Embedded unexploded ordnance encountered during combat casualty care: a review of clinical management for UK deployed service personnel

Explosive remnants of war (ERW) include landmines, unexploded ordnance (UXO) and abandoned explosive ordnance. Nearly every conflict in modern times has left behind large amounts of ERW, and they remain a persistent problem and a deadly threat that can kill and injure those who encounter or disturb them. A rare UXO hazard may present when military medics begin to assess and treat survivors of combat injury and discover UXO 'loose' (on the patient's gear or stored in their pockets) or rarely 'embedded' in the patient's body. UXO threats to treating clinicians have been documented throughout history, including the most recent significant conflicts. With the threat of large-scale combat operations, it is timely for the UK Defence Medical Services to discuss how to manage this rare, but high-risk situation. This article scrutinises the anatomy of UXO, examines clinical priorities during management of UXO in survivors of combat injury and considers how to establish an effective medical treatment facility to cope with this unique situation, including the risk from a Chemical, Biological, Nuclear and Radiological perspective. We aim to summarise the current literature regarding the treatment of a patient after a UXO has been discovered, to inform clinical management for deployed service personnel in the modern battlespace.