# Patient Question



## daveg (Feb 6, 2008)

Hello, I am not a paramedic, so i apologize in advance for writing on your forum but it seemed like the only place to have my question answered accurately. 

I am a 17 year old high school student and feel as though I was mistreated and almost abused by paramedics, I'm just wondering if what they did to me is standard protocol or malpractice. 

here is my story... 

I was is class when I suddenly had a seizure. I ended up falling and cutting my head pretty bad and briefly losing consciousness. When I regained consciousness the school nurse and principal were treating me, minutes later paramedics arrived. The paramedics stethed my chest, then put both a neck brace and oxygen mask on me. They then began cutting off my clothing, they cut away my shirt, pants and uderwear. They even removed my shoes and socks. I uderstand that sometimes clothig needs to be removed, but I was fully conscious and able to move all my limbs, and to top it off my school nurse and principal were still in the room. They then strapped me to a backboard and didn't cover me up until they lifted me up onto the stretcher. 

Once i was in the ambulance, the paramedic removed my covers again she gave me a full pysical workup including a pelvic, is this at all needed? She didn't cover me up untill we arrived at the e.r. 

Im not an expert, from what I have read there was no need for all of that to be done, I'm hoping that some of you REAL paramedics can give me insight into whether or not this is proper procedure. 

Thanks for your time. 
Please post back or e-mail me


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## Emt /b/ (Feb 6, 2008)

daveg said:


> Hello, I am not a paramedic, so i apologize in advance for writing on your forum but it seemed like the only place to have my question answered accurately.
> 
> I am a 17 year old high school student and feel as though I was mistreated and almost abused by paramedics, I'm just wondering if what they did to me is standard protocol or malpractice.
> 
> ...



Yeah...there was really no need to cut off all of your clothes. Or any of them, really.


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## RavenMaster (Feb 6, 2008)

yeah, i cannot see just cause for that.


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## TheMowingMonk (Feb 6, 2008)

yeah unless you had some bleeding or tenderness in other areas, they really didnt need to cut you clothes off, c-collar and O2 were find cause you fell and hit your head, but it does seem like them cutting off all your clothes was excessive, specially the underwear, most of the time its a last resort to remove that unless the injury directly affects it.


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## seanm028 (Feb 6, 2008)

Do you know if they were EMT-B (Basics) or EMT-Ps (Paramedics)?  If you don't know for sure, do you remember if one of them started an IV?  Did they put you on a heart monitor?

I can understand cutting off a shirt, but I'm not positive about the rest.  On the other hand, they were probably just trying to be thorough, and they might have had some reason (unknown to you) to suspect further injury.  I would like to give them the benefit of the doubt, especially because it can be a little intimidating (especially for a new EMT-Basic) to be making instant decisions that can have huge ramifications.


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## JPINFV (Feb 6, 2008)

I'll second the "cutting off the clothes was not needed" crowd. There probably are cases, though, where new EMTs (B or P) take the "expose" part of the trauma assessment too far.



daveg said:


> Once i was in the ambulance, the paramedic removed my covers again she gave me a full pysical workup *including a pelvic,* is this at all needed? She didn't cover me up untill we arrived at the e.r.



Either this thread is a troll and full of BS or there's an EMT someplace that needs to be in jail. To the best of my knowledge, pelvic exams are not taught at any level of EMS and have no use in the prehospital environment.


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## bstone (Feb 6, 2008)

Jail??? 

Perhaps she wantes to visualize any injuries. I have never cut away the clothing of any seizure paitients unless there has been tenderness, deformity, bleeding, etc . Perhaps it's their protocols? No harm in being extra careful. 

Surely there was no criminal intent. Why the rush to judgement?


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## VentMedic (Feb 6, 2008)

How does a male(?) 17 y/o non-medical person define "a pelvic"?

Do you have a history of seizures?

Do those around you know you have seizures?

Do you wear any type of medical alert ID?

How did the call did phoned in as?

What did the witnesses say that might suspect other injuries?

Did they check for signs of a spinal injury by check sensation, movement and asking questions along that line? 

What type of furniture was around you when you fell? 

Since none of us were at the scene with you it is hard to second guess what another medical professional is thinking or seeing when they assessed the area around you.  It is also always bad to take a bleeding patient to the ED and find that the obvious injury was a distraction from another injury. 

I see you are posting this on different forums.  Is there more to this than curiosity?  Do you have any interest in pursuing this further?


