Fishing guides and emergency room doctors can’t help but recall gory wounds and pasty faces when hearing the phrase, “get hooked on fishing.”

After all, those professionals must often remove fish hooks from the ears, hands, fingers, and other body parts of panicky victims. Guides are often the casualty or the extraction expert, given that they must constantly attach lures, net fish, and unhook fish; and then stand again in harm’s way as clients cast bait, set hooks, yank snags, or lay flies and lures where they don’t belong.

Brody Henderson, MeatEater’s senior editor, guided trout fishermen for 18 years in Colorado, and estimates he’s been hooked at least 12 times, and removed hooks from at least 20 people besides himself.

In one case, a man in a nearby boat hooked his buddy so close to the eye that Henderson didn’t risk messing with it. He taped down the hook so it could do no further harm, and directed the men to the nearest hospital. In the other case, Henderson drove himself to the hospital after his young son’s errant cast drove a treble hook behind his jaw, sticking one hook into an ear lobe and the other into his upper neck.

Miles Nolte, MeatEater’s director of fishing, guided anglers in Alaska and Montana for a combined 13 years. In that time he extracted hooks from at least 12 clients, and several more from himself. One client nearly passed out after a whitefish drove a hook deep into Nolte’s hand as he unhooked the fish. When Nolte popped the hook from his hand with the client’s help, blood shooting from the wound painted the boat so red that it looked like they had “sacrificed a chicken for the fishing gods.”

Speaking of spurting blood, Sam Lungren, MeatEater’s fishing editor, recently took a hook deep into a thumb knuckle while unhooking a northern pike, four portages into Minnesota’s Boundary Waters Canoe Area Wilderness. The large hook buried itself so far into the joint that Lungren’s father couldn’t yank it out with pliers. Lungren used his knife to widen the wound channel around the barb, then asked his dad to try again. The second yank failed, too, but his dad “gave it more juice” on the third pull. When the hook popped free, “blood squirted several feet.”

Lungren also drove a fly into his ear as a kid while fly fishing in Alaska during a cruise, and sought help from the ship’s doctor. The doctor lacked tools to cut the hook, so Lungren’s dad suggested he call the ship’s electrician, who brought cutter dikes. When the doctor hesitated to use the unsterilized cutters and left the room, Lungren’s father cut the hook and removed it.

Hooks and Hospitals
Whether they involve guides or everyday anglers, most accidental hookings are so minor that victims or fishing partners handle it themselves, especially if a hook’s barb didn’t sink below the skin. A buried barb, however, often requires a doctor’s care. In turn, doctors who work near popular fishing destinations get endless opportunities to remove hooks of all sizes from anglers of all fishing persuasions.

The Howard Young Medical Center in Woodruff, Wisconsin, for example, is surrounded by the state’s largest concentration of inland lakes, as well as hundreds of miles of trout streams. Doctors in the hospital’s emergency room remove as many as 137 hooks annually from anglers with colorful flies, plugs, spoons, spinners, jigs, crankbaits, jerkbaits, and bait rigs buried everywhere from toe to scalp.

Fish hook surgeries are so common at Howard Young and the Ascension Eagle River Hospital 25 miles away that both facilities stock 6-foot-square “People Catcher” trophy cases with fishing lures liberated from patients pinned on human-shaped boards. The emergency-room staffs long ago filled each trophy case to capacity, and now must remove lures when adding entries.

Northern Wisconsin is famous for walleyes and muskies, but muskie anglers make up only about 10% of those seeking emergency hook-removal surgery, according to Dr. Roderick Brodhead, who recently retired after serving over 20 years at the two hospitals. Brodhead said most victims are casual recreational anglers who fish for whatever bites best. He notes, however, that muskie anglers are the humblest victims.

“Most people are very good natured and stay lighthearted about it,” Brodhead said. “But some experienced guys are humiliated. They tell us over and over how they’ve been fishing for years, and they’ve never had this happen before. They just have to tell us how it happened, and it’s seldom their fault. They usually blame their buddy, the wind, or a rogue wave.”

Brody Henderson with a hook buried behind his jaw.

Where Hooks Attack
Brodhead removed hooks from every region of human anatomy except the crotch, but he said hands and fingers are especially hook prone. Dr. Maria Tillman, a current ER hook-extractor in Woodruff, said that’s because most anglers get hooked while reaching into their tackle box, attaching lures or hooks to their line, or trying to unhook a fish.

Dr. Alan Lazzara agrees. Lazzara, a loyal MeatEater Podcast listener and guest on Episode 192, practices and teaches emergency medicine at Henry Ford Allegiance Health in Jackson, Michigan. Lazzara said most fishing skills require good hand-eye coordination, which becomes trickier when dealing with dim light, blinding sunlight, rolling waves, farsighted astigmatism, alcohol effects, or some combination of those factors.

“Unfortunately, fishing and drinking go together for many people,” Lazzara said. “It affects your judgment, not just hand-eye coordination. Maybe you aren’t so careful unhooking the fish, or maybe you yank too hard when setting or unsnagging your hook.”

Lazzara said it’s impossible to know how many people suffer fish-hook injuries nationwide every year because most such accidents don’t require medical care. But to learn how fish hook injuries occur, Lazarra referred to a statistical sampling of hospitals nationwide by the National Electronic Injury Surveillance System, run by the Consumer Product Safety Commission. After searching NEISS records for fishing injuries from 2014 through 2018, Lazzara located 1,063 cases for review.

