Injury risk in behind armor blunt thoracic trauma.

First responders and military personnel are particularly susceptible to behind armor blunt thoracic trauma in occupational scenarios. The objective of this study was to develop an armored thorax injury risk criterion for short duration ballistic impacts. 9 cadavers and 2 anthropomorphic test dummies (AUSMAN and NIJ 0101.04 surrogate) were tested over a range of velocities encompassing low severity impacts, medium severity impacts, and high severity impacts based upon risk of sternal fracture. Thoracic injuries ranged from minor skin abrasions (abbreviated injury scale [AIS] 1) to severe sternal fractures (AIS 3+) and were well correlated with impact velocity and bone mineral density. 8 male cadavers were used in the injury risk criterion development. A 50% risk of AIS 3+ injury corresponded to a peak impact force of 24,900 +/- 1,400 N. The AUSMAN impact force correlated strongly with impact velocity. Recommendations to improve the biofidelity of the AUSMAN include implementing more realistic viscera and decreasing the skin thickness.