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Medical Aspects of Body Armor in Korea

Medical Science Publication No. 4, Volume 1

TUESDAY AFTERNOON SESSION
20 April 1954

MODERATOR
MAJOR CURTIS P. ARTZ, MC


MEDICAL ASPECTS OF BODY ARMOR IN KOREA*

ROBERT H. HOLMES, M. D., WILLIAM F. ENOS, JR., M. D.,
AND
CAPTAIN JAMES C. BEYER, MC

The results of ballistic surveys of American casualties in Korean fighting were presented in a previous paper (1) which also stressed the urgent need for body armor by combat personnel and discussed its probable effectiveness. The first field trial of body armor in Korea (1951) indicated that it could be worn without interference to combat performance, that the soldiers unanimously desired it, and that an appreciable decrease in casualty rate and also in the severity of wounds received could be anticipated. Since that time body armor has become standard equipment for field forces, both Army and Marine Corps, and has been used by large numbers of troops under combat conditions for a significant period. It is believed that the value of the armored vest in the total medical effort to conserve the fighting strength of our field forces has been demonstrated and that this report on it is not premature.

The causative agents of wounds were carefully evaluated as to relative incidence, wounding potential, physical characteristics, explosion distances, range, probable velocities and chance factor for wounding. Anatomic regional frequency and distribution of wounds were determined under variable tactical circumstances, and comparative data compiled for the killed-in-action, the wounded-in-action, and those dying of wounds in hospitals. A large number of autopsies upon the killed-in-action were performed in order to observe significant phenomena of wound production, such as morphologic characteristics of entrance and exit wounds, missile passage and adjacent trauma, and the varied effects of missiles upon skin, soft parts, bone, hollow organs, solid organs, specific lethal wounds and probable casualty survival time. Finally, Army missions in 1951 and 1952 determined beyond doubt that the field soldier could wear, would wear, and desired to wear the body armor afforded him.


*Presented 20 April 1954, to the Course on Recent Advances in Medicine and Surgery, Army Medical Service Graduate School, Walter Reed Army Medical Center, Washington, D. C. To be published in the Journal of the American Medical Association.


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Classification forbids release of certain date but, in general, the significant observations leading to the adoption of body armor were as follows:

    1. The nature and behavior of the wounding agent. It was determined that about 75 percent of wounds are caused by shell fragments; not shrapnel, as they are erroneously called. The mean size of these fragments is less than 50 grains and about 1 cm. in greatest dimension. Distance from the shell explosion is usually from 1 to 25 meters for the wounded-in-action, and probably much closer for the killed-in-action. This impression has been obtained by examining the relative wound incidence per casualty in the two groups and by interrogating the wounded.

    2. The probable velocity of a significant percentage of the shell fragments was determined by deduction from certain wound characteristics and was found to fall within a range for which protection could be obtained. It was noted that about 70 percent of all missile wounds were of a penetrating type, that is, having a wound of entrance but no wound of exit, rather than a perforating type or "thru and thru wound." This fact allowed for a fair estimate of the average missile velocity of shell fragments upon the battlefield.

    3. The anatomic regional incidence of wounds showed that hits on the thorax and abdomen accounted for about 30 percent of the wounds among the wounded-in-action (table 1), 46 percent among those dying of wounds in a hospital, and 45 percent among those killed-in-action (table 2).

Table 1. Regional Distribution of Wounds in WIA

 

Percent

Without armor

With armor

Head

14. 4

14. 2

Neck

3. 0

2. 5

Thorax

19. 0}30. 0

{8. 7} 19. 5

Abdomen

11. 0}30. 0

{10. 8}19. 5

Upper extremities

25. 0

28. 3

Lower extremities

27. 0

35. 0

Genitalia

0. 6

0. 5


Total


100. 0


100. 0

Multiple wounds

53. 0

59. 0

Small arms missiles

15. 3

15. 4

Shell fragments

84. 7

84. 6


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Table 2. Regional Frequency of Lethal Wounds (Without Body Armor)

 

Percent

DOW*

KIA**

Head

25. 5

41. 5

Neck

3. 0

4. 1

Thorax

24. 0

36. 0

Abdomen

22. 0

9. 4

Extremities

20. 5

6. 0

Buttocks

5. 0

3. 0


Total


100. 0


100. 0

*DOW-died-of-wounds (in a hospital).
**KIA-killed-in-action.

    4. Actual field trial in Korea showed that the soldier could carry an additional 6 to 8 pounds, suspended from the shoulder girdle, without interference to combat performance. In addition, he desired this protection and manifested improvement in morale and increase in aggressiveness.

Following these observations, body armor was adopted as a standard item of field equipment and, as quickly as production allowed, was issued to frontline combat personnel. Subsequent wound ballistics surveys have demonstrated the value of this armor as shown by the accompanying statistical chart (table 3).

