PT  - JOURNAL ARTICLE
AU  - Johno Breeze
AU  - R Fryer
AU  - E A Lewis
AU  - J Clasper
TI  - Defining the minimum anatomical coverage required to protect the axilla and arm against penetrating ballistic projectiles
AID  - 10.1136/jramc-2015-000453
DP  - 2016 Aug 01
TA  - Journal of the Royal Army Medical Corps
PG  - 270--275
VI  - 162
IP  - 4
4099  - http://militaryhealth.bmj.com/content/162/4/270.short
4100  - http://militaryhealth.bmj.com/content/162/4/270.full
SO  - J R Army Med Corps2016 Aug 01; 162
AB  - Introduction Defining the minimum anatomical structural coverage required to protect from ballistic threats is necessary to enable objective comparisons between body armour designs. Current protection for the axilla and arm is in the form of brassards, but no evidence exists to justify the coverage that should be provided by them.Method A systematic review was undertaken to ascertain which anatomical components within the arm or axilla would be highly likely to lead to either death within 60 min or would cause significant long-term morbidity.Results Haemorrhage from vascular damage to the axillary or brachial vessels was demonstrated to be the principal cause of mortality from arm trauma on combat operations. Peripheral nerve injuries are the primary cause of long-term morbidity and functional disability following upper extremity arterial trauma.Discussion Haemorrhage is managed through direct pressure and the application of a tourniquet. It is therefore recommended that the minimum coverage should be the most proximal extent to which a tourniquet can be applied. Superimposition of OSPREY brassards over these identified anatomical structures demonstrates that current coverage provided by the brassards could potentially be reduced.