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## TheMowingMonk (Feb 6, 2008)

yeah im feeling the Pelvic exam might just be checking for tenderness, he might be thinking of a pelvic exam like a doctor does and think its the same thing. What did they do for this pelvic exam?


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## *ofLife (Feb 6, 2008)

Hmm...

I am also a 17 year old female from Wisconsin. After being involved in several serious accidents, I decided that being an EMT was my calling and will be attending EMT-B training this summer. 

One of my many terrible experiences was being involved in a head-on collision on a busy county road. A female not much older than myself who was under the influence of some OTC drugs, crossed the centerline and collided with my vehicle going a little under 60 mph. 

My ankle was crushed into over a hundred pieces (my foot was on the break when we collided), the skin on my knee was basically cauterized, and my wrist was dislocated from the air bag. 

The EMTs were from my home town, and I knew half of them on a first name basis, and trusted them with my life. They also stripped me of all my clothing in the middle of the hospital and left me that way for quite some time before finally covering me with a thin sheet. Though I understand it may have been much more appropriate in my situation, I was caught off guard as well, but just happy to be okay and appreciated their help and concern.

Was it a necessary act? Probably not. But it can be justified. The important thing is that you're okay, and I'm sure your well-being is the only thing that remains on the mind's of the individuals that may have gotten a glimpse of your bare-ness.

I hope that helps 
Don't hesitate to message me if you have any questions about my experience(s)


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## Asclepius (Feb 6, 2008)

Sounds like they did their job and was being thorough. You had a seizure and hit your head and lost consciousness. The paramedic or emt has no way of knowing the full extent of your injuries unless they expose. A = Airway, B = Breathing, C = Circulation & C-spine, D = Deformity, and E = Expose. 

It's never fun to have your body exposed, but sometimes it is necessary to discover injuries you may not even have been aware of having. Sounds like to me you're very lucky for having had such a good team. Also, not covering you until they lifted you up to the stretcher is not uncommon. Having the sheet getting tangled up in the process of moving can be an issue sometimes.

See, the flip side of this is that if they didn't do a thorough examination and because of that missed something...then they face the wrath of the angry patient or medical director. Having lost consciousness after having struck your head is good cause to believe that you may have an injury that you're not even aware of.

As for the pelvic exam...we are, in fact, taught that part of the assessment is to visually inspect the genitalia. If that is all that happened, than that is not out of the norm. However, if they did a gynecological pelvic exam, then you were indeed violated.


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## EMT19053 (Feb 6, 2008)

In a trauma situation the clothes are usually cut off at the scene to allow a visual of dcap-btls during the rapid trauma assessment. For a seizure I would not have cut the clothes off unless the patient complained of pain in a certain area. A fall from a standing position or sitting in a chair is not a significant mechanism of injury to be deemed a "trauma" even though you can sustain an injury. I was taught to respect the patient's privacy by keeping them covered.


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## firecoins (Feb 6, 2008)

JPINFV said:


> Either this thread is a troll and full of BS or there's an EMT someplace that needs to be in jail. To the best of my knowledge, pelvic exams are not taught at any level of EMS and have no use in the prehospital environment.



what are you talking about?  We certainly are trained to check for pelvic fractures and look for signs and symptons on internal bleeding into the pelvis are.  This may or may not have bneen appropriate for the original post but it is certainly in the training.


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## Asclepius (Feb 6, 2008)

EMT19053 said:


> In a trauma situation the clothes are usually cut off at the scene to allow a visual of dcap-btls during the rapid trauma assessment. For a seizure I would not have cut the clothes off unless the patient complained of pain in a certain area. A fall from a standing position or sitting in a chair is not a significant mechanism of injury to be deemed a "trauma" even though you can sustain an injury. I was taught to respect the patient's privacy by keeping them covered.



It is indeed a significant MOI...especially since the patient lost consciousness as a result of it. Sometimes removing clothing is appropriate even outside a multi-system trauma. I wasn't there, so I don't know. But so far, nothing sounds like it was that far from the norm.


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## bstone (Feb 6, 2008)

JPINFV said:


> Either this thread is a troll and full of BS or there's an EMT someplace that needs to be in jail. To the best of my knowledge, pelvic exams are not taught at any level of EMS and have no use in the prehospital environment.



Checking pelvic stability and visualizing genetalia are  _standard_ parts of a trauma assessment. People can die from pelvic fractures.


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## Ridryder911 (Feb 6, 2008)

Okay, let's use something called common sense. Do you actually think you will find a pelvic fracture or abdominal evisceration on a seizure call? Ever heard of medical examination versus trauma? 

