Royal Centre for Defence Medicine, Birmingham, UK
Department of Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
BMJ Mil Health. 2021 Jun;167(3):163-167. doi: 10.1136/jramc-2019-001254. Epub 2020 Feb 20.
Severe haemorrhage from the arm that is unresponsive to direct pressure necessitates the application of a tourniquet. Detachable arm protection, referred to as brassards, are used by the UK Armed Forces to protect the upper arm from fragmentation threats. However, the coverage they originally provided was based on limited medical evidence. Medical consensus has determined that the dimensions of arm protection should in future be related to how far up the arm a tourniquet can be applied.
CT scans of 120 male Armed Forces personnel were analysed to ascertain the vertical distances from acromion process to the point at which a tourniquet can applied, equating to the anterior axillary fold. These values were statistically compared with those derived from the 2007 UK Military anthropometric survey using a paired t-test. Additional distances were added to account for tourniquet width and slippage, with the total value compared with VIRTUS brassard length.
No significant difference (p<0.01) was found in mean acromion to axilla length (114 mm) compared with that found in the anthropometric survey confirming sample validity. The deltoid insertion lay 24 mm below the axillary fold for the 50th percentile value from CT. Essential arm coverage for the 99th percentile male in this study was calculated as 201 mm.
Based on this research, a single new brassard for the VIRTUS body armour and load carriage system was recommended and manufactured based on the 99th percentile. This is over 30% shorter than the existing VIRTUS brassard, reducing the overall weight burden for the soldier and improving heat dispersion, integration and interoperability. The new brassard has been issued to Armed Forces personnel since October 2018. The reduced mass of ballistic protective material in conjunction with requiring only a single size of brassard has already saved the Ministry of Defence £20 000 in procurement costs.
手臂严重出血且直接按压无效时，需要使用止血带。可拆卸的手臂保护装置，称为臂套，英国武装部队用于保护上臂免受碎片威胁。然而，它们最初提供的覆盖范围是基于有限的医学证据。医学共识认为，手臂保护装置的尺寸应与止血带可应用的手臂高度有关。
对 120 名男性武装部队人员进行 CT 扫描，以确定从肩峰到可以应用止血带的点（即腋前褶皱）的垂直距离。使用配对 t 检验对这些值与 2007 年英国军事人体测量调查得出的值进行统计学比较。增加了额外的距离来考虑止血带的宽度和滑动，将总距离与 VIRTUS 臂套长度进行比较。
与人体测量调查相比，肩峰到腋窝的平均长度（114 毫米）没有显著差异（p<0.01），证实了样本的有效性。三角肌插入点位于腋褶下方 24 毫米处，为 CT 的第 50 百分位值。本研究中 99 百分位男性的基本手臂覆盖范围计算为 201 毫米。
基于这项研究，建议为 VIRTUS 防弹衣和载具系统制造一种新的臂套，并基于 99 百分位制造。这比现有的 VIRTUS 臂套短 30%以上，减轻了士兵的整体重量负担，改善了散热、集成和互操作性。新臂套自 2018 年 10 月起已发放给武装部队人员。由于需要的臂套尺寸减少且减少了防弹材料的质量，国防部已经节省了 20000 英镑的采购成本。
