Impalements (HB)

Impalements are a category of wounds that involve an external object that remains in the body. Managing impalements is one of the Extended Transport Protocols.

With very few exceptions, you should remove impaled objects. Let’s be honest; you have probably been impaled numerous times in your life. If you ever had a splinter or a fishhook embedded in your skin, you have been impaled. And you likely removed that object with minimal effect. Technically if you ever got a shot or vaccination, you were also impaled. All of this is to say that it is generally okay to remove Impalements.

DO NOT remove Impalements that:

• Are in the globe of the eye.
• It would cause significant bleeding if removed.
• Would cause unmanageable pain.
• Would cause unacceptable tissue destruction.

The eye contains a fluid that you cannot replace. An impalement to the eye needs to be done in a sterile environment where they can manage it. Treat the patient by protecting the eye with the impalement using a cup or something that will not press directly into the eye. Then leave the other eye exposed but construct a blinder to prevent the patient from looking around with their eyes—make them move their whole head. The reason is that taking away a patient’s sight makes transport difficult. If they still have vision in one eye, they can help extricate themselves.

You should always anticipate bleeding when removing an impalement. Have a way to control the bleeding. If the object is embedded near a large vessel, you should consider leaving it in place, especially if the object is visibly moving in time to the patient’s heart beat.

If you attempt to remove the object and the act of removing causes pain out of proportion to the perceived injury, you should leave it. There is likely involvement of deeper structures that you cannot see.

If the impaled object is irregular in shape and removing the object will destroy more tissue, you should leave it in place. Think about a hunting broadhead on an arrow. They are designed to expand upon entry and have razor-sharp edges that could cause significant damage upon removal.