Removal of impaled objects regardless of the location may cause disruption to the bones, tissues, organs, or blood vessels and impaled objects should not be removed by the patient prior to presentation to the ER. Tetanus vaccinations should be updated every 5-10 years, not yearly. While using hammer and nails instead of a pneumatic nail gun may be safer, it is not practical for the patient to stop using a pneumatic nail gun in a profession where these are likely necessary. The wound may be washed with soap and water; avoiding cleansing the area may increase the risk of infection.