An impalement injury, where an object pierces and remains embedded in the body, represents a serious medical emergency. The primary concern is the potential for massive internal damage and uncontrolled bleeding. First aid efforts must focus entirely on preventing any movement of the foreign object, as even slight shifts can worsen the trauma already sustained. The immediate goal is to secure the object firmly in place until trained medical professionals can transport the patient to a hospital setting.
The Critical Rule: Why Removal is Forbidden
A person untrained in surgical procedures should never attempt to remove an impaled object from a patient. The object itself acts as a temporary plug, creating a mechanical seal that significantly slows or halts blood loss from damaged vessels, a phenomenon known as the tamponade effect. Withdrawing the object would immediately remove this seal, potentially leading to rapid and catastrophic hemorrhage from arteries or veins that have been partially or completely severed.
The depth and trajectory of the object are unknown to the first responder, meaning any movement could cause extensive secondary trauma. Pulling the object out might cause its rough edges to lacerate nerves, muscle tissues, or surrounding organs. Furthermore, the object may be stabilizing a fractured bone or holding together damaged tissue that would collapse upon its removal. Leaving the object undisturbed minimizes the risk of converting a severe but contained injury into a life-threatening, uncontrollable one.
Step-by-Step Stabilization Techniques
The first step in stabilization is to prepare the area by gently cutting away any clothing that covers the wound, being careful not to disturb the object or surrounding tissue. Never attempt to pull clothing over the impalement, as this action could exert force on the object and cause movement. With the wound exposed, the focus shifts to creating a secure, rigid barrier around the object to prevent it from shifting or being pushed deeper.
This stabilization requires the use of bulky materials such as clean trauma dressings, gauze pads, or even clean cloths rolled or folded thickly. The material should be carefully stacked and packed around the entry point of the object, completely filling the space between the body and the object itself. The goal is to build up the padding to at least the height of the object’s entry point, creating a protective “nest.”
For objects that are relatively thin or flexible, it can be helpful to create a ring pad or a “donut” shape with the padding. This involves folding or rolling a strip of cloth or gauze into a circle and placing it around the base of the impaled object, ensuring the padding elevates the securing bandages away from the wound’s immediate edges. This technique ensures that any pressure applied while securing the dressing is distributed over the healthy surrounding tissue rather than directly onto the wound or the object.
Once sufficient padding is in place, the object must be secured using tape, roller bandages, or triangular bandages. The securing material should pass over the bulky dressings and be firmly attached to the patient’s skin or limb without touching the impaled object. The stabilization must be robust enough to withstand potential jostling during transport, effectively immobilizing the object against the body. If the object is too long or unwieldy for a standard bandage, tape and additional bulky dressings can anchor the object to a separate, rigid structure, such as a splint applied to a limb.
Immediate Actions After Stabilization
Immediately after stabilizing the impaled object, the priority is to contact emergency medical services (EMS) by calling 911 or the local emergency number. Provide the dispatcher with a clear description of the injury and the stabilization steps taken. The patient must be instructed to remain as still as possible to maintain the integrity of the stabilization and prevent further damage.
The patient should be continuously monitored for signs of developing shock, a life-threatening condition resulting from inadequate blood flow. These signs include a rapid, shallow breathing rate, a weak and fast pulse, and skin that appears pale, cool, or clammy. While waiting for EMS to arrive, help the patient maintain their body temperature by covering them with a blanket or coat, as hypothermia can worsen the effects of shock.
If the patient is conscious and anxious, speak to them calmly and reassuringly, explaining that help is on the way and that their stillness is helping to prevent further injury. Never give the patient anything to eat or drink, as this could complicate the administration of anesthesia or surgical procedures required at the hospital. The impaled object should only be cut or trimmed by EMS personnel, and only if its length makes safe transport impossible.