The goal in fish hook removal is to minimize additional tissue trauma and provide proper wound care following removal. Prior to removing any foreign body such as a fish hook, cleaning the wound is an ideal initial practice. Have a good understanding of what the situation is under the skin before attempting removal. If you're not confident doing any of this yourself, seek professional care at an emergency room or quick care facility.
Sometimes you can remove a hook yourself and other times you may need to go to the emergency room. Prior to removal, the wound must be cleaned. You can do this with a little bit of diluted hydrogen peroxide or wait until the staff at the hospital can clean it with other solutions. Also consider bringing another hook as an example so the doctor can know exactly what the hook looks like. Remove anything attached to the hook, including bait, line, and lure. Most injuries are minor and require little treatment.
If there is eye involvement, immediate removal is not indicated, but rather the patient must be seen by an eye doctor aka a referral to an ophthalmologist by another physician. X-rays or other scans may be necessary if the hook is near important structures or embedded all the way into the bone. You can understand the importance of such a scan if the hook would be too close to anything like bone, tendon, a nerve, or major vessel. You would not want to blindly advance a hook into any of those structures and cause further harm. Free hooks on a treble or multiple hook should be cut or taped so that they do not cause additional injury while removing the embedded hook. A pair of side cutters should suffice, however, hooks are becoming increasingly difficult to cut through. Make sure you have the right tool for the job within reach.
There are four methods commonly used. These are the retrograde method, string-yank method, needle cover method, and the advance and cut method. The method used depends on the type of hook involved, the location of the wound, and the depth of the hook.
The retrograde method is the most simple, but not always possible and actually the least successful. Use this method for the most superficially embedded hooks or barbless hooks. Apply downward pressure on the hook shank to try and free the barb. Then back it out of the entry wound, stopping if any resistance is felt at all. Otherwise, more tissue damage could occur. Do not force it and cause more damage. Try another method.
The next method is the string-yank method. The benefit of a string-yank technique is that it can be done without anesthesia and in the field. It is also the least traumatic method. Do not use this technique on involved body parts that are not fixed such as an ear. An embedded hook barb in the ear may require another method, but if the hook went all the way through, an advance and cut method might be your method of choice (see below). Perform the string-yank method carefully as it can cause more damage if performed improperly. Wrap string or fishing line around the middle of the bend in the hook and hold the ends tightly with a good grip so that it will not slip. Stabilize the body part, apply downward pressure to the hook shank parallel to the skin, and apply a firm swift jerk parallel to the hook shank while still pressing down on the eye/shank of the hook. If using the string-yank method, wear protective eyewear and do not allow anyone to stand near the path of removal. They might get hit by a flying hook.
The third method is the advance and cut and is the most effective, yet it can cause the most tissue damage. This method is very useful if the point of the hook has advanced close to the surface of the skin. It may require anesthesia. Advance the point through the skin, cut the barbed end with pliers, and back the hook out the way it went in. If the hook has multiple points as a treble hook might, the eye end is cut so that the shanks are free and the hook may be advanced from the barbed end. Cutting the shank of a treble hook can be quite difficult without a suitable cutting tool.
The last method is the needle cover method performed at the hospital using an 18 gauge needle or larger. It works best for large hooks with single barbs, especially if the hook is only superficially embedded. Insert the needle parallel to the hook shank with the bevel turned so that the opening will slide over the barb in the next step. Advance the hook forward to free the barb and with a pull and a twist motion, capture the barb inside the hole of the needle. Then just back the hook out the way it went in. More difficult injuries may require a scalpel technique to supplement the needle cover method allowing moving room for the hook point.
Follow removal with a wound examination for any foreign body. Further wound care involves antibiotic ointment like Neosporin and a wound dressing along with a course of oral antibiotics like Augmentin (amoxicillin/clavulanate) or Keflex (cephalexin). They have to cover for Pasteurella multocida. A tetanus booster might be given if there is no record of an up to date tetanus booster within five years. Oral antibiotics or prophylactic IV antibiotics may be given to people who have problems with wound healing as in diabetics, anyone with peripheral vascular disease, or additionally for anyone with deeper wounds involving other structures. Follow up with your doctor to make sure the wound has healed properly.
I have been told of a method involving silk taught in boy scouts. Little, if any, information is available online pertaining to this approach. I would appreciate anyone who is familiar with what I'm talking about to post a comment here and enlighten us all.
These four methods came from the American Academy of Family Physicians web site. I have used an advance and cut method when I put a hook through my ear. Most fishermen are familiar with cutting off the barbed end and then backing out the hook though. Now you know medically acceptable methods for fish hook removal.
You may find a full article online or as a pdf at the following locations. I only offer this blog version as a summary and for people who are not physicians as the language in the original article was not written for laypersons, per se. I would still encourage reading the original article in its entirety.
1. Gammons MD, Matthew, Edward Jackson, MD, "Fishhook Removal" American Family Physician < http://www.aafp.org/afp/20010601/2231.pdf >, 1 June, 2001. 13 August, 2007.