Impaled Objects
Objective: Leave it in, stabilize, and only remove if it kills the airway or you cannot compress — then be ready for the bleed.
Why This Is Hard
The rebar is through the thigh and bystanders want it out. ATLS/TCCC: the object may be tamponading. Pulling it in the field can start a bleed you cannot stop.
- Bulky dressing to stabilize. Do not wiggle it to grade the wound.
- Shorten only if you must to move them, and only if trained/protocol.
- If it is in the cheek and they cannot breathe, that is an airway exception — be ready to suction.
Field Rules (Education)
- Leave it. Stabilize, control around it, go.
- Remove if: it prevents airway/ventilation or prevents CPR, or it is in the cheek and obstructing — then expect bleeding.
- Eye: stabilize, both eyes covered per training to limit conjugate movement, do not pull.
- Document time, what you did not pull, and why.
Field Pitfalls
- Pulling it to “see.”
- No plan for hemorrhage if you must pull.
- Long scene for photos.
Practice
60-second drill
Partner: (1) knife in the abdomen, talking; (2) rebar through the mouth blocking the airway. Pull or stabilize.
Related: MARCH.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- ATLS education — impaled objects generally stay in place
- TCCC — do not remove impaled objects unless they obstruct airway/CPR
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.