Not all explosive ordnance explodes. A patient with an unexploded ordnance (UXO) embedded in the body needs to have it removed carefully, without injury to the patient or the surgeon.
Example: mortar round, rocket grenade
The first step is to make sure that the ordnance is not a booby trap and does not have a delayed fuse.
Things that could trigger an unexploded device:
(1) metal to metal contact
(2) excessive vibration
(3) electromagnetic field
(4) electrostatic charge (which may develop in a helicopter)
(5) physical impact
(6) impact on the fuse
(7) laser light
Since transportation may introduce many of these triggers and any explosion would endanger the transport vehicle, the device is usually removed as soon as possible.
The patient can usually be X-rayed, which can help locate and identify the ordnance.
General steps:
(1) The patient is kept away from other patients and is usually treated last.
(2) The removal should be done in a safe place outside and away from the hospital facility.
(3) The number of people involved should be kept to a minimum.
(4) Local or regional anesthesia is preferred since it does not require an anesthesiologist.
(5) The patient should be surrounded by a barrier of sandbags or other blast barrier.
(6) The operating team should wear protective clothing with eye, facial and head protection.
(7) There should be a container in which to place the ordnance once removed.
(8) Oxygen or other items that might contribute to a fire should be kept at a distance.
(9) Removal of the device en bloc or by amputation may be necessary.
(10) Surgery should be performed as gently as possible with manipulation kept to a minimum.
