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A T2 Translational Science Modified Delphi Study: Management of Patients With Embedded Unexploded Ordnance in
Eric S Weinstein1,2, Jacques Mather3, Drew Delp4
1Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, FL 33606, United States.
Military Medicine
|August 6, 2026
Summary
Managing patients with impaled unexploded ordnance (eUXO) requires specific guidelines, especially in low-resource settings. This study developed consensus-based treatment principles for eUXO patients without explosive ordnance disposal (EOD) assets.
Area of Science:
- Medical Management
- Trauma Care
- Public Health
Background:
- Implanted or embedded unexploded ordnance (eUXO) poses a significant risk during conflict and criminal activities.
- Misfired ordnance can lead to severe injury or death and facility destruction.
- Fewer than 50 cases of eUXO impalement have been reported, necessitating guideline development.
Purpose of the Study:
- To develop treatment guidelines for patients with eUXO in low-resource settings lacking explosive ordnance disposal (EOD) assets.
- To establish consensus-based principles for managing eUXO patients.
Main Methods:
- A modified Delphi approach was employed, involving 37 experts.
- Fifty-three statements were derived from literature and a PRISMA-Scoping review.
- Experts rated agreement on a 7-point scale over three rounds to achieve consensus (SD ≤1).
Main Results:
- Twenty-nine statements achieved consensus after three rounds of expert review.
- Key safety, transport, and training principles were agreed upon.
- Twenty-four statements did not reach consensus, indicating areas of uncertainty.
Conclusions:
- Consensus was reached on critical aspects of eUXO patient management in resource-limited environments.
- Uncertainties persist regarding the optimal clinical prioritization for detonation risk reduction.
- Further research is needed to address remaining ambiguities in managing eUXO patients without EOD support.
