In 2005, it was high time to review the IMAS on Personal Protective Equipment (IMAS 10.30). As a member of the Review Board with a specialism in PPE and in accidents, there was a rather radical change that I wanted to make.
I wanted to change the minimum protection for the eyes and face. The requirement was for a 5mm untreated polycarbonate visor. I wanted this to become 5mm untreated polycarbonate eye protection. My reasons for thinking that this would be an IMPROVEMENT in protection are given below.
Here is the context. In March 1997 the UNMAS standards for Humanitarian Demining were issued. They required all deminers to wear flak-jackets, ballistic combat helmets and 13mm thick visors. These were so heavy and hot that they were not used. They were also not designed to protect against a blast from below, and the majority of demining injuries involved a blast from below. With the publication of the first Database of Demining Accidents in 1998, there was evidence that the recommended equipment was not being used (even in UN programmes). There was also evidence in support of limiting the parts of the body that needed protection to reduce weight and improve 'wearability'. In response to this evidence, I had already developed the frontal demining 'apron' body armour and the 'half-visor' already favoured by dog handlers. The frontal apron protection was taken up and adapted by many manufacturers but the half-visor was only made by one.
As part of the process of devising the new IMAS, in 2000 a working group on PPE was convened and reached a consensus on what was a more practical PPE requirement. When the IMAS were released in 2001, the requirement was for a full-face polycarbonate visor and frontal body protection. The use of back protection and helmets became optional. I was a vocal part of that working group – arguing against people who believed we should wear bomb suits – and the result was a compromise rather than a reflection of any one person's opinion.
The accident record in the years since the release of the IMAS shows that most accidents still occur when the deminer is exposing an anti-personnel mine. The severe injuries that result are caused by blast and environmental fragment damage rather than by deliberate metal fragmentation. Fragmentation mines can defeat the visor, body-armour and helmet – but fortunately accidents with these mines are rare. Despite the 2001 requirement for deminers to wear a 5mm full-face visor, there has been no significant reduction in the loss of eyes in anti-personnel blast mine accidents since that time.
The visors do not normally fail. They are simply not worn, or not worn in a fully down position, when the blast occurs. Despite this, the incidence of severe facial injury remains very rare indeed. Most facial injuries result in light scarring and no permanent disability. In contrast, a single grain of hot soil driven into the eye will leave a trail of necrotic tissue that cannot be excised and that will cause infection that often leads to eye loss. The same grain of hot soil might not leave any permanent scar if it struck the cheek.
When a deminer is left blind in a post conflict economy he is often sentenced to a slow death. If his face were scarred but he could still see, he could still work and be a useful member of the community.
This is a summary of what I wrote to other members of the Review Board in 2005.
I find that the current minimum requirement for eye protection is not widely implemented and, as a result, eye injuries are still common. The predominant threat is still anti-personnel blast mines, and they are almost invariably beneath the eye protection worn (the mines are on, or in, the ground). Blast debris entering the eyes is common even when full-face visors are worn. The debris gets behind the visor-face from below, either because it is raised or because the wearer has his head tilted backward to see beneath the lower edge of the visor.
More than 25% of all recorded deminer victims have suffered eye injury or loss.
Many field operators would welcome the opportunity to wear eye protection that did not distort vision, allowed ventilation of the nose and mouth, and that weighed rather less. Some have tried visors and returned to using unrated industrial safety spectacles because they are cheaper, easier to use for long periods - and because their accident records show that they rarely fail (they are so thin and inappropriately designed that they do fail, but not often). Some groups that issue deminers with visors give their supervisors and visitors industrial safety spectacles because they can see better over long distances and communicate without having to raise a visor.
Visual distortion is partly the result of the curvature of the visor, but mainly the result of the distance between the eye and the visor surface. In bright sunlight, reflections on the inner surface of the visor can also cause problems.
