Removal of Unexploded Ordnance from Patients: A 50-Year Military Experience and Current Recommendations

Abstract

Isolation of the operating room and protection of personnel and equipment are essential. Patients should be triaged in the delayed category, because most are not morbund on arrival and all patients operated on survived. Explosive Ordnance Disposal expertise should be used. Knowledge of and adherence to several basic principles will protect personnel and equipment while permitting optimal patient care.

Impaled Unexploded Mortar Shell Injury during Iran-Iraq War 1980–1988

“…2 There is little to be found in the literature regarding impaled unexploded ordnance (UXO) injuries. [3][4][5] In a review of 50 years of military experience and case reports from World War II, Vietnam, and Somalia, Lein et al found 36 patients with impaled UXO. Twelve out of 36 patients had injuries from impaled unexploded 48mm to 82 mm mortar ordnances.…”

Impaled Unexploded Ordnance Involving Fireworks Mishap

“…The physicians and staff caring for this patient incurred a certain amount of risk especially during care, movement, or manipulation of the patient. 1 The key management principles include early identification of the material, isolation of the patient, and immediate notification and engagement of the EOD personnel. The role of the EOD personnel may include identification of the device, risk assessment along with technical advice on removal, and disposal.…”

“…The role of the EOD personnel may include identification of the device, risk assessment along with technical advice on removal, and disposal. 1,2 If appropriate, personal protective equipment for the staff should be used and movement or manipulation of the patient minimized. Ideally, the operative area should be cordoned off to all but necessary personnel.…”

Blast Injuries: Biophysics, Pathophysiology and Management Principles

“…Weapons most commonly implicated are the M79 grenade-launcher (40 mm round) and mortars (48-82 mm rounds). In a recent review of 32 such patients injured in conflicts from WW II to Somalia (1993) and who survived surgical removal of unexploded ordnance, a strategy for the management was proposed (Lein et al 1999) (Table 10). which may detonate the round, should be avoided in patients who are moribund.…”