Three of the six cases of impaled ordinance found in patients during the Global War on Terrorism were not recognized until the patient was in the OR. The impalement was unknown at the point of injury, transport, or initial evaluation by a Role 2 or Role 3 trauma teams since it was completely embedded in a body cavity or extremity with no exposed portions to alert the staff. The time and location when impaled UXO was initially recognized is not mentioned in previous reports. Intra-operative is not the ideal time to find the ordnance, but due to the nature of trauma and war wounds, this may be the case. Units must have a plan to address this. The core principles used in a known case of an impaled UXO should be followed. Minimal staff to remove the device is recommended, limit patient movement, and stop the use of medical equipment that may arm or detonate the device. The facility leadership and EOD team need to be notified as soon as possible. If the patient is stable, pause until EOD can confirm and identify the impaled device. Staff remaining to care for the patient should have their protective gear brought to them so they can don it rapidly. One of the biggest decisions is to stay within the facility or to relocate. This decision is complex and is dependent on multiple tactical and clinical factors. The medical treatment facility commander and senior surgeon must rapidly decide on the best course of action and ensure the safety of the staff while striving for survival of the patient. The goal is to care for the patient while preserving the personnel and equipment to care for current and future patients as well.