Now, if this a combination or a trauma induced seizure I could understand. 

Since I *was not there* I believe the post to be a little vague and question the integrity of the initial poster. 

Do I strip every seizure patient...NO. There is no reason to. Do I toally strip chest pain or diabetic patients..on medical calls.. NO! Again, for what reason? Do I strip them if they have been involved in trauma? Yes! (again within reason). 

For those so big on stripping patients, (in which I for on *true* trauma patients, do you really assess all the lower quadrants as well as the symphysis pubis.. probably not.

So strip when appropriate and need be. For as checking for pelvis? Why if the patient was conscious and denying pain. From what I have seen most pelvic fractures are symptomatic and will inform you if they are hurting in that area. Since pelvic fractures are always symmetrical (never isolated). 

R/r 911


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## Asclepius (Feb 6, 2008)

I don't strip all of my patients either. However, I am saying that none of this seems to be malpractice. I, without having any other knowledge of this call, side with the medics on this. They likely had a good reason for performing a detailed assessment and then a detailed secondary assessment. I also believe in doing too much in caring for my patients as opposed to doing too little...again with in reason.  It doesn't sound like the school nurse or principle saw anything that alarmed them, because if they had, I believe the poster would have added that to insight even more doubt in his care.


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## VentMedic (Feb 6, 2008)

daveg said:


> Once i was in the ambulance, the paramedic removed my covers again she gave me a full pysical workup including* a pelvic*, is this at all needed? She didn't cover me up untill we arrived at the e.r.
> 
> Im not an expert, from what I have read there was no need for all of that to be done, I'm hoping that some of you REAL paramedics can give me insight into whether or not this is proper procedure.



To those ASSUMING a trauma pelvic exam, the phrase "a pelvic" was used by a 17 y/o non-medical person which could be read as a genitalia exam or a pelvic fx exam.  

Patients also deny a lot of things if they were doing something they weren't supposed to be doing or if they are embarrassed by their medical condition especially as a teenager.  

Since the patient was in high school and 17 y/o, another adult who is a representative of the school should be present to provide information either for the school or who will contact the family.  The nurse is the medical professional at the scene until the paramedics assume care. 

We also do not know the intent of the person posting this thread.


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## Ridryder911 (Feb 6, 2008)

VentMedic said:


> We also do not know the intent of the person posting this thread.



This was my main thinking too!..

R/r 911


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## JPINFV (Feb 6, 2008)

Sorry people, but to me someone saying 'full medical exam including a pelvic' does not fully equate to my mind as 'checking for pelvic instability,' especially after a patient has been fully stripped. I won't rule out that I'm reading too far into it, but with how it was worded came across with giant red flags, shiny red lights, and noise makers.


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## Ridryder911 (Feb 6, 2008)

You know I do have a lot of complaints of the speculum's being too "cold"! 

R/r 911


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## piranah (Feb 6, 2008)

not being on scene....i have no right to judge someone elses care because i dont know the circumstances....that being said if i had a seizure Pt i dont think i would do a pelvic exam unless the was a significant MOI....but hey we also dont know the whole story this kid never checked back...so...idk


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## bstone (Feb 6, 2008)

JPINFV said:


> Sorry people, but to me someone saying 'full medical exam including a pelvic' does not fully equate to my mind as 'checking for pelvic instability,' especially after a patient has been fully stripped. I won't rule out that I'm reading too far into it, but with how it was worded came across with giant red flags, shiny red lights, and noise makers.



So you're saying you jumped to conclusions and didn't think like an EMT? When an EMT says pelvic to me I think checking pelvic stability/deformity.


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## Chimpie (Feb 6, 2008)

*The thread has been moderated and off topic posts have been removed.  Let's try to stay on track from this point forward.*


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## daveg (Feb 6, 2008)

Ok thanks everyone for helping me understand the situation. She examined around my pelvis and not my genitals, so thank you for clarifying for me that this is standard protocol. She did not give me an i.v or ekg so I'm guessing she was an EMT-B (not sure though). I still can't understand why my principal was allowed to see me in that state, or why the paramedic didn't cover me up until we arrived at the hospital (even though she had finished examining me). But I really appreciate all of your professional feedback. The whole situation just kind of freaked me out, it was my first experience like this.


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## VentMedic (Feb 6, 2008)

There could be one more logical reason for not covering you.  Seizures do not always have to be in the form of the "grand mal".  There can be just slight tremors that are isolated in the extremities.  She may have been watching for other signs of any type of seizure activity.

