An impaled object injury occurs when an item pierces the skin and remains embedded within the body tissues. The objects can vary widely in size and material, ranging from shards of glass to pieces of wood or metal rods. Because the object is lodged inside, these injuries carry a high risk of internal damage and severe bleeding, making them a medical emergency.
First aid for this type of injury demands calm, decisive action to stabilize the victim and prevent further harm. The first priority is to contact emergency services immediately, as an impalement wound requires specialized medical attention for safe removal and treatment. Attempting to manage the injury without professional assistance can significantly worsen the outcome.
The Critical First Rule
The rule in first aid for an impaled object is to never remove it. The embedded item often provides a mechanical plug, creating a tamponade effect that helps control internal and external bleeding. Pulling the object out prematurely can release this pressure, leading to sudden, massive hemorrhage that is difficult to stop.
Removal also risks causing irreparable damage to surrounding structures like nerves, major blood vessels, and internal organs that the object may be bypassing. Any movement during removal can cause the object’s sharp edges to slice through previously undamaged tissue. The object must remain in place until medical professionals can surgically manage the wound and control bleeding in a sterile environment.
Trained personnel may consider removing an object in specific situations. This includes an object impaled through the cheek that is obstructing the victim’s airway or causing blood to drain into the throat. It also includes situations where the object prevents the administration of cardiopulmonary resuscitation (CPR) when the victim is unresponsive and not breathing. For the general public, the safest action remains stabilization.
Stabilization and Securing the Object
Stabilizing the impaled object is the primary goal of initial first aid management. This prevents any movement of the object, which minimizes further tissue damage during transport or while waiting for emergency responders. Movement of the object is the primary cause of additional internal injury.
Begin by exposing the wound area by carefully cutting or removing clothing around the site. It is important to avoid moving the impaled object or the injured person while doing this. Once the wound is exposed, use bulky dressings, clean cloth, or even towels to build up support around the object.
The technique involves carefully placing material around the base of the object to fill the space between the skin and the item. Additional layers are applied to create a cushion or support structure, sometimes described as a “doughnut shape.” This structure must be built high enough to incorporate and immobilize the protruding portion of the object.
Once the bulky dressing material is built up, secure it firmly in place using tape, bandages, or cloth strips. The securing material must not put any pressure directly onto the impaled object itself, nor should it push the object deeper into the wound. The dressing should be tight enough to eliminate movement but must not impair circulation, especially if the injury is on an extremity.
Managing Associated Injury
Once the object is stabilized, attention must turn to managing the associated consequences of the trauma. If there is bleeding around the edges of the wound, apply gentle, direct pressure to the dressings around the object, ensuring no force is applied to the object itself. Controlling blood loss is a priority to prevent the victim from going into shock.
Monitor the victim continuously for signs of shock (hypoperfusion), which can develop rapidly after severe trauma and blood loss. Symptoms include rapid, shallow breathing, paleness, cold and clammy skin, and an altered mental state or confusion. Cover the victim with a blanket or coat to prevent heat loss, even if the environment is not cold.
While using clean materials like sterile gauze is recommended to reduce the risk of infection, do not attempt to clean the wound itself. Definitive wound irrigation and cleaning must be performed by medical staff in a controlled setting. Attempting to clean the wound risks introducing more contaminants or disturbing the impaled object.
Next Steps and Professional Care
After the object is stabilized and external bleeding is managed, immediate transport to a medical facility is required. If emergency services have not already been called, contact them immediately. Keep the victim as still and calm as possible to minimize movement of the impaled object.
Before moving the victim or upon the arrival of emergency responders, ensure the object is clearly visible and its stabilization is secure. If the injury is to an extremity, the limb should be immobilized with a splint if possible, ensuring the splint does not cause any pressure on the object. Gathering information such as the time of the injury and the nature of the object can be helpful to medical personnel upon their arrival.
Reassure the injured person throughout the process, maintaining a calm demeanor to help reduce their anxiety and keep them from moving. The object must remain undisturbed during any movement until professional care takes over.