Protocol for the assessment of potential health effects from embedded metal fragments

Potential health issues arising from embedded metal fragment injuries are an operational health issue in the military medical community. Embedded fragment injuries can occur not only from standard-use munitions, but also from improvised explosive devices (IEDs). With few exceptions, the behavior of metal fragments, when embedded in the body, is not known. Herein, we propose a multitiered assessment protocol that can be used to both determine future health issues associated with newly developed munitions and, once the composition has been identified, determine potential toxicity of embedded fragments as a result of an IED event. The main premise of this assessment protocol is to view the embedded fragment as an implanted medical device and to utilize the guidelines already in place for testing the safety of such materials. Use of this structured, tiered approach will yield information critical for informed medical decisions.