Table 3. Effectiveness of Body Armor Against Missile Hits

 

Total

Shell fragment

Small arms

Unknown

Vests hit by missiles:

Number

254

184

63

7

Percent

100. 0

72. 4

24. 8

2. 8

Missiles hitting vests:

Number

874

725

123

26

Percent

100. 0

82. 9

14. 1

3. 0

Defeated by vest

593

549

30

14

Perforating vest

281

176

93

12

Percent defeated*

67. 8

75. 7

24. 4

53. 8

Percent perforating*

32. 2

24. 3

75. 6

46. 2

Average number of missiles per vest hit

3. 4

3. 9

2. 0

3. 7

*Percentage of missiles hitting vests.

Nylon and Doron, a compressed fiber glass, are the materials presently utilized in the various prototyes of body armor. The first


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armored vests used in Korea (1951) were a combination of nylon and Doron, the shoulder girdle being tailored with nylon. This allowed for comfort and mobility. The protective properties of the two materials are essentially the same. Recent vests in use by the Army have been made entirely of nylon. They weigh about 8 pounds and provide a high degree of protection against shell fragments and some degree of protection against small arms fire, depending upon the angle of incidence of the bullet and the range. Bullets hitting at acute angles and/or reduced velocities occurring at the terminus of flights are frequently defeated by the vests. In other instances, the severity of wounds is significantly reduced even though the vest may be perforated.

Because of the widespread use of this armor a relative increase had become apparent in the percentage of head wounds, neck wounds and severe wounds of the extremities. For example, those who have suffered multiple missile wounds, some or one of which could have been lethal if in the thorax or abdomen, survive to reach a hospital with a head wound or severe mutilations and amputations of the extremities. Combat surgeons have also noted that the severity of abdominal wounds has decreased and fewer extensive bowel resections are performed. This increase in survival time actually leads to an additional reduction in killed-in-action because of advanced technics in battlefield recovery and helicopter evacuation. Once a casualty reaches a hospital, modern medicine and surgical care assure him of a 98 percent probability of survival. In addition to the prevention of wounds and reduction in severity of wounds to the thorax and abdomen, a valuable psychological adjunct has accrued in terms of improved soldier morale, for greater confidence in personal safety increases aggressiveness in combat.

Classification forbids detailed discussion, but it can be stated that in a statistically significant number of instances 68 percent of all missile hits on armored vests worn in actual combat were defeated. In other words, two out of every three of all missiles hitting the vests failed to produce a wound. Because of the probability of multiple wounds, this does not necessarily mean that a casualty or a fatality was prevented, but it does mean an absolute reduction in the number of wounds any one of which conceivably could have been fatal or disabling. Since about one-third of all who sustain thoracic and abdominal wounds are wounded in these anatomic regions alone, it follows that there is also an actual reduction in total casualty incidence. It is possible, and now appears to be true, that this reduction in casualty incidence is of approximately the same magnitude for both killed-in-action and wounded-in-action; therefore, a significant change in the KIA-WIA


221

ratio due to body armor need not be expected. This ratio will remain constant or fluctuate, determined by the relative change in the two magnitudes. The true effectiveness of the vest is a simple expression of the percentage of missiles of all types on the battlefield which hit the vests and are defeated. The determination of the ballistic qualities of present body armor is dependent upon carefully controlled laboratory experiments, and its value on the battlefield is specifically related to the number of missiles which it defeats. This has been shown to be 68 percent.

The body armor in current use has been designed primarily for the reduction of battlefield killed-in-action. Any reduction of wounded-in-action is a gratuitous and natural expectancy. The use of such armor is, and always will be, a compromise between the maximum protection desired and the weight load that can be carried without lowering combat efficiency. Vital anatomic regions-head, thorax and abdomen-must therefore assume unquestioned priority in protection. Improvement of design and search for new materials providing maximum protection with minimum weight are continuous.

It is also cogent to consider the application of similar protective device in the civilian defense program. The battlefield is no longer confined and the spectre of atom-bomb and H-bomb blast upon homeland cities is an accepted prospect. Injury from flying debris, such as masonry, metal and glass, is of great importance following such blast (2), and conceivably the use of body armor could lessen appreciably the staggering morbidity and mortality anticipated in such a mass civilian disaster.

Summary

Medical care upon the battlefield is one of the greatest challenges presently before us and it is being met vigorously by prevention of wounds as well as by treatment of wounds. The concept of prevention is of potential value also in meeting the tremendous problem of civilian medical care in the event of all-out war.

References

1. Holmes, R. H.: Wound Ballistics and Body Armor. J. A. M. A. 150: 73-78, 1952.

2. Liebow, A. A., Warren, S., and DeCoursey, E.: Pathology of Atomic Bomb Casualties. Am. J. Path. 25: 853-1027, 1949.