Influence of Personal Armor on Distribution of Entry Wounds: Lessons Learned from Urban-Setting Warfare Fatalities

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Background:This study was undertaken to examine the distribution of entry wounds resulting from firearms and shrapnel in soldiers wearing military personal armor systems (MPASs) in low-intensity urban combat conditions.Methods:Data were collected for a retrospective analysis of all combat fatalities sustained by the Israeli Defense Force (IDF) between March 30, 2002, and April 22, 2002, during Defensive Shield Operation in the West Bank. Twenty-six of the 30 fatalities were evaluated in the Israeli National Center of Forensic Medicine.Results:A total of 149 entrance wounds were categorized as shrapnel and bullet groups. The face-neck region had the highest density rate in comparison with other body regions in both the shrapnel and bullet groups (2.97 and 2.41, respectively; p < 0.0001). In both groups, the overall prevalence of anterior injuries was significantly higher than that of posterior ones (78.9% vs. 21.1% in the shrapnel group and 68.5% vs. 31.5% in the bullet group, p < 0.001). However, anterior and posterior chest injuries had a reverse yet more even distribution (43.8% and 56.2% in the bullet group and 40% and 60% in the shrapnel group, respectively; p < 0.001). The difference in the average diameters of entry wounds in the covered versus uncovered regions (0.79 ± 0.42 cm vs. 0.73 ± 0.29 cm, respectively) was not statistically significant (p = 0.11).Conclusion:The use of MPASs turned the face-neck region into the most vulnerable body part, as shown by its prominent density rate, especially in the shrapnel group. MPASs designed for urban-setting warfare should provide maximal shielding to both the anterior and posterior chest regions. The diameter of entrance wounds in the covered versus uncovered areas was not statistically significant, suggesting that only a minor deformation of the bullet takes place as it traverses a protective vest.

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