The Only Absolute is That There Are No Absolutes

“Never remove an impaled object unless it is in the cheek and impairs airway and ventilation.”

I learned that little maxim and a whole bunch of other stuff way back in EMT school that proved to be bogus.

In fact, it has happened so often that I’d venture to say that you can tell when you’re about to be fed some bullshit, myth, dogma or the instructor’s personal opinion, because the statement usually begins with always or never.

I don’t trust absolutes.

Case in point: we were taught not to remove impaled objects because, lacking radiographic capability, we were unable to determine what internal structures were damaged by the offending object. For all we know, it might be embedded in bone, or be effectively occluding the major artery it just penetrated.

But, as with any rule, there are always exceptions, like our patient earlier tonight, with a big nasty razor blade still buried in the flexor tendons of his right wrist.

He wasn’t near an artery – if you try to kill yourself by cutting crosswise across your wrist, either you aren’t serious or your aim sucks – and the bleeding wasn’t arterial.

But he still needed that wrist bandaged, and likely restrained as well, due to his announcement that he wasn’t going to the hospital without a fight.

Your choices in such a situation are A) do one of those elaborate improvised dressings EMT’s are famous for, leaving a razor sharp object embedded an inch away from a major artery, still potentially slicing deeper with every struggle against his restraints all the way to the hospital…

… or B) you can ignore yet another maxim, pull the damned thing out and be done with it.

I’ll take Option B, please.

Technicians believe in absolutes. Professionals know better.

Of course, with my luck it’ll probably be a technician who QA’s my run report…