Why US troops have new shoulder pads

For military medics, the lesson that matters most from Lt. Jeff Copeland's US Marine convoy is not that it was ambushed three times by Iraqi insurgents on a single run.

The key point for them: How and where were the two US casualties wounded?

As US troops struggle with ongoing violence, a newly established US Navy Combat Trauma Registry is charting casualty patterns in hopes of improving troop protection. The number of US dead in April has reached 122, with nearly 900 troops wounded.

Already, specific dangers for US forces - roadside bombs and urban warfare - are prompting swift innovations.

The military, for example, has rush ordered thousands of Kevlar shoulder guards and blastproof sunglasses. The reason? Ask Lieutenant Copeland, a US Navy combat medic officer from Gainesville, Fla., whose first taste of combat came two weeks ago. Two of his marines took shoulder injuries from bullets and shrapnel. "He's done, he's gone home - he can't shoot," Copeland says of one case. New Kevlar shoulder guards might have protected the marine and kept him on the battlefront.

Monday, Fallujah remained relatively calm as marines prepared for joint patrols with Iraqi forces later this week. But in Najaf, US forces killed 43 Shiite militiamen in a gun battle and destroyed an antiaircraft system belonging to the insurgents. Spanish peacekeeping troops also completed their withdrawal from positions in Najaf and Diwaniya.

At Camp Fallujah, seven miles east of the city, new forms arrived this week that will allow surgeons to log details of injuries and answer questions about their cause, and armor used.

Using a prototype form until now, US Navy medical corpsmen at the Bravo Surgical Company here have detailed more than 190 trauma cases.

The new forms can be filled out on computer; some medical officers nearer the front line will hold voice recorders. "All we have is this huge database from Vietnam that ... needs updating," says US Navy Capt. Eric McDonald, chief surgeon for the 1st Marine Expeditionary Force. "We're trying to answer those questions - which glasses are better, which armor, which vehicle is better - in a scientific way."

There has been close cooperation between the US Army and the Navy, which traditionally provides medical support for the marines. "If you watch Roman Legion movies, that is where we are getting to," says Navy Capt. John Siefert, a doctor from San Diego, Calif., referring to Kevlar shoulder guards and lower skirts on flak vests.

"I've seen mockups of the future warrior, and they look like [Star Wars] storm troopers," says Cmdr. Ben Ernst, medical director of the unit, from Chillicothe, Missouri.

Trauma centers in US hospitals today are a direct outgrowth of Army medics coping with combat trauma in Vietnam. Improvements since that era - including forward surgical teams much closer to front-line action - have trimmed front-line death rates.

In the 1991 Gulf War, ceramic armor plates were used only by Special Forces; today they are standard issue.

Parallel to the budding Navy effort, the Army has been pursuing the first stages of its own trauma registry. The birth of key innovations in Iraq, in fact, began over the winter, when the Army's 82nd Airborne controlled this area.

It was Lt. Col. Kelly Bal, an orthopedic surgeon with the Army's 82nd Airborne, who first detected the pattern of wounds to exposed shoulders.

Colonel Bal jerry-rigged a Kevlar groin protector from a typical armored vest to fit around the upper arm, says McDonald. A prototype saved a soldier. The Army quickly bought 6,000, some 2,000 of which are now being used by marines. The Marines have ordered 25,000 more shoulder protectors.

A similar story surrounds the wide use of Wiley-X sunglasses with ballistic lenses and padded frames, and toughened goggles - a direct result of blast wounds to the eyes from IEDs.

"Ideally, we would travel in hermetically sealed bubbles ... but we don't drape ourselves in this stuff [because] everything you add is a benefit, and has a cost," says McDonald. Shoulder protectors may hamper a marksman and add a heat burden. Some ballistic glasses tend to fog in heat.

Experts are also working on a better earplug that permits frequencies like voices while protecting against the noise of a nearby grenade blast. Surgeons here also expect more coverage of neck and lower abdomen areas. "The future is mining that database," says McDonald, "to find the places where benefits [of new measures] outweigh risks."