A lack of air-flow across the nose and mouth can cause a feeling of airlessness that invokes heavy breathing, and so misting of the inner-visor surface. This restricts vision when looking downward and has been cited as a reason for raising the lower edge of the visor. But if you move the lower edge of the visor away from the face, you increase visual distortion, and are more inclined to look out beneath the lower edge of the visor to see clearly.
A full face visor with head-mounting usually weighs around a kilo. Because most of the weight is in the visor face, the head-mounting has to be fastened tightly, which causes sweating and can cause pressure headaches.
5mm polycarbonate can be used to make eye protection that sits close to the eyes so reducing visual distortion. To achieve this with a full-face visor would normally require moulding compound curves that stretch (so thinning) the material in places and adding greatly to the price. Eye protection that only protected the eyes could leave the nose and mouth clear, so avoiding misting and reducing both heat and the feeling of airlessness. The weight of this protection could be reduced to below 20% of a full visor, so increasing general comfort. These advantages combine to make it more likely that the protection would be worn correctly when an accident occurred.
Concerns over severely life-threatening injury to the head, face and neck have to be balanced by the evidence in the accident record. Of those where the activity at the time can be clearly identified, the largest activity category by far is 'excavation' where the Victim was attempting to uncover a device. The next two largest categories are 'Missed-mine' and 'Handling/demolition'.
In 79% of recorded 'Excavation' accidents, some kind of visor was available to the Victim(s). In more than half of these, the visor was not worn or worn raised. As a result, in 42% of all excavation accidents in which a visor was available, eye injury or loss resulted.
In more than a third of all accidents involving AP blast mines and for which a visor was available, eye injury or loss occurred. Facial injury occurred in 43%. Light fragmentation and blast injury to the face occurred in three quarters of these. Severe injury (requiring surgical intervention) occurred in the remainder.
In a few AP blast mine accidents during excavation, very severe injury to the face and head has occurred and the victim has died. Medical details are not always available in enough detail to judge definitively, but the only instance in which a severe facial injury was clearly the direct cause of subsequent death involved the Victim's face being cut in half by the blade of his hand tool. In others, the use of short tools (such as the AK bayonet) meant that the victim was hunched directly over a large AP blast mine, lost a hand or arm and died as a result of multiple injuries. In only two cases, a severe neck injury was cited as a cause of death. In one of these, body armour was not worn at all. In the other, the victim fell forward onto a mine and detonated it with his visor.
Eye loss can be an indirect cause of death when a deminer is left blind in a post conflict economy without significant support for the severely disabled.
When balancing the risk of eye damage against the risk of severe head and face injury, it seems that the chance of suffering eye loss is far greater than a risk of suffering severe facial injury, even when visors are not worn, or not worn in a way that protects the eyes.
Trying to be realistic about the need for practical eye protection that is really going to be used, the suggested revision to the IMAS reduces the minimum requirement to 5mm polycarbonate EYE protection, not protection of the full-face. I propose that visors (worn correctly) should still be cited as the preferred option within the IMAS but that the minimum requirement should be effective eye protection.
The change would permit goggles sealed over the bridge of the nose and cheeks. It would allow short visors, shaped over the nose so that they hang closer to the eyes (like some dog-handlers wear today in order to be able to issue clear voice commands). It would also allow the ROFI face-mask - where only the eye lenses are polycarbonate and the rest of the mask is a complex, lightweight and non-transparent moulding that allows good upward ventilation but restricts the wearer's view of his/her feet.
The fact that thin industrial safety spectacles are widely used as an alternative to visors despite the requirements of the IMAS proves that the current IMAS is not accepted in the field. These spectacles have performed well in some accidents, but so have sunglasses. Their protection level is known to be inadequate and I would like to stop them being used by proposing a new minimum requirement that is actually an increase in what is often used in the field. I am suggesting a compromise that I believe would actually increase safety for deminer's eyes in two ways. Raised visors would not be used, and safety spectacles would also be rejected. The light 5mm thick goggle-style protection that replaced them would also be significantly cheaper than a full-face visor, while being smaller and easier to protect against accidental damage in storage and transit.
