a. If the casualty is conscious, tell him to remain still and not move the impaled
b. Expose the impaled object by cutting or removing clothing to expose the
c. If the object is protruding from an extremity, check the pulse distal to the
wound to determine if circulation is impaired. If circulation is impaired, evacuate the
casualty as quickly as practical.
d. If there is serious bleeding from the wound, apply manual pressure to the
wound to help control bleeding while you prepare to dress and stabilize the object. If
possible, have a fellow soldier or the casualty himself apply the pressure while you
dress the injury.
Do not exert force on the impaled object or on the tissue directly
adjacent to the edge of the impaled object.
e. Apply a dressing to the wound using a field dressing or three sterile pads.
The dressing helps to stabilize the impaled object and protect the wound.
(1) Field dressing. Use your scissors to cut a field dressing halfway
through, slip the cut around the impaled object, and secure the field dressing with the
(2) Three pads. Cut three sterile dressings halfway through. Place the
first dressing around the impaled object (impaled object in slit as shown in figure 8-1).
Place the second dressing around the impaled object, but coming from the opposite
direction. Place the third dressing around the impaled object, but coming at a right
angle to the first two dressings. If no additional bulky dressings are to be applied,
secure the dressings with a roller bandage or cravat as described in paragraph g.
f. Apply additional bulky dressings, if needed to build up the area around the
impaled object to further protect and stabilize the object. The bulky material may
resemble a doughnut with the impaled object in the "doughnut hole."
g. Secure all dressings. Apply bandages, such as elastic bandages or cravats,
to hold bulky dressings in place. The bandage should be tight, but not tight enough to
interfere with blood circulation.
(1) If the wound is on an extremity, place a cravat under the limb with the
center of the cravat on the side opposite that of the impaled object. Wrap the ends of
the cravat around the injured extremity in opposite directions, covering the edges of
the dressings. Tie the ends of the cravat away from the impaled object.