BACKGROUND: Bullet-proof vests and helmets protect from harm in combat and military engagements. The use of armor against shrapnel has been studied, yet little has been documented as to how they protect from high velocity gunshots. This study aims to describe the medical consequences of high velocity firearm injuries and to differentiate between patients injured while using protective wear and those injured unprotected. STUDY DESIGN: National trauma registry data on injury characteristics, treatment and outcomes between October 1, 2000 and December 31, 2003 were retrieved and analyzed. RESULTS: There were 669 terror-related firearm injuries recorded: 236 (37.8%) in soldiers (protected) and 433 (62.2%) in civilians (unprotected). Injury severity was notably higher in civilian patients (31% versus 16% with Injury Severity Score < 16). Civilians had more ICU care (26% versus 20%, p = 0.06), and double the inpatient mortality (8.6% [n = 37] versus 3.4% [n = 8] patients). Protected body regions such as abdomen, chest, and brain, were injured less frequently. Once a traumatic brain injury was sustained, no statistical differences were found in severity distribution, ICU stay, or inpatient death between protected and unprotected patients. But injury severity in patients with chest injuries was much higher in those who were unprotected (Injury Severity Score < 25, 41% versus 23%, respectively, p = 0.08). This increased severity could be attributed partly to more multiple injuries involving the chest. Abdominal injuries showed a similar pattern. CONCLUSIONS: Body armor has a protective effect on victims of high velocity gunshot wounds; lower rates of head, brain, chest, and abdominal injuries are seen. In addition, armor reduces the severity of injuries to the chest and the abdomen.