Your principal has a vested interest in your safety while you are on school property.  Remember the princi*pal *is your *pal*.


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## rsdemt (Feb 16, 2008)

Emt /b/ said:


> Yeah...there was really no need to cut off all of your clothes. Or any of them, really.



If you had a seizure I can see no reason to remobe any clothing.
Since you said you were conscious, and could tell them what happened, I would say they should of just immobilized you, and taken you to the hospital.
I believe in patient modesty, and actually was trained to give a patient cover, when removing clothes.
I would say you should report this to the chief, of the department that ran the call.


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## Topher38 (Feb 16, 2008)

They could have just been trying to be careful. If they had missed anything it would have landed on them.

I wouldn't have removed all the clothing, I would have asked do you feel pain any where besides your head?

Then maybe a rapid trauma assessment with the clothes on, just to be safe, I wouldn't have removed really anything unless you were complaining of pain when I palpated. Check PMS. 

They definetly should have covered you up after they assessed you, theres no reason to have you uncovered for no reason.

You did go unconcious.

They probably where just trying to make sure they didn't miss anything, but I could be wroung. 

Report it and see where it goes.


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## Flight-LP (Feb 16, 2008)

VentMedic said:


> Your principal has a vested interest in your safety while you are on school property.  Remember the princi*pal *is your *pal*.



Ha! I haven't heard that one in years!!!!!!!

OP, listen, it is understandable that you feel violated and all, but if you have thoughts or intentions of pursuing this matter further, A) have an adult pursue as you will get no where, and B) do not solicit information on an anonymous forum website. Have legal experts gather the info needed, getting it here will only discredit you and harm any potential case you may have. And honestly , based on what you have posted, you do not have a case of anything other than self perceived embarrassment. You are still considered a minor and you were on school property. As such, the principal has every right to be present. Did the medics over do it, maybe, but was it such a traumatizing experience that necessitates legal action, highly doubtful. Personally I think there is more to this, but again, should you feel that there was an injustice done, have the pros look into it.


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## mikie (Feb 16, 2008)

Don't know the entire situation or anything, but perhaps for a seizure pt, they were inspecting for any incontinence (as it can happen in seizure pts).


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## enjoynz (Feb 16, 2008)

daveg said:


> Ok thanks everyone for helping me understand the situation. She examined around my pelvis and not my genitals, so thank you for clarifying for me that this is standard protocol. She did not give me an i.v or ekg so I'm guessing she was an EMT-B (not sure though). I still can't understand why my principal was allowed to see me in that state, or why the paramedic didn't cover me up until we arrived at the hospital (even though she had finished examining me). But I really appreciate all of your professional feedback. The whole situation just kind of freaked me out, it was my first experience like this.



You do have rights as the patient. Did the EMT's let you know everything that they were intending to do for you and the reason why? 
It's called 'Informed Consent'. 
If you were left uncovered in the ambulance and felt uncomfortable about it, you did have the right to ask the EMT to cover you up! If she felt it was necessary to monitor you uncovered, she should have told you the reasons for it, and given you the options.
I'm not saying what the EMT did was wrong, but if you had concerns at the time, you could have said something!
Maybe something to remember if you find yourself in that situation again.

Cheers Enjoynz


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## ffemt8978 (Feb 17, 2008)

enjoynz said:


> You do have rights as the patient. Did the EMT's let you know everything that they were intending to do for you and the reason why?
> It's called 'Informed Consent'.
> If you were left uncovered in the ambulance and felt uncomfortable about it, you did have the right to ask the EMT to cover you up! If she felt it was necessary to monitor you uncovered, she should have told you the reasons for it, and given you the options.
> I'm not saying what the EMT did was wrong, but if you had concerns at the time, you could have said something!
> ...



Actually, since the OP was a minor, they can not give consent.  It must come from a parent/legal guardian or the school under the In Loco Parentis doctrine.


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## enjoynz (Feb 17, 2008)

ffemt8978 said:


> Actually, since the OP was a minor, they can not give consent.  It must come from a parent/legal guardian or the school under the In Loco Parentis doctrine.



That's interesting. In New Zealand under our Health and Disability Act, the legal age to give Informed Consent is from 16 years old.
What age do they need to be in the States?


