Unexploded Ordnance Management

Abstract

The purpose of this Clinical Practice Guide is to provide details on the procedures to safely remove unexploded ordnance from combat patients, both loose and impaled, to minimize the risks to providers and the medical treatment facility while ensuring the best outcome for the patient. Military ordnance, to include bullets, grenades, flares, and explosive ordnance, retained by a patient can be a risk to all individuals and equipment along the continuum of care. This is especially true from the point of injury to the first treatment facility. Management of patients with unexploded ordnance either on or in their body is a rare event during combat surgery. Loose munitions are usually noted and easily removed prior to the patient receiving medical treatment. However, impaled munitions provide a significant challenge. These are usually caused by large caliber, high-velocity projectiles. Patients who survive to arrive at a treatment facility must be triaged safely and simultaneously treated appropriately to ensure both the survival of the patient and the treatment team. Between WWII and the Somalia conflict, there have been 36 reported cases of unexploded ordnance from U.S. soldiers. Since 2005, there have been six known cases during the U.S. wars in Afghanistan and Iraq and one additional case in Pakistan. Optimal outcomes require a basic knowledge of explosives and triggering mechanisms, as well as adherence to basic principles of trauma resuscitation and surgery.

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

“…Mechanical non-powered manual saws and drills rather than saws and drills that use electricity and pneumatics must be used because of concerns about discharge and vibrations. 3,4 This letter emphasizes that there is a risk with impaled UXO injuries. Each reported case illustrates the importance of cataloguing experiences learned during crisis situation and bringing further insight to management of this very unusual and serious type of injury.…”

“…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.…”

“…(3) In 2005, Oh et al recognized six further known cases of impaled UXOs during the US wars in Afghanistan (four) and Iraq (two). 4 There was one additional case of impaled UXO in Pakistan. 5 Impaled UXO may be a risk to care providers, equipment and surroundings of the victim.…”

“…Combustible agents such as oxygen, alcohol-based solutions and combustible volatile anesthetics must be removed from the operating theater. 3,4 A review of the reported cases demonstrates that the impaled UXO were some sort of propelled explosive devices such as mortars, rocket propelled grenades (RPG) and rifle-launched grenades. These ordnances basically include a propulsion system, a trigger mechanism, and a main explosive component.…”

“…Appropriate management requires thorough knowledge of the triggering mechanisms because an inadvertent bypass of the safety mechanism or a malfunction may trigger the ordnance to explode. 3,4 All impaled ordnances must be considered armed or activated. There are a variety of triggering mechanisms for explosive ordnances which are usually located at the tip of the main explosives.…”