# When do you "Make'em Naked"?



## MedicPrincess (Mar 1, 2006)

Last night we had a decent MVA.  It was dispatched as a single car, rollover w/possible ejection.  While responding we get the update, that PD is on scene, and there are "3 bodies laying in the road." The hwy they were on is fairly straight, and a main hwy between 2 cities.  Not uncommon for cars to reach speeds well over 100 MPH, especially at 3 am.  So, anyway, we get there and it turns out there are a total of 5 patients, 3 ejections, 1 entrapped, and 1 that pulled herself out.

After stopping the FF from standing the patient up, we got him collared and on a backboard.  His rapid assessment revealed nothing spectacular.  No pain anywhere, except his head which had a fairly large lac across it.  Now from where my guy was to where the car was, was about 1/4 mile.  So they had to have been traveling a good rate of speed.

Anyway, since he didn't complain of any pain anywhere except his head, I decided not to cut his clothes there in the middle of the hwy, in an effort to let him maintain a little modesty.

Once we got our second patient loaded, our shift captain was in the ambulance with me while the Paramedic on the ambulance I was on was putting the third patient (who had a very not right looking femur.  it was bent, definantly where it shoudn't have been) onto Life Flight.

Anyway, our Shift Captain noticed the first patients (mine) clothes were not cut off yet.  She asked why and I explained I decided not to cut them because on both the rapid and secondary assessments he didn't complain of any injuries anywhere.

She had me cut them anyway, due to mechanism and possibilty they could have something we cannot see because of the the alcohol and drugs they were "So Sorry they had been doing."  They were both trauma alerts and if they needed to be off by the time they were to the hospital.

Would y'all have cut'em off on the road, or waited until in the ambulance?


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## Celtictigeress (Mar 1, 2006)

In that scenrio considering it was an accident I would have cut them off...that way I could do a quick once over before the ambulance arrived The thing with alochal and drugs is it numbs everything and diroeitns... since you were getting them on a board anyway once they were stabalized and ready to go remove said clothing and rapid trauma...at least in my opinion... Knowing they were in an accident and "Drugged" so to speak I would take much word on it cant treat if you cant see it... they may have the underlying injuries and the intoxication wouldnt help any so better be safe then sorry CYA...the only reason I say this

when I was in my accident and broke everything (they knew my leg) It was considered trauma (even if it was caused by a horse) you cant treat what you cant see.... if they have clothes you may not see the flailed chest which interfers in the ABCs... The stripped my arse (I was half concious) turned out I had the whole flailed chest bit goin myself But what I DO remember was AFTER they had me c spined and secured to the board.


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## TTLWHKR (Mar 1, 2006)

Cut em off.. They will in the ER anyway, with a dozen people standing around, in a bright open room..

A little time in the middle of the roadway is the least of their worries...


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## emtI (Mar 1, 2006)

For me, it would have depended on a couple other factors, such as weather conditions and immediate life threats such as oncoming traffic, etc.  

I know you said PD  was on scene, but since you said it was a main highway where it's not uncommon for cars to reach 100 MPH, my choice would have been to get the pt off the roadway as rapidly as possible.  I've seen too many accidents where the oncoming traffic didn't yield, wasn't paying attention, etc. to risk my and the pt's safety to spend much time cutting clothes off on the highway.

If it's really cold out, rainy, snowy, etc, I would have quickly secured and loaded the pt and then cut off clothes in the unit rather than then and there on the highway.


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## coloradoemt (Mar 1, 2006)

It takes so little time to strip and flip that in most cases I would answer road. You cannot properly assess a pt in this case with their clothes on.


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## natrab (Mar 1, 2006)

+1 to all the previous comments.  With that sort of mechanism, you have to suspect EVERYTHING (not just anything).  That means cutting the clothes and visualising.  Pain doesn't always set in right away, especially if someone's in fight or flight, and the patient can be distracted with obvious pain like a broken arm while he (and you if you don't do a full survey) doesn't even notice he's bleeding out from his femoral artery.  Modesty is secondary to your rapid survey in this type of accident.


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## Jon (Mar 2, 2006)

I had a similar situation in January. I got the 3rd patient, and we had 2 medics... it was below 30 degrees, and my patient was already cold. Mine had generalized abdominal and chest pain..... we were supposed to get a bird. I told my supervisor on scene we were going BLS to the LZ, and I'd get ALS from a flight medic there.... not going to play around on scene. I loaded my patient up after only getting a crappy primary assessment, and got her naked in the truck.

Up here, we've got to be VERY careful about exposure in the winter months. Having a patient naked on the ground in cold weather (or even cool weather) the patient will go into shock MUCH faster.

In your situation, in our weather here.... I'd probably cut the clothes (pants up the legs, shirt sleeves and down the chest) but leave them on. I'd also be getting a blanket or 2 to keep my patient warm while waiting for enough help to get them onto a board and into an ambualnce. The Secondary exam should include exposing the patient, but that SHOULD wait if you can quickly immobilize the patient and put them in the truck.

Jon


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## TTLWHKR (Mar 2, 2006)

It is so much more difficult to strip the victim while placed on a board and fully restricted from movement. This would require straps to be removed, so we basically remove all the clothing while in the process of board placement.


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## Stevo (Mar 2, 2006)

i have to echo Jon on the cold, we've been well below 0 on some of these calls....oh and.....*don't cut the friggin' down jackets!*

~S~


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## Ecnalubma (Mar 6, 2006)

Yea, I would have cut 'em on the road. Down to undies. Then after they are naked then I do my rapid assessment, then board them and go.


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## MedicTroll (Mar 7, 2006)

*Use common sense*

First there are many factors to consider, first and for most if your the first unit on scene of an MCI (which is more the 3 pts.) then you just triage till more help gets there, not worrying about stripping a Pt..  But personally stripping every pt. due to mech of injury I don't agree with and is not what our state protocol calls for either. Also with our training we are to expose not strip, expose an area you may need to exam, but cover up after your done. Your dealing with shock with every Pt., exposing them and not covering them back up is only dropping body temp and may cause more problems.  I would also like to comment on the practice of generalize treatment, just cause there have been drunk driving MVA in an area before doesn't mean all are the same and shouldn't factor treatment. Remember this, there currently is a paramedic serving a sentence for manslaughter for this very reason. They responded to a single car MVA at 0230, common area for DWI accidents, medic let the combative Pt. RMA, stating no injuries found. Pt. died at police station from diabetic incident. Just use common sense people, this isn't rocket science, most of what we do is monkey skills, just have to use common sense.


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## EMTI&RESCUE (Mar 9, 2006)

It would be hard to convince my C.O. that I did my assesments when they arent stripped and cloths arent ripped. Its hard to find those contusions without seeing the skin first. If I was in a wreck strip me and save me rather than keep the world from seeing me in my glory and killing me. Best case senerio I'll say "it was COLD it was COLD" hahaha


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## halesyousay (Mar 10, 2006)

If they are hot, make 'em naked.  JK, do what you have to do but retain as much modesty as possible.


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## Luno (Mar 18, 2006)

*Hahaha*

EMTPrincess, only you would ask such a question....


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## MedicPrincess (Mar 19, 2006)

LUNO!  Man I thought you had died!  

Of course, leave it to a post about getting naked to bring you back around.


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## Luno (Mar 19, 2006)

Yeah, well that one was too good to pass up on, I'm back in the FAB NW, and still up to my ears in work.  I dropped by the site the other day just to see what was going on, and of course, it was too tempting to pass up.


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