When I circulated the above, one member of the Review Board replied angrily and another with concerns about insurance. Two others responded in agreement. I replied with the following, which has been shortened and edited for anonymity.
Mr Willoughby states that, for his Saints, that the full-face visor that his deminers use is a “must”, and he proudly states that getting it worn is merely a “matter of discipline”.
I agree that the full-face visor provides better protection than the smaller 5mm thick eye protection. I have suggested the goggles as an alternative MINIMUM for those groups who disagree with Mr Willoughby about the long visor. In the proposed revision, the full-face visor remains the preferred option.
I contend that the “discipline” that Mr Willoughby promotes is not quite as easy for anyone to maintain as his email suggests – not even for his own deminers and staff. Over the years, he has declined to make the accident data for his demining NGO available for inclusion in the Database of Demining Accidents (DDAS). But his demining NGO’s accident data has sometimes become available from other sources. As a result, the DDAS contains details of 36 of his demining NGO’s accident victims over 10 years. Leaving aside those accidents that involved a device other than AP blast mines, accidents where victims were issued with safety spectacles and accidents where the victims were not wearing any PPE, we are left with 22 of his deminers on record as having been issued with visors at the time of accident involving an AP blast mine. In eight of these the visor was not worn or worn raised. This is known because five victims suffered severe eye injuries and an additional three had minor face and eye injury. From the DDAS records, in more than a third of his demining NGO’s accidents where a visor was issued, eye injury occurred.
This deminer from Mr Willoughby's demining group was injured in Kosovo by a small AP blast mine. The internal accident report recorded that, “The section commander indicates the deminer was working in the correct position and correctly wearing his PPE.”
Included in the report were photographs of the demining NGO’s accident investigator, a senior staff member, kneeling in the accident lane showing shards of the tool the deminer was using at the time (the victim's hands were also injured). The senior staff member was conducting a formal investigation in a live minefield and was not wearing any PPE at all. He was so confident that this did not breach the NGO's rules that he included the picture in the report provided to the MAC.
Despite Mr Willoughby's claims that “If a deminer is ever found to be wearing his visor at half mast or not at all when working on the minefield, then he is immediately dismissed and so is his section commander - simple, no 'ifs and buts'” - his demining NGO’s internal accident report’s recommendations did not include dismissal of anyone.
The victim was “totally blinded” and an unspecified amount of insurance was paid (source: Kosovo MAC).
I want to make the IMAS more flexible so that more groups can meet the minimum requirement – and raise their protection a little in the process.
Very few demining groups issue PPE that is compliant with the current IMAS. Many pay lip-service to the IMAS but frequently allow cost and comfort to dictate the detail.
Here are another demining NGO’s supervisors in Cambodia. This NGO wear different armour in different countries, reflecting national norms.
Safety spectacles and sunglasses……
The deminers wore the Helmet visor that this demining group often issue to deminers. It is far too short to interface with the armour and leaves the lower face fully exposed. It is also very easy to wear so that you look beneath it when you need to see clearly. The deminer above is examining a part of a fuze.
Many groups opt for ex-combat equipment. The picture below show an unusually thick visor on a helmet that was issued by a demining NGO in Bosnia. Despite the thickness of the visor, the wearer was blinded by a small AP blast mine because the blast went beneath the visor.
Other NGOs sometimes use a short visor mounted on a plastic helmet....
and habitually look out beneath the visor. The body-armour collar is inside the visor and folds flat to the chest, failing to protect the lower face at all. This equipment is designed for HD, but not very well. It is cheap, and is widely used, but does not meet the minimum requirement in the current IMAS.
Several demining groups have really tried to meet the recommendations and requirements of the IMAS by using the bolt-down visor faces made in Zimbabwe and sold by ROFI and ForceWare. But they still have eye injuries in AP blasts – because the deminers tilt the whole head-frame back on their heads to look beneath, seeing clearly and feeling cooler. Although common-sense dictates that visors locked in a down position should be safer, accident evidence does not support that view.
