Is behind armour blunt trauma a real threat to users of body armour? A systematic review.

INTRODUCTION Behind armour blunt trauma (BABT) has been defined as a non-penetrating injury caused by the rapid deformation of body armour. There has been an increasing awareness of BABT as an injury mechanism in both the military and civilian worlds; whether BABT results in serious injuries is debatable. METHOD A systematic review of the openly accessible literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method to investigate those injuries classified as BABT and their severity. RESULTS 50 sources were identified that included pertinent information relevant to this systematic review on BABT injuries. Typical injuries reported included skin contusion, laceration and penetration, rib fracture and contusions to lungs, kidneys, spleen and (rarely) the heart. No evidence of fatal injuries due to BABT was identified. CONCLUSIONS Whether BABT can lead to life-threatening injuries when small-arms ammunition impacts body armour components designed to stop that ammunition is debatable. It should be emphasised that other data may be available in government reports that are not openly available. Further research should be considered that investigates developments in body armour, including initiatives that involve reducing burden, and how they affect BABT.