# clothing removal



## billycorgi (Feb 5, 2014)

Hello,

Removal of a trauma patient's clothing on scene to see the entire body for critical injuries or bleeds or in the back of the ambulance? I know school always says for testing purposes that you expose and examine a trauma patient from head to toe on scene but in reality does this happen or is it just exposing the areas that need to be instead of cutting all the patient's clothes off.


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## DesertMedic66 (Feb 5, 2014)

Depends on how critical the patient is. You don't have to completely strip the patient on scene. There are some things that can wait until you are in the unit.


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## mycrofft (Feb 5, 2014)

We've ragged this one to death, but it's not bad to reiterate.

http://www.emtlife.com/showthread.php?t=29955&highlight=removing+patient+clothing


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## Handsome Robb (Feb 5, 2014)

It's tough to strip someone once they're in spinal motion restriction.

I'm not advocating spinal motion restriction but most places require it for most trauma patients and someone critical enough to need to be stripped trauma naked probably isn't going to fit any clearance protocols out there sans a few very progressive departments. 

Trick to shirts is cut it right up the middle of the back when you log roll them. One cut and it comes off easily from the front.


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## mycrofft (Feb 5, 2014)

Robb said:


> It's tough to strip someone once they're in spinal motion restriction.
> 
> I'm not advocating spinal motion restriction but most places require it for most trauma patients and someone critical enough to need to be stripped trauma naked probably isn't going to fit any clearance protocols out there sans a few very progressive departments.
> 
> Trick to shirts is cut it right up the middle of the back when you log roll them. One cut and it comes off easily from the front.



Man that is a trick, maintaining enough tension to hold the cloth taut and scissor like crazy. I don't even want to think what trying to use a V blade would be like, except that nicking or severing a belt or fingers would be of ascending likelihood (working on the "two AM in the rain and the dark" paradigm). But it makes ultimate sense. 

How many cases with pt stripping aren't going to include a board?

BTW, how are people being "stripped" in blizzard-like conditions? Or blizards?


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## unleashedfury (Feb 5, 2014)

Consider patient modesty, If you were in a auto accident, would you want the EMS personnel stripping you down in the middle of the roadway? or in a truck where the exposure is limited, on top of that Reducing your patient to exposure to elements. 

When to expose your patient? when you need to gain access to a specific injury they can tell you about I.E. Pain in the hip, femur etc. 

Or when they are unconscious and you need to get a full physical exam


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## DesertMedic66 (Feb 5, 2014)

mycrofft said:


> Man that is a trick, maintaining enough tension to hold the cloth taut and scissor like crazy. I don't even want to think what trying to use a V blade would be like, except that nicking or severing a belt or fingers would be of ascending likelihood (working on the "two AM in the rain and the dark" paradigm). But it makes ultimate sense.
> 
> How many cases with pt stripping aren't going to include a board?
> 
> BTW, how are people being "stripped" in blizzard-like conditions? Or blizards?



Defiantly not by cutting down jackets inside the rig.


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## Handsome Robb (Feb 5, 2014)

mycrofft said:


> Man that is a trick, maintaining enough tension to hold the cloth taut and scissor like crazy. I don't even want to think what trying to use a V blade would be like, except that nicking or severing a belt or fingers would be of ascending likelihood (working on the "two AM in the rain and the dark" paradigm). But it makes ultimate sense.
> 
> How many cases with pt stripping aren't going to include a board?
> 
> BTW, how are people being "stripped" in blizzard-like conditions? Or blizards?




I don't use rip shears. I just spend a couple bucks on nice shears every now and again and take good care of them. When they roll them I always inspect he back so I have the person doing the rolling pull the shirt taught so I can grab it with my left and hold tension and cut with my right top to bottom. 

Anyone getting stripped in the U.S. Is probably getting placed in spinal motion restriction as well.

In blizzards I get them on the board hold manual c-spine with a collar and gurney belts then move to the back, strip them then fasten the spiders.

Might've had to do this more than once


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## mycrofft (Feb 5, 2014)

DesertEMT66 said:


> Defiantly not by cutting down jackets inside the rig.



Yeah. L.L. Bean Blizzard (down jacket)


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## mycrofft (Feb 5, 2014)

Robb said:


> I don't use rip shears. I just spend a couple bucks on nice shears every now and again and take good care of them. When they roll them I always inspect he back so I have the person doing the rolling pull the shirt taught so I can grab it with my left and hold tension and cut with my right top to bottom.
> 
> Anyone getting stripped in the U.S. Is probably getting placed in spinal motion restriction as well.
> 
> ...