These examples are meant to demonstrate that we do not have IMAS 10.30 right. If we did, people in the field would be able to use it and the severity of injuries would be reduced as a result.
Insurance: It has been suggested that insurers dictate what PPE is acceptable. Many demining NGOs and commercial companies self-insure. They do not pay an insurer a large sum, but hold back an amount from which they can pay appropriate compensation and medical expenses when accidents occur. From the accident data available in the DDAS, I believe that no demining organisations deny a payout based on the Victim's failure to adhere to SOPs. If a deminer’s training and supervision is such that he works outside the rules and is injured as a result – his punishment is the injury. When his injury is a permanent total disability in a country with no social service provision, the rather small cash compensation he receives is often of no lasting value.
One insurer has tried to impose a requirement for SOP adherence before compensating victims but, to my knowledge, that group has always eventually paid compensation to date. Other insurers do not impose the same constraint – (and even that insurer does not try to impose it on ex-pats).
Insurance is not a problem. If insurers start to make more and more demands on the PPE provision, then the demining group can choose to meet their requirements or buy cover elsewhere, no matter what is in the IMAS. It is not our job to double-think the insurers (who are certainly hard to predict). In fact, insurance varies from country to country – and some funders and even MACs impose their own requirements. Some demining groups do too.
The result of this exchange was that, despite general agreement that a change was needed among the members of the Review Board at the time, the issue was set aside while 'tempers cooled'. My knowledge had really annoyed Mr Willoughby, who threatened me with litigation. I did not reply. I believe that the delay in making a decision must have cost eyes.
In 2008, it was high time for this issue to be resolved, and the Chairman of the Review Board pushed the issue forward. At that time, two draft revisions of IMAS 10.30 were being considered. The substantial difference between them was that one made goggles the minimum requirement at all times, and the other allowed goggles to be worn at all times except during excavation. I argued as follows:
It has been argued that wearing a visor during excavation will not only save the eyes but also the ears, the mouth, the nose, voice and teeth, all of which will NOT be repaired in an acceptable way in a third world medical system. This argument is fundamentally flawed, for two main reasons.
One: the loss of function of other parts of the face and throat (except hearing) does not often happen although facial injuries do occur - and usually when wearing a visor. Very severe facial injuries do occasionally occur but even when the surface of a face is badly damaged and features removed, they can be rebuilt - and they generally ARE. (And if not, we cannot cater for irresponsible demining organisations who fail to meet basic medical care requirements.) There are close to 1000 victim records in the DDAS now - and this is the only empirical evidence we have to rely on, so I refer to it often. The DDAS records have informed my opinion that eye protection is paramount and far outweighs the requirement for face protection.
Two: To leave a man without eyes in many post-war countries, is to kill a man slowly. He has lost his opportunity to work and become a dependant without an income in a ruined economy. That is not the same as losing teeth or looking strange. It has been stated that other facial damage "is very nearly as tragic as eye loss". I am constantly surprised that I have to argue that blindness is infinitely MORE severe than any other severe injury in HD (except, perhaps, the loss of both hands). Deminers are, almost by definition, manual workers and have few options when severely disabled by blindness (or double-hand loss). The cash compensation is no real compensation. It is cursory by Western standards, and usually spent rapidly (often by relatives).
If you yourself were blinded, your current life would be destroyed. With your advantages, you might rebuild your life into something different, but real deminers do not have your advantages. If your face were a mass of scars but your eyes were OK, you could continue to do the same job and lead much the same life that you do now. That is also true of deminers. For example, there is one Englishman who had bad facial scarring after his confrontation with an anti-personnel blast mine in 1992. He kept his eyes because he was wearing Raybans (polycarbonate not more than 1.5mm thick). This man has been working in demining ever since - and has been Operations Manager for an NGO in Angola for many years.
