#impaled objects

Ultimately this would require surgery to treat definitively. In the field before surgery is available however, the main goal is to secure it in place so it doesn't wiggle around and cause pain or more bleeding.

There are a couple of ways to do this. For a small object in an arm or leg, wrapping with bulky gauze usually suffices:

Note that there are gauze pads on either side of the object held in place with rolled gauze, keeping everything secure. One could also use self-adhering bandage to hold it all in place, which might be a better option if there is a long way to travel.

If it's in the torso, you've got more problems, but it's not impossible. Essentially you're doing the same thing on a larger scale. Take 4 rolled hand towels (or honesly whatever you've got) and stack them log cabin style around the object:

Once the object is stabilized this way, you can bandage or tie these towels to the person's torso.

If the object is in the eye, place an upside-down paper or styrofoam cup with a hole poked through the bottom over the eye and secure it in place with gauze:

Uh oh. Character C is in the wilderness with Character D and they just got stabbed by a murderer / impaled by a tree branch / walked over barbed wire / fell on a pointy thing. What should D do? Leave the impaled object in? Or take it out?

Luckily, the author has read a lot of medical advice posts online and knows that you always leave impaled objects in. Right?

Nope. As a wilderness first responder, we are actually empowered to remove impaled objects in most cases (assuming we are two hours away from care).

Why Remove?

Leaving an impaled object in lets it do more damage. C is halfway down the Grand Canyon. One of those infamous Grand Canyon serial killers has just stabbed him. How does D intend to wrap the knife in place so that hiking out does not jostle it around and stab C more?

The answer is D cannot. The same is true of sticks and other implements—unlike in the front country, C and D need to travel at least two hours before care and that changes the rules.

A second excellent reason to remove an impaled object is if the object is so large, C cannot travel with it. In the wilderness, D might not have the ability to saw through a log so C and his impaled object can hike out together. Should D just leave C there? No! It's time to remove that impaled object.

A third excellent reason to remove an impaled object is when it is impeding a basic life support function. For instance, if C needed CPR and the barbed wire he'd impaled himself on was thwarting D's access, that barbed wire is gone. (Remember: when raising the dead, essentially nothing in contraindicated).

When NOT to Remove Impaled Objects

The object is in the eye

Eye liquid is difficult to replace. Losing it can mean losing the eye, so even though it sucks, D should leave the impaled object in C's eye while they hike out. D should splint the object in place using a cup or similar object and get out ASAP. Depending on terrain, D might also cover the uninjured eye. This is to keep C from moving his eyes.

Put the cup upside down over the impaled object and wrap it in place.

The patient yells "stop stop stop!"

My WFR instructor liked to say "never say never, never say always," but one rule that is about as close to an always as you can get in the wilderness is: if the patient is screaming and begging for you to stop, you should stop.

Therefore, if D tries to pull out the impaled stick and C starts shrieking in pain, it is now time to leave that object in place.

Removing the object will cause more harm

If C was, for instance, impaled by a barbed harpoon, or shot with an arrowhead, it might behoove D to leave it in place during evacuation.

The same is true if it looks like removing the object will lead to blood loss, as blood loss should be avoided, in the wilderness and outside of it.

The impalement is in the core

The core is home to two of the three most important organs in the body, (and, unfortunately, to the spleen). It has also plenty of big arteries and other important things that should not be damaged. If evacuation is possible without removing the object, the object should stay in place.

Conclusion

For references? Sure. Prehospital Trauma Life Support, orPHTLS, is the EMS trauma guidebook, though it has its limitations. I think thecurrent version is something like the 9th edition?

As for what to do with an impalement, we as medics aretrained to stabilize the object in place and transport the patient. We do not do removals in the field, unlessit’s an impalement in the cheek andit gets in the way of breathing. True story!

Now, the specific howsof stabilizing that impalement are going to depend on the object and itslocation. In general, we find some bulky things (like roller gauze), and takethem together around the impaled object. Take the object with the person.Pulling it out could literally kill them.  

This is what I advise your characters to do, too. Best ofluck!

xoxo, Aunt Scripty

disclaimer    

The big question with something stuck in the brain is, what did it hit? Contrary to myth, we use 100% of our brains. If the impaled object just... stays, the question becomes, does it cause an infection, and, does it move? If it moves, the person could die. If it causes an infection, the person could die.