Cheers Enjoynz


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## certguy (Feb 17, 2008)

While strip - n - flip is warrented in pts. that are possibly major traumas becuse you don't have time to play peekaboo looking for injuries . This didn't seem appropriate for the situation , however , none of us were there and we're only hearing the pt's side of the story . The pelvic exam was probably a pelvic rock to check for a possible fx . Again , seems like overkill , but we weren't there . This does remind us of the need to talk to our pts. and let them know what we're doing and why . It also reminds us that our pts. can feel embarressed and intimidated by what we feel is appropriate treatment . 


                                            Craig


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## RESPONDA (Feb 17, 2008)

Talk is good! 
I would prefer, and can, talk to my pts before I carryout my intended proceedures. At least then they can refuse if need be, to any treatment/s intended.
I believe the attending EMT was doing what they felt was the best for their patient. Why would they jeopardise their welfare?

Responda


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## ffemt8978 (Feb 17, 2008)

enjoynz said:


> That's interesting. In New Zealand under our Health and Disability Act, the legal age to give Informed Consent is from 16 years old.
> What age do they need to be in the States?
> 
> 
> Cheers Enjoynz



18 except in certain circumstances.


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## BossyCow (Feb 17, 2008)

Does anyone else recall the section in pt assessment about age specific concerns.. particularly the part about adolescents being deeply concerned with their modesty and very easily embarrassed?  This is a perfect case in point. Being the age the pt is, the disrobing and sense of personal space violation is more embarrassing than the fact they were thrashing and seizing.  A good reminder for us all to remember how differently kids react at different stages of development.


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## daveg (Feb 19, 2008)

I did have a pretty big cut on my head that required 8 stitches from falling off my chair. I was pretty woozy the entire time and had alot of neck and back pain. I don't really remember having the seizure but i apparently fell pretty hard. When I got to the E.R they took x-rays and several different doctors checked out my spine.


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## ffemt8978 (Feb 19, 2008)

If you were having neck/back pain, then a strip and flip may have been warranted, especially with the head injury.


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## TheMowingMonk (Feb 19, 2008)

i could understand stripping to the underwear in that case, but its the removal of the underware itself that i see as excessive


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## WuLabsWuTecH (Mar 14, 2008)

In the BLS class I took as a prereq to the EMT-B class I am not getting ready to take, we were taught that when perfomring CPR, it is best to remove all clothing from the chest and that that meant everything including any undershirts, bras or swimsuits.

Is this really necessary?


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## JPINFV (Mar 14, 2008)

Yes. You aren't going to attach an AED OVER an undershirt now, are you? Also, it will help ensure that you are doing CPR at the proper site.


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## WuLabsWuTecH (Mar 14, 2008)

No, obviously for and AED its necessary, but I was wondering if its good practice to do it for CPR alone.


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## oneluv79 (Mar 14, 2008)

Once i was in the ambulance, *the paramedic removed my covers again she gave me a full physical workup including a pelvic, is this at all needed?* She didn't cover me up until we arrived at the e.r.


According to the.... Patient Assessment/ Management (Trauma) version (from EMT-B training)

1. BSI
2. Scene Safety
3. MOI/NOI
4. # of patients
5. Additional help
6. C-spine
7. General impression
8. LOC
9-10. Chief complaint
*Assesses airway/breathing*
-apply O2 / assure adequate breathing
*Assesses circulation*
-control major bleeding
-check pulses
-check skin (color, temp.,condition)

11. Make transport decisions
12. Focused history and physical Exam/Rapid Assessment
13. S/S *(sample history)assessments (any or all of the following: respiratory, cardiac, AMS, allergic reaction, poisoning/overdose, environmental emergency, OB, and behavioral)*
14. A
15. M
16. P
17. L
18. E
19. Perform Focused phy. exam *( assess affected body parts/systems (completes rapid assessment (can be done as or with #23) (your hip/pelvic area applies here b/c you hit the floor, but not the removing of your underwear b/c there was NO direct trauma to your genital area )*
20. Vitals
21. Obtain MD for medications (Interventions)
22. Transport
23. Complete detailed phy. en route
24. Ongoing Assessments ( checking vitals and ABC' s, pulses etc...)

*Which it seems they did things along those line....*


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## Ridryder911 (Mar 14, 2008)

WuLabsWuTecH said:


> No, obviously for and AED its necessary, but I was wondering if its good practice to do it for CPR alone.



It is not uncommon. Seriously, if you are performing CPR the patient is dead, right? It allows you locate landmarks easier and better as described. If you feel uncomfortable about it, then don't. Just don't surprised when I do. I can guarantee you I will. (I have to period).

Also oneluv79, assessing the pelvis is NOT the same as a pelvic examination. 

R/r 911


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