First Aid for UXO Blast Injuries

UXO detonations produce a specific and severe pattern of injuries that differ from most civilian medical emergencies. Blast injuries, traumatic amputations, and penetrating shrapnel wounds require immediate life-saving intervention. As a bystander or community member in an area where UXO detonations occur, knowing these techniques may be the only medical care available until professional help arrives.

⚠️ Your safety before the casualty's safety. Before approaching a UXO casualty, be certain the area is safe. A detonation may have scattered other ordnance, or the victim may have triggered one device while others remain. Approach only when you are confident there is no secondary hazard directly in your path.

Understanding Blast Injuries

A UXO detonation creates injuries through several mechanisms:

Mechanism	Injuries
Primary blast (pressure wave)	Lung damage, ruptured eardrums, bowel perforation — invisible externally
Secondary blast (fragments/shrapnel)	Penetrating wounds throughout the body
Tertiary blast (being thrown)	Fractures, head injuries, internal injuries from impact
Quaternary blast (burns, crush)	Burns from fireball; crush injuries from collapse

Traumatic amputations — partial or complete loss of limbs — are the most visible UXO injuries and are often survivable with rapid haemorrhage control.

The First Priority: Stop the Bleeding

Traumatic amputation and severe blast wounds bleed rapidly. Massive haemorrhage is the leading preventable cause of death in blast injuries.

Tourniquets

A tourniquet applied correctly to a limb haemorrhage can be the single action that keeps a person alive until they reach medical care.

How to apply an improvised tourniquet:

1. Position: Apply 5–8 cm above the wound — on the limb, not on the wound itself. Never apply over a joint.
2. Material: Use the widest available material — clothing strip, belt, scarf. Narrow material like rope or wire causes additional tissue damage and is less effective.
3. Wrap: Wrap the material tightly around the limb twice.
4. Tighten: Tie a half-knot, place a stick or rod on top, tie a full knot over the stick, then twist the stick until bleeding stops. The tourniquet must be tight enough to stop blood flow completely — this is painful and that is expected.
5. Secure: Tie the stick in place so it cannot unwind.
6. Mark the time: Write the time of application on the casualty's skin or clothing near the tourniquet. Medical staff need to know how long it has been in place.
7. Do not remove it — once applied, a tourniquet should only be removed by medical professionals.

Commercial tourniquets (CAT, SOFTT-W) if available are more effective and easier to apply — follow the instructions printed on the device.

Direct Pressure for Non-Limb Wounds

For wounds to the torso, neck, or areas where a tourniquet cannot be applied:

1. Place a clean cloth or bandage directly over the wound.
2. Press firmly and continuously — do not release to check.
3. If the material soaks through, add more material on top — do not remove the first layer.
4. Maintain pressure until bleeding stops or medical help arrives.
5. If the wound is to the neck, apply pressure carefully — do not compress both sides simultaneously.

Wound Packing for Deep Wounds

For deep, penetrating wounds with significant blood loss:

1. Tightly pack clean cloth or bandage into the wound cavity.
2. Apply firm direct pressure over the packed wound.
3. This is uncomfortable and the casualty will resist — explain what you are doing and maintain pressure.

Treating the Airway

Blast injuries can damage the airway through heat, pressure, or trauma:

1. Check for consciousness — speak to the casualty and observe response.
2. If unconscious but breathing — place in the recovery position (on their side) unless spinal injury is suspected.
3. If unconscious and not breathing — begin CPR (30 chest compressions, 2 rescue breaths, repeat).
4. Clear visible obstructions from the mouth — blood, debris.
5. Tilt-chin lift to open the airway if unconscious and no suspected spinal injury.

Shrapnel Wounds

Multiple penetrating wounds from fragments are common in UXO casualties:

1. Do not remove embedded shrapnel — removal can worsen bleeding.
2. Apply clean dressings over all visible wounds.
3. Stabilise large embedded objects to prevent movement — surround with padding, secure without pressing down.
4. Cover wounds to prevent contamination — use the cleanest material available.

Blast Lung and Internal Injuries

Primary blast wave injuries may not be visible:

Signs of blast lung or internal injury:

• Coughing blood
• Difficulty breathing; chest pain
• Blue or grey discolouration of lips (cyanosis)
• Rapid deterioration without visible blood loss

If blast lung is suspected:

1. Keep the casualty as calm and still as possible.
2. Semi-upright position if conscious and breathing with difficulty.
3. Do not give food or water.
4. Prioritise rapid evacuation to medical care — there is no field treatment for blast lung.

Burns

If the casualty has burns from the blast:

1. Cool the burn with clean cool water for at least 10 minutes — do not use ice.
2. Do not break blisters.
3. Cover loosely with a clean, non-fluffy material (cling film if available, or a clean bag).
4. Do not apply creams, toothpaste, or other substances.

After Immediate First Aid

1. Keep the casualty warm — blood loss causes rapid drop in core temperature; cover with blankets or clothing.
2. Monitor breathing and consciousness continuously.
3. Treat for shock — lay flat with legs elevated if conscious and no spinal injury suspected.
4. Call for medical evacuation immediately — give location, number of casualties, nature of injuries.
5. Reassure the casualty — calm, clear communication reduces panic and helps maintain cooperation.

Do not move the casualty unless they are in immediate danger — spinal injuries from the blast can be worsened by improper movement.

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Quick Reference

Injury	Action
Limb amputation / severe limb bleed	Tourniquet 5–8 cm above wound; mark time; do not remove
Torso or neck wound	Firm, sustained direct pressure; add layers; do not remove
Not breathing	Recovery position (conscious) or CPR (unconscious)
Embedded shrapnel	Do not remove; dress and stabilise
Blast lung (coughing blood, breathing difficulty)	Semi-upright; calm; no food/water; urgent evacuation
Burns	Cool water 10 min; cover loosely; no creams
All casualties	Keep warm; monitor; evacuate urgently; reassure