Impaled Objects
Objective: Leave an impaled object in place and stabilize it. Remove it only if it blocks the airway or you cannot do CPR. If you must remove it, be ready for the bleeding. Shorten it only to move the patient, and only if protocol allows.
Why this matters
An object is through the thigh and bystanders want it out. The object may be plugging the bleeding site. Pulling it in the field can start bleeding you cannot stop. Leave it in. Stabilize it. Go to a trauma center. MARCH still applies: massive hemorrhage, airway, respirations, circulation, then hypothermia and head injury.
- Build a bulky dressing around the object so it does not move. Do not wiggle it to judge the depth.
- Shorten the object only if you must, so you can move the patient, and only if you are trained and your protocol allows it.
- If an object in the cheek blocks breathing, that is an airway exception. Be ready to suction. If you remove it, expect bleeding.
- Leave it in. Stabilize it. Do not wiggle it.
- Shorten it only if we must move the patient, and only if protocol allows.
- An object in the cheek that blocks the airway is the exception. Suction is ready.
Clinical sequence
- Stabilize the object with a bulky dressing. Do not wiggle it to see how deep it is. Control bleeding around it.
- Shorten the object only if you cannot move the patient with it in place, and only if you are trained and your protocol allows it.
- If the object is in the cheek and the patient cannot breathe, you may need to remove it. Be ready to suction. If you pull it, be ready for the bleeding that follows.
Teaching points
- Leave it in. Stabilize it, control bleeding around it, and transport.
- Remove it only if it blocks the airway or ventilation, it prevents CPR, or it is in the cheek and blocking the airway. Then expect bleeding and have a plan for it.
- Eye: stabilize the object, shield the eye, and do not pull it. Cover both eyes, as you were trained, so the eyes do not move together.
- Document the time, what you did not remove, and why.
Common errors
- Pulling the object out to see how deep it is.
- Removing an object with no plan for the bleeding.
- Staying on scene for photos while the patient still needs a surgeon.
Practice
One-minute check
Answer two cases. A knife is in the abdomen and the patient is talking. Do you pull it or stabilize it? A metal bar through the mouth is blocking the airway. Do you pull it or stabilize it, and what do you get ready for?
Related: Massive hemorrhage first.
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; your protocol decides
- ATLS education — impaled objects generally stay in place
- TCCC — do not remove impaled objects unless they obstruct airway or CPR
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.