced, and the second one after.
"The use of armor . . . reduced wounds of the trunk to such an extent that the regional distribution of wounds shifted markedly. From 19 percent of the total, trunk wounds declined to 11 percent. The difference was absorbed entirely by the extremities," wrote Medical Corps officers Gilbert W. Beebe and Michael E. De Bakey.
The Vietnam War evidence comes from an unusual "natural experiment," the little-known Wound Data Munitions Effectiveness Team study that was conducted from 1967 to 1969 at the request of an Army general. People from the military's munitions branch accompanied combat teams and recorded every combat injury, no matter how trivial.
At the time, Marine commanders were much more insistent than their Army counterparts that their troops wear protective vests, which were made of nylon. As a result, 49 percent of wounded Marines wore them, but only 10 percent of wounded Army soldiers. Despite the relatively flimsy nature of the vests, the study showed that the incidence of chest and abdominal wounds was 10 percent lower among Marines than among Army troops.
While small in relative terms, this difference had a large practical effect. In Vietnam, 71 percent of shell fragment or bullet wounds to the chest and 35 percent of such wounds to the abdomen were fatal, said Ronald F. Bellamy, a retired Army colonel who helps prepare textbooks on military medicine at Walter Reed Army Medical Center. He calculated that about 1,000 Marines owe their lives to the vests.
Perhaps the most striking feature of this Gulf War -- and of its predecessor 12 years ago -- was the paucity of deaths from diseases not associated with injuries.
In the Civil War, twice as many people died of diseases as of battle wounds. In World War I, about 56,000 U.S. soldiers died of diseases, slightly more than were killed in battle. In World War II, the number was 14,000; in Vietnam, 930. The first Gulf War had one death from a disease. In this Gulf War, there was one more.
Sempers,
Roger
Most Nonfatal Injuries of U.S. Troops Were on Limbs, Not on Protected Torsos
By David Brown
Washington Post Staff Writer
Sunday, May 4, 2003; Page A28
The vast majority of American soldiers who suffered life-threatening wounds in combat in Iraq were hit in the limbs, not the torso, suggesting that the body armor now worn by all soldiers is remarkably effective.
The first look at the injured soldiers found that 58 percent were wounded in the hands, feet, arms or legs. Only 9 percent were injured in the abdomen, chest, back or groin. The findings are based on a study of 118 Army troops who suffered battlefield injuries severe enough to require that they be evacuated to Europe or the United States.
The military has not yet analyzed the injury pattern in soldiers killed in combat, but it is clear that most died of chest, abdominal or head injuries too severe to be prevented by protective vests and helmets under any circumstances. Among nonfatal wounds, however, the highly skewed pattern suggests that the latest armor provided real protection.
The search for ways to protect the vital organs during combat goes back to the dawn of warfare. Since the invention of gunpowder, however, few protective devices have been able to stand up to explosives and bullets. This appears no longer to be true.
"The few truncal injuries seen so far in the Iraq operation indicate the effectiveness of body armor," said Col. Terry J. Walters, the physician who is chief of health policy in the office of the Army's surgeon general. At least anecdotally, a similar pattern is being seen among soldiers wounded in the ongoing combat operations in Afghanistan, she said.
In the 1991 Persian Gulf War, the first major conflict in which all U.S. troops were provided with body armor, soldiers wore vests made of the synthetic fabric Kevlar. The vests were capable of stopping shell and grenade fragments and, when fitted with ceramic plates, could stop bullets. But the fully loaded vests weighed 25 pounds apiece and were used only in unusual circumstances, generally by Special Operations troops.
In subsequent conflicts in the Balkans and in Afghanistan, combat units were outfitted with vests that became successively better and lighter. They are now routinely worn with the ceramic plates in place. The Interceptor Body Armor used in Afghanistan and Iraq is said to stop fragments and 9mm slugs without the plates, and high-velocity 7.62mm rifle bullets -- capable of piercing light armored vehicles -- with the plates in place. Loaded, they weigh a little more than 16 pounds.
Even in situations in which blast injuries were fatal, the effectiveness of the body armor was evident, said the chief medical examiner for the armed forces.
"We've seen injury patterns where the truncal area is protected while there are shrapnel wounds to the head and extremities," Navy Cmdr. Craig Mallak said.
As of two weeks ago, Mallak and other forensic pathologists at Dover Air Force Base in Delaware had performed 154 autopsies on soldiers killed in Iraq. Although the causes of death have not been analyzed, head wounds made up the largest category, Mallak said.
Compared with that from the first Gulf War, data from the latest fighting also reveal a dramatic reversal in the ratio of combat to noncombat casualties.
Twelve years ago, 50 percent more soldiers died in accidents (235) than in battle (147). In the recent war, there were only a third as many noncombat fatalities (36) as deaths in battle (101). The same pattern appears to hold for nonfatal injuries, with the data on evacuated Army troops showing that 107 had noncombat injuries, compared with 118 who had combat wounds.
Walters attributed the steep drop in noncombat deaths and injuries, in part, to the Army's effort to improve driver safety and to ensure that soldiers were well-rested when operating vehicles. In the first Gulf War, motor vehicle accidents alone accounted for about half of all serious injuries. "Because this was such a motorized effort, we expected many more accidents than we actually saw. I think this is a definitive success story," she said.
The "rather large number of ankle and foot injuries" was partly the result of parachute jumps by soldiers with loads of gear, Walters said.
The Iraq war data strongly reinforce the evidence of body armor's usefulness that has been accumulating since World War II.
Army Air Corps crews that bombed Germany from high altitudes from 1943 to 1945 -- whose planes were routinely subjected to barrages of antiaircraft fire -- were the first modern troops to routinely wear protective vests. The Army collected data on airmen's wounds for two seven-month periods -- the first before "flak jackets" were introduced, and the second one after.
"The use of armor . . . reduced wounds of the trunk to such an extent that the regional distribution of wounds shifted markedly. From 19 percent of the total, trunk wounds declined to 11 percent. The difference was absorbed entirely by the extremities," wrote Medical Corps officers Gilbert W. Beebe and Michael E. De Bakey.
The Vietnam War evidence comes from an unusual "natural experiment," the little-known Wound Data Munitions Effectiveness Team study that was conducted from 1967 to 1969 at the request of an Army general. People from the military's munitions branch accompanied combat teams and recorded every combat injury, no matter how trivial.
At the time, Marine commanders were much more insistent than their Army counterparts that their troops wear protective vests, which were made of nylon. As a result, 49 percent of wounded Marines wore them, but only 10 percent of wounded Army soldiers. Despite the relatively flimsy nature of the vests, the study showed that the incidence of chest and abdominal wounds was 10 percent lower among Marines than among Army troops.
While small in relative terms, this difference had a large practical effect. In Vietnam, 71 percent of shell fragment or bullet wounds to the chest and 35 percent of such wounds to the abdomen were fatal, said Ronald F. Bellamy, a retired Army colonel who helps prepare textbooks on military medicine at Walter Reed Army Medical Center. He calculated that about 1,000 Marines owe their lives to the vests.
Perhaps the most striking feature of this Gulf War -- and of its predecessor 12 years ago -- was the paucity of deaths from diseases not associated with injuries.
In the Civil War, twice as many people died of diseases as of battle wounds. In World War I, about 56,000 U.S. soldiers died of diseases, slightly more than were killed in battle. In World War II, the number was 14,000; in Vietnam, 930. The first Gulf War had one death from a disease. In this Gulf War, there was one more.
Sempers,
Roger