July 20, 2011 -- Dez Heal, 13, of Lynchburg, Va., was rushed to the hospital with a bamboo stick impaled his neck.
Dez had been playing a Ninja game with friends and "decided to put the bamboo stick in the back of my shirt," he told ABC affiliate WSET-TV.
"I guess when he jumped, the stick must have went forward," Nicholas Blencowe, Dez's friend and Ninja partner, told the station. "And when he hit the ground, the stick went in his neck."
Dez's father, David Heal, described to WSET how the stick pierced Dez's neck and came out about about 3 inches behind his ear. Heal called 911.
It might seem surprising, but when emergency room physicians see an impaling injury like Dez's, they don't rush to yank the piercing object out -- they leave it in as they take the time to appraise the patient.
"It sounds counterintuitive, but it's important to leave the object in place," says Dr. Abi Mehrotra, assistant medical director at the University of North Carolina Department of Emergency Medicine. Even if an object is impaled in the eye, don't pull it out, he warns. "You don't know what the damage is to the structure underneath. The object may be stopping the bleeding that may be happening."
Dr. Paul Pepe, chairman of emergency medicine at the University of Texas Southwestern Medical Center at Dallas, agrees. " You don't pull it out. You do nothing" initially, he explained, because of the risk involved in extracting it.
"If it is going through an artery, if you pull it out, the leak may explode," says Pepe.
Luckily for Dez, the stick did not hit an artery.
Pepe went on to describe the deliberate, painstaking ABC protocol -- airway, breathing, circulation -- that's followed for an impaling injury like Dez's.
"There could be abnormal breathing if the phrenic nerve is hit," he said, referring to the nerve that begins in the neck and supports the movement of the diaphragm. Doctors have to ensure that there is not a loss of circulation, and that the patient is not bleeding out.
A patient might be asked to wiggle his toes to see whether there is a spinal cord injury, Pepe explains.
Doctors use imaging, including CT scans, and possibly angiograms, to further determine the nature of the injury.
Only after a meticulous assessment do doctors consider cutting off the ends of the object and moving to "a very careful surgical removal," Pepe says.
By appraising the injury beforehand, a hospital can make sure it has the appropriate expert on hand -- such as a vascular surgeon if an artery has been struck, Mehrotra says.
Such accidents -- often shown dramatically on TV, especially in a famous "Grey's Anatomy" episode in which two patients were impaled on the same pole -- "aren't as rare as we would like to think," according to Mehrotra. He says he frequently sees fishing hooks impaled in skin.
Larger, more serious impalements happen to workers who fall on the job, and to those caught in tornadoes, Pepe says.
As a result he says, "We've got the drill down."