Medical Management Guidelines for Impacts to Body Armor

Even if an officer is wearing body armor, there is still a risk of injury, and each incident should be assessed. The following are guidelines for the care of an officer sustaining behind armor blunt trauma: [1]

Flowchart for evaluation of officer shot while wearing body armor 

Flowchart for evaluation of officer shot while wearing body armor
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  1. Take all officers who are shot while wearing body armor to an emergency department or trauma center. The vest should accompany the officer because it is critical in understanding the officer’s potential injuries.
  2. Medical personnel should use Advanced Trauma Life Support (ATLS®) recommendations in evaluating and managing patients.

The following is a suggested course of evaluation based on experience and the limited scientific data associated with behind armor blunt trauma. Clinician judgment should always take priority, and trauma upgrade should be considered when necessary.

1. Evaluate the vest for perforation.

When the patient is stable, the treating physician should evaluate the vest for the location of the shot(s) and if the shot(s) perforated or penetrated the vest.

  • Perforation — the shot went all the way through the vest.
  • Penetration — the shot went into the vest and was stopped.

2. Evaluate for injury underneath the vest.

Workup[2] should be commensurate with relating "at risk" underlying anatomy as follows:

  • Anterior chest — Imaging (chest X-ray or chest CT or both).
  • Anterior chest over cardiac zone — Above imaging and evaluate for blunt cardiac injury via EKG. (According to ATLS, cardiac enzymes are not necessary.)
  • Posterior thorax —
    • If tender in midline — appropriate regional spinal imaging should be obtained.
    • If tender lateral to midline back or flank — consider CT abdomen/pelvis for evaluation of appropriate retroperitoneal structures.
    • If tender upper posterior thorax — chest X-ray
  • Abdomen — Clinical clearance[3] if no outward signs of trauma or pain. If outward signs of trauma or abdominal pain/tenderness exist, then consider a CT of the abdomen with IV contrast to rule out associated intra-abdominal injury.

3. Ensure referrals for psychological assistance.


[note 1] Over the past several years, an interdisciplinary review panel reviewed the specific incidents in which officers sustained behind armor blunt trauma. Funded by the National Institute of Justice, this panel identified some key findings, including the need to establish routine medical care when an incident has occurred. The medical subcommittee intends to make these guidelines a living document. As new information and cases become available, the guidelines will be updated and disseminated to the larger medical community. The subcommittee respectfully submits the guidelines for the health and safety of those who put their lives on the line for the public good. See the final product submitted by the subcommittee:

Bir, Cynthia, J. Cecconi, A. Dennis, M.J. McMullen, C. Sloane, "Behind the Badge (pdf, 3 pages)", Final report submitted to the National Institute of Justice, Award No. 2004-IJ-CX-K040, February 2011, NCJ233645.

[note 2] A "workup" is a thorough medical examination for diagnostic purposes.

[note 3] The term "clinical clearance"' means that based on a focused physical examination for that region of the body, the physician has determined that injury can be ruled out and that no further radiographic or other testing is warranted. 

Date Created: July 23, 2012