Injury Prevention · 2012 · 35 citations · 17 references
Public HealthInjury PreventionPulmonary Function TestingSports Injury PreventionTraumatic Brain Injury PreventionBlast Injury ManagementBlast Injury PreventionBlast SafetyProtective EquipmentTraumatic Brain InjuryBlast OverpressureBlast PressureBlast Pressure EffectsBlast-induced Air OverpressureBlast-related Traumatic Brain InjuryPrimary Blast Injury MechanismsPrimary Brain InjuryProtective Vests
Clinical studies increasingly report brain injury but not pulmonary injury after blast exposures, despite frequent explosive device exposure. The study aimed to assess how personal body armour affects the risk of primary blast injury to the brain and lungs and its implications for patient care. A shock tube generated blast overpressures on NIJ Level‑2 soft and Level‑4 hard ballistic vests while measuring pressure behind the vest. Both soft and hard vests markedly reduced pulmonary injury risk across conditions, with the hard vest lowering behind‑armor overpressure by 56.8× and the soft vest by 14.2×; body armour increased the 50th‑percentile pulmonary death tolerance above that for brain injury, indicating that chest protection may explain the higher incidence of head injuries without lung damage and warrants heightened clinical suspicion for brain injury in blast‑exposed armour wearers.
Background Clinical studies increasingly report brain injury and not pulmonary injury following blast exposures, despite the increased frequency of exposure to explosive devices. The goal of this study was to determine the effect of personal body armour use on the potential for primary blast injury and to determine the risk of brain and pulmonary injury following a blast and its impact on the clinical care of patients with a history of blast exposure. Methods A shock tube was used to generate blast overpressures on soft ballistic protective vests (NIJ Level-2) and hard protective vests (NIJ Level-4) while overpressure was recorded behind the vest. Results Both types of vest were found to significantly decrease pulmonary injury risk following a blast for a wide range of conditions. At the highest tested blast overpressure, the soft vest decreased the behind armour overpressure by a factor of 14.2, and the hard vest decreased behind armour overpressure by a factor of 56.8. Addition of body armour increased the 50th percentile pulmonary death tolerance of both vests to higher levels than the 50th percentile for brain injury. Conclusions These results suggest that ballistic protective body armour vests, especially hard body armour plates, provide substantial chest protection in primary blasts and explain the increased frequency of head injuries, without the presence of pulmonary injuries, in protected subjects reporting a history of blast exposure. These results suggest increased clinical suspicion for mild to severe brain injury is warranted in persons wearing body armour exposed to a blast with or without pulmonary injury.
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