That needs to get into the texts.


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## medicsb (Feb 5, 2014)

I've never had a problem cutting clothes in the back of the ambulance.  I've never thought "oh, I should have done this in the middle of the street".   I guess I would say it is a pet peeve of mine seeing someone being stripped in public.  If they're sick, you should be working on getting going and doing everything on the move.  If they are not that sick, then you can wait to get them some privacy.


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## Handsome Robb (Feb 5, 2014)

mycrofft said:


> That needs to get into the texts.




Well thank you sir, I appreciate that.


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## TheLocalMedic (Feb 6, 2014)




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## mycrofft (Feb 6, 2014)

thelocalmedic said:


>



hah!


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## RebelAngel (Feb 8, 2014)

We went over CPR/AED today. Instructor said cut tops and bras off in order to do what needs to be done in the most efficient way possible. Because of this thread I asked him about being in a public place and offering female patients dignity by keeping bra on. Response to that is a bra isn't going to do them any good if they're dead, better to be exposed than dead. Screw trauma shears...I think I'm getting a rescue hook...rips 'em off faster. :rofl:


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## Carlos Danger (Feb 8, 2014)

RebelAngel said:


> We went over CPR/AED today. Instructor said cut tops and bras off in order to do what needs to be done in the most efficient way possible. Because of this thread I asked him about being in a public place and offering female patients dignity by keeping bra on. *Response to that is a bra isn't going to do them any good if they're dead, better to be exposed than dead.* Screw trauma shears...I think I'm getting a rescue hook...rips 'em off faster. :rofl:



The problem with that approach is that is presupposes that somehow rapid exposure is going to prevent death.

I assure you there is nothing your are going to learn by removing a bra in public vs. 30 seconds later in the ambulance that will help you prevent death. 

Move to the ambulance and head towards the trauma center. Do your assessment enroute.


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## medicsb (Feb 8, 2014)

RebelAngel said:


> We went over CPR/AED today. Instructor said cut tops and bras off in order to do what needs to be done in the most efficient way possible. Because of this thread I asked him about being in a public place and offering female patients dignity by keeping bra on. Response to that is a bra isn't going to do them any good if they're dead, better to be exposed than dead. Screw trauma shears...I think I'm getting a rescue hook...rips 'em off faster. :rofl:



This thread is about trauma patients, not cardiac arrest.  Now, if you're talking about trauma arrest, then its questionable whether you should be working the patient at all.  But, supposing that there is reason to work the trauma arrest, why would you trauma strip the patient in public and not get the patient to the ambulance for transport as soon as possible?  (And your remark about ripping bras off faster followed by the rofl, makes you sound creepy.)


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## ZombieEMT (Feb 8, 2014)

medicsb said:


> This thread is about trauma patients, not cardiac arrest.  Now, if you're talking about trauma arrest, then its questionable whether you should be working the patient at all.



Pretty much exactly what I was going to state. Not applying an AED (due to bra) for modesty is different than not exposing on scene for a trauma. Also not the question.


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## mycrofft (Feb 9, 2014)

RebelAngel said:


> We went over CPR/AED today. Instructor said cut tops and bras off in order to do what needs to be done in the most efficient way possible. Because of this thread I asked him about being in a public place and offering female patients dignity by keeping bra on. Response to that is a bra isn't going to do them any good if they're dead, better to be exposed than dead. Screw trauma shears...I think I'm getting a rescue hook...rips 'em off faster. :rofl:



You're not taking out MY daughter! :glare:

Seriously, we had combination V-blade and Dzeus fastener keys both on one tool as crash recuemen (USAF), and the V-blades needed more technique and care in use than a pair of serrated shears. And we never needed Dzejus keys.

I'm not seeing anything in my materials about needing to remove a bra to do CPR or use an AED as policy. I can see needing to do it sometimes. An underwire bra would not preclude defib, if the electrodes are placed properly* especially at AED energies. Teaching it as a time-wasting "every single case" deal and especially resorting to the "do it or they die" argument without justification smells of his or her own private protocol. (But see if it IS local protocol. Can never tell).

