I hope this is the right Exchange. For background, I do have official military combat trauma training and official civilian first aid training but the particulars of Scenario 3 below have me wondering if I possess the understanding that I think I do.

I know that if a person gets impaled, say in the leg with a piece of rebar, the object should not be removed as removal could cause further tissue damage and could lead to more uncontrolled bleeding as the "plug" is now removed.

I also know that if a person is suffering from a sucking chest wound, an occlusive bandage on the wound is needed to prevent air from filling the chest cavity instead of the lungs when inhaling.

Assuming all I have is a few rolls of gauze and some tape, ignoring the realities of a flailing injured person, and assuming advanced medical assistance is at best ~45 minutes away, what is the procedure for when the puncturing object is still present? I'm sure this scenario has a decently large number of "situation dictates" sort of conditions but I can't quite get a warm and fuzzy on what I'd do if it were up to me to respond to this situation; Specifically scenario 3 below.

Scenario 1 - Fully self sealed: I am one of three people in a remote area and person 2 falls on a loose 36 inch piece of rebar with enough force to result in the rebar entering their chest through the left lung and exiting the back, luckily not shattering any ribs in the process. After instructing person 3 to go call for emergency services, I assess that the rebar's entry and exit wound are sufficiently sealed by the rebar and the clotting blood around it so a sucking chest wound is unlikely to occur.

I do the standard practice of placing two rolls of gauze on either side of the protrusion and tape in place to both help stabilize the metal and further promote clotting around the entry and exit points. With gauze in place, I then lay the injured person on their side in the recovery position, insulated from material that would whisk away their body heat, so that the injured lung is down to ensure the in-tact lung is not impeded as much as possible. Monitor for changes.

Scenario 2 - Only entry or exit self sealed: Same situation as above except the object is an irregular shape resulting in the exit wound being sufficiently sealed but the entry wound cannot self seal and is being held open by the shape of the protruding metal.

What I currently think I should do is try to get the wound to seal around the chest protrusion by packing with gauze as much as I can into the part of the wound that is being held open, prioritizing the available gauze to filling the hole over bracing the protruding metal from their back. If I can get the wound to seal, treat as above in scenario 1. If I cannot get the wound to seal enough to prevent suffocation before help will hopefully arrive, I feel I am left with no choice but to carefully remove the object, ensuring not to twist or turn, and then treat both chest and back with an occlusive dressing (e.g. Insides of clean sandwich bags, some clean plastic wrap, credit card, etc.). I think I should then try to have them sitting up against something to make sure the injury is not the lowest point to help prevent blood from entering the lung as much as possible. Monitor for changes.

Scenario 3 - No self sealing: Same situation except worst case: The metal was a piece of punched metal tubing (Hollow tube with holes all throughout the sidewalls). The end person 2 fell on was capped so no tissue entered the tubing to act as a plug. I could probably tape up the holes and un-capped end to essentially seal the tubing off from atmosphere but, not only would that volume allow for lots of blood loss, I feel like there is now a highway for blood to pour into the impaled lung which would quickly begin getting into the uninjured lung causing them to drown or, at least a highway for blood to leave the body unchecked via the tubing and causing them to die from blood loss.

What I currently think I should do is try to pack the tubing within their torso with gauze/fabric to seal everything up internally. Once I've packed in as much as I can, treat as above in scenario 1. Monitor for changes.

Is this response the best I can do in this dire situation?

  • Welcome to MedicalSciences.SE. I have been taught different techniques of dealing with impalement injuries over the years and UK recommendations change with some techniques being banned from use by first aiders. My recommendation would be to get proper official training from a reputable first aid training company such as Red Cross or St John Ambulance before tackling such injuries. Oct 7 '20 at 12:15
  • Thank you! I guess I should add that I do have official military combat trauma training and official civilian first aid training. The particulars of Scenario 3 are not something that's really covered specifically so this is more me trying to confirm I understand things as much as I think I do/should. Oct 7 '20 at 12:31
  • 2
    I think you're overthinking an extraordinarily unlikely scenario. Treat as for penetrating injury to the chest and expedite transport because the only person who's going to help that patient is a trauma surgeon. Spending even seconds packing gauze into a tube is seconds lost and also increases risk through additional manipulation of the impaling object.
    – Carey Gregory
    Oct 7 '20 at 15:35
  • True, I'm certain I'm overthinking and it's definitely an unlikely scenario, thankfully. It's really more about my thought process than the specifics of the injury. Your comment was very helpful, and I appreciate it. It might even be the only valid answer this question can receive, it sounds like. Oct 8 '20 at 20:51
  • Maybe you could add some sources for recommendations/guidelines to this post?
    – Thomas
    Oct 12 '20 at 15:48

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