Anatomic distribution of bullet head injuries in combat fatalities
Gun-shot wound head injury comprises a substantial fraction of combat injuries and a major cause of death in the battlefield. Current shielding gear is totally ineffective against bullets, because bullet-proof materials are too heavy to be worn on the head. The aim of this work was to describe the anatomic distribution of bullet entry wounds to the head in combat fatalities and to discern whether distribution is random (null hypothesis) or not.
We retrospectively examined the forensic external examination reports of all Israeli Defense Forces combat fatalities during the years 2000 to 2004, the Second Lebanon War (2006), and Operation Cast Lead (2009) and mapped the exact anatomic location of all bullet entry wounds to the calvaria.
We found 76 gun-shot entry wounds to the heads of 49 fatalities. Among these wounds, the occipital and anterior-temporal regions were found to be hit significantly more often than expected compared with their relative surface area (p < 0.001 and p < 0.001, respectively). Fifty-five percent of all injuries occurred within 15% of the surface area of skull.
These findings imply that gun-shot entry wounds to the head are unevenly distributed. A partially bullet-proof protective helmet may prevent a substantial fraction of injuries (and fatalities) without a significant weight addition to the helmet.
Influence of personal armor on distribution of entry wounds: lessons learned from urban-setting warfare fatalities
This study was undertaken to examine the distribution of entry wounds resulting from firearms and shrapnel in soldiers wearing military personal armor systems (MPAS) in low-intensity urban combat conditions.
Data were collected for a retrospective analysis on 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.
A total of 149 entrance wounds were divided into shrapnel and bullet groups. The "face-neck" region had the highest density rate compared with other body regions in both 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 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).
The use of MPAS turned the face-neck region into the most vulnerable body part, as shown by its prominent density rate, especially in the shrapnel group. MPAS designed for urban setting warfare should provide maximal shielding both to the anterior and posterior chest regions. The diameter of entrance wounds in the covered versus the uncovered areas was not statistically significant, suggesting that only a minor deformation of the bullet takes place while traversing the Kevlar vest.