It is a fact that visors are frequently not worn - or not worn down - during excavation. Whatever the reason may be - condition, comfort, visual distortion, fogging, poor supervision, relatively high cost of replacement, bad design, etc - it is a fact that they are often not worn correctly when an accident occurs. It was suggested that things had changed - but the most recent updates to the DDAS show that it has not. The loss of eyesight remains as common as ever. There is strong evidence that visors are often raised by kneeling deminers at the very moment when they are most needed - in order to see clearly.
And there are many who do not wear the visors at all.
This picture above shows a previous secretary of the IMAS Review Board and an ex-pat supervisor in a minefield in Sri Lanka. The senior personnel wear unrated safety spectacles. To have to wear 5mm polycarbonate goggles would be a significant INCREASE in their protection. The inclusion of this picture is no reflection on the Board's ex-secretary. If I had possessed a picture of myself in safety spectacles, I would have used it - but I was taking the picture (with safety spectacles on top of my head).
The point is – we should avoid double standards. To my knowledge, at least four members of the current IMAS Review Board wear safety spectacles or goggles or less when inside the minefield if they are allowed to do so. I prefer a half-visor myself.
Here is a photograph of a man issued with a visor who raised it in order to see clearly when excavating... 19 years old.
And here is the same man after his face was rebuilt in a third world hospital ...
He would have kept his eyes if he has been wearing goggles as defined in the draft IMAS 10.30 up for consideration. Severe facial damage is not an irreparable loss of function and is not in the same disabling category as eye loss. It is our job to try to prevent severely disabling injury - not every injury (because that would make demining impossible).
Blindness is common, whereas this much facial damage is rare - he was directly above a PMN and the raised visor may even have contained the blast. People are often blinded by blast and blast debris that does not leave any permanent facial scarring. MOST deminers blinded today were 'wearing' visors, and most do not have badly scarred faces.
Of course I cannot be sure that this young man would not have raised goggles if he had been issued those - but I have worn them and not been tempted to do so, so I doubt it. They allow the lens to be very close to the eyes - limiting visual distortion as much as possible - and can be very comfortable to wear down – and uncomfortable when shifted to the forehead.
What this means is that IMAS 10.30 is currently requiring a kind of protective equipment that we know does not save the eyesight of deminers. It should have done so, of course, but there has now been compelling evidence for several years that it does not.
These are the kind of goggles I recommend - allowing good peripheral vision and with a comfortable rubber housing.
The argument that all you need is discipline is both simplistic and unrealistic – we have not been able to make the deminers wear the visor correctly. If the visor remains intact and eye injuries occur, it is a fact that it cannot have been correctly in position. We should start from where we are, not where we would like to be. That deminers are not wearing the visor appropriately when many accidents occur is an indisputable fact (although the reasons for this can always be disputed). Starting from where we are, we need to find a way to reduce the incidence of eye loss.
The alternative suggestion for IMAS 10.30 is NOT to throw away visors. It is that full-face visors worn correctly should be the preferred protection and that effective blast-goggles shall be the minimum protection - to be worn at all times when working. If worn at all times, there is a far higher chance that they will be in place when the unexpected happens. For the time being, only 5mm polycarbonate has been proven effective - in tests and in accidents – so the goggles should be 5mm thick.
I really want the IMAS to be useful and respected. The fact that we are wrong on PPE now is proven by the fact that many demining groups do not obey its requirements. It has been agreed several times, then apparently forgotten, that the IMAS should not set standards at which we should aim - but minimum requirements that match the best practical and proven solutions in the field. These are very different goals that should not be confused.
At the end of 2008 the IMAS Review Board voted on this issue. The result was split roughly 50/50 so no changes were made.
In the IMAS Review Board Meeting in March 2009, the Review Board members present voted on this issue and there was 100% agreement to change the minimum requirement to 5mm polycarbonate eye protection while recommending that full-face visors continue to be used. I do not know what had changed their minds but I suspect that the desire to allow the new ROFI demning mask to be used may have led to some pressure being applied by the Norwegians.