What to do if someone gets impaled in the stomach?

Question

Background: This question is motivated by an accident that happened to my sister in a very rural area. She was on a fence and fell onto a t-post which basically impaled her, but which fell out by the time she hit the ground. (Details are gruesome.) We padded the injury with some shirts and then basically panicked until we saw a helicopter. We signaled the helicopter, which landed; we put her on a tarp and transferred her to the copter, which flew her to a hospital 15 miles away.

The Question: We were lucky. I've thought about this incident and wondered how a similar (not identical) incident could be handled far from help.

Assume you are in the wilderness. Phones are dead, you don't have a PLB, and if you walked out, help could not arrive in less than three days. You have a first aid kit and some other equipment that might be helpful, including but not necessarily limited to, gauze, hydrogen peroxide, pliers, scissors, fishing line, iodine, tape, and rope You have a well set-up campsite and plenty of easily accessible food and water.

Your hiking partner gets stabbed through the stomach with a tree branch. The branch is still all the way in and is small enough so your partner can be moved. Your only options are to attempt to treat them or watch them die. What can you do? What should you not do? What aid can you give before hiking out for help?

One commenter asked if the branch had splinters. Branches often do, but an answer that does not account for splinters could still be useful. I chose branch instead of generic object, which seemed vague, and because my own experience, which was a t-post, would make the question too narrow.

Answer 1

To quote from the Wilderness First Responder manual,

Large objects found impaled in a wound should be left in place if you can get to a medical facility with relative ease. Yanking on an object can stimulate serious bleeding and damage underlying structures, especially if the object is impaled in a body cavity, such as the chest, abdomen or head

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The object should be stabilized with padding to prevent movement. The padding should be as high as the object to protect it from being bumped during transport and the patient should be carried out.

In many cases there is nothing easy about getting to help and impaled objects sometimes make evacuation very difficult. Removal of impaled objects in the wilderness is an oft-debated subject. They are often difficult to stabilize over rough terrain.

Page 107 Wilderness First Responder -Buck Tilton, MS, WEMT

With any abdominal injury anticipate nausea and vomiting. Over time blood may appear in the vomit (often looking like coffee grounds), in the urine (often appearing pale pink), or in the stool (often described as black and tarry), depending on where the damage occurred. Over time a fever may develop.

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Stay alert to the possiblity of vomiting. Generally treat for shock.

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If evacuation is delayed and the patient is alert, the patient may be given clear fluids to drink, as long as she or he tolerates the fluids.

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The immediate seriousness of any penetrating abdominal cavity, as with blunt trama, is determined by what got damaged inside and how badly its bleeding. With severe bleeding, shock is imminent and immediate evacuation is the only chance of salvation. Over time the risk of infection is very high.

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External bleeding should be controlled. Wounds should be cleaned and bandaged... Impaled objects, in almost all cases should be stabilized in place.

Page 75 Wilderness First Responder -Buck Tilton, MS, WEMT

In short it looks like the odds of the impaled person dying are very high and yet in this scenario you really don't have much choice but to go for help.

You would want to treat before going for help and since there is probably going to be vomiting, the victim should know about the recovery position in case they go unconscious so they don't choke on their own vomit.

It trying to get help from anyone around you before going for help by making a distress signal like blowing a whistle in three blasts or shouting or gunshots. Then before leaving you could make three X symbols on the ground to indicate that you need medical assistance in case a plane were to fly over.

On your way out, I would say to keep blowing your whistle and try to find other people on the way and direct them back to help the victim.

Situations like this are part of why the minimum group size is 3 so that one person could stay with the victim while the other goes for help. It would also be a good reason to carry a PLB or a Satellite device.