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Editor’s Note: This is a guest article by Marine Corps veteran and paramedic Charles Patterson.

Author’s Note:Given the nature of impalements and the number of variables that cannot be accounted for in one article, many of the treatment options will require a caveat of “depending on (x) or (y).” In every situation, common sense must be applied with extreme prejudice towards seeking help from medical professionals rather than attempting to correct or treat an impalement on your own. However, some situations occur far beyond the reach or support of emergency medical treatment. Receiving further training in multiple areas of survival and preparedness is essential for a positive outcome. Your level of training and preparedness and your distance from or ability to contact emergency care providers can mean the difference between full recovery, mere survival, or death. Be smart, be prepared, and live strenuously.

Impalement injuries happen when the body is penetrated by the forceful impact of what is typically an elongated, solid object. This force can be generated by the person themselves, as when a person falls from a height onto a spiked iron fence, or the force can be generated by an external source, as when the debris/shrapnel from a strong wind or explosion is propelled into the body.

With this kind of injury, an object with which someone has been impaled remains embedded. A bullet fired from a gun would not be considered an impalement, whereas a stab wound from a knife, with the knife remaining in place, would. An impaled object may be visible with some portion remaining outside the body, or it may be concealed and entirely embedded in the tissue. These embedded items are more commonly referred to as foreign bodies and are not the focus of this article. 

While being a relatively rare occurrence, impaled objects present unique challenges for patients, first responders, and hospital staff (and make for some gnarly-looking x-rays). Individual management of an impaled object varies widely based on the size, shape, and material of the item, whether fixed or free, the area of the body that’s impaled, the cause of the impalement, etc. 

Regardless of the many variables, however, an impaled object’s essential management is almost universally the same. And in all but the most minor instances of trauma involving an impaled object, emergency medical services should be immediately activated, if possible, or contacted at the earliest opportunity. Here’s what to do until you can reach/be reached by professional medical care.

How to Treat an Impalement Injury

Do Not Remove the Object!

You’ve probably heard this before, and it is the fundamental element of managing an impaled object. Leave the object in place! Depending on the size, shape, velocity, and area of impact of the object, it is likely that one or more blood vessels have been severed or internal organs penetrated. The object, left in its place, fills the hole that is created and can limit hemorrhage. When the object is removed, this void is no longer filled, and immediate, massive hemorrhaging can occur, internally and externally, quickly leading to shock and death. While external bleeding

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