The American History of Wartime Head Injuries and Helmets, Part 6

September 07, 2018 5 min read

The American History of Wartime Head Injuries and Helmets, Part 6

ACH Combat Helmet

Afghanistan, Iraq, and the Global War on Terror

America’s latest conflicts have helped drive rapid advances in protective gear, combat medicine, and a deeper understanding of head injuries – particularly the closed traumatic brain injuries (TBI) caused by explosions.

Prior to the attacks on New York City and the Pentagon, the United States Army Soldier Systems Center had developed the Modular Integrated Communications Helmet (MICH), which was released on January 2001. It was developed after special operations troops requested a lighter-weight helmet that was more comfortable and could more easily accommodate attached accessories such as optics. About 20,000 MICH helmets were procured, a number that was soon dwarfed by the helmet that followed it.

Introduced in 2003, the Advanced Combat Helmet (ACH) is a derivative of the MICH that is made of “advanced Kevlar 129 and chemically similar Twaron brand ballistic fibers,” which make it lighter than the PASGT (2.4 pounds) as well as more resistant to shrapnel, fragments, and bullets. The ACH maintains a good protection profile, covering the upper back of the neck and sides of the head; it has a shock-absorbent liner; and it was integrated with a rail system that allowed soldiers to affix pieces of gear, including night vision optics. 1.4 million of these helmets were procured by the US military.


Both the MICH and the ACH utilized the latest versions of aramid fibers (also known as DuPont’s brand name Kevlar), which are “in a family of synthetic products characterized by strength (some five times stronger than steel on an equal weight basis) and heat-resistance (some more than 500 degrees Celsius).”

Much like the PASGT, these helmets can stop smaller, low-velocity rounds (9mm) as well as various forms of shrapnel and missile fragments. The main improvements in the MICH and ACH helmets were the fact that they are lighter and have improved suspension, fit, and adaptability. While they still couldn’t stop a close, direct hit from a high-velocity 7.62 bullet, they could save a wearer’s life, as one Marine who was deployed to Fallujah found out in early 2007:

Three weeks later, near the southwestern village of Hasa, Kopera would be shot in the head. His Marines were conducting a patrol when an insurgent’s bullet penetrated his Kevlar helmet and embedded itself in his brain, briefly knocking him down and out cold.

Zofchak was about twenty meters away and had immediately jumped into a ditch for cover. When he turned around, the corporal watched in horror as a now conscious Kopera stood up and began stumbling around in the open, dazed, as machine-gun fire cracked around him. Zofchak ran to his squad leader and pulled him into the safety of the ditch. Muñoz assessed the injury.

“My head hurts,” slurred Kopera.

The sergeant tried to take his helmet off but Muñoz stopped him; the corpsman feared it was the only thing keeping his head intact. A mostly lucid Kopera was quickly medevaced, walking onto the helicopter under his own power. He survived after having a nickel-sized piece of his brain removed.

 Now medically discharged, Kopera suffers short-term memory loss and loses his temper a little more often than he did before his injury. It sometimes strains his marriage. He jokes that he’s “the same asshole, but now [he has] an excuse.” He voices no regrets about his days as a Marine.

There are numerous other stories of individuals surviving shots to the head, and the military often presents the damaged helmets as souvenirs to the individuals saved by their gear.

Combat helmet saved soldier's life

Staff Sgt. Frankie Hernandez, an Army reservist with the 668th Engineer Company, was shot in the head in Panjwai, Afghanistan in 2012.The bullet may have ricocheted off of a nearby bulldozer. Image source and an article describing the event: Army Times

GWOT advances in medical care

Originally developed in the 90s by special operations forces, Tactical Combat Casualty Care (TCCC) is a group of procedures that incrementally made their way into the conventional military and by 2011 had become the front-line standard for care across the US military and its Coalition partners. It outlines actions that combat medics take under three scenarios:

  • Basic Management Plan for Care Under Fire
  • Basic Management Plan for Tactical Field Care
  • Basic Management Plan for Tactical Evacuation Care

Each scenario includes a series of prioritized procedures, including everything from “return fire and take cover,” to managing an airway, controlling bleeding, the medications used, and how to prep a patient for evacuation.

Unfortunately, the roll-out of TCCC took time and involved learning numerous hard lessons, as “when the U.S. military first entered Afghanistan and Iraq, little had changed in medical doctrine since the Vietnam War.” Medical advances that have been part of or separate from the TCCC include:

  • Widespread usage and training in the use of tourniquets by non-medical personnel.
  • Implementing advanced hemostatic dressings, “which are medical bandages containing chemicals that promote blood clotting.” Combat Gauze, for example, uses nanoparticles to staunch bleeding.
  • The creation of the Department of Defense Trauma Registry, a database that tracks “wounded soldiers and the type of treatment they receive once they arrive at field hospitals” and then when they “are moved to more-advanced treatment facilities in the United States.”
  • The increased deployment of helicopters to ensure more were available for quick medevacs, and the improvement of military medical evacuation standards to match the superior standards of their civilian counterparts.
  • The wider use of CT scans, better burn care standards, vastly improved prosthetics, and the use of ketamine instead of morphine to manage pain.

    Ketamine was widely seen as a “horse tranquilizer” due to its use in veterinary medicine and is also known as an illegally-used recreational drug – but it was actually widely used as a surgical anesthetic in Vietnam. The huge benefit of ketamine over morphine and other opiates is that it relieves pain without the dangerous side effects of slowing respiration and reducing blood pressure.
  • A better understanding of traumatic brain injury, post-traumatic stress syndrome, and how these two conditions interact.

Improved medical treatment and protective gear upped the chances of surviving an injury in the recent wars to unprecedented levels. “About 92 percent of Soldiers wounded in Iraq and Afghanistan have made it home alive, according to Lt. Gen. Nadja Y. West,” Surgeon general of the Army and commander of Army Medical Command. West noted that the “survival rate in Vietnam was around 75 percent.”

To Be Continued: The American History of Wartime Head Injuries and Helmets

In the next blog in this series, a look at the wars in Iraq and Afghanistan continues. Improved armor plus the rise of the improvised explosive device (IED) lead to the signature wound of the conflict: the closed head injury – and medical professionals and the military work to define and treat it. 

Previous installments:

The American History of Wartime Head Injuries and Helmets, Part 1

The American History of Wartime Head Injuries and Helmets, Part 2

The American History of Wartime Head Injuries and Helmets, Part 3

The American History of Wartime Head Injuries and Helmets, Part 4

The American History of Wartime Head Injuries and Helmets, Part 5