Fish hooks accounted for 48% of those injuries, while the other 52% were caused by falls, knife cuts, ice-auger cuts, stepping on sharp objects when fishing barefoot or wearing flip-flops, and getting stabbed by fish spines—often from kicking a catfish.

Of the report’s 507 hook-related injuries, 117, or 23%, occurred while the victim was trying to unhook a fish; and 41 (8%) occurred by stepping on a hook. Getting hooked while casting (self-inflicted or by someone nearby), was seldom listed (18 cases, or 3%) in the descriptions. Casting’s count is surely a minimum, because the reports often don’t describe how the hook got into in the victim’s ear, face, neck, head, arm, torso, calf, thigh, or butt.

When to See the Doc
So, when should you seek a doctor’s expertise to remove a hook? In general, any time it’s a big hook buried below the barb, or any hook stuck in “loose parts” like lips or earlobes, or any hook near or in an eye or major blood vessel. But such judgments can even be tricky for experts.

In a recent case in Canada, a man showed up in the emergency room with a large hook buried in his neck. The nurse didn’t think it was bad, and so the patient waited four hours until a doctor examined him. She noticed the hook was pulsating. Upon further review, they learned the hook was looped around the man’s carotid artery, with the barb barely touching the artery. Those facts required an ambulance ride to another hospital, where a vascular surgeon delicately removed the hook.

Lazzara said hook extractions are much like real estate: “It’s all about location, location, and location. Where is the hook stuck, and where are you when you got stuck?”

When Lungren hooked his thumb in Minnesota, he was a day’s paddle into a wilderness area, and figured he and his dad were on their own. But when he hooked his ear in Alaska, they walked back to the cruise ship to see the doctor since they didn’t have the necessary tools.

Nolte recalled an incident in Alaska when a client caught a flying hook with his upper lip after it broke free of a sockeye salmon. There’s no such thing as “the nearest hospital” on such trips, so Nolte took charge. He and the angler’s brothers extracted the buried hook by holding the man’s head still, pressing the hook’s eye flush to the skin, looping a strong line through the hook’s bend, and jerking it out.

When the hook popped out, the angler passed out cold. When he awoke moments later, he looked up into the concerned faces huddled around him and shouted, “Who’s calling the play?” They all laughed and resumed fishing.

The “Loop, Press and Jerk” Method
Nolte, Henderson, Lungren, and Ryan Callaghan, MeatEater’s director of conservation, all endorse the “loop, press, and jerk” method for onsite emergency extractions, provided the hook is relatively small (less than 1/0), and it’s in a body part that can be held stable.

They recommend two people for the job. Start by cutting the line from the hook. Find an 18-inch to 2-foot piece of strong fishing line (at least 25-pound test), and tie it into a loop with a “perfection loop” or other secure knot. Slip the line over the hook, snug it into the hook’s bend, and press the hook’s eye flush with the skin. Wrap the line around the puller’s wrist and snug it lightly so it’s parallel with the hook’s shaft. And then get ready to yank.

When you yank, don’t be timid. “You have to mean it,” Nolte said. “Don’t softball it, and make sure you pull away in direct line with the hook’s shaft. And if you’re the one pressing on the hook’s eye, don’t let up. If you let up on the eye or give a timid pull, you’ll make it worse.”

Nolte and Henderson’s hot tip for this technique: “Tell everyone you’re going to pull on the count of ‘three,’ but do it on ‘one’ so they don’t flinch.”

Lazzara and Brodhead, however, do not recommend self-extraction. Lazzara considers the “loop, press, and jerk” technique ineffective, with the barb too often causing worse damage. They advise seeking a doctor whenever possible. If doctors have doubts about the hook’s orientation or whether it’s near a major nerve or blood vessel, they can order X-rays or CT scans for a better look.

If a hook is in or near an eye, you have no choice, of course. Lazzara recommends isolating the hook by clipping off the lure and other hooks. Protect the area by cutting the bottom from a paper or foam cup to cover the entire eye, and tape it atop sunglasses so the victim can’t touch it. Henderson also suggests covering the other eye to keep the victim from looking around. “No one can move one eye without moving the other,” he notes.

In most cases, doctors inject lidocaine or other painkiller, push the hook through, snip off the barb or eye, and slide the shank out.

If you’re on your own and think you can push the barb through, first numb the area with ice. Anthony Licata, MeatEater’s editor-in-chief, said he considered trying that after sinking a crankbait hook deep into the tip of his right index finger. “That sounds reasonable in writing, but it’s terrifying in real life,” he said. Licata went to a clinic instead, where they slid a tiny tube over the hook’s barb and backed it out.

Once the hook is out, wash the wound with soap and clean water, apply antibiotic cream, and dress it to avoid infections.

Prevention is paramount, of course. Always wear eyeglasses or sunglasses when fishing. Also, choose your fishing partners carefully, check your surroundings before casting, remove fish from landing nets before unhooking them, and use pliers to remove hooks from the fish.

The Catch
If you find yourself hooked and in an emergency room, surrender your lure if the staff wants it for their trophy case. Brodhead recalled a patient who kept his lucky muskie lure after a doctor extracted it from is hand. The angler said he couldn’t part with it and walked out.

He soon returned, pointing to his butt. He had absent-mindedly tossed the lure onto his truck’s front seat, rearranged some gear in his boat, and then jumped into the cab. After being released a second time, the man’s love for the lure vanished.

“Keep it,” he said, limping off.