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Crowbar impalement: the PHEM perspective
  1. Saad Jawaid1,2 and
  2. Dan Cody2
  1. 1 Emergency Department, University Hospital of Leicester, Leicester, UK
  2. 2 Pre-hospital Emergency Medicine, Magpas Air Ambulance, Huntingdon, UK
  1. Correspondence to Dr Saad Jawaid, dr.saad{at}


A man in his 50s suffered an impalement on a crowbar after falling from the roof of a domestic shed. A helicopter-based prehospital emergency medical service team was called to assist in the patient’s care. The crowbar had entered from the left-upper quadrant and was tenting the skin of the right iliac fossa. Analgesia and prehospital sedation were provided to facilitate extrication. A series of improvisations were carried out to support the logistics of transferring the patient using an air ambulance to the regional major trauma centre with the crowbar in situ. The patient was taken to the operating theatre without any imaging and a section of perforated bowel was removed. He made a full recovery and was discharged home 9 days postincident.

  • prehospital
  • trauma
  • accidents, injuries
  • sedation

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  • Contributors SJ: doctor in the HEMS team that treated the patient, followed up patient after discharge to obtain consent, attended the meeting with patient and discussed the post discharge journey, intention to write the case report and gained the consent, also obtained patient’s perspective for the case report, literature search and review of previously published articles and case reports about impalements. Both authors discussed and planned the contents of the case report. Wrote the initial draft of the case report and finalised it after the initial draft was reviewed by coauthor DC. DC: consultant paramedic in the HEMS team which treated the patient, attended the meeting with patient and explained to the patient the educational benefits of publishing the case which assisted in obtaining the consent, took all the pictures of the incident on the day and have provided them for the publication, assisted in writing up the case report and made contributions to all the sections particularly abstract, background, presentation and treatment.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.