* and the bra is placed properly too. Does he suggest ripping out breast implants too since they don't conduct electricity the same as mammary tissue?h34r:


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## gotbeerz001 (Feb 9, 2014)

unleashedfury said:


> Consider patient modesty, If you were in a auto accident, would you want the EMS personnel stripping you down in the middle of the roadway? or in a truck where the exposure is limited, on top of that Reducing your patient to exposure to elements.
> 
> When to expose your patient? when you need to gain access to a specific injury they can tell you about I.E. Pain in the hip, femur etc.
> 
> Or when they are unconscious and you need to get a full physical exam



Patient modesty? The only reason that I am cutting all of your clothes off is because you are going to die. Modesty is out at that point. (Trauma)

If the pt is oriented enough to have a conversation, there are obviously ways to visualize affected areas that preserve modesty. Check the areas that area required before moving to the rig. Once there, perform the required secondary assessment.

If we are talking about cardiac arrest in public, I will instinctively work around a bra until it proves to be getting in the way. Sports bra? Probably gonna cut.


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## SandpitMedic (Feb 9, 2014)

gotshirtz001 said:


> Patient modesty? The only reason that I am cutting all of your clothes off is because you are going to die. Modesty is out at that point.



:/

Is that in book 1? I must need to go back and re-read my course materials.

I've never had an issue with a bra inhibiting my professional assessment.


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## Carlos Danger (Feb 9, 2014)

gotshirtz001 said:


> Patient modesty? The only reason that I am cutting all of your clothes off is because you are going to die. Modesty is out at that point. (Trauma)


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## gotbeerz001 (Feb 9, 2014)

SandpitMedic said:


> :/
> 
> Is that in book 1? I must need to go back and re-read my course materials.
> 
> I've never had an issue with a bra inhibiting my professional assessment.



Let me clarify, was editing when my 10 minutes ran out...
I rarely "make 'em naked". Cut clothes to underwear before I board an unconscious or severely altered pt in trauma setting. We have lots of hands where I work; it takes 30 seconds to have 2 people cutting, me getting a rapid trauma done, rolling and boarding. I don't have all those hands in the back of the rig and I'd rather leave the clothes onscene to be bagged up by the sup than cluttering up the back of a busy rig.

The cardiac bra issue came up in later comments that I had not read.
Seemed that the OP was asking whether we actually cut clothes on a trauma or not. My answer is YES. I have no problem cutting away what I need in order to visualize areas that are affected on a pt that cannot communicate.


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## NomadicMedic (Feb 9, 2014)

It depends on the severity of the injury. Ped struck in the highway? Naked. CPR? Everything above the waist removed. RSI? Usually everything above the waist removed. 

Anything else? I expose as needed. Use your judgement.


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## mycrofft (Feb 9, 2014)

*Flash from the past: don't take off that boot (shoe)*

I show my first aid students the video (the next to latest version shows a first aider palpating the toes of a closed-toe sports shoe) telling you to check toes for circulation but telling you elsewhere not to remove the shoes. (This is in regards anatomic/self-splinting the legs with four cravat bandages and no padding).

One of the "Great Paradoxes of the ARC" .

But not insurmountable. If it hurts them more, don't do it. No, you can't check toes through a shoe, and the video does not tell them what to look or feel for at any rate. However, knowing the "leave the boot on" deal was from the era when they didn't have the supplies we have today, and if in the wilds you might need that foot bound up in its boot to get out to help, and since EMS help in the city/suburbs is not that a far away (heck, for a foot-only, a private auto is an ok workaround), shoe removal is still basically only done if you need to control important bleeding; otherwise,leave it on, or take it off, just do no more harm. 

(EMT level: yes take it off, prevent compartmentalization and assess distal signs).


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## RedAirplane (Jan 13, 2016)

Old thread, but I wanted to pose a particular scenario:

You respond to a pedestrian struck by a motor vehicle. She is curled up on the sidewalk yelling (loudly but intelligibly). Visual assessment shows three large lacerations to the head.

Under the assumption that you were going to C-spine the patient, would you have to get off all the clothes first? Otherwise it's hard to inspect the posterior on a backboard. On the other hand, she's somewhat alert, and I'm hesitant about displaying her butt for the world. 

In a first responder role, I can cop out and hold C-spine, control obvious bleeding, and do an exterior exam until fire and ALS shows up right behind. But if I were in a transporting role, I should know how to handle the situation.


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## DesertMedic66 (Jan 13, 2016)

Just because you cut cloths off doesn't mean you have to expose the patient to the public. Cut the cloths on the sides so that after you are done doing your physical inspection you can place or fold the cloths back over onto the patient to keep them warm and prevent exposing them to everyone. 

Now for my area once they are in the back of the ambulance their cloths get cut off or removed (aside from under garments) and then covered with a blanket. Our trauma center prefers us to have the patient "trauma naked" but keeping them covered to reduce heat loss.


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