Impalement by an object, such as an arrow, is a serious and life-threatening medical emergency. The goal of bystander action is to stabilize the victim and the injury until professional medical services arrive, not to offer definitive treatment. Immediately contact 911 or your local emergency number, clearly stating the nature of the injury. Until help arrives, focus entirely on maintaining the victim’s stability and ensuring the impaled object does not move, prioritizing the prevention of further harm.
The Primary Rule: Non-Removal
The most important principle in managing an impalement injury is to never remove the object. Removing the arrow, even if it appears superficial, can transform a contained injury into a catastrophic hemorrhage. The arrow may be pressing against a major blood vessel, effectively acting as a plug that slows or stops internal bleeding—a phenomenon called tamponade. Pulling the shaft out removes this pressure, potentially causing immediate, uncontrollable blood loss from a severed artery or vein.
Many arrows, especially those used for hunting, feature barbed or specialized broadheads designed to resist removal. Attempting to extract such an object would significantly tear and enlarge the wound track, causing extensive soft tissue and nerve damage. Leaving the arrow in place also provides surgeons with a precise “roadmap” of the internal damage, guiding their operative approach. The object must remain in the body until its removal can be performed in a sterile operating room environment with access to blood transfusions and surgical repair.
Securing and Stabilizing the Impaled Object
Once the arrow is left in place, the immediate physical task is to prevent it from moving, which could worsen internal damage and bleeding. Gently cut or remove any clothing around the wound to fully expose the entry site without disturbing the arrow shaft. Any movement of the object could cause the internal tip to lacerate surrounding tissue, nerves, or blood vessels.
Stabilization requires using bulky materials to pad the area around the entry point, creating a firm buffer that holds the shaft steady. Use sterile gauze, rolled bandages, or clean cloth to build up material on all sides of the arrow. A common technique involves creating a donut-shaped ring of material that fits snugly around the shaft, cushioning the object and preventing lateral movement. If the arrow has an exit wound, both the entry and exit points must be stabilized using this bulky dressing technique.
After the bulky padding is positioned, the entire assembly must be secured with tape or a long bandage. Ensure the arrow is immobilized and cannot rotate or be pushed deeper. The tape or bandage should only anchor the dressings to the victim’s body and never press down directly onto the arrow shaft. This mechanical stabilization minimizes the risk of secondary trauma while awaiting EMS arrival.
Managing Systemic Emergencies
While the arrow must remain untouched, the body’s reaction to the trauma, such as the onset of shock, must be urgently addressed. Traumatic injuries often lead to hypovolemic shock, a dangerous state resulting from rapid fluid loss. This causes the body to divert blood away from extremities and skin. Signs of shock include a weak, rapid pulse, cold and clammy skin, and faintness.
To manage potential shock, maintain the victim’s body temperature by covering them with a blanket or coat, as warmth helps stabilize the circulatory system. If there is no suspected head, neck, or spine injury, and the arrow is not in a limb, slightly elevating the victim’s legs can help return blood to the core organs. Continuously monitor the victim’s airway, breathing, and level of consciousness, as maintaining a clear airway is the highest priority.
Control any external bleeding not coming directly from the impalement site with direct pressure. Take care not to apply pressure that might move the stabilized arrow. If the victim is conscious and does not have an abdominal wound, small sips of water can be given, but avoid this if immediate surgery is likely. Providing emotional support is also important, as keeping the victim calm helps mitigate the physiological stress response contributing to shock.
Preparing for Professional Care
The final steps involve preparing the victim for a smooth transition to EMS care and transport. Only consider shortening the shaft if the arrow is so long that it genuinely prevents the victim from being moved or transported. If cutting is necessary, the arrow must be secured on both sides of the planned cut to ensure the internal tip does not shift or vibrate during the process.
A carbon-fiber arrow can often be cut with strong shears or a multi-tool, but this must be done with extreme caution to minimize movement and vibration transmitted to the body. Before EMS arrives, gather pertinent information, including the exact time of the injury and a brief description of how the impalement occurred. This information is invaluable for medical staff making rapid treatment decisions.
Ensure first responders are immediately informed about the presence of the impaled arrow, the stabilization method used, and any changes observed in the victim’s condition. Continued monitoring of the victim’s breathing and consciousness remains necessary until they are formally transferred to professional care. The goal is to deliver the victim and the stabilized arrow to the operating room with minimal movement or complication.