• Adam T Biggs, Matthew R Doubrava, and Lanny F Littlejohn.
• Naval Special Warfare Command, Coronado, CA 92155, USA.
• Mil Med. 2022 May 3; 187 (5-6): e787-e791.

AbstractClose quarters combat training is designed to replicate the mental and physiological stressors of firing upon an adversary while in close proximity. One method to replicate combat stressors is to use non-lethal training ammunition specifically designed for force-on-force exercises. These rounds can be fired from slightly modified service-issued weapons and provide a pain sensation upon striking the opponent. The current investigation presents a case study of several injuries when these rounds impacted the head directly, which is a primary area of concern for safety issues. Most impacts produced initial swelling that reduced substantially within the first few hours. Approximately 24 hours later, the swelling disappeared entirely with a visible contusion near the impact center. Bruising would typically clear within a few days. However, another example produced sufficient bleeding to require intervention before continuing with the training exercises and sanguineous crust or scabbing rather than the typical contusion. Pain was minimal for all wounds after only several days, which aligns with previous research on pain from non-lethal training ammunition wounds. Based on the head wounds observed here, loss of eyesight is a realistic possibility. Eye protection should be a requisite across all force-on-force training exercises without exception. This case study documents some potential hazards of force-on-force training, but more importantly, it further highlights the need for medically informed training standards about engagement distances and personal protective equipment.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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